Diplomacy, politeness and the underlying threat

The Poem ‘want a positive birth? say please‘ was inspired by the frequent advice related to how to write a birth plan, that suggests you be polite, positive.  And not adversarial.

The scene is set: clearly birthing is Us vs Them.  And there is no shortage of horror stories.

The purpose of the birth plan, as originally intended when introduced by Penny Simkin and Carla Reike in the 1980’s, was as a communication tool.  In response to the medicalisation of birth, women needed to be able to navigate not just biologically normal birth, but also the medical options – which were fast becoming the standard.

A birth plan was supposed to be developed over time, in conjunction with care providers, a kind of ‘advance care directive’, which acknowledged that informed consent required advanced knowledge and time.  Informed Consent was introduced in response to recognition that patient-centred care was important.

But the birth plan has devolved…and what began as women advocating for themselves soon met with push back.

How dare women voice themselves!

And so, the birth plan adapted…softly softly, don’t take up too much space, keep it short, polite and happy happy happy.

Just murmur the word plan in a maternity environment and you’ll soon get the gist.  Try using ‘preferences’ or the even more submissive, ‘wishes’…there’s a good a girl.

For example (from the otherwise brilliant don’t throw the birth plan out with the birth water):

“Try not to be adversarial in your language – you want people working with you, not against you. End the plan with something like “Thank you so much for helping make our birth special”.” 

Why?  Am I under threat? 

If I don’t appeal to the self-declared authority in the room, to the ego of the medico, I will be treated poorly?

Will these professionally trained medical people work against me?

Surely not?

And what exactly is adversarial language?

BabySparks   suggests:

Keep it positive. Birth professionals agree that demanding birth plans tend to create unnecessary negativity or even hostility around the birth process. A positive tone promotes mutual respect.

Others take this to mean using words like these (from here):

Make your birth plan read like a list of requests or best-case scenarios, not like a set of demands. Phrases such as “I would prefer” and “if medically necessary” will help your health care provider and caregivers know that you understand that they might have to change the plan.

Think about the other personnel who’ll be using it — hospital staffers might feel more comfortable if you call it your “birth preferences” rather than your “birth plan,” which could seem as though you’re trying to tell them how to do their jobs.

Try to be positive (“we hope to”) as opposed to negative (“under no circumstances”).

Would men be encourage to express their informed decisions in this way?

Or is it just women – birthing women – who are expected to be happy happy happy, and oh so flexible…which seems to mean obedient.

This sentiment is repeated in the wiki how which also has a section dedicated to appealing to your male partner’s needs.  Gently Gently.  Stand Aside!

The communication is vital.  Addressing your partners fears and anxieties is important, and should not override the woman’s preparations, [his] fears and ‘preferences’ are not a trump card. And yes, using positive language is good, but active language, a statement of your decision, is not adversarial.  It does not need to be flowered with “we wish”, or ‘if it’s ok with you”.

They are NOT my 'Wishes' or 'Preferences' They are my INFORMED DECISIONS

Belief and Fear: the nocebo effect

Would you rather stand up or stand aside? 

The Language of Birth Plans


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