Seven useful words for the birth room…

When Nadine Edwards and I were updating Birthing Your Placenta, I was reminded of some really useful words for the birth room. This is something which I talk about in workshops a lot, but haven’t yet written about. The phrase is useful for almost anyone who cares about the decision-making autonomy of birthing women. That might include partners, family members or friends, midwives, doctors, student midwives or doulas. Anyone, in fact, who might be present during labour or birth.

The main reason this sentence is useful is because of something that happens frequently in birth rooms and often feels difficult.

Someone suggests something to the woman which you know contradicts something she has written in her birth plan. You suspect she might not really want it, and/or that might not be in her best interests. You may or not be right, of course, but you’ve got the woman’s interests at heart. But the woman is in the middle of labour or birth. Maybe she’s feeling vulnerable, or tired, or in pain. Or all of the above. She might not feel as able to express her wishes as well as usual. She might not have even heard the question, or realised its implications. You want to help, but you don’t want to undermine the person who has asked her, and you want to keep a good atmosphere in the room.

 

What could you say?

Offering such a scenario in workshops often leads to good discussion. The reality is that, actually, any of those people in the list above can also be the person who makes the suggestion. A few examples of where this kind of situation has arisen from my own experience:

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  • A midwife or doctor offers an intervention which the student midwife knows the woman doesn’t want. The student has read the birth plan in the woman’s notes. There’s no emergency going on, but the woman is tired. That means she is more likely to comply. The student wants to make sure this is the right decision for the woman.
  • Another woman is becoming really tired in late labour. Her doula and partner are encouraging her to get up and dance to some high-energy music. The woman’s midwife knows that she needs to replenish her energy for the pushing stage. The midwife’s experience tells her that the woman might be better off if she rested on the bed for a while. She could even try to nap in between surges. She wants to be able to offer rest as an alternative but without undermining those who are trying to offer support.
  • A woman’s mother interrupts her focus to suggest talking to another family member on the phone. The woman’s midwife knows the woman really wants to concentrate on her breathing. She wants to help the woman without creating ill feeling or undermining relationships.
  • A woman’s partner becomes stressed through tiredness and, when he sees a doctor in the corridor, begins asking her about having some help. The midwife and the woman’s doula don’t think this is necessary, or what the woman wants. They want to bring the woman into the conversation and also let the doctor know that the woman herself is not behind this request.

Now, we could debate each of those examples all day, because they are not at all clear cut. There’s often no right or wrong, just different approaches and a variety of people who all mean well. But in each of these situations and many more, there is one sentence that the concerned person can say to the woman which will help keep the focus on the birthing woman and, often, change the direction of the conversation.

The sentence is: “Is that what you want to do?”

In some situations, the value of the sentence is to draw the woman’s attention to the fact that something is being offered. In others (like with the phone example), it can be helpful because it can feel less confrontational to some people to say no to a direct question from another person (such as ‘is that what you want’) than to say no ‘out of the blue’ to someone making a request.

In a couple of the examples above, person A is making an offer that person B isn’t sure the woman will want. By asking the question, person B is simply opening a conversation in a non-confrontational way. It reminds the woman that the decision is hers. This can be especially important in situations that could easily become fraught or difficult. For instance where the person making the ‘offer’ is being directive and ‘telling rather than asking’. The question can be asked softly, with concern. The asker can ask in a relatively innocent way, because they are just checking. That makes the power more balanced.

If you’ve not tried this before, then I invite you to add it to your toolkit and try it out.

Or if you have other useful sentences, then please feel free to share them.

 

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photo credit: Jan Huber’s CC Archive Silhouette of a hiking signpost at dusk in Switzerland via photopin (license)

1 comment for “Seven useful words for the birth room…

  1. October 1, 2018 at 7:18 am

    This is a very simple reminder of how to retain the power balance during labour.  The focus is too often on obtaining ‘consent’ rather than supporting decision making. (https://bellabirth.wordpress.com/2018/02/17/the-trouble-with-consent/).

    An informed birth plan (birth map) is the result of a decision making process, like an Advanced care directive. Ignoring it to offer something contradictory is disrespectful, and when coupled with a power imbalance carries coercive and confusing connotations. And when it is clear we are expected to comply/consent, being reminded that we have the option of saying no is a wonderfully supportive (and simple) act.

    Doulas are good at this, and will ask variations on this theme…such as

    “Do you need more information?”
    “would you like some time to discuss this?”
    “According to the birth plan that is not consented to in these circumstances”

    When there is no doula, the support person might find it helpful to practice saying a phrase that helps prompt decision making.

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