During Childbirth, Enduring the Patriarchy Was the Hardest Part

Pregnant people are coerced, given unnecessary interventions, threatened and denied lack of informed consent. These kinds of practices are based on the dangerous idea that the person giving birth is under the authority of the medical provider or institution. (Brian Teusch / Creative Commons)

Everyone from medical professionals to strangers tell pregnant people what they should and shouldn’t be doing with their bodies. Throughout my two pregnancies, OB-GYNs, nurses, family and friends often used phrases like “you can’t,” “you’re not allowed to” and “we’ll let you” when discussing my body.

While in labor with my first child in 2015, I was told I couldn’t move around or go to the bathroom on my own, switch positions without assistance or eat anything besides ice chips. Not being able to go to the bathroom on my own was annoying—but not being able to switch positions or move the way my body wanted to increased my pain. Enduring labor without eating or drinking was exhausting, and it directly affected my resolve to keep going without an epidural. It also didn’t have a scientific basis: Not long after I gave birth, new research found that food during labor was not harmful and could actually be beneficial.

At my second child’s birth, a nurse repeatedly told me not to scream, which I did naturally to cope with the pain. Between the contractions and labored breathing, it took me a while to protest. When I finally did speak up, it wasn’t particularly assertive—“It’s all right, I can scream”—but it did get the nurse to stop.

Unfortunately, this is standard practice in U.S. medicine, which supports a disease-based, doctor-centered, patriarchal model of care, as opposed to patient-based care that emphasizes collaboration, understanding and choices. In the U.S., policies and protocols are set up to avoid liability, not honor patients. And when misogynistic, restrictive language is directed at you for nine months, it’s easy to forget that people, including the medical professionals you hired, are giving you advice about your body—and that you’re the one who gets to make the final decisions.

Pregnant people have a lot of experience being told what to do with their bodies. By the time they’ve made it to their first prenatal appointment, they’ve likely been told to dress their bodies in pink, shave their legs and arm pits, keep their skin smooth and cellulite-free and cover themselves so as not to send the “wrong message.”

The normalization of this persistent body policing means that many of us don’t have a sense of body ownership and agency, and there are a wide variety of abuses that occur during childbirth because we don’t know or don’t feel like they have options. Pregnant people are coerced, given unnecessary interventions, threatened and denied lack of informed consent, which requires the provider to give the patient a comprehensive overview of possible risks and benefits of a treatment.

“The most pervasive language I find when dealing with pregnant people in the medical setting is coercive,” my doula, Erin Carter, told me. “[It’s] either meant to convince a parent that they don’t know what they know, or elicit their consent by questioning the safety of the baby—whether or not there is a safety concern at play. I have literally heard the phrase, ‘well you don’t want a dead baby, do you?’ come out of a nurse’s mouth. It’s ironic that I have seen this coercive language used most frequently in early labor with what would be typically considered minor medical interventions. And when clients have encountered true medical emergencies, the language used with them has more frequently been compassionate and fact-based in nature.”

These kinds of practices are based on the dangerous idea that the person giving birth is under the authority of the medical provider or institution. “In more progressive places, women have more freedom,” Cristen Pascucci, founder of the organization Birth Monopoly and a childbirth legal rights advocate, explained to Ms., “but that freedom belongs to them only as far as their care providers or institution allows it.”

Thankfully, this kind of medical bullying is starting to get some pushback. Recent U.S. court cases addressing abuse and coercion during childbirth have come to the fore. In one, a physician was charged with assault and battery, based on lack of informed consent, for performing an unwanted episiotomy on a patient who repeatedly said no to the procedure—a nearly unprecedented decision. In another, a plaintiff was awarded $16 million after receiving unnecessary medical interventions that left her permanently injured from a hospital that had advertised itself as a natural birthing environment.

After feeling pressured into a C-section during my first birth, I had more of an idea of what I would and would not allow to happen to my body during delivery during my next pregnancy—and I hired a midwife and doula in addition to an OB-GYN to ensure my decisions were taken seriously through pregnancy and birth. (All of whom, by the way, were women.) I was kept up to date on what was going on—in my body and my baby’s. I was given treatment options. I ultimately felt cared for. And in the delivery room, everyone worked together to ensure I had a safe and successful vaginal birth.

My daughter arrived after just four hours of labor, and I felt like my body belonged to me, something I did not feel at the end of my first birth. Unfortunately, that’s not a typical experience—especially for people of color, poor people, LGBTQ people and disabled people, who often lack adequate access to health care that empowers them.

In the birth environment, Black women struggle for supported, healthy births. The maternal mortality rate for Black women is almost four times higher than for white women, even when Black and white women share the same socioeconomic status. Black patients are also more likely to suffer severe birth complications, be denied effective pain medication and lack support for breastfeeding.

Black women also have different language directed at them in the delivery room. Sherronda J. Brown, author of the essay “White Women in Robes,” explained that Black cisgender women deal with their sexuality and reproduction being politicized with stereotypes of “mammies,” “jezebels,” “sapphires” and “welfare queens,” each constructing Black women as inherently undesirable, emasculating, licentious, angry and sexually irresponsible. Black women are “continually battling against words like ‘grown’ and ‘mannish’ that are inscribed upon our bodies from the time that we are children,” she said. “We are muled, by everyone.”

The language we use directly reflects the way we treat each other. The differences between my two births were largely due to the team of caregivers I assembled, all of whom practiced some form of respectful maternity care. The language used during my second birth was also much more respectful, with far less occurrences of restrictive verbiage.

Each person is the only one who gets to make decisions about their body.

This article originally appeared on yesmagazine.org. Republished with author permission.


Rachael Rifkin's work has appeared in Narratively, The Development Set, GOOD and elsewhere. She is a ghostwriter and freelance writer who once posed as eight of her ancestors. Follow her on Twitter @Letters2Ruthie.