In this country, we have a basic lack of respect for pregnant mothers and people.
The concept that birth matters and the way that we’re treated during pregnancy and birth is not just a women’s health issue, but a human rights issue. One of the greatest contributors to our staggeringly high maternal mortality rate is the racism in our country and healthcare system that leads to black women being 3-4x more likely to die due to pregnancy and childbirth complications than white women. While that is an issue that needs to be addressed clearly and frequently, this post addresses the ways that we prioritize the health of a baby over the health of its’ mother.
A HEALTHY BABY IS NOT ALL THAT MATTERS.
This does not mean that your baby’s health is not important and shouldn’t be considered. Saying a healthy baby is not all that matters - agreeing with this philosophy - does not mean that you don’t care about a baby or their health. What it means is that your health - both physical and mental - matters just as much, if not more.
As birthing people, we are not just vessels. Yes, you may have decided to give birth to the life that you carry, but that does not mean you have given up your bodily autonomy and integrity. No one can decide what’s right for you, not your doctor or your midwife or your partner or nurse or doula or mother or family or ANYONE else. With skyrocketing maternal morbidity and mortality, it’s more crucial than ever that women and birthing people feel empowered and confident choosing what is right for them.
Here are some infuriating scenarios we see regularly as doulas:
- Prior cesarean delivery, excellent candidate for VBAC combined with desire on the mother’s part, provider says VBAC is too risky to baby due to risk of uterine rupture and schedules a csection instead.
- Term pregnancy of di-di twins with Baby A head down. Evidence shows that a vaginal birth of twins is a safe and reasonable option but physician recommends scheduling a cesarean instead.
- Frank breech presentation in a pregnancy after two prior successful vaginal births. Strong desire from the mother for a vaginal birth in hopes to avoid surgery and recovering while caring for three children. Provider only counsels on risk to baby of vaginal breech, does not consider the mother's desires, and schedules a cesarean.
- Birthing person has a very dense epidural, cannot move legs and has absolutely no sensation of contractions. After two hours of pushing, provider declares “failure to progress” or “arrest of descent” and says that it’s time for a cesarean.
- Mother is pushing while flat on her back (not evidence based, leads to decels in fetal heart rates, lower oxygenation, and more severe perineal tears). Asks to change positions. Baby’s heart rate starts to decline and provider says baby needs to be born ASAP and informs mother that they’re cutting an episiotomy to get the baby out fast. Baby is healthy, mother has a tear through her rectum.
We need to stop weighing the “healthy baby” as the heaviest factor in a choice. Everything has inherent risk, some procedures are riskier for mothers than they are for babies. Did you know that cesarean birth has a rate of maternal mortality 5x higher than that of vaginal birth? Well it’s true! And yet 1 in 3 people in the US give birth via Cesarean. You’re faced with so many potential choices: vaginal birth, episiotomy, induction of labor, vbac, repeat cesarean, birth position (lithotomy can take a flying leap), place of birth, type of provider, and more - what do YOU want? What is best for YOU? Because when weighing risks, considering your own health, safety, and wellbeing is completely reasonable.
So what can the birthing person do?
- Know that every birthing person has the right to informed consent AND informed refusal. For every procedure or medication offered, even things as benign as checking your cervix or giving IV fluids, you have the right to have risks & benefits of the procedure explained. Coercion is not consent.
- Don’t be afraid to ask questions. This is YOUR BODY. If anything is going to happen to your body, you have the right to say yes or no. Don’t stop asking until you feel comfortable.
- Take a childbirth education class. A strong foundation of knowledge regarding your options and choices in birth can lead to more confident decision making.
- Hire a doula. A professional doula is there for one reason: to hear your voice - your desires and dislikes - and then amplify your voice. And when you forget what question to ask, or even forget that you have the option to do things differently, your doula will remind you.
- Choose a provider you trust. Ask tough questions. If you don’t get the answers you want either find a new provider or be sure to find a good doula.
You are deserving of respectful care. You are deserving of the opportunity to choose what is right for you and your baby. What point is there to save all these babies if we’re killing, crippling, or traumatizing their parents along the way?