Self-Advocacy and Informed Consent
You’re more likely to have your birth hijacked by stress hormones if you don’t feel safe in your space and in your body.
It is so important that a) you and your birth partner(s) feel comfortable defending your birth space from unwanted elements and interventions, whatever that looks like for you, b) that you have a plan to make any birth space comfortable and safe-feeling for you, be that at home or in a labour ward and c) that you know and understand your birth rights.
Though it shouldn’t happen, many (if not most) interventions offered to you within the current UK system will be phrased as “musts”. You may encounter, for example, “if you could just pop on the scales we’ll weigh you” at your booking appointment, “we’ll book your induction for this date” at an antenatal appointment before you’ve even “gone overdue”, or “I just need to do a vaginal exam to see how far along you are before we can let you into the labour ward”. You can always say NO.
It is not legal for you to be refused care due to declining these offers of intervention (and yes, they’re all interventions).
Ideally, you’ll have researched whatever you’re being offered before you’re offered it (realistically unlikely unless you’re a total birth nerd like myself!), or be offered true balanced information by the one doing the offering. In reality, you’ll often be making decisions as you go. Most of the time, if you’re unsure, you can always take some time to look into it and make the decision further down the line. If it’s truly an emergency and there’s no time for that, or you need some structure to ensure you’ve coevered your bases, I’d recommend using BRAIN.
The Basics of Birth Rights:
You are free to make choices about your own pregnancy and childbirth, even if your own caregivers do not agree with you.
You cannot be forced to attend hospital. If you want to birth at home you can speak to the Head of Midwifery and request a midwife is provided.
It is against the law to give medical treatment to a pregnant woman unless she agrees to it. This is legally known as giving consent.
Freebirth: Women are not obliged to accept any medical or midwifery care or treatment during childbirth and cannot be compelled to accept care unless they lack mental capacity to make decisions for themselves.
The right to autonomy means that a woman's consent must ALWAYS be sought before performing any medical procedures.
The Power of “WHY?”
You may come up against resistance with some of your choices, ranging from the environment you are in (e.g. medical staff not wanting you to use your fairy lights, or move the bed up against the wall) to your induction preference.
If this happens you must always ask WHY.
Dig for the detail! If they present you with a 'risk' ask for the numbers, make sure you have all the information available to you, and do your own research.
If you’re uncomfortable with what’s being suggested by your care provider but don’t know what to ask, or are struggling in the moment to advocate for yourself or your birth partner, you can always fall back on BRAIN! Save the image file toy our phone so it’s handy whenever you need it.
Further Reading:
Exercises for Practising Self-Advocacy
Even the most forthright person, outgoing and confident, who normally never shies away from standing up for themselves and their truth, can struggle speaking up in the birth room.
Sometimes, it’s because of the pressure of medical staff using language such as “have to” or “can’t” or “allowed”. Sometimes, it’s just because it’s can be a very intense space to be in, and not something you can really practise for in everyday life!
Part A: Self-Advocacy “Affirmations”
Now that your birth plan is complete and you know what you want and don’t want, you can practise some key phrases that will come in handy in the birth room. By practising these aloud, you’ll help to wire them into your brain, so when your mind reaches for these phrases when it is under pressure or stressed, you will find it easier to speak up!
It can be a good idea to make these part of your daily affirmations, so that they’re as much part of your mind as your coping tools are. You could also set aside separate time (ideally every day, if you can) for specifically practising self-advocacy phrases out loud.
Printable Affirmations | Affirmation & Self-Advocacy Cards
“Please familiarise yourself with my birth plan.”
“Why are you recommending that?”
“What are the alternatives? Could we try [option] instead?”
“No, I don’t consent to [insert intervention here].”
“What are the benefits? What are the risks?”
“What happens if we wait? Can we reassess in [time period]?”
Part B: Self-Advocacy Roleplay / Scripting
If self-advocacy is something you really struggle with, it can be helpful to roleplay scenarios with your birth partner or doula to practise further. For example, if you don’t want vaginal exams:
1) Make sure you know your reasons why (and “I don’t want fingers in my vagina” is a perfectly valid reason!)
2) Look into why this intervention is offered, and what the pros and cons are of declining.
3) Write a short script like the one below, and have your birth partner or friend be the “pushy” professional so you can get practice saying what you need to!
4) Repeat this process until you feel comfortable advocating for your birth preferences.
If you’d like extra support creating scripts for your scenarios, please get in touch.
Example Script
Person A (Pushy Professional): I need to do a vaginal/internal exam to see how far along you are.
Person B (Birthing Person): No, I don’t consent to that.
Person A: If I don’t see how far along you are, we can’t let you onto labour ward/have gas & air/support you properly.
Person B: You’re not allowed to withhold care because I’m declining, that’s coerscion.
Person C (Advocating Birth Partner, if needed): She has said that she is declining a vaginal exam and does not consent to them to assess her labour’s progress. Please use other skills to assess her progress. Here is our birth plan for your reference.
Part C: Show Off Your Birth Plan
Attach your final Birth Plan to the front of your pregnancy notes, and to the door of the room you’re birthing in if you’re at home. This makes it harder for medical staff to miss (or, sadly, avoid).