What over 200 Birth Rooms Taught Me About Consent
One of the biggest things that they don’t tell you about consent during labor is it has to be re-established every five minutes + the overall environment isn’t really set up for it in a natural way.
Consent isn’t a form that you sign when being admitted. It isn’t a checklist of things that you are okay with like picking through a menu. Honestly, consent isn’t that conversation that you had with your provider two weeks ago at your last appointment. Consent is what is happening or not happening in real time, in this exact moment, every single time a hand goes near your body. Every time someone proposes a new intervention + every single time the plan shifts.
Two hundred + ten beautiful births in, I can literally pinpoint the moment when consent gets steamrolled. Like most things, there is a pattern. A set of possibilities that heightens the chance that consent isn’t handled as intentionally. Once you know the pattern, you can prepare + even plan for it.
Truth Moment?
Moments that consent gets violated are not random. They are predictable + happen at the same points in almost every labor. If you know when they’re coming, you + your support team can build strategy in advance that way when the room speeds up or details start to come fast, your “no” doesn’t have to compete with your nervous system.
What I’ve witnessed.
Consent gets steamrolled when contractions get close.
During active labor. We are in the thick of it + contractions are stacking, this is not the time to really be asking questions + she isn’t in the frame of mind to negotiate what’s happening around her. Her brain isn’t doing what it normally does. It’s not connecting the dots or brainstorming, instead it is moving inward. There isn’t the analyzing of language. She isn’t noticing the difference in “we are going to start Pitocin” + “would you like to discuss starting Pitocin.” I can tell you first hand, both sound like radio instructions when you are seven centimeters dilated + your body is feeling things you have never imagined.
This is why conversations have to happen so much earlier than labor. Well before contractions are close + the room is loud + buzzing with people. This is before birthing brain shows up, because once she is fully in it, every single decision needs to be filtered through someone whose brain is focused on protecting her + her birth preferences.
Consent gets steamrolled when the baby’s heart rate dips.
Listen. Decels happen. They are very much a part of the birthing process + are incredibly normal. The decels are a real part of how a healthy baby tolerates labor. Here’s the thing, two things can be true at the very same time. The moment the number on the monitor moves in a direction that the nursing + provider staff isn’t comfortable with, the room does shift. It can feel really intimidating going from just you, your support person(s) + nurse to several more bodies in the room preparing for a potential all hands on deck moment. The energy can feel on edge + then decisions begin being announced instead of discussed.
This is a moment that is yours, despite what it may feel like. A moment that’s your right to ask, how often is this happening. How is the baby recovering between contractions. Are there different positions that we can try first. What the actual urgency level is, on a scale. Is this an absolute emergency or are we in a moment that needs attention.
A lot of the time, when those questions are asked, the answer typically is: this is something that needs attention but there is time. Most of the time, not always, the fluency in knowing the difference is why you are pay a doula or having a trusted advocate in the room with you.
Consent gets steamrolled at shift change.
One of the biggest things that I personally call out to clients is shift change. That 90 minutes before + after shift change can feel like the twilight zone. The team you started your journey with is now preparing to go home, while a new team is being debriefed on their patients for their shift. They haven’t met you yet, they have read a couple of notes + heard the highlights from your nurse. They don’t know what your birth preferences are + they will come in + do their own version of an assessment that you likely went through hours prior. In the same breath, this new birth team might be the breath of fresh air that you needed. A boost of new energy + suggestions to help get you over the hump.
The real good ones will come in + introduce themselves + actually ask questions. The not as good ones will just start. They will come in chatting, lifting your gown maybe asking to check your cervix. They talk at you. Telling you what they are about to do while they are already doing it. The shift change moment can truly make or break a labor. You could put a sign at your door if you wanted to, asking newcomers to introduce themselves before getting started.
Consent gets steamrolled when they believe progress isn’t happening.
There is no such thing as a labor taking too long. Labor will take however long it takes. This is especially true when the birthing person + baby are both tolerating labor with no issue. There could be a person in the room that doesn’t share the same philosophy. A nurse that believes you should be further along by now isn’t a medical opinion, that is a feeling. Unfortunately feelings do get acted on, especially in delivery rooms.
This is the moment that you ask: is this a clinical concern. Which number is moving in what direction. What does the protocol actually say for this situation. If the answer starts anything like “I just think we should move things along,” you are more than well within your rights to say “I would like more time. What does my doctor or midwife say.” “Is the charge nurse available.”
More times than not if the birthing person + baby are looking good, the doctor or midwife will say give her more time. Oftentimes in situations like this the nurse is acting on their own preference or end of shift fatigue. Knowing + understanding the difference is the kind of literacy you can build before you even get to the birthing room.
What you can do before labor.
Practice. Rehearse the language. Say the words out loud. Do this with your partner, doula or your friend. Say the sentences + repeat them until they are automatic. I’m talking roll off the tongue.
“Can you give me a minute to think about that.”
“What are my other options.”
“Is this an emergency or do we have time.”
“I’d like to wait another hour + then reassess.”
“Please ask before you touch me.”
“I am not consenting to this. I would like another option.”
None of these are aggressive sentences. They are legit the bare bones of informed consent. Not a one of them should be hard to say. The only time they become hard to say is if you have not practiced. So take the time to practice.
And tell your people. Tell your partner: if I say no to something, don’t let it keep happening. If you see someone doing something I did not agree to, ask them to stop. If the plan changes without my input, ask them to pause + explain. This isn’t being rude. This is them advocating for you. This is them being your person.
Birth consent is ongoing. It is one of the most ongoing forms of consent there is. Every five minutes the situation changes + you are entitled to be the one who decides what happens next, for your body + baby every single time.
This is the work of the room. This is what I do for the families I support. And this is something that you can do for yourself with the right preparation even if you don’t have me there.
