There are two questions to think about when we explore issues of dignity in birth. The first is, “What is it?” What does dignity in birth look like? The second question is, “Do we have it?” Does our maternity care system treat women with dignity during birth?
Here’s what I think dignity in birth looks like: a woman and her family/support system are at the center of the birthing experience. A recognition and respect for the knowledge that a woman’s body is sacred. Appreciating that pregnancy is not an ailment to be rescued from, but is a normal function of a woman’s body. Dignity in birth is the understanding that a woman is the expert on her body and her baby; the woman is making informed decisions about her care in respectful collaboration with her care providers.
Dignity in birth means being treated with humanity and respect, even when the woman makes a decision that may not be what a care provider recommends. It means the informed consent process is not just a policy, but rather a thoughtful and thorough conversation that invites and carefully addresses questions. Dignity means that there is no shaming or name-calling; there are no threats, no coercion.
It also means that when a woman is feeling less than great about her birth, she will not be silenced or dismissed; rather, we invite healthy discourse and dialogue about her feelings and her experiences. Dignity in childbirth reveres the love a mother has for her baby – knowing that she cares more about her baby than anyone else. Dignity in birth means that care providers will make it a priority to ensure that this mom and this baby’s first meeting is the best it could possibly be (as the woman defines it).
Here’s what dignity in birth does NOT look like:
- “They would/wouldn't let me….”
- “I was wasn't allowed too…”
- “I was tied to the bed" (sometimes metaphorically, sometimes an actual physical restraint)
- “I wasn't given any other options”
- “No one asked me…”
- “No one told me…”
- “They took my baby…”
- “I was alone and my partner was not allowed to…”
- “When I asked a question, I was told I needed to do what I was told or my baby might die."
- “They made it clear that ‘no’ wasn't an option.”
- “I was laughed at.”
- “Because I said ‘no,’ I was treated worse.”
- “I was told my problem/issue/thoughts/feelings/concerns did not matter.”
- “No one gets an award for...."
- “I know you wanted to _______, but I don't do that. If you want _______, you can go to someone else next time."
- “Those are nice ideas, but if you want a good outcome, you'll leave these decisions to us.”
- “What are your credentials?”
- "I'm the expert. That's my reason."
- "Who is the captain of this ship?"
Comments like this are all too common when women share stories about their birth experiences, and are just a sliver of the things we hear all the time within the American maternity care system.
Many of these statements are based on the false assumption that in order to achieve a positive outcome in birth, a woman must turn off her "thinking brain" and submit to whatever the system demands of her. Many would argue that these behaviors have become so commonplace we do not even think about them as problematic. They have become so normal they fail to raise eyebrows. We have become so content with this status quo that we overlook the need to challenge the behavior, let alone the line of thinking behind it. There’s a word for this situation: hegemony.
This assumption implies that birth is a simple systematic process, like a factory. To fail to recognize the human beings in that process and minimize a life-changing experience to a one-way-only assembly line is inappropriate. Yet this is what the current maternity care system often does. This perspective excuses inhumane and undignified behavior as nothing more than a necessary, if undesired, byproduct of the working machine. In fact, this line of thinking promotes “good behavior” as the best way to a good outcome. Anyone stepping out of line needs to be put back in line, by whatever means necessary. Anything that was said or done that lacked dignity during birth was only done to "protect" the baby or mother.
Perhaps a better question is this: can women be treated with dignity during birth even in the face of real medical emergencies? I would say that we should be treated with an increased level of dignity and respect when things turn towards emergency. When things start going awry is when we need MORE love, more tenderness, more kindness, appreciation and understanding – not less. Is there any reason to assume we, as women giving birth, are not worthy and deserving of dignity?
We must stop assuming that the need for basic human dignity cannot be maintained in the face of any potentially dangerous situation. We must stop assuming that in the face of any risk - perceived or actual - our values go out the window.
We spend hours of our lives validating our friends for "rude" customer service (even when the result was what we desired) and echo them when they rant about writing letters to the manager and so on. Yet, when a woman begins to speak about disrespectful treatment during labor & delivery, she is all to often silenced, and the disrespectful behavior excused. This must stop.
First, we must start listening to these women, validate their experiences, and honor their feelings.
Second, we must stop excusing the system for operating on an assumption that healthy babies come at the expense of their mothers' well-being and dignity.
Third, we must shift our paradigms around birth. We can no longer think or behave under the philosophy that a woman must put herself aside in order to yield a positive outcome. The science of childbirth does not support such a philosophy. We shouldn't, either.
Rather, we must enter into birth knowing that we are worthy and deserving of support, dignity, and respect - and that our safety is integral to our babies' safety. We must challenge the attitude that our own well-being is in conflict with our babies'. We must make it known that we deserve and expect respect, no matter what.
Being treated with dignity and respect is more than wishful thinking. It is up to us to make it the expectation, rather than the exception.