Labor and Delivery: Education, Agency, and Self-advocacy
When I encounter people who have experienced birth trauma, the common theme usually surrounds time. Decisions are presented, interventions are offered, urgency is expressed, and consent is demanded. Then later, they are left to unpack those decisions and assess what they really consented to. Those decisions deeply impacted their bodies, their ability to care of an infant, their ability to return to exercise. Were they lifesaving? Perhaps. Were they brash? Perhaps. When people can go into labor and delivery with understanding of what choices may be presented to them, and how they would ideally like to respond to those choices, the outcome all around is better. People may feel tremendous grief when their babies are not delivered the way they imagined, but there is less trauma when INFORMED consent is given.
I always encourage my patients and clients to explore a birth plan with their partner for this very reason. It is not to hold firm to a rigid unyielding plan. It is to spend time conversing. This should open the lines of communication and highlight hopes, dreams, fears, and preparation strategies.
These are the things I encourage people to fully understand prior to giving birth:
Different places babies can be born – hospital, home, birth center.
What are the risks and benefits of each?
What feels aligned with your ideal outcome?
Does my birth environment have a birth plan template?
Why might I be induced and what are the different types of induction?
Some can be turned up or down, others are permanent.
Do I want an epidural?
What are the risks and benefits?
How will this impact my positioning, pushing, hormones, milk supply?
Will I be allowed to labor and deliver in any position I want / am able, even with an epidural?
If I don’t want an epidural, or want to wait as long as possible, how can I communicate that to my team?
Do I want cervical checks?
How often and for what reason?
What are the cesarean birth, episiotomy, and Grade III and IV perineal tear rates of my Doctor?
What are the risks to the pelvic floor of an episiotomy, vacuum or forceps?
Does my birth environment promote delayed cord cutting and the golden hour?
I also encourage people to remember that urgency is a scale.
When an intervention is proposed, it is ok to take a beat and implement the following acronym:
BRAIN
Benefits
Risks
Alternatives
Intuition (what does your intuition say)
Nothing (what if you do nothing)
By going through this process of inquisition, both pregnant and supporting person will find out what their emotional attachments and triggers are. This will generate such important conversation, that then in the moment, will allow consent to be given in an informed way. The partner will know the birthing person’s desires and can be their advocate in the instance they cannot advocate for themself. Everyone keeps their agency, and the processing that takes place after may be laced with grief, but the experience should not have to feel traumatic.
