Whose birth is it anyway?


Why does it seem that so much about birth has to do with who controls what? For many people who choose to give birth outside the box, some of the most irritating things about the hospital environment have to do with control. The hospital seems to have a great need to control every aspect of the birth and hospital stay of the mother and baby. They have rules about just about everything!

  • There are rules about the birth tub — IF there’s a tub, you can stay in it for labor, but typically not for the birth, and sometimes not at all if your membranes have ruptured (depending on the hospital).
  • There are rules about the hours that your loved ones can be with you — partner 24/7, grandparents can stay until midnight, children until 8pm, etc.
  • Rules about bathing your baby — the baby is considered a biohazard, so most hospitals require the baby must be bathed ___ hours after the birth.
  • Rules about whether your baby can go home in the car seat you brought with you — don’t even get me started about the car seat test!
  • Rules about whether you can even take your baby home from the hospital — can’t take the baby home if you don’t have a car seat. Not a bad rule, but a rule nonetheless.
  • Rules about doulas — some hospitals don’t even allow them!
  • Rules about what you can eat and drink — pretty much nothing, although your labor partner should eat and drink frequently to keep his strength up. (Hmmm… who’s the one laboring here?)
  • Rules about the Vitamin K and Erythromycin ointment — they look at you like you just grew a third eye if you even question it.
  • Rules about how many people can be in the room — usually no more than 3 plus the laboring woman (depending on the hospital, some are more lenient) and usually only 1 if the birth is a cesarean birth. But, there can be as many hospital staff members as the hospital wants.
  • Rules about having to have an IV — must have it unless your doctor “allows” you to opt for a hep-lock instead.

Yeesh! All of those rules! How does the presence of these rules affect a laboring woman? My thought is that just having someone else calling the shots on things you may or may not care much about, hands your power over to that person or institution for the things you do very deeply care about. The woman gives up her power and her responsibility to think for herself because the institution has a rule for every decision she would normally have to make for herself. Giving up this power and responsibility for the most basic decisions about food, comfort, companionship, and her baby’s treatment puts her in a position of relinquishing control of the bigger decisions by default. She’s already accepted the hospital and doctor as the decision makers for her basic needs, so how could she have the gumption to question the more complex decisions they make for her? Birth becomes something that is done to her, rather than by her.

When listening to women talk about their hospital births, how often do you hear something like this: “I’m not sure why, but they did ____ to me. I’m sure they had their reasons.” Or, perhaps, something like this: “The doctor allowed me to _____.” Something like that would just not fly in midwifery care! In midwifery, the woman takes part in just about every decision made. She becomes informed about the options available, she learns about the objective evidence regarding the risks vs. benefits of those choices, hears her provider’s perspective about her own clinical experience, considers that information along with her own goals and preferences, and then makes a decision about her care based upon this informed choice process. This participative style of decision making is the cornerstone of midwifery care.

Are there rules for out-of-hospital birth with midwives? Sure, of course there are. Each midwife has her own practice guidelines, and there is a community standard of care, but midwives support the mother’s informed choices, even if those choices are not exactly the choices we would make for ourselves. Skip the eye ointment and the vitamin K? If you’re informed about the risks and benefits and feel like that’s the best choice for your family, yes, of course. Eat and drink in labor? Absolutely. In fact, most midwives insist upon it. Get in the water after membranes have ruptured? Sure, why not? Have your loved ones with you 24/7? Absolutely. We wouldn’t have it any other way, provided that’s what you want. Skip the bath? It’s your baby, why not? If someone is worried about disease, they can wash themselves after they touch the baby! Car seat? Yes, but we’re not going to do the car seat test! Ultrasounds? If you want them, you can get them, but that’s up to you. Want to catch your own baby? Go for it, but if you want your midwife to do it, she’d be happy to do so.

The point is that you have as much control as you want to have. You have choices in your birth. Your midwife might guide you, and she might point you to information to help you make decisions about your care, but having a midwife means you have the control to make the choices you believe are best. It’s your birth. You own your choices, which means you own your birth.