The Illusion of Choice: Navigating the Childbirth System

How to Navigate the System Without Making Your Birth a Battlefield

illusion of choice

Navigating the maternity care system in the United States is one of the most common concerns of the families I work with. As a doula, I support families from all different backgrounds who make a diverse group of choices for birth. I am seeing that we may be moving from the era of informed consent and into something called the illusion of choice.

One of the key threads in my work with families is that I follow their lead. They are on a transformational journey through pregnancy and birth. I’m there to witness their transformation as it unfolds. I hold their sacred space. I am the witness to the transformation. I’m with you on your journey and I’m there for support. I go where you go.

In light of this idea, a common question I get – either directly or indirectly – is, “How do I navigate this without making my birth a battlefield?”

Working Under the Illusion of Choice

Something birth workers talk about all the time is how a family will build their perfect birth plan. They put tons of time and energy into researching and making choices. However, when they’re in labor and arrive at the hospital they start to defer their choices to their care provider. They realize their birth plan is going out the window. They follow their providers plan for their birth, and they just want to get their baby and get the hell out of there and go home.

Is this the energy we want from the most transformational experience of life?

Families are aware that this happens to people. They tell me about other people’s stories all the time. They want to know how to avoid this. Birthing families know this happens and they really don’t want that.

Fear and the Illusion of Choice

The maternity care system KNOWS that there is a HUGE fear of birth. One technique that is used to gain compliance (getting you to agree to the choices they want you to make) is to tap into your fear.

Let me tell you a story about fear in pregnancy and birth.

I have an amazing family I’m working with. They’re expecting their first baby. I can feel as I’m meeting with them that they’re afraid. The mother started talking about how she feels really nervous about everything and hopes that it just goes smoothly.

So, I said, “okay, tell me more.”

She said she was worried about everything – about the pain, about what would happen to her body, about someone doing things to her baby without her permission, about her baby being in danger, about losing her own life in childbirth – THAT is a lot. It’s a lot. This is what we’re unpacking with families. She was choking back tears of anxiety as she is telling me this.

I asked her if she felt like it would be helpful to visualize the birth process and talk through it at this time (she was early in her pregnancy so we didn’t really get to the childbirth education point yet) and she said sure, that could help.

Fighting Fear

I have this exercise I do where I use an amazing visual guide called the birth atlas. I go through the entire labor and birth process with them from the physical and spiritual perspective. We know birth is a holistic process. We have to connect the physical to the spiritual, mental, and emotional transformation that is occurring.

I walk the family through the brain wave changes, the hormonal changes, the emotional changes, the physical changes and sensations. This session lays out the general “map” of the transformation of birth. I absolutely love doing this.

I went through my holistic birth journey with this family. It’s kind of a long talk. And I got to the point where the baby crowns and it ends with the birth of the baby. And she starts sobbing and hugging her partner! They’re just in this space together.

I thought – Oh my god did I just traumatize her? What did I do? I said to her, tell me what’s on your mind? What are you feeling? How can I help?

And she said, “I’m so sorry… I’m just so excited to give birth!”

Fear, Coercion, and the Illusion of Choice

One of my absolutely favorite moments of working with families is supporting them as the move from the fear place and into excitement for birth.

There are several tactics that the medical childbirth system will use to get you to comply with what they want you to do.

They may try to tap into your FEAR of birth. And they are very well aware that families are often terrified of giving birth. This is known and used as a way to get you to defect to their choices for you and give up your power.

Another tactic that is often used is guilt. This might sound like, “Don’t you just want a healthy baby?”

Also, another highly damaging tactic is the introduction of shame to get you to comply. It might sound like, “What kind of mother would you be if something happened to your baby? Do you really care more about your birth experience than your baby?”

Lastly, another tactic that I see used is compliance by LOVE. The system is well aware that, especially in pregnancy, birthing people want to be loved and nurtured. When they really need you to comply with something, they may even use this as a tactic against you. It doesn’t feel wrong at first, but you’ll see it now that you’re aware of it. They honestly may not even be aware of what they are doing.

It sounds something like, “I care about you as if you were my daughter. And if you were my daughter, I would tell you to _______ (get an epidural, have Pitocin, get an IV).” Essentially saying, “I will give you love if you do this…”

Informed Consent vs. The Illusion of Choice

We are living in the age of informed consent. A lot of people are pretty familiar with the term informed consent. It essentially means that you’re asking for the risks, benefits, and alternatives before making a decision about any medical test or procedure.

But I actually think that we’re living in what is more properly called the illusion of choice. Here’s why.

Standard of Care and Your Choices

If you are a medical provider with a state license, and you’re working with a facility or with another group, you have what is called a standard of care. Standard of care is basically the policies, procedures, and protocols followed by professions from a given organization, location, or license.

For example, policies such as “you have to have an IV in labor” or “no eating and drinking in labor” are considered standards. Standards of care can be totally different from one birthplace to another. Standard of care is individual and frankly often arbitrary.

The idea of informed consent can be tricky. This is because professionals have to follow the standard of care for their organization, license, or place of work. The standards aren’t uniform, they’re often made up by individuals.

Why Standards of Care Erode Informed Consent

If you’re a medical provider and you go outside the standards of care for your community, you can be sanctioned, persecuted, and punished.

If you’ve gone to medical or midwifery school, you’ve been considerably invested in being able to work in your career. That is a hugely intense lifelong commitment that I have the utmost respect for. And thank goodness for great medical care providers. I am so incredibly appreciative of the ability to access great care when it’s needed.

Informed consent gets tricky when the person providing you with information really NEEDS you to make a certain choice for their well-being. They can be punished and sanctioned for allowing you to make a choice outside of the standard of care.

How Does This Effect Your Choices?

This changes the type of information you might receive about tests and procedures in your birth. Your provider HAS to have some bias towards you doing the thing they want – according to the standards of care – because their license and employment may depend on it.

Do you really have the ability to receive informed consent and true choice from someone who’s career is invested in your decision?

So what we really have instead of choice, is the ILLUSION of choice in our care.

What Can You Do?

One of the best things you can do is this…

“Don’t give birth with someone who isn’t 100% invested in you.” – Whapio Bartlett

That can be really hard to bridge and figure out. It might feel confusing to make that happen for you. How do you know if your provider is 100% invested in you? That’s for you to ask yourself and answer.

One thing I can tell you, is that having a doula and an educated and supportive partner is one of the most important things you can do to truly ensure you have access to true choice in your care.

Doula Support and the Illusion of Choice

Having someone with you who understands the medical language of birth and understands how to interact with the childbirth care system is an incredibly important resource in getting true informed consent.

If your provider says something to you like, “We’d like to give you a little bit of Pitocin to jump start your contractions…” You can say something like… “Can you give us the risks and benefits of doing this right now? How will this affect my labor? How will it affect my baby?” You want to ask about this, for example, because your provider might be under pressure to have their patients on a timetable for labor.

Everything is wiki wiki. There’s a lot of pressure on them to have you follow their standard of care if your labor is taking what their hospital considers to be “too long.”

Your doctor will give you some information, and then you can say “Can we have a minute alone to talk about this?”

Then you can talk with your partner and your doula. Your doula can help you filter and fill in the gaps with information to help you get a clear, non-biased set of information.

In this scenario, if you’re not into this intervention… something really powerful that you or your partner could say here is, “We’d like to wait another hour.”

Partner Support is Critical!

Beyond having a doula, a supportive partner is so incredibly important.

Your partner can be the person to say, “We’d like to wait one an hour” or ask for more information, or request a moment alone to talk and think before making a decision. It can be so incredibly empowering for your partner to have the language of advocacy. They can advocate for you and baby.

I don’t mean this in a way to say that birthing people can’t advocate. But we know that in birth, you are in an altered state of consciousness. When you have to be dragged into the “real world” and continuously answer questions and have conversations and fight your way in your experience, you’re going to be pulled out of that brilliant cocktail of birth hormones that allow your labor to progress and build your endorphins to comfort your pain.

Too often, the birth partner is pushed to the side in the birth experience. They’re trivialized, even made fun of sometimes, and brushed off. If we don’t prepare partners in the language of advocacy for their family, then we’re losing out on a huge opportunity for family empowerment.

This also plays into family dynamics, gender roles, and changing roles in society. Partners need to be encouraged to SHOW UP in the birth experience.

Partners as an Advocate

You don’t need to be a doula or anything to do that. Sometimes honestly it’s just a matter of knowing that you CAN. You don’t need a huge education base to do this. It’s good to be educated of course and knowledge is power. But for a birth partner, realizing that they have a voice is HUGE.

You will know by the energy of the room if something is a true emergency, or if it’s just a matter of protocol and procedure. If someone takes the time to convince or coerce you into doing something or making a decision, then you can be pretty sure it’s not an emergency. If it doesn’t feel right, it’s not right. Always go with your gut.

Doulas are incredibly valuable in the process of gaining and processing information – not because we are asking for you – but because there is immense value in receiving a neutral explanation.

How Doulas Are Involved in the Illusion of Choice

Sometimes, doulas are very much in this same system. What do I mean by this? I thought doulas were a neutral and independent party, right? Not always.

In some places, doulas are required to be a VENDOR of the hospital and given permission by the hospital by paying them to be able to serve families in their facility. That means that those doulas literally are working for the hospital. They give them their permission to exist.

It is your fundamental and universal human right to have the support person of your choice at your birth.

I fully believe that you should NEVER have to ask someone’s “permission” to have your human rights respected in birth.

If your provider tries to say anything about “not allowing a doula” or tries to say that you can only have certain people on a list support you in your birth, I would HIGHLY question the kind of care you are going to receive.

Do you really expect a doctor to respect your choices for birth when they won’t even allow you to have the support person of your choice? What are they planning to do during your birth that you’re only allowed to choose from a list of “approved” people? Seriously, think about that one.

Can a doula be in the system and 100% invested in you?

Another highly suspect thing that I see happening is hospitals training doulas. There are many hospitals out there that are training doulas to work in their hospitals. Then in return, those doulas get some “perks” from the hospital, such as being listed as a “featured doula” and extra promotion. OF COURSE a hospital is going to promote doulas who they have trained to support them and be “good doulas” for them.

Hospital licensed and promoted doulas are a major conflict of interest. Is your doula really going to fully show up 100% for you to support you if you’re choosing to go against the “standard of care” or making your own choices?

How are they going to support you as you follow your own compass in birth? How are they going to be 100% invested in YOU when their picture is up on the hospital wall? I’d be willing to bet that if they supported clients who didn’t go along with the narrative their perks would be removed. It’s the same thing. They’d be sanctioned, persecuted, discriminated against, and have their picture taken out of the break room.

It’s not their fault. They are incredibly loving and supportive people, and this is viewed as a way to extend doula support to more people. Bless them.

Independence and the Illusion of Choice

You know what this reminds me of? It reminds me of how the hospital childbirth education classes really just teach you to be a good patient. They tell you what interventions they’re going to use and tell you what’s going to happen to you when you birth there and what you have to do.

This is what I’m talking about when I say the illusion of choice. Sometimes even your choice of a doula is an illusion of choice. As you can probably tell, I’m not really down with that. Families want their choices to be respected, they don’t want an artificial construct of choice.

Respect, Cooperation, and Collaboration is Critical

I fully believe that working in cooperation, respect, collaboration, and positivity is incredibly important. It’s of the HIGHEST importance. But I really do believe that we can simultaneously build positive relationships, support well-being in childbirth, and work as independent family advocates at the same time. This doesn’t have to be a battle ground.

Want to connect with me? Join my Facebook group called Follow Your Own Compass. Connect with other parents who want to follow their own compass in birth and get tons of free resources to support your journey.

I have an amazing new course called the Blissful Birth Mini-Course. This course lays the foundation for a confident, peaceful, and powerful birth. I teach this course through my strategy called the 3 R’s – relaxation, ritual, and radical love. Check out this online course to help you have a confident and powerful birth! The link is right in the episode notes. I’m offering this course to you at just $7, although the resources in it are worth $57.


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