In this blog, I want to encourage you to start thinking about self-advocacy during your birth. In a future blog, I will continue this conversation by considering a birth plan, which will take you deeper into exploring your choices and finding your voice to advocate for yourself within the maternity system as it stands today.
Holding your boundaries in your birth space might not be something that jumps to the top of the priority list when you think about birthing your baby. The problem is that the way you envisage your birth, if you are able to envisage it, might be very different from how the hospital or midwifery staff envisage it.
The first thing to know is that because it is your birth and your baby, by law you have the right to accurate information to enable you to make your own decisions. If you don’t think about how your birth might look, you can’t know what you want. By the same token, you also have the right not to know, if knowing isn’t helpful to you.
What do I mean by all of that? Well, let me give you an example. If you already know that you are noise-sensitive, the chances are you will want a quiet birthing space. However, if you relax more easily in an environment with background noise, you might be happy for a little chatter from midwives and some music. We are all individuals, and at the very least, it can be helpful to think about what you find helpful or difficult in day-to-day life. It’s your birth, and even in hospital, you can expect the boundaries that are important to you to be respected.
Thinking about some examples of how holding your boundaries can look will hopefully give you a better understanding of the importance of at least considering whether boundaries are important to you.
Making the Space Yours
While making the space yours might seem to some to be a frivolity, it can actually have a huge impact on the subtle dynamic in the birthing space. Let me explain: if you are planning a hospital birth, don’t skip the paragraph below about home birth, because it helps to beautifully illustrate the point I’m making.
If you are planning a home birth, this is your space and therefore medical staff are guests in your home. Letting them know that they can make themselves a drink, help themselves to biscuits, and showing them where the toilet is allows them to feel comfortable in your space, helping to create a good atmosphere conducive to birth. It also says, “This is our space, and you are our guest.” For example, if you would prefer a quiet space to birth, you can tell them that and let them know that if they need to talk or discuss something, they can use the kitchen area so as not to disturb you.
If you are planning a hospital birth, you might like to bring things that make the space feel more homely, such as your pillow or duvet, maybe a photo, or a positive affirmation to Blu-Tack to the wall, or little battery-operated tea lights to make the space feel less clinical. Again, by doing so, you claim the space as yours, both psychologically for yourself and for anyone coming into your space.
Many people don’t think about boundaries when it comes to a planned caesarean section. It is just as important to feel respected so that you leave that experience feeling positive and well. You may have elected for a c-section, or it may have been a medical necessity. Either situation can bring its own unique feelings around birth. There may have been feelings of grief around not being able to have a natural birth, or it may have felt the safest option for you. That said, ensuring we only add positive experiences where there might already be complicated feelings is so important.
So how does that look? It might be as simple as asking the medical team to tell you what is happening at each stage, asking for calming music of your choice to be played, or ensuring your birth partner is by your side so that you feel safe. You could also ask that at the point the baby is being born (assuming all vital signs are good), the bright lights are dimmed for a moment to give your baby time to adjust to being outside the cosy world it has grown in. Or maybe you’d like to see your baby being born and, at the point of birth, the screen that shields you from the c-section operation is lowered.
Birth preferences for a c-section can also be considered even when you plan a physiological (natural) birth. Whilst you might not plan to have a c-section, you can still make the medical team aware of what you do or don’t want, just in case. That way, if you do find yourself in that situation, you still have some control over your space.
Boundaries in Your Birth Preferences
Sadly, the midwifery and obstetric team aren’t mind readers, so it can be really helpful for them if you put things that are important to you in your birth preferences. You can also include a copy with your birth notes so that anyone reviewing them can see your preferences. You might also pop them on the door to the room where you are labouring and birthing, so that anyone entering the room is informed. Knowing that the team around you have access to your preferences also means you can have more confidence in calling out people who don’t respect your boundaries.
For example, if Mum does not like to be touched unexpectedly, you can add to your birth preferences that everyone should ask permission and explain why they might need to touch her. If someone doesn’t respect that boundary, you or your birth partner can clearly but gently say, “Please can you read through Mum's birth preferences she does not wish to be touched unnecessarily.” And if they persist, say more firmly, “Mum does not give you permission to touch her. If you explain why you need to touch her, she can be fully informed to give consent or decline.” And if they still persist: “You have been asked not to touch Mum without permission. You need to stop touching her immediately.”
You might also add to your birth preferences: “Mum will be working hard to switch off her neocortex so that her body can reach its optimal primal state for birth. Please keep the birthing room as quiet and peaceful as possible.” Expecting everyone in the birthing space to be as quiet as possible is your boundary. People forget or don’t notice, that’s okay but you absolutely have the right to hold that boundary, especially where chatter isn’t relevant to the birth, by saying, “I’m wondering if you can take that conversation outside so that we don’t disturb Mum,” or if it is relevant, “Can we lower our voices whilst we discuss this to minimise disruption to Mum?” And if the boundary continues to be ignored, then, “As per the birth preferences, this is our quiet space, so I need you to take this conversation outside.”
You can ask someone to leave your birthing space. According to Birthrights, the human rights in birth organisation, you have the right to make decisions about your care and to have those decisions respected. You can also say that you need some time and space if you need breathing room to consider your options.
Language You Use Needs to Be Clear to Avoid Any Doubt
- I need you to explain to me
- Where can I find the evidence for this?
- I/we have decided that
- I don’t consent to
- I do consent to
- You need to stop
- Please don’t touch me there
- I need you to
Digging Deeper into What You Have Been Told
- How is that likely to help?
- You’ve said my baby is struggling - how is that likely to help?
- You say I’m not progressing - why is this a problem and how is what you’re suggesting likely to help?
- What happens if we don’t?
- What changes if we wait a while to see if things progress?
How You Are Feeling
- I feel better when you…
- I’m worried that…
- I’m scared…
Who to Call on for Help if You Aren’t Being Respected
You’ll need to research in advance which of these people are available at your hospital:
- Head of Midwifery
- Professional Midwifery Advocates
- Supervisor of Midwives
- Consultant Midwives
I’m very aware that this blog about boundaries borders closely with birth preferences, which opens up a whole other important area. What I hope you’ve taken from this blog is that burying your head in the sand might have repercussions you don’t expect.
Here’s the hard truth - and whilst no individual is to blame - you are birthing within a medical system that is stretched. The labour ward needs the room, and so moving you through efficiently might be a factor in how your birth progresses. The midwife might be looking after too many births or have been on too many shifts that week, and so cannot possibly hold the space for you as she would like.
In conclusion, you are legally entitled to birth your baby however you want. The sad reality is that, to take what you are entitled to, you may need to go to a place that feels uncomfortable - to hold your own boundaries and your space. If you don’t, you risk handing all your autonomy over to a system that often does not have the capacity to put your and your baby’s emotional or physical needs first.
If you need my help in planning how to decide on your birth boundaries and preferences, you can contact me through my website melsspace.com, by email at talk@melsspace.com, or through Instagram.
Reference
Birthrights. (2021, August). Human rights in maternity care: The key facts. https://birthrights.org.uk/factsheets/human-rights-in-maternity-care/
All-Party Parliamentary Group on Birth Trauma. (2024). Listen to Mums: Ending the Postcode Lottery on Perinatal Care. [PDF] Available at: https://www.theo-clarke.org.uk/files/2024-05/Birth%20Trauma%20Inquiry%20Report%20for%20Publication_May13_2024.pdf.