Diplomacy, politeness and the underlying threat

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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, and 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.

In conjunction with care providers, as a kind of ‘advance care directive’, a birth plan was supposed to be developed over time, which acknowledged that informed consent required advanced knowledge and time.  Informed Consent was introduced in response to the recognition that patient-centred care was important. However, this focus on consent rather than decisions has proven problematic.

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

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 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, will I 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”).

This implies that ‘adversarial language’ is any that does not pander to the ‘authority’. It gives a sense that unless you are ‘nice’, you will be considered difficult and perhaps not receive good outcomes. “Unless medically necessary” is one of the four main mistakes made in birth plans.  It could easily pave the way to handing over your power and losing your power to make informed decisions.  A recent paper about forced professional passivity being a fallout from birth plans highlights the precarious nature of such sentiments.  This undermines the importance of the woman giving birth, who owns the decision-making and has a right to autonomy.  This avoidance of, or discomfort with, women being decisive is thinly veiled misogyny.  The suggestion that asserting yourself is adversarial is frighteningly reflective of a system, a society, that does not value women or see them as autonomous or capable beings.

Would men be encouraged 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!

Communication is vital.  Addressing the concerns and skill limitations of the care provider is essential. As is addressing your partner’s fears and anxieties. Neither should override the woman’s preparations; care providers’ or partners’ fears and ‘preferences’ are not a trump card. When tensions arise, diplomacy, not submissive politeness, is called for: the tactful and sensitive way to navigate difficulties.

A statement of your decision for a specific situation is not adversarial.  It does not need to be flowered with “we wish” or ‘if it’s ok with you”. It needs to be discussed in advance, understood and respected.

Belief and Fear: the nocebo effect

The Language of Birth Plans

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