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Autonomy & Advocacy

I've heard several stories of issues with autonomy, consent, and advocacy in the birthing realm. I'm happy to say I have never been in a situation where I have seen this occur, nor have been subject to this, but I felt a need to share my thoughts on the topic and (hopefully) urge you to advocate for a type of care that respects your autonomy as a birthing person.

Here we go.

The below points are taken from the ACOG (American College of Obstetricians and Gynecologists) education module "Advocacy 101."

Advocacy is a coordinated combination of problem identification, solution creation, strategy development, and actions taken to make positive change.

As an advocate for the patient, 'the concerns and best interests of the patient are at the core of all decisions and interactions.' Physicians should listen to their patients, respect their autonomy and beliefs, and allow patients to be fully involved in their healthcare decisions.

Making decisions for patients or withholding key medical information is not being an advocate for their patient and it does not allow the patient to be an advocate for themselves.

Key components of a physician advocate:

• Inform the patient and promote informed consent

• Empower the patient and protect autonomy

• Protect the rights and interests of the patients where they cannot protect their own

• Ensure patients have fare access to available resources

• Support the patient no matter what the potential cost

• Represent the views/desires of the patient and not just her needs Many women report feeling scared into interventions they were not totally on-board with or being denied interventions because a practicing physician didn't typically opt for that type of method. They have also reported not being informed about other options, being told "this is your only choice."

I have heard stories of trauma and manipulation time and time again. I've also heard women speak without any knowledge that what happened to them was wrong.

Women report having episiotomies done without their knowledge or consent, having their waters broken without their knowledge or consent, having cervical checks done without consent, and being told their baby will die if they don't listen while they were asking questions about the procedure (aka trying to be informed enough to consent). They have been told they are not "allowed" to go past their due date with no explanation, still don't full understand why they had a C-Section, and did not know they had other options because no other options were presented.

Go back and re-read what advocacy looks like, and then read those examples again.This is wrong, this is not advocating for the patient, and this is not full informed consent.

I never want to blame a birthing person for experiencing this awful form of care, but I do think it's important to point out that this is common, so common. Therefore, if you are opting for a birth that does not follow standard protocols, or if you are simply looking to be in more control of your healthcare - something I believe is not only wise, but a human right - finding a physician that is on board is vital. If there are no good options for you, then hiring a doula and midwife to fill in the gaps and give you the full education and care you are looking for is a smart choice.

In addition, having the full education will allow you to change course if needed and know when interventions are truly necessary, allowing you to work with your medical team.

You might be asking, "Why are things this way?"

OB-GYNs are trained primarily in emergency medicine, meaning they are trained on the side of worst case scenario, and receive very little education on the unmedicated, natural physiological process of birth. Unless your doctor has done more education outside of their typical schooling to learn more about birthing in this way, they do not fully understand the process. Furthermore, they are the most sued of all physicians, so they operate on the side of caution for themselves and the hospital as well.

It's human and natural to want to intercede and to be able control outcomes as much as possible, however; our numbers in the United States reflect that maybe all of our interventions are doing more harm than good.

But I digress.

Don't get what I'm saying twisted - I believe that medicine, especially advanced medicine, saves lives. I'm strictly discussing the problems I see women facing due to lack of education on her physicians part and fear-driven type of care.

Every single person deserves to feel cared for, heard, seen, and valued. Every single person deserve respect and full informed consent. Every single person deserves to be treated with love and understanding.

In order to ensure you receive this type of care, I urge you to act. Do something. Do not allow yourself to fall prey to this type of care. Speak out, seek support, educate yourself, switch doctors or hospitals. Advocate for yourself. We live in a time where we have to be proactive about our care and ask all the questions to get the full picture of things. It's an unfortunate reality, but it's the reality nonetheless.

Lastly, know that there are doctors out there doing the good work. They are gems and they are healing old wounds, ushering in a type of care that is truly centered on whole health, and creating a safe space for birthing women. Rare as they may be, they are there. And we thank them!

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