AIMS IrelandThe Power of Words: Birth Language and Self Advocacy
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When it comes to making decisions about how and where you want to birth your baby, the information can often be overwhelming. Words like ‘private’, ‘public’ and ‘semi-private’ take on an entirely new meaning. In pre-pregnancy days, these terms were possibly not on your radar, at all. And then as soon as you get the positive result, pregnancy can appear as one long decision making process. Gathering all of the information that you can and trying to ensure that it is evidence-based and unbiased is an enormous task, in and of itself. One can forget that you are your own individual – with your own thoughts, feelings, history, personality and all the things that make you who you are.
When you get your booking reference number for the first time from the maternity hospital you will be attending, it is hard to remember your individuality. That’s where it is important to spend some time not just looking at the information that is relevant to ALL pregnancies, labours and births, but to look even deeper than the standard ‘what to expect’ tidbits that permeate so much of the birth literature.
Preparing for how you will speak to your medical team and how you will answer their questions may seem like a lot of work, but paying attention to the language we use and the intention and meaning behind those words opens up a much clearer line of communication in all situations, particularly in significant situations where the power dynamic is intrinsically and institutionally unbalanced.
Your experiences in pregnancy and birth – particularly your first birth – will become a part of your life story. These are indelible memories that can enhance the blossoming relationship with your infant. It has long been known that a baby’s first sense to develop in utero is hearing and researchers have recently discovered that language learning and differentiating sounds is part of that developmental growth while in the womb. This underlines the importance of language and how it shapes our perceptions, thoughts, experiences and emotions.
Most births take place in a hospital and are therefore shared with an interdisciplinary team (ie. Obstetricians, midwives, etc.). The language used in hospitals to communicate and to record childbirth tends to be medicalised and can often be confusing and difficult to comprehend for many women. It helps to get acquainted with the language but it is also helpful to develop your own understanding of the various words that are used and to find suitable definitions that make meaning FOR YOU when common medical terms are used. It is also helpful to begin to establish a collaborative effort with the obstetric team that will be attending your birth. This means preparing for appointments and conducting some research (as you are doing right now) so that you can ask your team pertinent questions and you can ensure that you have a fully informed understanding of everything that your doctor and/or midwife are explaining to you.
It can be intimidating for many women to go into their antenatal appointments and to ask a number of questions of their doctor or midwife. Outpatient clinics are extremely busy in Ireland and there is usually very little time allocated to discussion of anything other than the basic ‘check in’ questions of weight and urinalysis. It is important to remember that you are more than just a patient checking in, though. You are a service user when you are attending any maternity unit or provider in Ireland. This means that you are in a position to gently remind the person who sees you at your antenatal appointment(s) that you are about to embark on one of the most significant events of your life and their care and compassion during this time is valued. If you are feeling for any reason that your maternity care provider is not giving you the time you need, you are free to seek out a second opinion – as any other health care consumer is entitled.
In the birth setting, there can be conflicting advice and evidence that can make a woman uncertain about the choices she should make in relation to her labour and birth. One way to bring some clarity to the situation is to be aware of the language being used in the birth setting. Developing your own understanding of the language of birth, including some of the most widely used medical terms, means that you are creating a more level playing field between you and your health care providers (HCPs). Advocating for oneself is closely linked with informed decision making and seeing your team of HCP’s as a group you are sharing ‘power with’ rather than one that has ‘power over’ you.
Some common phrases or medical terms you may hear as you get closer to your due date and during your labour are:
| Medical Term | Translation |
| macrosomia | big baby |
| induction | medical initiation of labour |
| failure to progress/dystocia | cervical dilation, or opening, not meeting the hospital guidelines |
| rigid perineum | mistaken belief that the perineum is not stretching |
| episiotomy | surgical cut of the perineum, the area around the vaginal opening, that requires stitches (evidence shows this is an unnecessary procedure and should not be routine) |
| syntocinon | a drug commonly used to accelerate or to ‘hurry up’ contractions (it is a synthetic form of the naturally occurring birth hormone oxytocin). it is often used in an injection form to hasten the delivery of the placenta |
| oligohydramnios | a suspicion that there is not enough water or amniotic fluid around the baby |
| polyhydramnios | a suspicion that there is too much water or amniotic fluid around the baby |
This list is just a taste of some of the phrases that you may hear when you are attending your antenatal appointments or during labour and birth. It is important to be aware of these phrases, and others like them, in the effort to reframe them. When and if you hear them during your labour and birth experience you can gently remind the doctor or midwife that you understand these terms and that you will work with them to ensure that your birth will focus on what you want and how you and your baby are doing, rather than on hospital protocol.
Often, when women are deciding on where to birth, they place a huge emphasis on the setting and what it can offer them. There are thousands of internet forum discussions requesting opinions on certain hospitals and the medical people who work in them. In this age of tracking apps, birth fora and social media, there is virtually a wealth of information readily accessible form the comfort of our homes. While it is important to seek out information about the hospital where you are planning on having your baby, it is even more important to plan on seeking out as much information as you can for yourself in relation to your preferences and what you will bring to the birth experience.
All women should arm themselves with as much knowledge about childbirth, self advocacy and the support they would like to have during their pregnancy, labour and birth. The old adage that ‘knowledge is power’ holds some truth but it is also necessary to be able to apply that knowledge in the relevant circumstances. Perhaps the most salient and poignant thing to remember when you are embarking on this life changing experience is that it is YOUR INDIVIDUAL EXPERIENCE. This means that once you have informed yourself and you have spent your pregnancy learning about your body, your baby and the choices you would like to make in childbirth, you will have developed the confidence and trust in yourself to have an empowered birth.
What does an obstetrician with over 25 years experience working with midwives and birthing women have to say about women who are fearless, prepared, trust in their own bodies and are active participants in their own birth process?
“Women that have empowering births, feel great going into birth. They feel stronger. They feel there’s no question about their birth. They don’t look back and say: ‘I wonder if I could’ve done this differently?’ There’s no regret.” – Dr Stuart Fischbein in The Birth Book, by Sarah and Steve Blight
What women say about self advocacy and empowered birth:
“I tried to learn as much as I could about the process of birth and I used that information to build confidence in the way my body innately knows how to have a baby! I ended up feeling very sure of myself during labour on my first baby as I knew that contractions would only last seconds and that I would have a break between them. This helped me to feel that I could do it and that the end result was in sight!!”
and:
“My first birth felt really empowering as I felt very connected to my body and my baby and I was able to trust in the normality of labour and birth. It was a fairly quick and uneventful birth, but I also felt that if I had encountered any difficulties, I would be able to handle this and advocate for myself. I had spent the entire pregnancy preparing for things to go well and accepting that if any complications arose I would be able to talk to my health care providers about what the best course of action would be”
and:
“On my first, I wanted to do it without pain relief, but I didn’t prepare, and when I was induced, I felt like my body had failed me. When I asked for pethidine and then the epidural I continued to feel like I had failed somehow. Although I escaped without episiotomy or section, I didn’t feel like I had any control – it was something that was happening to me, not something I was actively taking part in. So I wanted to do things differently [the second time] around. [This time] I kept an open mind, and tried to focus on trusting my body. [After a quick labour and birth], I felt elated. I still do. I did it, I trusted my body and my baby and it all went perfectly”
and:
“I did lots of research into birth in Ireland, interventions, hospital protocols, natural pain relief and so on. I had a fantastically easy pregnancy and pretty much sailed through the nine months. Even though I didn’t have the minimal intervention birth that I had wanted, it was still a gentle birth. I was so calm and confident throughout and so was [my baby] – his heart rate never faltered. And no matter how it happened, I can’t look back and regret anything – I accept the path my birthing took”
Please feel free to add YOUR stories of advocating for yourself and feeling empowered during your pregnancy, labour and birth in the comments section below.
Some evidence based links for gathering accurate, unbiased and reliable information on pregnancy, labour and birth include:
https://www.facebook.com/aims.ireland
http://evidencebasedbirth.com/
http://www.scienceandsensibility.org/
http://vbacfacts.com/13-myths-about-vbac/
http://givingbirthwithconfidence.org/category/pregnancy/childbirth-education/
https://www.facebook.com/positivebirthmovement