17. The Limits of Your Rights in Birth
Last week, we explored the ways you can re-center yourself in your birth experience. The tl;dr is, “You are in charge.” You get to say yes or no to everything in labor. And yes, you get to decide even if…
it’s an emergency
it goes against what your provider is telling you to do
you’re “high risk”
it goes against hospital policy
it “increases the risk” of something happening to you or baby
you signed a paper at some point in the past saying you consented to something
you verbally consented to something in the past
You have the legal right to say “yes” or “no” to what is offered to you. If you decline what is offered to you, you cannot be turned away from the hospital in labor (at least in the US, where I am). Again, the hospital is legally required to provide care for you in labor even if you decline something. I wrote that twice because people have asked me if they can be “kicked out” of the hospital if they decline something in labor. No. The hospital has to provide care for you.
So if you can say “yes” or “no” to anything in labor, what can’t you do?
In short, your authority extends to your body, but not someone else’s. You can’t make your provider give you something beyond basic care.
Let’s jump into an example. Imagine you’ve been admitted to the hospital for an induction. Your provider has offered Drug A to you for cervical ripening, and you decline that. You’d really like Drug B instead. You can absolutely talk to your provider about this, and they may offer it to you. But they also may not. If they don’t feel comfortable offering Drug B, that’s their right. You can’t make them offer you that option.
Another example: Let’s say you agree to an induction with Pitocin, but you don’t want continuous fetal monitoring. Your provider comes in to talk to you and tells you that they don’t feel comfortable starting you on Pitocin without continuous monitoring. They are not obligated to give you Pitocin if you don’t agree to monitoring.
A little tangent here… What are some things that might influence a provider’s decision to offer (or not offer) an intervention?
their training, education, and experience: This is why you’ve hired them! You want recommendations based on their knowledge.
their practice’s culture: Certain practices may get used to doing things in a specific way. This may or may not align with what you’d prefer to do.
hospital policy: Sometimes, a provider may truly want to offer you an option, but it may go against hospital policy. You as the birther are not bound by hospital policy, so you can decline anything. However, the provider has privileges to practice at that hospital, and if the hospital wants to, they can terminate those privileges, effectively costing the provider their job.
All of the above (the examples and my little tangent) underlines two key points:
1. It’s so important to find a provider whose style and philosophy about labor and birth aligns with yours! You can ask questions in your prenatal appointments, and if you don’t like the answers, you can switch to a provider you feel more comfortable with. If you’re wanting to know more about your provider’s typical way of doing things, I highly recommend asking open-ended questions like, “In what situations would you typically recommend an induction?” and “What are your thoughts on the different approaches to fetal monitoring?” This allows you to get actual answers about what your provider usually does instead of an answer that your provider may think you’re looking for. Don’t forget that different providers may have different styles within the same practice, and you usually don’t know who will be on call for your birth.
2. When you’re discussing interventions with your provider, ask about the other things that come along with those interventions. When you make a decision about something, you want to be saying yes to that thing and everything else that accompanies it. It’s a great idea to ask how an intervention will affect your monitoring options, your mobility, and your ability to have or not have other things down the line. The more you know, the better your conversation will be with your provider, the easier it will be to make a decision about what feels right for you.
Let’s go back to the beginning when it comes to being in charge of your own body. Are there any situations where a provider can make a decision for you?
Yes.
If you are unable to give consent and your partner is also unable to give consent, a provider can make a decision for you.
What could this look like in real life?
You’re unconscious. Your partner is unconscious.
Is that likely to happen? Probably not.
Want to know more about your rights in birth? Check out Cristen Pascucci’s Birth Monopoly, where you can find resources on obstetric violence, advocacy, and more, and check out Evidence Based Birth’s recent podcast with Mama Doctor Jones about patient autonomy.