7 Tips to reframe the conversation around birth and assert your right to choice
One of the most significant challenges expat couples encounter in the Munich Kreißsäle (delivery wards) is the culturally distinct and very direct, authoritative style of communication practiced by a number of physicians and midwives.
No matter who turns up that day, review these 7 tips to help you establish a strong working partnership with your care provider. After all, the birth of your child will forever be one of the most memorable moments of your lives.
1. Tune in to how choice is talked about:
You’ll likely attend several information evenings in order to decide on a birth location. This is your first glimpse into the care and services offered by that facility. Your attention to detail should not only fall to the range and quality of care (breech birth, NICU, etc.) offered, but to the way in which physician-patient relationship is talked about.
Do doctors and midwives “allow” or “let” birthing mothers do certain things? Do they “forbid” or “prohibit” anything, such as food and drink? Can you expect a relationship of mutual respect and collaboration?
2. Clearly communicate your preferences from the get-go.
Once you have chosen a birth location, you will have already scheduled a pre-registration appointment or do so shortly afterward. This is your next opportunity to ask any questions you have and inform the midwife or physician in charge of registration of any preference you have.
This needn’t be an elaborate set of birth preferences; in fact, it could be as simple of a statement as this:
Unique Circumstances / Special Preferences: if you have a preference or concern close to your heart, your pre-registration meeting is a great opportunity to bring it up. That way you can have your preference noted in your file. When in doubt as to whether your preferences can be followed, always request a consultation with an experienced physician as his/her opinion can and often does carry more weight should be you be confronted with conflicting medical advice from another medical professional at a later point in time.
A word to the wise: always take note of the names of midwives and physicians you speak to. Addressing them by name not only fosters connection, it helps ensure accountability.
3. Each and every interaction with your care providers counts.
Set a frame of mind conducive to positive interaction.
Holding the thought: “Everyone I meet has the best of intentions and a genuine desire to help me birth my baby safely” can help you maintain an awareness that different doctors and midwives may have different approaches when it comes to which course of action may be helpful in your unique situation.
Practically every midwife or physician entered the birth profession with the altruistic intention of supporting women during one of the most physically, mentally and spiritually profound moments in life. You can communicate your recognition of this by seamlessly integrating it into your dialogue with care provider:
In this one statement you have:
- Acknowledged your care provider’s altruistic intention behind his/recommendation
- Acknowledged his/her expertise and professional experience
- Reminded him/her of your own legally protected right to fully understand the recommended use medication or procedure before giving your informed consent.
4. Communicate your consent clearly.
Our society blatantly and repeatedly disregards the voice of women. “No” or “stop” do not carry the weight they should. Language such as “I do not consent” or “I withdraw my consent” carry more weight legally and thus protect your rights. In choosing these words, you effectively remind all persons present of your right to informed consent and patient autonomy as a patient entrusted to their care.
5. Your labor and the birth of your baby are unique.
Of course your physicians and midwives are aware of this and are often mindful of it. Yet, sometimes, the reality of a busy Kreißsaal can subtly alter the dynamics of the situation and quite possibly your relationship. Creating a relaxing and comfortable ambiance (dim lights, curtains drawn, quiet voices, music, etc) for yourself can do much to project the uniqueness of your labor and your birth. You, your baby and your situation are unique (i.e. you are not a statistic). As a mother, you are the person most emotionally, physically and mentally invested in the health, safety and well-being of your child. There is NO ONE in this world who cares as deeply for your child as you. Sometimes, mothers may hear a phrase like “You care about your baby, right?” And, while, yes, your physician genuinely cares about your baby, so do you. Remarks such as these ultimately and often unintentionally serve to coerce a birthing mother into a decision a care provider deems to be medically sound. You can preempt a coercive remark such as this one by clearly stating the following:
6. Trust your instincts about everything and never worry about inconveniencing anyone.
You will only be pregnant with this baby this one time, you will only give birth to this baby this one time - don't spend even a second worrying about the convenience or inconvenience of others. What matters most is you and your baby.
Don’t hesitate to ask questions. You have a right to understand the care being recommended and to make an autonomous and informed decision regarding that care.
In fact, the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, e.V. (Association of the Scientific Medical Societies), an organization responsible for developing and maintaining evidence-based practice guidelines, acknowledges the importance of concepts such as “informed choice” and patient autonomy:
7. You do not need permission – so don’t feel compelled to ask.
As an active participant in your own healthcare including that of your baby, you do not need permission to do anything. Asking for permission can have a marked effect on the dynamic of your relationship with your providers.
You may have noticed that there are no ‘yes’ or ‘no’ questions in any the above examples. Instead, most needs have been framed as statements. When you ask a ‘yes’ or ‘no’ question, it is easy to say ‘no’ – whatever the reason behind it may be. Asking open-ended questions is more effective in getting a clear answer.
If you have kids, you surely know what I mean. How many times has your child(ren) asked you for something and, without even thinking, the default answer has been ‘no’. But after a few moments, you realize there may not be a reason behind it. This is not to suggest that your care provider may answer you without careful thought. This was only meant to illustrate how quickly a ‘no’ can slip out when confronted with a ‘yes’ or ‘no’ question.
Remember: You will only give birth to this baby once. You deserve to be and have the right to be a respected participant in your own and your baby's healthcare.
Do I believe that mother should carry the full burden and responsibility of consciously forging positive relationships with her care providers in order to receive evidence-based care and ensure informed consent? No, absolutely not. You have enough to focus your attention on. Receiving evidence-based care and being given the opportunity to exercise informed consent are not contingent -- and never should be -- on the quality of relationship you have with a provider.
The reality, however, is that all members of your birth team present on your and your baby’s special day(s) are just people with their own set of personal and professional experiences, expectations, preferences, and, of course, their own personalities. And the truth remains: consciously doing everything within your power to promote and protect the health of your baby is just another day in the world of being a mom.
Please share this with any friends or family who might find these tips helpful.
*The hypothetical medical situations outlined above are no way intended to be medical advice or a recounting of a specific example that has actually occurred in real life. It was created for illustrative purposes only.
None of the above is intended to be medical advice. If you feel these devices will not work for you or you do not feel comfortable using them, you are in no way obliged to do so. You know what’s right for you.