A ‘Safe Word’ in birth.
A safe word is a word that two consenting adults agree is the ultimate message to stop what is happening. It is often used in a sexual context, but I propose that we are getting to a point in birth that we need a safe word to stop the damage being done to birthing people and their families.
Anyone who is familiar with me and my writing knows that I am an eternal optimist, definitely a 'glass half full' person, if my feet were to fall off I’d celebrate that I didn’t have to buy shoes anymore. However, I cannot do that today. I am tired and ground down. I do not feel positive or optimistic about the future of birth right now, and it is making me sad, angry and like I’m shouting into a void.
I am currently working with a dad with such bad PTSD from the birth of his first child that he cannot look at baby photos and the thought of having another child brings him immediately to tears.
I am currently working with a woman who will never be able to give birth vaginally again due to a series of circumstances during and after birth. Circumstances that she believes were totally avoidable.
I am working with a woman who is pregnant with her first child who has spent most of her pregnancy being told she has made bad choices, can’t possibly birth her baby well, coerced into decisions that she constantly questions but feels like the bad person for asking questions out loud.
I have page after page of messages from parents who are pregnant and who have experienced birth in the UK recently and luckily lots of them have positive births. .. . despite the system. The conversations that are being fed back to me on a weekly basis make for very sad reading, at best, and are rage inducing or heartbreaking at worst.
The element that is common throughout all of these messages is the inability of our birth workers to communicate effectively. Do not get me wrong, there are amazing midwives, obstetricians, GP's, anaesthetists, who ARE wonderful, family-centred practitioners. They are great at listening, hearing, supporting and advocating. But I have to say that there are many, many others who are not working in this way. They are using coercion and scare tactics to get parents follow their ideals.
For years I have said, when teaching, that no one goes into our maternity system to sabotage birth. A number of people who work within the system have told me I am naive and I refused to believe it, for years. I am now getting to the point where I cannot deny it any more. Some of the people who work in our system are more concerned with their need for power over others than the wishes of the people they are caring for. I don’t have the words to describe how sad it makes me feel that that is the case. I am not writing this blog for them. I am never going to get through to them. You can find them on social media slamming ‘natural birth’, ‘breast feeding’, birthing people wanting more than to come out of the experience alive.
The ones that I’ve written this blog for are those who do not want to sabotage birth. The ones who follow the code, ‘First, do no harm’. Those who are driven by fear of their own.
Fear is not reserved for parents.
Most of us are aware that parents are generally scared of giving birth. It’s not really surprising when we look at the portrayal in the media, stories etc. But that is a topic for another blog. What may surprise you is that that fear is not reserved for the people having a baby, or babies, it is rife within our system too. With good cause.
If you are a birth worker you want good outcomes. You want a healthy parent and a healthy baby. It seems so obvious. I have worked with so many midwives who tell me that there is no support for them when things do not go well in birth. NO SUPPORT. They simply have to pick themselves up and get on with work and life. I have spoken to so many obstetricians who say the same, and when you consider that they ONLY see birth when it has deviated from ‘normal’, you can imagine the things that they have seen.
A healthy parent and a healthy baby. What does that look like? It makes a difference. Is it a parent and baby that are alive? Is it a parent and baby that are complete, physically, mentally and emotionally? That’s a different thing, don’t you think? What you consider to be healthy defines your focus in labour and birth.
As well as poor outcomes there is also the ever present fear of litigation. With good reason. If you look at the CQC information for 2017/18 48% of all the payouts in the whole of the NHS was in obstetrics. That is a huge driving force. I spoke to a group of 3rd year midwifery students recently and they said that in their final 6 months of training, every lecture they had was punctuated with the phrase, “How would that look in crown court?”. How much women centred care can we give if THAT is our main focus in the birthing room?
‘No’ no longer means no.
In the UK we are very lucky that we have the law of consent which says;
‘Nothing can be done to us without our fully informed consent, and that it must be given freely and without coercion.’
There are often two bits overlooked in our maternity system; fully informed. To make a fully informed decision we must be given the benefits and risks of a procedure and the benefits and risks of doing nothing. With that information we can make choices that are right for us, based on what WE deem to be the benefits and risks. Not what anyone else thinks, not what any piece of paper says, not what a study shows. Risk is based on individual experience and circumstances. When I teach I often use the analogy of bungee jumping. I like to bungee jump. I look at the risks involved and I have decided that it is safer than driving my car, so I am happy to take the plunge. I know that the vast majority of people look at the risks and think, ‘Not on your nelly!’. But no one stops me from doing it, they understand I am an adult of sound mind and can make that choice myself.
Why is it in pregnancy, labour and birth we stop letting people choose what is right for them??
At what point do we hear ‘NO’ and think ‘Well that is not the right decision’ and carry on?
I understand the fear. I do. I walk around London and I see on the side of buses, “Were you traumatised by your birth??? Call 0800 XXXXXX”.
What that says to the population is that birth is someone else’s responsibility and when it goes wrong we can blame someone else.
But this is a self fulfilling prophecy.
If we take the choices away from parents and things go wrong then they have no option but to blame someone else.
If we support choice and give parents confidence to make choices that are right for them, and then support them in those choices, chances are they are going to be happier with the birth they experience.
And this is what I see. Lots.
In my courses I give parents information about the choices that they have. I encourage them to ask questions, think for themselves, take responsibility. They generally have very positive experiences. . . whatever birth they have. They have positive inductions, caesareans, home births, I’ve even had positive car births. And the thing that ties them all together is the care they had, the feeling they were listened to, supported, not ridiculed for their choices, the feeling of control around their birth.
However I also hear lots of grumblings and again it is to do with all of the above. NOT being heard. NOT being supported. Mums have told me that their caregivers have said “Well if anything goes wrong, it’s YOUR FAULT!” when wanting to be supported out of guidelines. Parents are upset, traumatised, hurt by caregivers who are so risk adverse that they stop looking at people as individuals and put them on a conveyor belt of care.
This ties in with the second part of the law of consent that is often missed and that is to do with coercion. We all know it happens. There is the obvious, “If you don’t do this then this terrible things will happen”. But there is the insidious, loving coercion, “Well, if you were my daughter. . . .” “If it was my partner . . . .”. This is NOT ok. Coercion is coercion, however you wrap it up.
We need a systematic change.
We need to start seeing parents as adults, not wayward children.
We, as parents, need to take responsibility for our birth. It’s your body, your baby, your choice, your responsibility.
It will not change over night. We are not used to being responsible for anything these days. If a coffee is too hot and we burn ourselves we do not think,’Oooh, I should have been more careful’ we look to blame someone for not telling us the coffee could burn us.
A SAFE WORD.
NO should mean NO.
If a pregnant person says, ‘no thank you’ to a procedure, it should be respected. It does not mean, "Now convince me". If a person has been given the information and they have understood, that should be that.
If a pregnant person is in labour and says NO to a procedure, that should be that. It should not be done anyway and explained away afterwards.
If a pregnant person in labour says that there is something wrong, someone must listen, even if 99 times out of 100 it is fine.
We shouldn’t need a safe word. NO must mean NO.