Consent: A Progression of Decision-Making in Birth

11/11/19 • 19 min

Birth Words: Language For a Better Birth

In this episode, I tackle the hot topic of consent in the birth space.

TRANSCRIPT:

Before we jump into the content on today's episode, I wanted to encourage you to head on over to www.birthwords.com, check out the new website and all the features there. You'll notice a few things. There's a Classes tab, where you can sign up for one-on-one video consults. And I'd love to meet with you that way, either for expectant families or birth professionals. Stay tuned, in a while those will turn into full fledged online courses, but for now, you can have the one-on-one if you sign up there. You can also check out the Shop tab which has birth affirmations cards that you can choose from the ones that speak to you or customize your own and order from there. And, if you use the promo code podcast for either of those purchases, you can get 15% off, so head on over to www.birthwords.com. Come and check it out.

Hi, welcome to today's episode about informed consent. This is a big phrase in the birth world. I know doulas who have T-shirts that say “informed consent is my jam.” And it's important and people are passionate about it, because it doesn't always happen the way that it should. I've talked a little bit about this topic previously. I'm thinking about my conversation with Rebecca Dekker that was aired on October 28. Go back and check that one out if you haven't. We talked a little bit about informed consent or informed choice in that episode. And it's a really important topic that we'll continue to touch on and dig into in upcoming episodes. Today I want to talk about this progression from no consent, to consent, to informed consent, to informed choice.

So, no consent, unfortunately happens in the birth space more than people would like to admit. Occasionally it makes headlines, but most of the time it doesn't. And most of the time, this looks like things like the nurse saying: “Okay, the doctor wants me to turn up your Pitocin," so she turns it up, not waiting for any sort of consent, not waiting for a verbal “Yes, that's okay.” So, I'm thinking of when you fly in an airplane, if you're seated in an exit row, they tell you the roles and responsibilities of being seated in that row and what you would need to be able to help with in the event of an emergency and the plane will not take off until each person and an exit row has given a verbal “Yes.”

And sometimes, in the birth space, that verbal “Yes,” is not waited for and it can have traumatic, long-lasting effects. I'm thinking of unconsented episiotomies--have a huge effect. And, just other things that are done during the birth process that don't recognize and honor a woman as a life-giving agent, engaged in a praiseworthy work, right? Somebody who's bringing new life into the world, who has carried this life within her own body for nine months, and is now emerging, and is now inviting that baby to be born, the birthgiver is playing a critical role in the ongoing drama of life. And, acting for her, acting upon her, without her consent is completely counter to the truth of the work that she is doing, and the beauty of it.

So let's talk about consent, then. We talked about no consent, let's talk about consent: "compliance in or approval of what is done or proposed by another." That's Merriam Webster, there: "compliance in or approval of what is done or proposed by another.” So still here, that agent, the actor is the care provider. Saying: “Hey, I'm going to do this,” but it does in this case, wait for that “yes. That's okay. You can proceed with that."

Still, with the power in the hands of the care provider, with the nurse or doctor or midwife being the one proposing or doing a course of action, and then leaving the role of the birth giver to be simply to consent, again, I argue does not honor the beautiful, life-giving, life changing work that she's doing in bringing that baby into the world. And of course, people will argue, and I will not disagree, that in some emergency situations, this is appropriate for the care provider to be the one really proposing the course of action. And, then we'll go into the next step of informing as much as possible, as much as emergency allows, and then moving forward with it.

In some cases, that's appropriate.

But in most cases, as I talked about in episode one and episode three, birth is typically emergence, not emergency, and sometimes we act as if it's the other way around. So, let's take another step forward into informed consent. Google says that informed consent is “permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits.” So, with this model, who is granting the permission? The patient. It's a step up in that the pat...

In this episode, I tackle the hot topic of consent in the birth space.

TRANSCRIPT:

In some cases, that's appropriate.

Previous Episode

Photography: An Interview with Birth Photographer Sarah Roberts of Yellow Kite Lifestyle Photography

Sarah Roberts, birth photographer, shares her birth experiences and journey to becoming a birth photographer. We discuss the rhetorical role of being a birth photographer in the community and how her profession honors the birth experience.

TRANSCRIPT:

Sara

Welcome to the Birth Words podcast. Today we have a special guest, my friend Sarah Roberts. She is a lifestyle photographer and specializes in birth photography. She is here today to tell us about her stories of birth with her three children and the role that language played in those births. So welcome, Sarah!

Sarah

Thank you!

Sara

It's great to have you here. I'm going to just jump in with some questions. And for any of these, feel free to answer them specific to one of your pregnancies and births or kind of touch on all of them, whatever just comes to mind as being most relevant. Because I know you have three different experiences to draw from. So, my first question is, what words did you use to identify yourself as an expectant mother and as a laboring mother, and where did these words come from? Did you read books? Did they come from family members, your personal experiences, or maybe from your care provider? Where did these words come from? That you identified yourself with.

Sarah

I think that's kind of hard, I didn't really enjoy, like, during the actual pregnancy, I don't think I really identified with any particular words. I think in my mind I was like, feeling: how do I want for this to go? Do I want to lean towards my friends who went unmedicated and all natural or do I just want to lean towards, you know, having a hospital birth and having the medications that I need, and that will help. So I kind of identified myself in those terms. And I really felt like I didn't have any other knowledge. And I'm thinking specifically more of my first pregnancy because it was, I felt like, just the most impactful for me because it was the first one. But I think maybe the biggest thing that I identified with was, which is kind of sad, it was dealing towards the weight gain. I had I gained about 40-ish pounds during that pregnancy, which was, you know, it's hard. It's hard to do that. And then, one of my doctors mentioned to me that I shouldn't gain any more weight. And I was about six months in, or maybe halfway I can't remember. And that was so hard for me to hear because, here I am feeling like I'm doing all I can, I'm working to create, I'm creating a child within me, and then to mention that what I'm doing is something wrong because I'm eating too much and being too lazy, I don't know. And I was, I felt kind of stuck. I didn't know what to do about that, like, how do I, I mean, I have these cravings, I'm hungry all the time, and you're telling me not to gain any more weight. And so that was kind of impactful for me. And in fact, when I went into labor, he was there, he was the doctor on call, and I was really disappointed. I didn't want him to be there during something so pivotal. Luckily, he was there while I went into the hospital, and I just was like, I don't want to deal with him. I have really hard feelings about it what he told me. But fortunately, all he did was break my water, and administer and he left and there was a shift change. And so, by the time I delivered, it was a new doctor who I felt more comfortable with. So, anyway, there you go!

Sara

No, thank you for sharing that. I think that's really important because, like, this one thing that he said, totally affected your relationship with him and the trust that you felt and the comfort, the level of comfort that you had when you were doing this awesome work not only during birth, but throughout your pregnancy. And, you felt like his words acknowledged only one thing that he was judging wasn't being done, as he would recommend, and didn't acknowledge all the amazing things that you were doing exactly as you should be doing and that were going so well. And it sounds like he didn't give any additional advice. Like, if he really was concerned that there shouldn't be more weight gain, then you'd hope that he would also give some tips or like guidance about how to healthfully manage that and still be able to get the nutrients that you and your baby need. And you know, and it sounds like it--

Sarah

Yeah well, and even if he did, I probably wouldn't hear it, you know, because I was so focused on how he said it. And the way he said it was just so negative to me. And if I had a better relationship before with him, maybe it would have made a difference to or even mentioned, the more positive things. I don't remember any of that. So it was just that negative thing that I focused on.

Sara

That makes a lot of sense. Because, when you are an expectant woman, you are doing so much good and there are some really hard things that you're sacrificing for, and it's really hard to not have peop...

Next Episode

Collaboration: Birth Geeks and Birth Words Unite! with Hillary Melchiors

In this episode, I collaborate with Hillary Melchiors from the Birth Geeks podcast, as we discuss three guiding principles for positive language during pregnancy and birth.

Transcript:

Hillary

Hi, Sara!

Sara

Hi Hillary! How are you? I'm just fabulous. I'm so excited to be talking to you.

Hillary

Ditto, I'm a big fan. I totally fangirled when I met you, by the way. Do you remember that?

Sara

Oh, I totally remember. It made my evening. I was so nervous. And then I was like, people know me and appreciate me! It was very awesome. I really appreciate it.

Hillary

Oh, anytime.

Sara

Okay, good. Let's set up another meeting time so you can fangirl again. Okay, so yeah, this is Hillary Melchiors, right?

Hillary

Yeah!

Sara

I actually just listened to your podcast so that I would say it right. But just the little intro part, like how does she say it? Okay, and Hillary is a podcast host too, over at the Birth Geeks. I'm going to see if I can remember your slogan... I know it's something about...oh: "Upping the--" but up is not the verb you use-- "Something, the professional something, getting the conversation, upgrading the conversation and something your professional mox--"

Hillary

--helping you renew your professional moxy

Sara

There we go, ok! "Upgrading the conversation, helping you renew your professional moxy."

Hillary

Do you know, one of my daughters, actually, we had our kids record the tagline. And she kept saying "PROfessional" and we were laughing so hard. It's really cute. And this is Sara Pixton. Sara is a doula in Utah, but she's also a podcast host of Birth Words. So she's also a linguist, which I love, as a language nerd myself.

Sara

One of my very favorite things that happened on social media was on Instagram a couple of weeks ago, somebody tagged me and was like, "There is literally a podcast for everything. If you're a word nerd and a birth geek, I just found your thing!" And I was like, I'm so glad I fill that niche for you!

Hillary

Right? And now we are here.

Sara

Yes, the word nerds, the birthy, wordy, nerdy geeks. That was a really, really good introduction.

Hillary

Yes.

Sara

I just have to comment one other thing, that your pin from the EBB conference, that "I'm a Birth Geek" pin that was like in the swag bags or whatever, my daughter found it the other day and was like, "What does a birth geek mean?" And I was like, "It just means you just know and love every single thing about it." And she was like, "Great, can I wear the pin?" And then she had this kind of like identity crisis throughout the rest of the next few hours that she was wearing it where she was trying to defend her right to wear the pin, but like not totally sure that she wanted to commit to everything that it represented. She was like, "I'm a birth geek, because that means I love everything...well, I don't know if I love everything about birth, but like, I really like the pin."

Hillary

Yeah, so we're recording this on Halloween it's going to be a little bit before we publish, but I wanted to tell you that my Birth Geek friends always have the best costumes. So one of my Birth Geek friends in Texas, she actually is dressed up as the IUD today.

Sara

Oh, wow! Can you put a picture of that in the show notes?

Hillary

I should. Well, I have to ask her...

Sara

If it's with consent.

Hillary

I mean she's, she's technically, like, the reproductive system, because her hands have the ovaries on them, but very much the middle of her sweatshirt is a big IUD. Fantastic.

Sara

Alright.

Hillary

So hi! So today we're going to be talking about... what are we talking about Sara?

Sara

We're talking about your top three tools to improve communication during pregnancy, birth and the postpartum period. Yeah.

Hillary

Well, and as a doula, I really do try to get my my clients to communicate with their care providers more effectively. I think that's really important. Especially,because you have such a limited amount of time with them before the big day. So, you have to really be careful.

Sara

Yeah. And you're probably one of many, many clients that they have, right. I mean, depending on circumstance, but especially if you're at a ob clinic, right? Right. Um, so yeah, knowing how to have that effective communication, really important.

Hillary

Absolutely. Well, and also, you know, as a doula, making sure that I'm communicating well with my clients and in a way that they want me to, I think that that's also good.

Sara

Yeah. And then I think from your clients perspective, obviously, they're communicating with you, they're comm...