Birth: Who Is The Boss, You or Your Dr?

It's vital to understand how power dynamics can play out in birth. When care providers take charge, and women are mere passengers, problems frequently arise.

Birth: Who Is The Boss, You or Your Dr?

Imagine you are planning to hire someone to paint your house. You make a few phone calls and get some quotes, and then the big day comes. The painter arrives. The painter sets eyes on your house and tells you that they can’t possibly paint your house in the colour you have selected, your house needs to be painted hot pink. No exception. 

What would you do? Would you:

  1. Laugh incredulously and not stop until they’d packed their equipment up and driven away
  2. Nod meekly, fetch them a cup of tea and a bikkie,  then move out of their way.

Of course we’re making the assumption that you wouldn’t like a hot pink house here.  If you actually would like one, or you already have one, then please just substitute pink for another colour you hate (and send me a photo of the hot pink when you get a moment)

The thing with painting your house is that, expense aside, if you don’t like the colour, you can just paint over it. With a birth, you only get one chance, so you REALLY need to know how it works.

A birth care provider has studied pregnancy, birth, and babies, but you are the only one who knows what you want from them. Women often say that they only thing they want from birth is a healthy baby, but what does the baby want? The baby wants a healthy mother, and birth is about more than physical health. Good health after birth is mental and emotional as well. Maternity care providers – like painters – are paid to provide you with a service, a service dictated by your health and preferences in conjunction with their recommendations. It is not their job to tell you what to do, it’s their job to advise you on health, and the available options.

It can be hard to assert yourself in labour, so it’s a good idea to establish whether your care provider has a healthy understanding of their role before push comes to shove (excuse the pun). Any care provider who seeks to obtain your complete submission does not have your best interests at heart. There are a number of ways care providers can seek submission, some are blatantly obvious, but others are quite covert, so it pays to be on the look out for red flags. 


1) How do you feel when you ask questions? 

When you ask questions, how do they respond? Do they listen politely or seem disinterested? Do they give off an air of importance, as if they don’t have time for the pesky, trifling questions or hormonal pregnant women? Do they give you proper answers or brush you off? Do they take your questions as an insult, as if you should just do what they tell you to do? Do they resent questions because they are an expert?

A good care provider will be happy to answer your questions because they want you to feel safe with them, they will want to earn your trust. They also understand the importance of informed consent and are keen for you to be fully informed about everything. They are keen to meet their legal obligation to provide informed consent (or refusal).

2) Do they give you choices?

When a test is recommended are you told what the test is for, how it is carried out, how the results will be used to determine recommendations, whether the test is based on your health or whether it is a routine test, are the risks and benefits explained, do you feel like you can decline the test? What about options for birth. Is water birth an option, what about walking around in labour? Do they want to talk to you about the choices they can make available to women in their care, or are they disinterested in choice. 

Everything in pregnancy is OPTIONAL. There are no risk free tests. Testing can alter outcomes because it can alter the recommendations a care provider makes, as well as the decisions you make, and the way you feel (how you feel can have a big impact on birth).Everything is optional, your care provider just needs to make it available. Anyone who says otherwise does not respect your legal right to informed consent and refusal. They are putting their own professional interests ahead of your physical and emotional well being and basic human rights.

3) How do they present information?

Do they give you the benefits and risks of everything they recommend, of everything you request? When explaining risks or benefits do they use emotive language, or statements, or just factual?

If your care provider presents information in a biased or unbalanced way (for example IF YOU DO THAT YOUR BABY WILL DIE) they they are using information to control the decisions you make. This is an abuse of power. Your care provider should present ALL the facts, not just the ones that support their recommendations, because YOU are the person who makes the decision about whether to accept or decline any part of the service they are offering. If they don’t present information in a simple and factual manner they are showing blatant disregard for your right to informed consent.

A birth care provider is no different to any other service provider in any other industry. You hire them to provide you with a service, you appreciate their expertise,  and advice, but you are the one who makes the decisions and they are the one who is paid because they work for you. If they treat you like a wilful child, an inconvenience, or a fool, they believe that THEY are the person who wields the power in this exchange, and as such they are NOT a suitable care provider.

Remember this if you remember nothing else: Regardless of the outcome, your care provider will be paid. The bottom line is whether or not YOU will be satisfied with the service they provided. Take your business to a provider who respects you as a person, not just a pay cheque.


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Pink house and white house covered in snow
A pink house sure stands out
License: Creative Commons CC0.

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