It’s hard to say no. It’s even hard to say no thank you! People really struggle with it, women in particular. We are raised to be polite and friendly, to minimise our impact on others so that we never inconvenience them. To never question authority and to be politely submissive. And whilst it’s good to be considerate, it’s not good that we are completely unable to say no, especially when it comes to a pushy maternity care provider.
Often women acknowledge that their care provider is not really providing them with the service they want, and yet they continue under their care for fear of offending. Women plan to fight for what they want in labour, but realistically speaking, if we can’t say “no thank you” when we are fully clothed in an office, how do we say it when we are in a hospital gown, in hard labour?
It’s a testament to the good nature of women that they strive to be likeable. However we have to remember that care providers are there to provide us with a service, not the other way around. It isn’t selfish or difficult of us to seek out care based on personal preferences, and it shouldn’t feel as if we are inconveniencing our care providers by simply asking them to tailor services to our individual needs.
During birth, we may find it extremely difficult to say no to suggestions that aren’t on our birth plan, but we have to remember, that our babies need us to advocate for them. Hiring a care provider who understands their role, and your relationship (as in YOU hired them, YOU make the rules) is the very best way to go about it, but of course that’s not always possible. for many women, options are limited.
In countries where healthcare is free women feel obliged to simply accept the services on offer, but it’s crucial to remember that you are still in charge – THE LAW SAYS SO. That’s right, local and international laws right across the world clearly state that women are in charge, no matter who pays.
Of course women in countries where healthcare is an out of pocket expense, either directly or through insurance are just as voiceless when confronted with pushy providers and difficult insurance companies who control their choices.
This is how we know that the difficulties of saying no thank you are about the ways girls are socialised into us, rather than related to the type of care provider, or the source of the money which will pay for the services.
Much of the maternity care across the world, displays a gross imbalance of power. This is partly why it’s so difficult for women to find a care provider that suits their needs. A care provider who genuinely respects their bodily autonomy and decisional capacity. The fact that women struggle to say “no” to such a degree only adds to the imbalance.
So what can women do about this?
Firstly, before settling on a care provider, interview as many as you can find. See who you feel most comfortable talking freely with. You want a provider who treats you like you’re the boss, not one who thinks it’s their job to do stuff to you.
- If you are accessing universal health care and you dislike one particular care provider it is your right to request someone more suitable.
- If you don’t feel like you can ask them a question, you probably won’t be able to say “no thank you” when you’re in labour.
- A good care provider will provide options, information, and then facilitate your wishes. A bad care provider will want to tick all the boxes, regardless of your personal preference.
Secondly, practice being assertive. We often confuse assertiveness with rudeness but the two are streets apart. Saying “no thank you” is polite, and assertive, it isn’t rude. You might feel silly doing this, but look in the mirror and actually say “No thank you” until you really feel like you can say it to anyone.
Thirdly, remember that you and your baby deserve the very best birth. Birth isn’t just one day in your life, it’s a very important meeting place. Birth has enormous ramifications on your health and your baby’s health. It’s our job to protect our families, and that begins on the day we welcome them, and before. When we say no to unnecessary or harmful obstetric practices, it isn’t just for us, it’s for our babies too.
Let’s bring a new perspective to the table. No one cares as much about your baby as you do. And no one is qualified to make decisions about your baby or your body like you are. Anyone who seeks to belittle your decisional capacity based on emotional coercion, is unprofessional, and an unsuitable care provider.
We have to be realistic about our ability to speak assertively. Don’t expect yourself to become a viking warrior queen in labour, if you can’t decline a vaginal exam in pregnancy.
When women struggle with saying “no” during pregnancy and labour they are often critical of themselves. However it’s not because you are weak or inept, it’s because being assertive is really hard! Furthermore care providers really shouldn’t put us in a position where we feel unable to speak. To do so is against their job description, and the ethics of medical practice. Wherever possible we need to compensate by trying really hard to find suitable care providers, and not only practicing saying “no thank you” during pregnancy, but also by ensuring that our support team will support us every time we say it.
FOR FURTHER READING