18. Your Responsibility in Birth (Part One)
The role of responsibility in our births has been on my mind a lot lately, and then I got an email from Intentional Birth, a doula duo with lots of offerings for parents and birth pros alike, and it was all about this exact topic! I wanted to dive deeper into it, especially because it pairs so interestingly with another concept that comes up a lot in birth: control.
I recently heard the term radical responsibility for the first time, this idea of taking responsibility for everything that actually falls within your control, nothing more and nothing less. I like this definition because it’s similar to one I’ve heard for boundaries: boundaries are where you end and another person begins. It got me thinking: what are the responsibilities of you (as the birther), your doula/support people, and your care provider, and what could happen if all three branches took radical responsibility for their own shit. (I mean “shit” in the all encompassing way, our own actions, reactions, decisions, beliefs, experiences, choices, traumas, etc.)
I personally think the main problem in our maternity care system is one with responsibility (and control… and boundaries… the three are intertwined). When any of the three branches (birthers, doulas, providers) takes responsibility for too much or too little, there are huge issues. And not only is it crucial that each group takes radical responsibility for their shit, it’s also important that each group understands and respects the other groups’ radical responsibility.
So what usually happens in birth? Very generally, from my own experience and what I’ve read, studied, and heard from others,
the provider takes on too much responsibility, the birther takes on too little, and the doula takes on the wrong kind.
Let’s go through each one.
The provider takes on too much. I think this comes from a good place. Care providers want to make sure no bad outcomes ever happen. They want birther and baby to be well, and they want birth to unfold smoothly and predictably. However, the (scary? freeing? both?) truth is, there is no way to guarantee that nothing bad will ever happen. I know that’s the thing you’re not supposed to tell people when they’re pregnant, but I’m going to say it again. Though rates of poor outcomes are very, very low, there is no way to 100% guarantee that complications, emergencies, and bad outcomes will never occur.
It’s taking on too much responsibility to think that one person can completely control the fate of every birther and baby they come into contact with. It’s like trying to control nature. Can we do our best to predict hurricanes, warn people, create evacuation routes, and build sea walls and shelters? Of course. Can we be ready to respond in a crisis? Yes! And we should do all of those things. But can we make it so that hurricanes never happen? No. That’s not a real goal. It’s out of our control.
(It’s important to note that I’m not talking about interventions here. We should of course use the tools, skills, and resources available to us to help people — with their consent — when complications, emergencies, and bad outcomes occur. We can even use them proactively if that’s what the birther wants.)
What happens when providers take too much responsibility for a bad outcome? I’ve seen them blame themselves. I bet many of them carry it with them into the next births they support. And because they feel they’ll be taking full responsibility—ethically, personally, and legally—for the outcome of a birth, many often feel they must take full responsibility for decisions made during the birth, and so they make those decisions themselves.
Here’s what that sounds like:
“It’s not just you I have to worry about. Someone has to be thinking about your baby too.”
“It’s no longer safe for your baby for you to keep…”
“You want your baby to be okay, don’t you?”
“For your baby’s safety, we need to…”
“I can’t let you do that.”
An important piece of context to this is that care during birth is partly science, but it’s also largely cultural. Medicine is not infallible. The human body is not a machine. A healthy birth can unfold many different ways, and that’s hard because we humans love predictability and certainty.
Do you see the problem here? Because the provider takes on too much responsibility for the outcome, they feel the need to take ultimate responsibility for care decisions too. And where does that leave us?
The birther takes on too little. We as birthers are conditioned to receive care and treatment in birth in the same way we would after a catastrophic injury. We’re encouraged to think we should just “leave it to the experts.” We’re actively discouraged from taking radical responsibility for our own bodies and births.
Here’s the real kicker: I think we sometimes go along with this because we actually don’t want to take responsibility for our births.
Why not?
Because it’s scary to think that our baby’s life is really in our hands.
And yet it is, as soon as we leave the hospital. We take them home, and we have to feed and cuddle and clean and nurture them. Their survival really is completely dependent on us.
Another factor that contributes to us being comfortable not taking responsibility for our births is that it can just feel like too much work.
It’s hard to put in the effort to find a provider that aligns with us or at least respects our right to make care decisions for ourselves. It’s hard to evaluate birth locations and make a switch if that feels right to us. It’s hard to learn all about birth and practice coping strategies and advocacy and know the pros and cons of the different tools available to us. It’s hard to speak up when we feel we’re not being heard. It’s hard to work against a system that ultimately doesn’t center us.
And again, there’s that fear: what if we make the “wrong” choice? What if we don’t know enough, and we do something or decide something, and something happens to our baby? What if we could avoid that responsibility all together and let our provider make the decisions based on their values?
(Another side note: I’m not saying that you shouldn’t trust your provider. I’m also not saying that you shouldn’t agree with them when they make a recommendation. I’ve just seen and heard so much birth trauma, and one of the things that comes up again and again is birthers not feeling like they had a choice in birth. Many feel that they were told to do something “or else” and that birth was something that happened to them. I want you to feel comfortable talking to your provider, asking questions, considering your own values and priorities, and stepping into the role of final decision-maker.)
So what about doulas?
The doula takes on the wrong kind. Many of us become doulas because we either had amazing birth experiences and we want others to have that, or we had really difficult or even traumatizing experiences and we don’t want others to go through that. I think both of those types of experiences can lead us to believe that a) we know what makes for a good or bad experience and b) it’s possible to guide clients through choices to ensure they have a positive experience.
But we don’t know what makes for a good or bad experience for someone else. What was wonderful for us might be deeply challenging for someone else. What we found traumatizing might be incredible for someone else. We can’t know all of the moments, beliefs, and experiences that make up a person and thus what they want in birth. (But we can definitely ask them lots of questions in our prenatal appointments!)
We also don’t have control over a client’s choices, and we shouldn’t. As hard as it can be to watch a client choose something they either said they really didn’t want or that we see as leading to an outcome they really don’t want, it’s our job to support them in whatever they want to do. We can offer thoughts, context, and information if the client wants, but it’s ultimately their decision to choose what’s best for them, not ours. Our job is to be there with them, holding space for their journey, doing what they tell us is important to them. Beyond what choices a client makes, we, like the providers, are also mere mortals, and we can’t know that certain choices will 100% lead to a specific outcome.
Whew! That was a deep dive indeed. So much so that I’m going to split this into two parts. This week was all critique, so stay tuned next week for what I think a provider, birther, and doula’s true responsibilities should be.