As a doula, I support families as they follow their own compass in birth so they can build empowered families and communities. One of the key issues of concern for families is their experience of birth itself. Birth is the great transformational experience of life itself, and can be a powerful spiritual awakening. It’s not only the experience of the parent, but the baby’s experience of birth is transformative as well.
Firstly, many families are increasingly concerned about experiencing coercion in birth. I find myself teaching families how to recognize coercion when it happens in order to unpack it and plan the best birth experience possible.
Freedom from coercion is one of the basic universal human rights in childbirth. You have the right accurate information about the full range of choices available to you in birth. As a birthing person, it is your right to refuse or consent to any medical procedure or intervention in birth. This must be FREE of coercion from your maternity care provider.
What is Coercion?
Coercion is the act of convincing someone to make a choice. It is the act of pressuring someone into action. Also, this is usually an action they would not take on their own accord. There are a variety of ways in which this can play out in pregnancy and birth.
Firstly, when someone is coerced into making a decision, they are subject to levels of manipulation by a person in power. Power dynamics are rampant in our maternity care system and often dominate the decision-making process in birth.
Secondly, when a person experiences coercion in birth, they are disempowered and taken out of the center of the spiral. As a doula, I support parents as they follow their own compass in birth and help families become the center of the spiral of their birth experience. If families are subject to coercion in pregnancy and birth, then they are removed from the center of their power.
This undoubtedly leads to many experiences of birth trauma. Statistically speaking, one in three families report having a traumatic birth experience. Coercion in pregnancy and birth is a huge problem and it runs rampant in our maternity care system.
Can’t Families Just File a Complaint if They Experience Coercion in Birth?
In the United States, families generally have little recourse for abuse, violence, coercion they experience during birth. However, countries such as Venezuela and Argentina have developed a framework for legal prosecution for gender-related violence. In this framework there is legal recognition of coerced medical procedures as abuse rather than a standard of care. Here’s why it’s so difficult to “file a complaint” in the United States:
- The state itself holds an interest in protecting the life of a viable fetus. Most states guarantee the right to refuse medical procedures, however this can be no longer considered valid under an “emergency” clause where the state deems it necessary to protect the life of a baby. For example, in Dray v. Staten Island University Hospital, a mother sued her doctor for performing a cesarean after she refused to consent to the procedure. Although NYS gives patients the right to refuse medical treatment, the state made an exception because the of the risk to her baby (Borges, 2018).
- Even when a decision does grant economic recovery to a patient, it generally only covers medical expenses related to the procedure and recovery. The transformative, emotional, and spiritual realms of childbirth are totally ignored and birth is simply seen through the lens of pathology. When someone is denied their choices in childbirth, they are denied the ability to make a decision in their power that affects one of the most transformative moments in their life (Borges, 2018).
What Does Coercion Sound Like?
One of the most important things you can do is recognize coercion and other abusive tactics used by your provider EARLY in your pregnancy.
Firstly, many families are unaware that their providers words are actually leading to coercion. Coercion in birth and prenatal care isn’t always malicious. It can often come across as friendly chatter. Jokes are especially notorious gateways to coercion in birth. It can come across as caring or friendly at first. This is also called “soft coercion.”
“If you were my daughter/wife/friend… I would tell you to…”
“Hahaha I just wish you would be more open to an epidural.”
“We’ll see how you feel about the pain when the time comes…”
“All we want is a healthy baby, right?”
Secondly, another type of coercion is more direct and really instills fear. This appears more clearly coercive, and often happens after a period of “soft coercion.” Hard coercion can sound like:
“If you refuse, we’ll have to call child protective services/our lawyer/the court…”
“If you leave the hospital, you might not be able to come back…”
“Do you want your baby to die?”
“If you don’t push right on your back, I’m taking you in for a cesarean.”
“I’m giving you one more hour then calling for a C-section.”
And coercion can also include not presenting choices accurately. This can sound like…
“We don’t allow you to…”
“Let’s get up on your back in the bed and push!”
“You could just push and be done.”
“If you just__________ it will be faster and you can be done.”
What You Can Do to Prevent Coercion in Birth?
We can’t fully prevent a provider from using coercion as a tactic. But, you can take some preventative measures in your pregnancy so you are more aware.
It’s important to recognize the signs of coercion early in your pregnancy. How does your provider speak to you? How do their words make you feel? Consider how your body reacts when you are with them. Does your pulse race? Do you feel flushed? Does your stomach churn a little at their words? These are all physical manifestations of fear and intimidation. Use the list above to help you recognize the signs early.
Also, it’s tempting to think that your provider is just trying to be nice. Do not confuse coercive language for kindness and compassion. When someone says, “If you were my daughter, I would tell you to…” they’re most likely saying that to simply get you to do what they want. They’re using a plea to your emotional sense to get you to comply. A provider who is truly caring and compassionate would respect you enough to make your own decisions and give you the information you need to do so. I’m coming at you FULL STOP about this.
If you are in labor, and your provider is using any of these tactics, you can:
- Ask them to provide evidence based information so you can make a decision
- Ask them to only provide advice based on medical information and evidence to support your decision-making process
- Stand your ground and use your intuition as a guide in your decision-making process. Chances are, if something is truly an emergency, there will be no need to coerce someone into making a decision.
- Remember that you have the right to ask for the benefits, risks, and alternatives for any decision. (BRAIN: Benefits, Risks, Alternatives, Intuition, do Nothing)
- There may be times when it is impractical or impossible for the birthing person to advocate for themselves. We are at our highest level of openness, vulnerability, and spirituality in birth. Have a conversation with your support team about what you can do together to protect your right to autonomy in birth. What are your expectations for advocacy from your partner and doula? Talk about this NOW, in your pregnancy, before you are in labor.
Did you experience coercion in your pregnancy and birth? How did you recognize it? How did it affect your birth experience? I would love to hear your story.
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