Last week, I wrote an article called “A Healthy Baby Isn’t All That Matters.”  It was about our opportunity for a higher standard for birth in the U.S.: “safe, respectful, family-centered birth,” in addition to a health baby and healthy mom. I also talked a lot about the need for respect of women in birth.

A couple of days later, a comment was posted to the article that included these words: “Get over yourselves” and “Get off your high horse.”  It’s disheartening to see a response like this to an article about respect for birthing women and their choices—especially coming from someone who identified herself as a care provider.

But it’s a great example, too.  What exactly do you do when your request for respect is met with disrespect?  I think sometimes our first instinct is to look inward to see what we might have said or done that would explain it away.  Instead of cutting to the chase, we tend to make excuses for the other person.

There is no excuse.  A lack of respect is not a starting point for conversations or progress or building bridges–and it’s certainly not appropriate between a pregnant woman and whoever she has hired to care for her and her baby.  It is a deal breaker.  It doesn’t matter what someone says to us—how correct they are, how valid their point is—if they can’t do it respectfully in a place where respect is valued.  And in birth, respect is all-important.  At Improving Birth, it’s one of our organizational principles.

So, in this case, I respectfully draw the line.  As I would say ever so gently to my young son, “I can’t let you do that.  You may not be disrespectful to Mommy.”

There’s another element in comments like these, though.  It’s an element of “I decide how much respect I give out, and who are you to question it?”

Therein lies the big, big problem.  As birthing women, the conflicting messages we quite often receive are:

You make decisions about your body—except when we do.
You are responsible for your baby—until someone more qualified thinks different.
You are in charge of your birth—until you’re not.

In so many ways, many of us are given choices in birth and respectful treatment only within a framework.  We may choose from among the choices we are given, not from a full set of choices.  Step outside those lines—assert that we are the final decision-makers on what happens with our bodies and babies, or that we are deserving of respect regardless of whether our providers think so—and we’re told to “get over ourselves.”

True choices and true respect include deference to us at each step of the way, fully informed consent, and support instead of coercion or pressure about our decisions.

The sad truth is, for most women in the United States, maternity care is simply a gamble.  The numbers bear this out: a steadily increasing c-section rate, the use of drugs to force or speed up labor in more women than not, and a rising maternal mortality rate.  When our well-being and the safety of our babies is so unpredictable, respect for our bodies and our decisions is more than a silly cliché—it’s a necessary protection.  It isn’t a compromise for safe, healthy birth, but an essential part of it.

At the end of the day, we may not know with any certainty what the “right” thing to do is in the event of a complication.  But we know what respect feels like and we know what disrespect feels like.  You know how your provider makes you feel.

So, again, I encourage you to walk away from providers who don’t treat you and your decisions with respect, and seek out those who do.  There are wonderful, caring, skilled providers all over this country who deserve your business.

While so many of us are working toward that “safe, respectful, family-centered” ideal for American maternity care, we’re going to come up against a lot of get-off-your-high-horse-s.

It will be up to each one of us to say respectfully, “I can’t let you do that.  You may not be disrespectful to Mommy.”

Author Cristen Pascucci, a political and communications specialist, recently joined Improving Birth’s executive board.

 

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  1. dona.su says:

    i congratulate, what necessary words…, a magnificent idea Certified labor doula

  2. Jamie says:

    When a caregiver chooses to illegitimize the concerns of a patient rather than address them, it’s a red flag indicating disregard for another human being. That attitude is guaranteed to be an active factor in the decisions made about how to treat his or her patients. Until this devaluing mindset is eliminated and the medical community once again viewed as a service industry, impeded birth and wounded families will continue to be the norm. If you pay them, you’re the boss and you call the shots. When did we forget this?

  3. Katy says:

    I think it’s great as long as mothers who choose to get relief with medications are also respected.

    1. Dawn says:

      Katy, I am the founder of ImprovingBirth.org and had an epidural because my birth went from hard work to torture. We are in full support of all women’s choices in birth here.

  4. Amanda Montgomery says:

    Combine your two articles, and these are the reasons why I left the OB office that had been my primary prenatal care for 6 years when I was 28 weeks pregnant with my 3rd child (I am now 34 weeks). My choices were met with a smug attitude, like I was another one of those “difficult Moms” who didn’t just say ok to anything and everything because the “doctor said so”. I did that with my 2 older children, and I do regret it. I had no idea what I was doing. Whatever happens this time, I know that this is MY body, MY baby, and OUR birth. And I will make informed choices every step of the way.

  5. Sarah says:

    Great article! We were so blessed to have OBs who were so very respectful. One time when one doc was doing her rounds, she stuck her head in my room and told me she would be back in a little bit because she had something time sensitive to do and she wanted to be able to give us the uninterrupped time we needed to get our questions answered. I know not all docs are like that and we were so thankful for our OBs!

  6. Amanda Tyson says:

    Great article. So often people get angry when you say “a healthy baby is NOT all that matters. A healthy baby AND healthy mama are both important”.

    People don’t understand that in *most cases, you don’t have to choose between a healthy baby OR a healthy mama. Both are achievable. Thank you for writing this article. I will be sharing it a few times.

    Amanda, Blogger/Admin for MotherWise
    http://www.motherwiselife.org

  7. Cristen says:

    Thank you all for your comments. Respect makes such a difference–from all sides, women and providers alike. Without respect, you have a win-lose situation where someone is right and someone is wrong. When we respect each other, we can actually talk. We can collaborate. We can make things better.

  8. Erin says:

    Thanks for this! You are right that it’s easy to know what respect and disrespect feel like, and it’s important to call people on it. Probably we should focus our energy, as you said, on finding providers who respect us as patients rather than trying to change the infinitely disrespectful world of online commenting. I was disrespected during my delivery by the on-call doctor, who didn’t think I needed to know what was going on and/or give my informed consent for interventions. I later stood up to him, wrote the hospital and changed regular physicians because I could not stand to go to someone who put me in the hands of someone so disrespectful to me as a patient. I have PTSD from the experience, and it has affected the health of my family. There is absolutely nothing I could have done to change what happened because I wasn’t informed about what was going on. All it would have taken was enough respect from the doctor to involve me in the process, and I’d be sending him thank you notes instead of complaint letters. So many women during hospital births have NO POWER, and makes it all the more important for doctors to be respectful. Thank you for pointing this out.

  9. Lindsay says:

    well written. sometimes it’s hard to respond kindly and respectfully when someone says something SO disrespectful and just plain rude. i think you did a wonderful job of making a very important point. and, for the record, i thought your first post of “a healthy baby isn’t all that matters” was spot on. something that has bothered me every single time it is said to me but i feel as if i am the one being disrespectful when i say how i truly feel about that comment.

  10. Janice says:

    Thank you Thank you Thank you to EVERYONE at ImprovingBirth.org. Cristen I enjoy your writing so much, you so eloquently put in writing feelings I have. It’s a beautiful thing.

  11. Cristen says:

    Erin, this is why we chose these two principles! We can’t allow our differences to hijack the bigger goal. It’s a waste of time to fight each other instead of working together to accomplish something.

    Inclusivity: We believe that focusing on what we have in common is key to working together, even with those who do not share our mission. Building bridges—not walls—is how we will move forward.

    Respect: We pledge to treat with respect both our supporters and those who do not agree with us. We will not engage in divisive dialogue. When we tell hard truths or advocate for our values, we will do so in a manner worthy of ourselves and of you.

  12. Erin oliver says:

    I think this applies to everyone within the birthing community. I have been treated with more i hate to say cattiness and disrespect by midwives and fellow doulas and I wonder if this is the reason it is hard to get progress accomplished.
    Being a doula or midwife I know isn’t a career choice came to by accident and I think deep beliefs are rooted there but it seems the political environment sometime causes people to be downright hateful towards each other. I think midwives who dislike CNM’s or those who are resentful of the expansion of the Medicaid to what has become to me as a judgement on those who have it. Those who have such a defeatist and negative attitude that they refuse to believe that change is possible and I have been a part of a state changing its ways (new Mexico) that they attack any attempts with the high horse attitude. I don’t feel like there is a fight for better maternal health anymore now that policy can be written towards that goal. It leaves a bad taste in my mouth.

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