What are my rights in childbirth?

PART I of II – Download your FREE printable Birther's Bill of Rights and Birth Rights Affirmations here. It's our gift to expecting families, because we believe that we can't improve the world until we improve how people come into it.

If you don't know your rights, you don't have any. And the most important legal, ethical right you MUST remember and protect in labor is

BODILY AUTONOMY ALWAYS OUTRANKS HOSPITAL POLICY

Hospital policies are NOT laws. Yes, hospitals have policies and protocols. But policies and protocols aren't protected by the law, whereas your bodily autonomy MOST EMPHATICALLY is. You have a legal right to bodily autonomy and informed consent at all times, and in all places, and in all things. 

Informed consent / refusal

Informed consent is the process by which your health care provider discloses all relevant information about a medication or intervention, so that you are able to make a voluntary choice to accept or refuse the proposed treatment. You have a legal and ethical right to control what happens to your body at all times. Your care provider has a legal and ethical duty to involve you in your own health care.

What are the elements of full informed consent?

1. The specifics of the medication or intervention
2. Reasonable alternatives to the proposed intervention
3. The relevant risks and benefits of each alternative
4. Free and un-coerced acceptance or refusal of the intervention

Consent implies freedom of choice

When you are coerced, intimidated, manipulated or scared into saying yes to something, your ability to consent has been diminished. It is very difficult to make a decision when you are being treated without respect, in a manner that creates so much anxiety that you feel like you must choose what your care provider prefers. In your prenatal appointments, watch carefully for signs that you are being manipulated, intimidated or frightened. You will feel it, even if you can’t put a finger on it — you’ll leave the appointment feeling upset, angry, out of control, confused, unsettled, annoyed, bullied, steamrollered — you get the idea. A care provider who uses those tactics before labor will certainly resort to them during labor. Find a care provider who demonstrates sensitivity towards your concerns, preferences, and feelings.

Manipulative words to watch out for

Hospitals use an intimidating legalese-type vocabulary to get compliance from you with as little friction as possible. This language is meant to sound legally binding, so that you will be less likely to challenge or object to their business practices. 

Some legalese words to watch out for include: mandatory, policy, protocol, required, allowed (or not allowed), non-negotiable, etc. The use of this vocabulary is intentionally authoritative, and it may influence you to comply in situations where you otherwise wouldn't. Legalese language in a medical setting is a way of sidestepping TRUE informed consent, and you shouldn't fall for it. 

Let me teach you how to translate this legalese into real language.

Nurse says, "It is mandatory for you to have a saline lock placed upon admission to Labor and Delivery."

Translate, "We recommend you allow us to start a saline lock when you get to your L&D suite."

The word "mandatory" immediately makes you believe that you don't have the ability to refuse the saline lock. They know this. That's why they use that word. You can still say no, if you want to. I'm not saying you SHOULD say no to a saline lock. I am saying you CAN.

Doctor says, "Hospital policy prohibits eating in labor. Clear fluids only."

Translate, "The nurses have been told not to give you snacks in labor, so they will probably say no if you ask for a granola bar. But if you bring your own, no one will stop you from eating them. Even if we see you with a mouthful of granola, we can't tell you to spit it out because that clearly violates your bodily autonomy."

In other words, hospital policies are only mandatory for the employees of the hospital. Hospital policies are not mandatory for you! Let me say it louder for the folks in the back: 

HOSPITAL POLICIES ARE FOR THE EMPLOYEES OF THE HOSPITAL, NOT THE PATIENT. Policies are NOT laws. Any hospital policy which violates or ignores your legally-protected bodily autonomy is illegal and unethical. 

Advocating for yourself in labor

“I understand that is the hospital’s policy/procedure/protocol, however, our preference is __________________.”

 All hospitals have mandatory policies, procedures, and protocols. But those policies apply TO THE HOSPITAL STAFF, not to YOU as the parent of the baby. As the parent, you have full rights over your body, and over your child, at all times, REGARDLESS of hospital policy or procedure. If one of these words is used by a nurse or doctor, to manipulate you into consenting to an unnecessary intervention or medication, you can use the following response:

“I understand that this intervention is considered mandatory, however, we have made the choice to __________________.”

Occasionally, you may have to sign a waiver if you refuse a policy or procedure which is considered mandatory. But you must realize that there are no other consequences to saying no! They cannot send you home, or refuse to admit you to the hospital. They cannot refuse to treat you. They cannot fine you extra money, or refuse to bill your insurance. Your insurance will NOT refuse to cover your birth expenses if you make choices that are different from the hospital protocols. It’s time for us to get comfortable with the word NO.

Sometimes, special circumstances occur during labor, which may require intervention.

As long as you and baby are doing well, interventions and medications during labor are neither mandatory nor necessary. You can ALWAYS say no, even if your care providers tell you a procedure is required. If you wish, you can request more time, or refuse the intervention for the time being.  If you’ve hired a care provider who you know is committed to helping you have the best, safest, most positive experience, you’ll feel confident about discussing your options and coming up with a care plan that feels best for all of you. A relationship of trust with your doctor or midwife is of utmost importance! Make sure you have hired a care provider who is an expert at supporting the type of birth you are preparing to have.

It’s not the hospital’s baby!

All choices for your pregnancy and birth are YOURS to make. You have the responsibility to educate yourself about your birth options and to choose a care provider who is an expert in the type of birth you are planning to have. You are the CEO of this birth, and your care providers are your employees. They work for you. If you have an employee who won’t provide you with the level of service and performance you require, then you need to find someone else who will. Expecting parents approach the birth experience very differently when they understand that they are in charge, and that the doctor, midwife or nurse is not an authority figure, but a hired part of their Birth Team. Our medical providers play a vital role in the birth experience, but it’s important that we understand what that role is: They are lifeguards.

Discussing a plan of care with medical personnel

Every single medication or intervention has possible benefits and risks, which is why we only use medications or interventions when the health benefits outweigh the risks. When interventions are used during a normal labor and birth, women and babies can potentially be exposed to unnecessary risks. You should choose a healthcare provider and place of birth that provides you with the full range of choices for your care, and uses interventions only when the benefits outweigh the risks. To make an informed decision about whether to accept or refuse a medication, procedure or intervention, discuss the following questions with your care provider:

Confident Decision Making — Using B.R.A.W.N.

What are the Benefits?
“How is this (intervention, medication, procedure) going to benefit me and/or my baby?”

What are the Risks?
“What risks are associated with this intervention?” “Do the benefits outweigh the risks at this moment?”

What are our Alternatives?
“What options do I have?” “What can I do instead?” “What are some non-medical options I can try first?”

What if we Wait?
“I’d like some time to think about this. Can we revisit this decision in an hour or two?” “Not right now. Maybe later.”

What if we do Nothing? 
Sometimes the choice isn't between A and B. And it's not even between A, B and C. Sometimes the best option is to choose nothing. Toddlers don't know this, which is why we use the red cup vs. blue cup manipulation with them. We give the an "illusion" of choice, without letting them know that choosing neither the red cup NOR the blue cup is an option. 

BIRTH PARTNER PRACTICE

When making decisions about how to move forward with a plan of care:

“Do you feel like you’ve got enough information right now to make a decision you feel good about?”

“If no one else were in the room and you could do anything right now, would this be your choice?”

“If you were to look back on this moment, would you say, ‘I wish I had held out longer’?

“Are you okay with what’s happening right now? Are you still saying, ‘Yes’ to this?”

”We talked about refusing this intervention. Is that still a priority for you?”

If you ever feel that you are being manipulated, coerced, intimidated, disrespected, dismissed, or deceived in any way, SPEAK UP immediately and assertively. Try the following phrases:

“I understand that is the hospital’s policy/procedure/protocol, however, my preference is _____________.”

Requesting a different nurse:

“It feels to us like you’re not on board with our priorities. Is there another nurse on shift today who would be more comfortable supporting our preferences? We’ll wait until you send her in, thanks!

To your doctor or midwife:

“We know you’re doing your best to keep our baby safe. As our care provider, we expect you to respect our birth priorities. We can be flexible, but we’ll make the choices we think are best.”

If you need to say no or stop something quickly:

“No thank you.”

 “We’re going to go ahead and refuse that for now, thanks.”

 “We’ve decided to skip that.” 

“My answer is no.” 

“I’m not comfortable with what is happening right now.” 

“I’m refusing this procedure.” 

“You need to stop.” 

“NO.”

Look for Part II of this blog post coming next week: How Partners can Protect Consent in the Birth Room