A number of features of our modern culture have made making birth-related decision making trickier than ever. Our TV, cinema and computer screens are filled with dramatic and unrealistic portrayals of birth, which often make it out to be ‘risky’ and cause people to feel scared of it. Such programmes also give people unrealistic ideas about labour and birth. A good example here is how, in TV and films, labour is often shown as being much shorter than it is in real life. This can then make it difficult for women who do not realise that they may spend a good many hours in what midwives call ‘early labour’ before their labour is considered to be ‘established’ or progressing. Some of these women will end up with intervention that they did not want, which they probably didn’t need and which might have been prevented if they had been able to gain a more realistic sense of what labour and birth can be like.
Social media feeds can easily become full of negative images, judgements and people telling others what to think and do. We live in a consumer culture and there exist people and companies who have an interest in perpetuating fear and persuading people to make the choices that are right for the company, because it benefits them personally or financially. And we have created centralised and standardised health care systems, which tend to offer a ‘one size fits all’ approach. In such systems, people can feel they are on a conveyor belt and professionals feel overworked and unable to give individualised care. Such systems leave many people feeling disrespected, dissatisfied and hurt, not to mention physically and/or emotionally traumatised.
Other challenges for birth-related decision making
A related issue is that nowadays many women don’t have confidence in their own bodies. For too long, women have been told that their bodies are the wrong shape and size, that they’re too hairy, too dirty, too smelly, too old, too fat and that they don’t work properly. We hear and see constant (though often very subtle) messages telling us that we are ‘inadequate’ and deficient and that we grow the wrong sized babies. We have been convinced that our bodies aren’t trustworthy enough to be allowed to labour without being closely monitored and watched; even though being monitored and watched can slow down our labours. We hear that we don’t go into labour at the right time, that we don’t labour quickly enough or well enough and then, when our babies do come out, we’re told that we then don’t have enough milk to feed them. Somewhat paradoxically, and despite all these criticisms, we also receive the message that a woman’s body is for the enjoyment of others rather than herself. Is it any wonder that many women don’t know how to trust their bodies or have a sense that decisions about their body are theirs and theirs alone to make?
In the months and years after they give birth, many women say that they wished that they had explored different options or had had more information about other paths that might have been available to them. Some women, for instance, wish they had chosen a different kind of caregiver or a different place of birth. Or that they had not agreed to something that was offered. Or that they had asked for something else.
Others are really happy with the choices that they made. The reality is that, for healthy women who live in high income countries today, many birth decisions are equally safe and appropriate. We know, for instance, that most women and babies are just as safe no matter whether birth takes place at home, in a birth centre or in hospital (Birthplace in England Collaborative Group 2011). We are also learning that, even when research tells us that one option may be slightly safer than another on a population basis (that is, when we consider what works for large numbers of women and babies across the board), that doesn’t necessarily make it better for an individual woman or baby. We also often see that, even when there appears to be a relative difference between two possible courses of action (or inaction), the absolute difference between these options turns out to be quite small.
But these nuances and complexities often get lost when we reduce everything to likes, comments and retweets and when rushed conversations take place in what can feel like a noisy, crowded marketplace. It’s clear that we need to find a way to get away from the noise so that we can talk about these issues, and to help people think about things before they make some of the most important decisions of their lives.
That is, in a nutshell, why I wrote ‘What’s Right For Me? Making decisions in pregnancy and childbirth‘. It looks at many aspects of birth-related decision making. If you’d like to, you can find out more here. And I’d like to send a huge thank you to all of those who have sent lovely messages since the publication of the book.