You're Not Allowed To Not Allow Me
We've all heard the stories, the ones that come from angry moms after they find out that the two words that had biggest impact on their births, "hospital" and "policy" are less about supporting science and evidence and more about avoiding loss and litigation. We have seen the massive rise in cesarean births in the United States, from 18.4% in 1997 to 31.9% in 2016, and I know I have personally thought to myself, "what is happening to women that the maternal mortality rate in our country is at an all-time high, yet, so are these routine birth "interventions?" Weren't these interventions created to save us?
The answers to all of these questions lie within the science of altering birth outcomes routinely with no understanding of the long-term implications.
This information is intended ONLY as a roadmap for parents to successfully navigate between what is being suggested for evidence based reasons and what is being suggested for hospital self-preservation. I will never demonize doctors or hospitals, there are MANY individuals as well as facilities, that practice with integrity and high standards of care.
When it comes down to it, however, the numbers truly speak for themselves.
So how does the modern family engage in cooperative care, while also advocating for their right to deviate from the hospital's standard practices? The first step is knowing the basics.
What exactly is a "hospital policy?"
Before defining the term, it's important to know that the policies used here for example are that of a specific entity. Each policy varies by multiple factors; state, facility, it even varies from doctor to doctor. I have had nurses happily hand me over a client's placenta for encapsulation on a Tuesday, and by Saturday I was being told it was against that same facility's policy to release it.
It is so important to have a birth plan, a good relationship with your care provider and a clear understanding of YOUR chosen facility's policies (in writing-as a doula I have learned that a lot of personal opinions are presented as policy. If it isn't in writing, it isn't an official policy).
A hospital policy is simply a guideline put together by doctors and legal teams to encourage certain routine practices. For example, The Baby Friendly Hospital Initiative is an effort by UNICEF and the World Health Organization to raise hospital standards of care regarding lactation. They have a clearly defined set of policies called "The Ten Steps" for every hospital they deem Baby Friendly. Among these steps are policies such as not giving infants anything other than breastmilk unless medically indicated, practicing rooming in (no hospital nursery), giving no pacifiers, etc. These are the "standards" by which these hospitals practice regarding infant feeding. As such, each facility has a set of standards by which they practice in labor and delivery. Some examples are no food or drink once admitted, constant fetal monitoring, routine administration of pitocin after birth, etc.
What are my rights when I want to go against hospital policy?
When your choices go against hospital policy, what do you do? This is a question I get regularly from my natural birth moms. Many facilities in my area "do not allow" for water VBACs. They will allow you to labor in the tub, but not birth. My question to my clients is always, "and what happens if you can't move and get out?" That usually gets the gears turning and leads us into a discussion about knowing your rights and making empowered, FULLY informed choices. This goes with any choice you have to make as a parent-circumcision, vaccines, birth choices, etc.
Unfortunately, patient rights in labor are much harder to find than hospital labor policies. However, Gulfport Memorial Hospital has their patient rights clearly outlined on their website. Among them, is number 9, "You have the right to accept medical care or to refuse medical treatment to the extent permitted by law and to be informed of the medical consequences of such refusal."
So what does this tell their patients about their right to decline hospital policy? It tells us that as long as declining this medical treatment isn't against the law or found to be legally neglectful, patients have a right to decline ANY and all ROUTINE treatments for themselves and their children.
Learning your rights, informing yourself, hiring a doula, and choosing a birth facility that is RIGHT for you are the best methods we have to reducing these mortalities and major surgeries.
*Every single situation is different, and it is 100% up to the patient or guardian to be fully informed about each choice they make regarding their care. I am by no means suggesting people buck the system just because they can, because in some circumstances, hospital policy does protect the patient. Please be completely informed when advocating for your family!
So what do I say to decline treatments?
A simple "we've decided to decline at this time" usually does the trick for decisions regarding your newborn. Often, in labor, mom can simply state "I don't want xyz" or "please do not xyz." The moment the patient has withdrawn consent, anything against her wishes that follows is considered assault.
I truly wish I could say birth rape/assault is a rare occurrence, or was isolated to the hospital setting, but unfortunately it has been my professional experience that (in my region) birthing women must be prepared to advocate for themselves at all times.
If you are unsure about a medical decision in labor or would like a few moments to catch your breath to speak up, simply request that the doctor or nurse allow you 10 minutes with your partner/birth team to come up with a decision. In emergency cases, this may not be allowed, but truthfully, I have yet to see anyone second guess an intervention in emergent cases. If your doctor simply does not wish to allow you 10 minutes out of impatience, this would be a great time to discuss birth plans with your birth team and make sure everyone is on the same page and supporting mom. If you receive resistance about your choices, do not debate, do not attempt to persuade; simply repeat your choice and inform them that you are aware of your rights and would like to be left to birth privately.
"You're not allowed"
These words can be deafening in our most vulnerable moments. We hear them, we believe them. What are we left with? We love our babies don't we? We want them to be born safely don't we? These are the undertones (which are often not even subtle) that drive us to make decisions in labor that we later regret.
But what I want every laboring mother to burn into her mind is the phrase "you're not allowed to not allow me." This simple statement lets pushy practitioners know that you are informed, you are prepared, and you will not be bullied.
Resisting entities we deem authoritative can seem scary, overwhelming and dangerous, but when you become aware of the foundation behind each policy, you are much better equipped to make a fully informed choice, and ONLY then, are you receiving an acceptable standard of care.
In a world full of overwhelming choices and a society that only grades mothers as pass/fail, I move that we go back to the basics in birth. Remove the convenience of routine, one-size-fits-all medicine, and treat each woman like an individual with not only the right, but the competency to make decisions for her own body.