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Making choices and learning to say “no”

Updated: Sep 4, 2023

Young girl looking out through a car window.

From a very young age, girls are taught to be “good”. To not make a fuss, to ensure everyone is happy, to make things run smoothly and not cause a scene. It is so ingrained in our society that you would be forgiven for thinking that subservience is a natural quality of women and girls; that little girls are “sweet” and “gentle”, and little boys are “boisterous” and “loud”. ​ This makes it more difficult making choices and learning to say “no” to things that we don't really want.

When women and girls don’t conform to this model of sweet compliance they are labelled “bossy” or compared to men. To see this in action one only has to look at the language used to describe female politicians. Because of this drip, drip, drip of social conditioning, it can be very hard for women to learn to say “no” or to challenge those in a position of authority - especially if what that person is telling them has to do with the perceived safety and health of their baby. I often hear women say that they are not “allowed” to choose certain things during pregnancy, that they “had” to be induced, that they were “banned” from having a home birth. Every woman is free to make her own choices about her upcoming birth and postnatal period - in fact, women are legally obliged to give informed consent for procedures and treatments occurring during birth - but often it doesn’t feel like it, from the information she is given and how this is communicated to her. Women are often given information during pregnancy which is presented as fact, yet a recent study found that fewer than 20 per cent of the RCOG recommendations were based on high-quality evidence. This information is often presented in a confusing or incomplete manner, or worse not even presented at all, and the negative language around pregnancy and birth can make it seem far riskier than it in fact is. It is clear something needs to change. Healthcare professionals urgently need to start presenting women with statistics and risk factors in a clear and objective way. They need to offer treatment or intervention as a genuine choice which women can feel free and comfortable to decline if they wish, rather than bullied or pressured into. Informed choice should be the right of all birthing women - not just those with a research degree!

Using your BRAIN A simple, and very powerful, decision-making tool is the BRAIN model. The BRAIN model invites you to consider: Benefits - what are the benefits to the proposed intervention or course of action? Risks - what are the risks to the proposed intervention or course of action? Health care providers have a duty to inform you of any risks to procedures they are suggesting, and you absolutely have a right to know, including statistics. Alternatives - what else can they suggest? What are the benefits and risks of these alternatives? Intuition - many women have stopped listening to their intuition, to their primal gut feeling, and are worried about getting things wrong. However, our “gut instinct” is in fact a powerful physiological response, and it is important to listen to it. A feeling of discomfort could indicate that a choice is the wrong one. Nothing - what happens if we do nothing, or wait a while? Again, what might the benefits and risks be? ​ As a doula, I encourage the mothers I work with to trust their heart and their body’s response, as it is rare for this to be wrong. Doctors recognise this intuitive connection the mother has with her baby before it is born, and will often tell them to contact their midwife if they feel that something is wrong. Intuition may not be something that can be measured scientifically, but it doesn’t mean that it’s not real and very powerful. I wish that this same trust could be placed in women when they make decisions about the rest of their pregnancy and birth. If you feel your caregiver isn’t listening to your wishes, what can you do?

  • Push back - ask for the evidence in your case, for statistics, for more information, and for more time

  • Ask for a meeting with the Supervisor of Midwives

  • Talk to the Association for Improvements in Maternity Services

  • Get support from Birthrights

  • Consider changing consultants, or even changing hospitals

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