There is an unspoken reality lurking in the undertones of maternity care.It is sinister and unconscious, a toxic unawareness that seeps into all communications and puts the weight of expectation onto The Woman.
I will call this
It is a game about power, about control. A game of Dark and Light. The aim of the game is to keep it light. The rules are simple, but never implicit. You sense the rules. And if you do not play by the rules the game gets dark. Very dark. The stakes are high.
In reading through the literature on birth plans, I discovered this undertone. The language women are expected to use to signify their place beneath the authority includes ‘being polite’ and using ‘preferences’ or ‘requests’...or even ‘wishes’. Women must be ‘flexible’, a code for obedience or compliance. We often hear that a ‘birth plan’ should use polite language, not be ‘adversarial’, and be concise. The argument is that staff do not have time to read it, and suggesting that anything other than polite is a declaration of war…which will be gladly accepted (!)
All of this ignores the intent and purpose of a birth plan:
To communicate a woman’s decisions.
The woman is expected to consider the emotional needs of her care provider, her partner and any other staff she may (or may not) encounter. She carries this unspoken burden, or mental load. It influences her decision making.
Why is a woman simply stating her informed decisions considered impolite, or adversarial, or defensive? Why must women continually step aside, and make room for the feelings of others, whilst her own are utterly disregarded?
All that matters is a healthy (alive) baby…apparently.
THE GAME STATES: A woman who attempts to experience birth is selfish, or irrational. She is not thinking of the baby’s safety. She can not be trusted, and is not worthy of respect.
This illogical statement is a human rights violation.
Women are expected to carry this burden of everyone’s needs, and yet are not trusted with it.
This catch 22, is wrapped up in the concept of informed consent.
At no point in the game is a woman issued with instructions or guidance. At no point are any clues given.
This is called ‘woman-centred care’.
This game plays out below minimal, in ‘Standard Maternity Care‘. This conveyor belt approach to birth assumes that all women want and need the same treatment. Treatment in a medical sense as well as a behavioural sense. This is a culturally accepted approach, and women are conditioned from girlhood to accept this approach.
It doesn’t have to be like this.
In Continuity of Midwifery Care models, outcomes (physical and emotional) for women (and their partners, the babies, and care providers) are better. Mounting peer-reviewed research tells us this. And yet, the game has not changed. Those women who know about birth centres and continuity of care programs know to book early. They also seem to know about independent childbirth classes, doulas, and normal birth physiology.
Balancing the power does not diminish the power of the care provider. It simply means acknowledging the power of the woman. This is a matter of respect. Of communication (i.e. care providers listening) and expressing informed decisions for various scenarios in advance. By having these conversations in advance and giving women time and space to understand the landscape of modern maternity care, we increase their power. Instead of woman-centred care, we have woman-led care in partnership with care providers. Leadership is not about dominance and meets the requirements of The Game of Birth, where all needs are considered. The roles and strengths of each member of the team come into play. The woman determines the best way forward; she is respected and acknowledged.
This shifts the game from superficial politeness or negative politeness, as described by Kim Hensley Owens in her book Writing Childbirth, to respectful communication. It levels the playing field. Key to this shift is a language change.
Instead of telling women to be ‘flexible’, we encourage them to ‘know their options’. And to place those options into context rather than in isolation.
Options are often presented in a smorgasbord way or a pick-and-mix, but this does not reflect reality. There are distinct pathways, and the way choices work will depend on the previous choice.
There is no one way. It is easier to determine the best way if you have a map.
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