You’re about to give birth in a hospital.  Perhaps you’re a bit nervous about how you will be treated, or about what kinds of things the health care providers are going to do with your body while you are in the throes of labour.

As a doula, I attend birth in every setting: from home births, to births in free standing centres run by midwives, to births in hospitals with family doctors or obstetricians.  A beautiful birth experience can be had anywhere.  In a hospital, however, there can be a seemingly endless sea of unfamiliar people tending to you.  Many only know your name by looking at your chart.  Fewer have time to get to know what you truly want or don’t want for your birth.  This is where your need to use your  voice to stand up for your wishes (whenever possible) becomes important.

These are some tips to help you feel like you have some influence within a situation like childbirth, which can be so very unpredictable.

1)  Know Who Delivers

This is not about knowing the person who will deliver your baby when it is time.  In many hospitals, you will have no control over this, and likely, this person will be a stranger.  What it means is knowing who the power of birth giving belongs to.

A prevailing attitude among birth givers in our highly technocratic birth culture is: “Women have been having babies forever, so I’m sure it will be fine.  I trust my doctor to get my baby out.”

There is a dangerous discrepancy in this statement. There is the intuition to” trust my body”, but then the responsibility left entirely in the doctor’s hands to “get my baby out”.

Though it is acceptable to say that doctors and midwives deliver babies, if we look more closely at the truth of that, if all is going well, all they really need to do is “catch” or “receive” your baby as you give birth.  Most health care providers admit that in a normal birth, aside from a little vigilance, encouragement, and a few reasonably simple safety measures, it is you who does all the work.

After the blood, sweat, and tears of birthing a baby, the glory of delivery belongs to YOU!  Nobody can have your baby but you. Step into and deliciously own YOUR power and agency in bringing forth life.

2) Don’t Leave it to Chance

The “whatever happens, happens” attitude towards childbirth does have its benefits in some ways.  It is important to be flexible when it comes to giving birth. You can certainly have a goal. Relaxation, a trust in your birthing magnificence, and positivity lend beautifully to the crafting and realization of your birth vision. Sometimes, though, your little passenger within calls some of the shots regardless of your hopes. Finding the balance between your expectations vs the reality of your birth’s unfolding will leave you ready for unpredictability.

Leaving it all up to your hospital care providers and luck, however, can set you up to feel quite discombobulated if you’re not prepared for certain things. You don’t want things to be a shock on the big day,  like the reality of the sensations of labour, or the fact that anesthetists (if you want an epidural) aren’t always available when you call them. You also don’t want to miss opportunities to feel more comfortable, and should know that in many places you CAN eat if you’re hungry and NOT lie on the bed if you’re not happy there. Just because you’re led to do something, doesn’t mean you have to do it if you don’t like it. Ultimately, if you don’t know your options, you don’t really have any.

It is so important as a pregnant person to take the time to explore how you would feel most powerful and satisfied giving birth.  It doesn’t really matter how, as long as you feel GOOD about it! Envision yourself giving birth. What might you like or not like? What makes you feel better when you are stressed out and in pain?  What are your values about giving birth? Do you want to/will your health allow your birth to unfold as normally and naturally as possible, or do you feel like/know pain relief or a Cesarean birth would be an important option for you? So many things to think about!

How do you begin to look at these options?

3) Educate Yourself

Nothing beats good childbirth education which focuses on your empowerment. A prenatal class that spends ample time describing the sensations of labour and how you and your partner (if you have a partner attending your birth) can cope with the experience is an excellent idea. This is important even if you plan on having an epidural early on. Why?  Because it is not feasible to expect you can co-opt all your sensations to be relieved by drugs as soon as you want that to happen. Not because you shouldn’t want that if that is your comfort zone, but because in a busy hospital, things don’t always go that way. Many birth givers have to wait much longer than they wanted for their pain relief, some having their babies come before the pain relief got there. Sometimes they receive a desired epidural, only to have it not work as well as they’d hoped. So having a few solid coping skills under your belt can ensure you are able to navigate the sensations of birth no matter how things happen. This can reduce the incidence of shock and birth trauma.

A good childbirth education series should not push any kind of agenda, but be open and inclusive to all your potential choices, informing you of the important things to expect, and how to speak up for yourself.

4) Know Your Rights

Hospital birth givers have rights. Often, you can find these rights published. This is what we have here in Quebec:
Women’s Rights in Pregnancy and Delivery in Quebec

Here are some examples:

a) You have the right to eat and drink as you please in labour.
b) You have the right to be informed of the benefits and risks of all medications and procedures
c) You have the right to informed consent and informed refusal.
d) You have the right to labour and deliver in any position that suits you.

Research the rights in your area!
In the US check out this book “The Rights of Patients” by George J Annas (thanks Jessica Turon!)

5) Use your BRAIN

When making decisions about your care, keep the following in your mind so you can make the best decisions for yourself.  It is important BEFORE you give birth to have an idea of what you want or don’t want so self-advocacy is easier, but if you are presented with something you’re not sure about, use the following questions as a guide:

B-What are the BENEFITS of the medication/procedure being offered?

R-What are the RISKS?

A-Are there any ALTERNATIVES to what you’re being offered medically? (example: having a snack and going for a walk up and down stairs to try to move labour along instead of labour augmenting medication…or maybe, you’d just like to have a nap and not have your birth clock monitored)

I-What does your INTUITION say? Your motherwit, meaning your innate, practical intelligence and common sense can be more active than you imagine in labour. What does your gut tell you?

NNOW? Health care providers are usually open to giving your body a chance to do its thing normally, so don’t be afraid to ask. Also, the word NO is allowed to be said! Even if you choose something the caregivers aren’t fond of, if this is your conviction, you have the right to say NO. “I do not consent.” is a phrase that holds a lot of power.

Parents often worry that a doctor or nurse will walk out of the room and abandon them if they make unpopular choices, but this is not the case.  They can be challenged at times by your wanting to labour or push in different positions or refuse an episiotomy, or whatever it is you feel strongly about, it is true.  But hey are not allowed to abandon you and leave you without care.  Practicing in pregnancy how to deal calmly and effectively with other people’s reactions to your choices can give you confidence. Most often, you will find your caregivers on your side and will be very happy for you if you have the birth experience you were hoping for.

6) Get Your Partner on Board

As many birth givers realize when the heat of labour is on, all of the above gets very difficult to implement because the brain goes from think-y to primal. Even just talking, never mind intellectual discernment, becomes challenging as the waves of contractions sweep you off into the hormone- hazed mind trip that is Active Labour.

Ensuring your support person knows your wishes allows them to do some advocating for you.  Nobody can ultimately speak for you in labour, however, they can relay the wishes you communicated to them prenatally, “Pat was wanting a hep lock for the Step B treatment instead of the whole IV setup,” for example, while you’re busy having a minute power snooze between massive contractions. Your partner is generally your strongest ally. Especially if they are one of the child’s parents, they have a say!

Many people create Birth Plans or Birth Preference Sheets to articulate their desires in labour. This can be helpful IF you have the type of hospital in which caregivers have the time to read them.  Many don’t.  Personally, I have never seen a birth plan make the difference between a good birth and not.  Birth Preference Sheets or Birth Plans are more effective as prenatal tools to help you explore your options and clarify your values than something to actually bring to the hospital.  They don’t “protect” you from anything. Only using your voice gives you the best shot at that.

7) Hire a Doula

“If a doula were a drug, it would be unethical not to use it.” -John H. Kennell, MD

While a doula cannot and will not assume to speak FOR you in labour, they will respect and uphold your sovereignty as a birth giver. They have spent  a fair bit of time with you prenatally, getting to know your hopes and fears, gathering ideas of how to tailor their support techniques to suit your own individual style. They also know what your partner needs to feel safe and supported as they witness you traversing rough and unknown terrain.

If your doula knows, for example, that you expressed a strong desire prenatally to push your baby out in the hands and knees position, and when the time comes you find the nurse turning you onto your back and putting your feet on the pedals, your doula will probably gently ask you, “Are you comfortable like this?  Is this how you want to deliver?”

Your doula will not jump in and say to the nurse, “Hey, don’t put my client on her back!”  Why?  This will create tension in the room in a big way, which is the last thing you need.  Your doula will not say, “Let’s get on your hands and knees.  That’s how you wanted to be, so let’s get you off your back now.”  Why?  Because you might have changed your mind.  There is a possibility you are actually super comfy the way the nurse is positioning you and find you want to be this way after all.  Your doula will not assume.

A question like, “Are you comfortable this way?” gently nudges your hormone besotted mind to remember what you valued prenatally. It is okay if that value has changed, but the doula wants to make sure things are going how you want.  The question allows you to say, “Yes, I’m good like this.” or “No, Nurse, this is not what I want.”  This is the subtle, elegant way doulas serve as supporters of your self-advocacy, leading you to use your own voice whenever possible.

While experienced doulas are experts in informing, comforting, and supporting a birth giver and their partner/s, they don’t generally claim to offer expert advice.  Why?  Because their job is to shine a light on your personal power and have you claim your own expertise as the one who makes, carries, births, and parents this baby/ies.  Your doula supports your work to step into this power that is already yours, and celebrates you as you own your birth.

Have a strong and wonderful birth!

Lesley Everest
MotherWit Doula Care