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The Authority Trap

Updated: Nov 1, 2023

Midwife and obstetrician looking at camera with folded arms.

As doulas, you play a pivotal role in guiding pregnant women through one of the most transformative periods of their lives. However, the journey is often fraught with challenges, especially when it comes to making informed choices. How can you help your clients navigate the complex landscape of pregnancy decisions, particularly when authority figures and societal norms exert such a strong influence?

To answer this question, let's delve into two seminal psychological experiments: Stanley Milgram's obedience experiment and Charles K. Hofling's hospital experiment. These studies offer invaluable insights into human behaviour under authority, and their implications for your pregnant clients are both eye-opening and concerning.

The Milgram Experiment: A Brief Overview

In the 1960s, psychologist Stanley Milgram conducted a series of experiments to gauge the extent to which individuals would obey authority figures, even when it conflicted with their moral beliefs. Participants were asked to administer electric shocks to a "learner" for every incorrect answer. What they didn't know was that the learner was an actor and the shocks were fake. Astoundingly, 65% of participants administered the highest level of electric shock, simply because an authority figure instructed them to.

Implications for Pregnant Clients

The Milgram experiment serves as a chilling reminder of how easily people can defer to authority, often at the expense of their own judgement. For your pregnant clients, this could mean unquestioningly following medical advice or societal norms, even when these don't align with their personal beliefs or needs. For instance, a client might be told that she "needs" to have an induction due to a perceived risk, even when the actual necessity is debatable. The fear of being labelled 'non-compliant' or 'difficult' can further push women towards conformity. This is particularly concerning when it comes to choices like opting for natural birth, breastfeeding, or even the decision to work during pregnancy. The pressure to conform can be so strong that women often side-line their own instincts and desires, potentially leading to dissatisfaction and emotional distress.

Tools for Doulas

  1. Question the 'Why': Encourage your clients to ask healthcare providers for the rationale behind their recommendations. This will not only educate the client but also make healthcare providers think twice before giving blanket advice.

  2. Provide Evidence-Based Information: Arm your clients with research and data that can help them make informed decisions. This will give them the confidence to discuss options with healthcare providers.

  3. Role-Playing: Prepare your clients for potential scenarios where they may feel pressured to conform. Role-playing can help them practice standing their ground.

Hofling's Hospital Experiment: The Medical Angle

In 1966, psychiatrist Charles K. Hofling conducted an experiment involving nurses who were asked by an unknown doctor over the phone to administer a potentially dangerous dose of medication to a patient. A staggering 21 out of 22 nurses complied without questioning the doctor's authority.

Implications for Pregnant Clients

Hofling's experiment is particularly relevant for your pregnant clients navigating the healthcare system. The study suggests that even medical professionals are not immune to the influence of authority, which can have a trickle-down effect on patients. Your clients may find it challenging to question or reject medical advice, given that even trained nurses hesitated to do so in a controlled experiment.

Tools for Doulas

  1. Be the Advocate: Sometimes, your clients may need someone to speak up for them. Offer to be present during medical consultations to help articulate your client's concerns and questions. It's especially helpful if you paraphrase to your client what you heard them say, helping them to really be able to speak-up for themselves with your support.

  2. Teach Assertiveness: Equip your clients with the language and techniques to assert themselves effectively. Phrases like "I would like to consider other options" or "Can you explain the risks and benefits?" can be empowering. Using the BRAIN decision-making acronym is great.

  3. Create a Birth Plan: Help your clients articulate their preferences in a written birth plan. This can serve as a useful tool for discussions with healthcare providers.

Empowering Choices: A Deeper Dive

So, how can you help your pregnant clients make empowered choices in a world that often encourages blind obedience to authority?

  • Educate: Knowledge is power. Provide resources, recommend books, and perhaps even organise workshops that can help your clients become more informed.

  • Seek Multiple Opinions: Encourage your clients to get a second or even third opinion if something doesn't feel right.

  • Trust Instincts: Remind your clients that their body, their baby, and their choice matter most. Encourage them to listen to their gut feelings.

  • Build a Supportive Network: Help your clients identify and connect with people who respect their autonomy and support their choices. This could be family, friends, or even online communities.

  • Consult a Doula: Yes, that's you! Your role is invaluable in helping clients weigh their options without the pressure of institutional guidelines.

The Milgram and Hofling experiments serve as stark reminders of the human propensity to obey authority. For your pregnant clients, this can create a complex landscape for decision-making. However, by arming them with knowledge, teaching them to seek multiple opinions, encouraging them to trust their instincts, and offering your unwavering support, they can reclaim their agency.

So, the next time you find yourself guiding a client through the maze of pregnancy choices, remember: guidelines are just that—a guide, not a mandate. Your client's body, your client's rules.

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