Author: Debs Neiger Independent Midwife.
Giving birth can seem daunting. The options seem endless, and yet sometimes restricted, depending on who you talk to during your maternity care and whether your midwife and/or doctor are supportive of choice, or less so. Birth plans seem controlling to some and get a bad rep from fellow mothers and some health care professionals (HCPs) alike.
Now, does that make sense? Absolutely not.
Is it not reasonable to want to be aware of all options available and then choosing the one that makes most sense? YES!
You likely would NOT leave planning another major life event like a wedding up to someone else……you would tell the wedding planner what you would like and expect them to facilitate this in constant discussion with you. And you certainly would not expect them to simply change your plans without consulting you even if the weather on the day is disastrous. And a wedding not being quite to your liking is unlikely to have long lasting physical and mental impact on the rest of your life like a traumatic birth might.
So, picking and choosing which aspects of care you are happy with, which you are not happy with, which you are undecided about and which you MAY consider if clinically necessary is perfectly reasonable and sensible. In turn it enables your HCPs to understand what is important to you and to provide the care that you want and need.
Here are a few of the things you may not know you have a choice over (Hint: You ultimately call the shots on all aspects of your care!!)
- Fetal monitoring: Whether and how you would like to be monitored during labour is also up to you. There are situations where intermittent monitoring as per NICE guideline is offered and there are situations during which very close monitoring is offered, to attempt to assess how your baby is coping with labour. It is always up to you as to whether and when you accept the offer. However, keep in mind that sometimes clinicians will not be willing to proceed with interventions making fetal distress more likely (such as some types of induction or augmentation of labour) without close monitoring. I’m often asked WHY some people opt for less monitoring than offered, and this is due to the fact that research has found routine continuous monitoring to lead to more caesarean sections without actually improving outcomes for babies. It also restricts movement in many ways and therefore can interfere with physiological birth, amongst other reasons. Essentially, fetal monitoring is a very complex subject matter and careful considerations as to what you feel is best for you is sensible. There is of course also the option to have no monitoring at all.
- Vaginal examinations: Again, whether and when you allow someone to put their fingers into your vagina is absolutely and always up to you. Coercing a vaginal examination or doing one without gaining your informed consent is assault. There are many alternative ways to assess labour progress to vaginal examinations and a confident midwife should feel happy providing care to you without checking your cervix. Of course there are some clinical situations in which a vaginal examination can give you vital information, without which your options may be limited (for example if your baby is showing signs of not coping well with labour and a vaginal examination might give indication whether birth is imminent. In this situation, the information could avoid you opting for a caesarean section). But it IS up to you.
- Mode of birth: If you want your baby born vaginally or by caesarean section should be up to you. NICE guidelines recommend that women ought to be able to opt for a caesarean option should they wish to. Even if your obstetrician is unwilling to facilitate this for you, they ought to refer you to an alternative care provider who will. Equally, no one can make you undergo a caesarean section if you would rather birth vaginally, regardless of your obstetric history. It is for you to decide if you feel more comfortable with a surgical birth or a vaginal one.
- Birthing position: You are free to choose your own birthing position, monitor leads can be adjusted and care providers can accommodate the birth of your baby wherever and in whichever position you would like to be, it is even possible to be creative for instrumental births (such as forceps or ventouse) but this is much less practical and most HCPs are not confident doing so.
After your baby is born:
- How to birth your placenta: Physiologically, or via a third stage managed with oxytocic drugs is completely up to you. Your midwife may recommend drug led management if you have predisposing factors for haemorrhage (a very long labour, induction or previous haemorrhage for example) , but you can do your research and decline or accept the offer. There are of course situations where more proactive management of the placenta birth becomes urgent, but this will hopefully be very clear at the time.
- When/if you have your perineum checked for tears and/or sutured: After your baby is born (vaginally), there will be a time when the midwife or doctor offers to check your perineum for any damage sustained. Depending on what they find, they will then let you know if and what sort of repair of the damage can be offered. Both the checking AND the suturing are optional. Always. But it is worth knowing that having a more substantial tear and not repairing it with sutures may lead to some degree of pelvic floor dysfunction in the long term. However, some women feel very comfortable checking their own perineum, and some women have previous trauma which influences their decision making regarding this. If you do get checked, this must always be on your terms.
- How to feed your baby: The decision how to feed your baby is up to you. Your midwife is always there to discuss the pros and cons of the different methods of feeding with you. Keep in mind that sensitively communicated, evidence-based information is NOT a judgement on your final feeding decision.
- What routine tests you would like your baby to have: Again, this is up to you. You have parental responsibility for your new little human. This is quite scary initially as suddenly you have to make choices for someone other than yourself, and the fear to get judged for those choices is strong for many parents.
This list is not exhaustive and does not cover every eventuality, but it does remind you that you have FULL autonomy over your own body, always.
The bottom line is, YOU ARE THE BOSS OF YOU.
It is never ok for anyone to make you feel bad for the choices you are making (including your HCPs), but be prepared to consider why certain interventions are offered to you, so you truly understand what you are accepting and declining . Those considerations are sometimes difficult and might feel overwhelming, especially in a vulnerable and potentially time sensitive situation such as labour, but it can be a very educational journey which leads you to truly proactively take charge of your experience.
Here are some more helpful links to more information and to aid your decision making further. AIMS’ publications and Sara Wickham’s books are very readable, balanced and evidence-based booklets that are brilliant for researching your options: