Autonomy in Childbirth – Why it Matters

Many women don’t seem to realise they CAN question the doctor, let alone seek another opinion or change care providers. As a society, we have been groomed to unquestionably trust the doctor. This patriarchal model of medical care works very efficiently and assumes everyone has the same values, needs and abilities. This patriarchal model places the power with the doctor, who is the authority, as we assume they are the ones responsible for our care.

The power dynamic that occurs when visiting the doctor begins the moment we make an appointment and is confirmed on our arrival at the set time: 

  • The act of waiting – makes you unimportant.
  • The act of being called – makes you submissive/obedient
  • Entering the doctor’s room – you become a visitor
  • The way the doctor launches into the procedures, types little notes or avoids eye contact – dehumanises you
  • The way you are ushered out before you can ask your questions – devalues you

and before you know it, you have processed your fee and leave wondering what happened. Some people are satisfied if they have a script or a test to do (something to show for the consultation).  Others leave feeling powerless and confused. Ultimately we are expected just to trust the care provider.

This concept of trust seems to mean: comply. This means that when the doctor recommends a course of action, we are expected to consent.

This is particularly problematic in maternity care, where the care we seek is not because we are ill.

You can be the most confident woman with a supportive partner, but as soon as you enter the doctor’s room or the maternity ward, something strange happens to you both. You can’t think straight. Is it the lighting? the medical jargon? the suggestions for interventions? the feeling of being rushed? the sense of authority?

Part of the Power Struggle associated with Childbirth is the nocebo effect: when the OB suggests a big baby (or other emphasised ‘issue’), the pregnant woman starts to doubt her ability and gives over her trust to the ‘authority’. So much weight is put on the ‘medical degree, years of study’ aspect of medicine, and women give up their autonomy (often without question).  Rhea Dempsey refers to this as the Trance of Acquiescence.


The perceived authority of the care provider can be so overwhelming that the ‘patient’ does not even realise that they have any power.  They accept their trusting and submissive role, are seemingly happy with it, and just ‘go with the flow’. This willingness to submit may also be related to the ability to take responsibility.  Sometimes the weight of responsibility feels too much, so it is given over to the ‘more qualified’ care provider.  Sometimes the ability to take responsibility is hindered by knowledge gaps. 

With great responsibility comes great power

When we trust the care provider, we believe they have the responsibility, and in turn, we relinquish our power. This handing over of responsibility, however, is an illusion. Women are required to provide informed consent, which means the responsibility is theirs whether they feel capable or not.  It is a fine line between consent and compliance.

When the power is relinquished, the outcome is often accepted with a sense of thanks or gratitude towards the ‘heroic’ care provider. We have unnecessarily high (and increasing) intervention rates, with 1 in 4 women experiencing childbirth as traumatic (physically and emotionally), and even more are disappointed or feel like they somehow failed.  Birth outcomes are far more important than simply surviving.  As a society, we either fear or tolerate birth; rarely do we Celebrate it.  As a society, we do not value the importance of this life event or understand the reality of matrescence. This begs the question of why and how our society has gotten to this point. 

The Five Stages of Being, when speaking of childbirth, are a great way to see where we are as a society in our approach to birth, and why it is so rare to hear of birth as a celebration.

FEAR: In this Stage of Being, we experience a physical reaction (rapid heart rate, for example), feel anxious and wary, possibly even angry.  In order to avoid the experience, we will choose ‘avoidance’ options to numb or ‘void’ this response.  It is also easier to hand this responsibility over to an authority.  This usually means a high intervention birth, with a belief of being saved.

TOLERANCE: In this stage, there is a level of knowledge that birth is a part of life, but still preferring to avoid fully experiencing it…there is a holding back and a reluctance to compromise.  There is still a feeling of avoidance, leading to a ‘managed’ experience.  Birth is processed but not experienced.  

ACCEPTANCE: This is the stage where women start to feel more open to the experience and will seek to compromise – to make some decisions more actively and look at the options more openly.  Less likely to avoid the experience and more likely to have a ‘plan’ that states “I will have a natural birth, unless medically warranted’ (see below)

UNDERSTANDING: This is a stage where the power shifts back to the individual.  This is where agreed differences, without judgement, can exist in harmony.  This is where open communication and enjoyment come into play.  The individual becomes assertive and able to explain their needs whilst understanding the full context.  They may seek support and do not seek to avoid the experience.  They are more likely to have a map (rather than a plan).

CELEBRATION: This is a Stage of Being where the individual takes full responsibility and immerses themselves in the experience.  They acknowledge the importance of this important life event and seek to engage in the experience completely.  They bring joy and confidence, choosing care providers and supporters that fully embrace the celebration.  

Unfortunately, because our society is currently in Stage One and, at best Stage Two, the small number of women who dare to question this authority may be labelled as troublemakers or have to enter into a power struggle to retain control.  If they are fortunate, they will have several genuine options for their care and will be able to choose the one that supports them (most likely a continuity of midwifery care model). 

Autonomy starts with genuine options.  Autonomy continues with the freedom and support to make informed decisions.

If your care provider is focused on ‘building trust’ rather than ‘building a relationship’: stay alert!

Trust Yourself

You have the power if you take responsibility. You can do this by identifying your knowledge gaps and tuning into your fear. Your fear is a gift – if you know how to use it. Trusting yourself means tuning into yourself. If you feel fear or uncertainty – this is a knowledge gap! This is a point where you need more information.

I wrote The Birth Map to make this process easy. The book came about because there were so many things I wish I’d known in advance; my mother-friends also had long lists of ‘if only I’d known’ points. The book lays out all the possibilities in modern, medicalised birth. This realistic approach means that we can align our expectations with reality and be better placed to navigate on OUR terms rather than needing to trust our guide. This trust in our guide is haphazard in a system that is insurance driven, with a view of sameness and a narrow band of ‘normal’. When you know yourself and can tune into your senses, you can trust yourself to make decisions rather than resorting to complicit consent.

Claim your Power – Seek Knowledge

Further reading (off site)
Fish can’t see water

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