“I’m just going to go with the flow.” “I don’t want to experience that much pain.” “I’ll just do what the doctors say.”
How often do people think things along these lines when it comes to childbirth? And how often do they actually know all the possible consequences of thinking like this ahead of time?
Many women go into childbirth wanting drugs and not knowing a whole lot about all of the drugs and procedures they’ll potentially be offered in a hospital.
Nor do they realize that they have the right to informed consent. In other words, the woman has the right to be fully informed about everything, including alternatives and whether something is actually necessary, and she may choose to accept or decline anything based on that information.
For instance, it’s pretty standard for women in labor to get an epidural for pain management. Many women don’t fully comprehend the potential risks of an epidural, however. For instance, an epidural, especially if received early on, increases the chances of needing pitocin due to slowed labor, and also increases chances of fetal distress and “failure to progress,” some of the most common reasons for emergency c-sections. An epidural also interferes with the body’s natural production of oxytocin, which is necessary for labor contractions to be effective and for labor to progress (hence failure to progress and need for pitocin), and is also the “love hormone” that aids in bonding with an infant, helping labor be seen as a positive experience, and even getting through the pain of contractions. Further, an epidural can lower blood pressure, sometimes catastrophically, endangering life of mother and baby and even causing brain damage in the baby.
Few hospital staff really explain these potential problems well to women. Even fewer explain that natural pain management can be highly effective, that going through a normal labor without interference of pain medication can be very empowering, that women are innately capable of handling labor, especially when supported by a carefully chosen birth team, and that the elation and bonding after delivery are usually far greater without an epidural.
The lack of information given can also interfere with women making the best decision about when interventions should be used. For example, I went into my labor planning on going without pain medications because I was informed about the risks of having them and the benefits of going without. However, I experienced complications, and after 32 hours of labor, a few of which were on pitocin (also an informed decision done for medically necessary reasons), I finally chose to receive an epidural. I made this choice understanding a number of things. The most significant was that I was exhausted, and I didn’t want to risk not being able to push because of that. Even if I was physically able to push after a few more hours of labor, the high blood pressure and overall exhaustion I was experiencing would make bonding more difficult than the interference of the epidural would; an epidural would allow me to get some rest, and it would bring down my blood pressure. I’d also gotten passed the point where an epidural was most likely to lead to a c-section, because I’d progressed far enough. Knowing all of that, I was able to make an informed decision, after discussion with my birth team, to receive an epidural. I also knew, after waiting for so long to get it, that I’d be able to go without one in an uncomplicated labor. I knew I was strong enough. I was empowered and encouraged by that knowledge.
And guess what? I got rest. My blood pressure became normal for the first time in my labor. I didn’t have a c-section. I was able to bond with my baby. And I don’t dread my next labor, which I hope won’t require a hospital and medical interventions due to complications next time.
Women deserve to be fully informed going into and during labor. And I don’t mean just signing a form. I mean that a woman should be able to ask questions and partner with her care providers in making decisions. She should be able to ask what any given drug, procedure, or intervention can do to her and her baby, what the benefits are, if there are any alternatives and what the risks and benefits of the alternatives are, and what would happen if an intervention wasn’t done.
It’s not that women should never choose interventions, drugs, and other procedures during childbirth, or that a woman who chooses to have them after knowing the potential risks is a bad mother. It’s that she has the right to know all of the risks and alternatives before anything is done during her labor.
Sometimes the interventions are beneficial and even necessary to protect the mother and baby. But all too often, they’re not, and one in three women are facing c-sections, when less than 10% would have been medically necessary had labor been allowed to progress naturally. These many women getting major abdominal surgery face higher risks of complications and death in that and future pregnancies, and so do their babies. If two-thirds of them wouldn’t have actually needed a c-section, then that’s two-thirds too many women and infants who are being put at risk unnecessarily. How many of them, if they’d been fully informed and empowered before and during labor, would have been able to make decisions that would have allowed them to, more than likely, avoid the c-section? Far too many for us to be okay with it.
When so many women are coming out of their births feeling helpless, negative, fearful of future births, depressed, and even traumatized, there’s a problem. Women need to take back their power during birth. Doing so removes a lot of the fear, the risks, the helplessness. We have the right to informed consent, no matter what setting we choose when we give birth, and we need to use that right.
The Life of Lee 