"I didn’t know I could say no," she exclaimed, turning her surprised face towards me. I can see the cogs literally whirring as she applies this new knowledge to her situation, as the possibility for a different way forward opens up.
I smile encouragingly, my own cogs working overtime as my mind is flooded with all that I desperately want her to know to ensure her birth goes as she dreams of… Where to even start?
I want her to know that her right to say no is enshrined in human rights law.
I want her to know that these human rights apply equally to her in pregnancy and birth just as they do at any other time.
I want her to know that these include the right to decline any treatment for any reason or even no reason at all.
I want her to know not to go in blindly trusting an overstretched system that is not women centred at its core, but to go in eyes wide open and ask for what she needs, expecting it to be given.
I want her to be aware of the limitations of this system with its overworked and understaffed workforce in supporting her so she is empowered to ask for more for herself.
I want her to know doctor doesn’t know best, she does.
I want her to know she has choices, more choices than she has been given so far.
I want her to know she is not just a passive passenger in this birth, an object of interest for obstetrician to tick off in their file but is the active agent.
I want her to know to ask for more information, with facts and evidence, to be able to make her choice and to expect this to be given with respect and dignity.
I want her to know she can request a new midwife, a different consultant, change hospital – whatever it takes until she is heard and respected.
I want her to know she deserves to raise the bar on her expectations for this birth and her treatment way, way higher.
I want her to know there is another world possible for her. A world where her birth isn’t all about managing risks, counting stages, measuring and charts.
I want her to know this world has her at the centre of her birth experience and that it is her opinions, desires and wishes that matter here.
I want her to know this is an everyday magical world where she, her baby and body will dance the birth dance in an organic flow of pulsing energy- maybe it is intense, maybe difficult at times but it is her dance no one elses.
I want her to know there is another version of her waiting on the other side. A strong, proud and confident woman and mother born with her baby.
I want her to know she is holding out her hand to invite her across the threshold and hold her hand throughout.
I want her to know to trust herself as the only real expert in her own birth, the only one who can really decide what’s best in each moment.
I want her to know and value her instincts that were telling her to say no and to have the courage to stand her ground.
I want her to know that when she really shows up and claims this space for herself in this way then she will see those supporting her change to reflect her newfound strength and conviction.
I want her to know there are people here who care and have her back.
I want so much for her.
I can feel the fire rising in me, burning through my silence and hesitation. I want this fire to touch her, to warm her heart so she knows she is loved and supported. I want this fire to light the fire in her own belly so she finds her courage to speak her deep desires. I want this fire to fan the flames of her own passion so she rises up to claim her desires. I want this fire to ignite her own passion for herself and her birth so she can make it happen her way. I want this fire to blaze a trail for us all to follow as we collectively transform the face of birth and the path to motherhood.
The fire is pulsing in my heart and flames flicker through my words as I repeat with as much emphasis and love as I can muster ..
“You absolutely have the right to say no. “
That day we did chat a little more and I know she has since given birth as she wished to a wonderful baby boy. This post today is dedicated to her and to all the women who didn’t or don’t know they can say no. For all the women who are hearing their soul whisper to them that they deserve more and better.
I hear your whispers too. I see you.
I love you.
Along with the passion and fire it’s good to get practical. Below is the grounded practical resource list you can draw on when you need to make a stand for what you believe in for your birth.
1 Knowing where you stand.
“Human rights require public bodies to treat you with dignity and respect, consult you about decisions and respect your choices.”
(From Birthrights fact sheet - Human Rights in Maternity Care
You don’t stop being a human being just because you are pregnant. You and your unborn child are not the property of the NHS. All your basic human rights apply in pregnancy and childbirth too. Along with dignity and respect you should be able to exercise your right to informed consent. Meaning that you cannot be made to do anything you don’t want to do and that you should be provided with all the information you need to make your own choice.
The human rights in childbirth charity - Birthrights -founded by Rebecca Schiller produce a number of excellent fact sheets. These include Human rights in maternity care, consenting to treatment, choice of place of birth, right to a c section, accessing your records and making a complaint.
I recommend the Aims booklet ‘ Am I allowed' By Beverley a Lawrence Beech, which gives in detail all the information you need to make an informed decision. Aims stands for Association for improvement of maternity services and this and other booklets that go into great depth on specific subjects can be bought direct from the Aims website.
2 Getting the information you need.
Now you know you have the right to dignity, respect and informed consent you might be forgiven for thinking this will all just be handed to you effortlessly at every step of your pregnancy and birth. Sadly this is not the case or I would not be writing this post.
Given the shortcomings in the existing system you may need to ask and ask again to get all the information you need. The Acronym BRAINS is one of the best and most widely known ways to make sure you cover every angle. Here it is in detail:
Benefits: What are the benefits of X (the procedure that has just been offered to you) You may ask- How will this help me? What problem will it solve? You can also ask what undergoing this treatment option means for you – how is it carried out, how long will it take what else is involved?
Risks: What are the risks of procedure, protocol etc? You can also ask about potential side effects and knock on effects for the birth. In some cases you may wish to ask what effect a procedure has on future pregnancies and births
Also a missing piece here is to check in with absolute versus relative risks. In other words there is a big difference between a risk that doubles if the original risk is 25% or 0.1% Finding this out can really put risk into perspective. A consultant is used to seeing difficult births and is likely to stress the risks of not doing a procedure they recommend. By asking more questions you can get the information you need and a fuller picture to choose what is best for you.
Alternatives: What else is possible? What other options do I have? Remember to go through brain again with each alternative. This part can really open you up to the choice that is so often present and that you may have been unaware of.
Intuition: Intuition or gut instinct is an undervalued but powerful tool For me, whilst listening to medical advice and getting information is important, intuition trumps everything when it comes to the final decision. We are conditioned to rely on information we can measure, and monitor. Birth is not linear and predictable in this way and you are not a statistic. Different people respond differently to different procedures and only you know what is right for you. Tune in to your body and listen to your inner guidance. After receiving all the information, take the time to discover what your intution, your baby and body need you to know You may like to ask for time for this and to make a decision ( see my next point below)
Nothing: What would happen if I do nothing? What would happen if we wait and how long may we wait for? Again you can cycle through the first part of the acronym and apply it to the strategy of waiting- What are the benefits ? risks? Etc
Smile: It can be very stressful trying to make decisions in a pregnancy that has taken an unexpected turn. We may be tense and worried about what may happen and concerned about making the right decision. Try consciously shaking out your body and stretching. Sit tall and smile- even if you don’t feel like it at first. The physical movement in your face fires off neurons and chemicals flow- a message of positivity is being sent through your body. This will be ok. I am ok. I can do this.
3- Taking off the pressure
On the spot under the gaze of your consultant or midwife you may feel pressured to make an instant decision. There is usually more time than you think even if you are in labour. It is important to ask and check so you can create some space and time for you to make the right choice from the right feeling place for you.
Thank you for all your information I /We would like to go away and think about it to make our decision.
How much time do I have to make my choice? Can I have ten minutes, half an hour?
Even if the decision is a no brainer, but it may not be the route you had hoped it can still be worth asking for a few minutes so you can come to terms with the change of plan emotionally and energetically. So that when you choose your next step you do so with calm strength dignity, and love.
Give yourself as much space and time as you can for each decision to feel good.
Remember- You are the mother, the one at the centre of this amazing birth experience and you deserve for your wishes to be heard and respected.
Much love to you on your journey.