Birth choices: context is everything

It is virtually impossible for a consumer to make birth choices in a vacuum – we are all influenced by internal and external factors, and some of these are more visible than others.

In reflecting on this idea of individual context and decision making, I created the Birth Choices: Influences resource to use with the birthing women, professionals and organisations with whom I work. This infographic captures the many factors which influence a consumer’s choices – factors which both support and erode personal autonomy.

Consumers can use this graphic to drive personal research, reflection and discussion; for care providers, this is a visual tool to examine the concept of choice and to encourage patients to critically appraise their own decision making context.

Please kindly share this image with source credit: (C) Tessa Kowaliw 2017, One Mother To Another.

Pregnant People Pleasers


if-you-keep-knocking-corners-off-to-please-others-you-lose-your-edge-1Have you ever found yourself entertaining 20 people for a dinner at your place, and yet you’re not entirely sure how it happened (as you stand madly peeling potatoes and seasoning them with resentment)?

Have you ever been more driven by guilt than desire to have a coffee with an old friend?

Have you ever kept a burning thought or idea to yourself because you were afraid of what someone else’s response might be?

If you’ve said ‘Yes’ to one or more of the above, and you find yourself generally saying ‘Yes’ to lots of things in life, then you, my friend, might well be a people pleaser… Which is fine, unless you’re also pregnant (or planning to be).

Pregnant people pleasers

During the course of nine months, birthing women are faced with a series of decisions to make about models of care, care providers, birth settings, whether to wait for spontaneous labour, what to use for pain relief… And the list goes on.

In exploring these options, a pregnant people pleaser is very quickly surrounded by folks wanting to be pleased. Each one of the above decisions has a series of people attached to it: doctors, midwives and specialists who provide clinical opinions, receptionists who might be looking for easy bookings and enquiries, friends who have recommendations about birth settings, family members who have expectations about your role as a mother, mothers and mothers-in-law who might want you making the same choices they did, and one’s own partner might have their own birth preferences, too… And so this list continues.

Pregnancy and parenting is full of other people who need you to say ‘Yes’ to their opinions and ideas because that helps them to validate their own experiences, beliefs and authority. But, be careful – in aiming to please all of these people in pregnancy, your ‘Yeses’ to others might become ‘Nos’ to your own birth plans.

Thought: If you keep knocking corners off in order to please everyone, you eventually lose your edge.

The problem with people pleasers

There’s not really anything wrong with people pleasers per se – those who go about life care-free and with generosity of spirit do make the world a better place. However, without firm boundaries, people pleasers do run the risk of being taken advantage of by others… And, the word ‘No’ is a very efficient way to set boundaries against such manipulation.

It can be an interesting task to ask oneself what drives people pleasing tendencies – i.e. what is one’s ‘reward’ for this behaviour? Is it the approval of others? Is it taking the path of least resistance? Is it avoiding conflict? Why does your cost:benefit analysis in these moments suggest it’s better to just please others than to say ‘No’ and please yourself?

My suggestion to reflect upon the underling drivers of people pleasing behaviour is not intended to promote cynicism. It is, however, intended to prompt pregnant people pleasers – in preparation for making sound birth choices – to differentiate ‘Yes’ moments offered out of insecurity, vulnerability and/or fear from genuine, enthusiastic consent.

If you, as a pregnant woman, are making a decision to question standard care, the word ‘No’ is intrinsic to your journey. It won’t actually matter, under these circumstances, how much evidence you have to decline standard treatment or negotiate routine care if you cannot learn to say ‘No’. Similarly, it can be very hard to say ‘No’ to family and friends who want to feature in your birth journey, whether you want this or not. Saying ‘No’ to these people is sometimes harder than a ‘No’ at the hospital, because they exist in your normal, daily life and those relationships will outlast your pregnancy. In both cases, it is so important to think about what stops you from saying ‘No’ more often in life, and to look for opportunities to change your relationship with ‘No’.

Start practising ‘No’

There are ample opportunities in your pre-pregnant life to start practising the art of saying ‘No’. That dinner party planned on your behalf? Just say, ‘No’. And, if you can’t do it, why not? Is it because you actually would like to see your friends, but you just can’t commit the time required to get your home guest-ready? Could your answer instead be: ‘No, let’s not do it at my place because that doesn’t really work for me – let’s head out for a meal instead’? Sometimes ‘Nos’ are easier to say when you have an alternative solution to offer.

saying-no3How about the person who gets angry when you say, ‘No’? Is their disapproval a reason to just say, ‘Yes’? Or is their response perhaps a fantastic example of their own short-comings? If you think you are about to say ‘No’ to someone who is used to hearing, ‘Yes’, plan ahead of time for some additional support so that you are able to stand strong when you need to.

Sometimes ‘Nos’ might actually be more about a ‘Not now’ situation. Buying yourself time by explaining, ‘I can’t say yes to this right now, but would like some time to consider it’ is sometimes better than simply saying ‘Yes’ and realising later that you wish you hadn’t.

Saying ‘No’ to well-meaning family and friends

The dinner party at your place might be your family’s plans to throw you a baby shower. Similarly, the guilt-laced coffee with an old friend might be the sense of obligation you have to entertain long lists of visitors in your hospital room whilst they have cuddles with your newborn baby. Both cases are examples of well-intentioned actions which might make an outright ‘No’ tricky to manage.

If you can’t simply say ‘No’, you will still need a different way to address unwanted offers if they are not part of the birth journey you are planning. The good news here is, however, that there is an element of being able to anticipate this sort of situation, particularly if you’re having your first baby (because your family and friends are probably going to want to be involved!).

So, be proactive and take control early! Get on the front foot and plan a mother blessing, for example, and then give your family members special roles for the afternoon. Alternatively, warn family and friends ahead of time that you are planning to have a private babymoon, and explain this to them, saying that you understand this might seem strange, but you look forward to seeing them on {insert day here} when you’re ready to introduce your new baby to his/her broader family.

Saying ‘No’ to a care provider

Because of the power dynamic, women often avoid upsetting their care providers because they are afraid that this will adversely affect the care they receive during pregnancy, labour and birth. What needs to be considered here, however, is how adversely a stream of ‘Yeses’ also affects one’s care… If care providers are not aware that you have an expectation of active involvement in making decisions about your care, they may assume you are simply happy to ‘go with the flow’ and make decisions on your behalf.

A ‘No’ with a care provider might be:

  • “No, I do not consent to that treatment.”
  • “No, I do not feel comfortable with that because I need more time/more information/another opinion, please, before I make my decision.”
  • “Thank you for your opinion about x, I really appreciate that you took the time to explain it to me. I have considered it and believe that I would like to continue with y instead.”

The AMA’s maternal decision making position statement supports a woman’s right to make informed choices and decline treatment.

And, if you feel you need support to be able to say no to a care provider at any point during pregnancy, labour and/or birth, don’t forget that you can ask your partner, a close friend, a doula or a student midwife to advocate your wishes on your behalf.

When you follow your ‘Nos’…

The beautiful thing about birth is that it doesn’t happen in a bubble – it is the perfect time to explore how one functions in life and to identify opportunities for positive change.

If you are a pregnant people pleaser, there is no harm in starting to practise using your ‘No’ muscle; in fact, with motherhood right around the corner (or an increased brood demanding more and more ‘Yeses’ from Mum), it’s a very valuable life skill indeed.

10 Reasons Why A VBAC Rocks

Are you planning your next birth after Caesarean and asking yourself ‘Why VBAC?’?

Based on my own personal VBAC experiences, here’s my list of reasons why I think VBAC rocks:

1. No major abdominal surgery!!
2. No trying to recover from aforementioned major abdominal surgery whilst also caring for a newborn and other children.
3. Emotional healing: for many (myself included), VBAC births are a positive step towards healing previous birth trauma.
4. Good for your baby: passage through the birth canal helps innoculate your baby’s gut with the variety of flora it needs, helps to ‘awaken’ your baby’s body and activate many of his/her physical systems ready for life outside the womb.
5. Breastfeeding is easier: no grappling with numbness, IV lines, pain or delayed milk.
6. The physical high: you know those memorable moments in the bedroom? Combine those and multiply by 100.
7. Satisfaction: knowing your body is not broken, your pelvis is not too small, your body knows how to birth, and being able physically complete the job your body has been working on for 9 months (or more, if you’re me!).
8. Up and at ’em: being able to eat, drink, walk and feel lucid within hours of delivery definitely gives VBAC an edge and facilitates early bonding with your baby.
9. Delivering your own placenta: this brings a new dimension to birth, particularly if you’ve never done this before, and can give a new appreciation of the amazing things your body can do (like growing an organ from scratch!).
10. The feeling of pushing a baby out of your body, pulling his/her slippery body up onto your chest and enjoying that moment of mutual discovery – truly, there is nothing like it.

Have you VBACed? Would you add any extra reasons to this list?

Birth Activism: Choose Your Own Adventure

Mary Celeste as Amazon in 1861There are three kinds of birth activists in this world… Which one are you?

The pessimist complains about the wind, the optimist expects it to change; the realist adjusts the sails. — William A. Ward

P.S. If you’d like to help adjust the sails, join the fun here or here, and ask questions here. 🙂


Image credit: Mary Celeste as Amazon in 1861, by Unknown. Source: Wikimedia Commons.

Your Destination: Is ‘a healthy baby out of your vagina’ all that matters?

As I mention in ‘Empowered Birth is Not In The Eyes of the Beholder’, one of the most disempowering assumptions to be made during a planned VBAC is that ‘a healthy baby out of my vagina’ is all that matters – this is a great and logical foundation for a bigger goal, but the process of planning a VBAC should not only be about babies and vaginas.

Here’s where I’m going with this… What if that baby comes out of your vagina, but you have to have an assisted delivery? What if that baby comes out of your vagina, but you are coached to push? What if that baby comes out of your vagina, but you feel totally out of control because your body takes over? (Google ‘foetal ejection reflex’ if you haven’t already.) And, what if you unexpectedly decide that you want to have a repeat Caesarean?

The passage of your next child through the birth canal is not automatically a passport to empowerment. Sometimes women ‘get their VBAC’ and yet still report feeling disempowered for various reasons. Conversely, others end up with unplanned repeat Caesareans and yet feel perfectly empowered during their birth. These are some of The Grey Zones of Empowerment.

Instead of focusing solely on the mode of delivery of your planned VBAC baby, have a think about how you want this birth to feel from your perspective. Yes, by all means plan to birth your baby vaginally – there are, after all, many benefits associated with vaginal delivery! But, don’t stop there – also plan to be empowered.

If you plan to be empowered, the fear of ‘What if I don’t get my VBAC?’ can disspate. Reducing fear ahead of a planned VBAC is actually an integral step towards VBACing! And, if you can say – I know what it feels like to be empowered, then, congratulations! This is about as close as you will possibly get to guaranteeing yourself a positive birth experience next time, which is right where we want you!

The Empowerment Ride Doesn’t Stop Here!!

The awesome thing about the VBAC journey is that it does not have to end with the birth of your baby. The things which we learn through the process of actively planning an empowered birth are, like many of the lessons of motherhood, transferable and applicable to many aspects of ‘Life After VBAC’. Empowerment during birth is the same as empowerment in life – once you’ve discovered your portable power, you can use it to make good decisions about anything.

VBAC By Numbers

Stop Two – VBAC By Numbers

Because we are not taught to cope well with ‘unknowns’ in life (and because the VBAC journey is full of them), it can be tempting to look for a ‘VBAC by numbers’ solution thinking also that a VBAC will automatically be an empowering experience in and of itself. And, I totally understand why this shortcut is so tempting, especially when we all have small children, minimal research time and a craving for VBAC Hacks which will make life easier!

The ‘VBAC By Numbers’ set of instructions for empowered birth often looks like this:

  • Consider choosing to birth in a birthing centre or at home
  • Employ the services of a VBAC-friendly care provider
  • Do a lot of research and read a lot of stories
  • Gather stats – lots of stats
  • Find professional support and assemble a birth team
  • Keep your physical body fit and healthy
  • Face your personal demons re ‘What Happened Last Time’ (and any others)

All of these steps are absolutely important and integral to planning an empowered VBAC. Everyone who is serious about planning a VBAC is well-advised to work through these things (plus a few extras which I will cover in a separate post!). So, please do go forth and consider doing at least one, some or all of these things.

However, here’s the harsh reality check… Ticking off all of these things and then assuming this will guarantee a VBAC outcome and/or an empowered birth is, unfortunately, ironic. Whilst a VBAC preparation list is something you can google and work through without any personal reflection at all, if you miss that opportunity for personal reflection, you have also missed a chance to practise being empowered.

The other problem with the ‘VBAC by numbers’ mentality is the danger of switching one form of outsourced responsibility for another – if you blindly follow a ‘How to Plan a VBAC’ list, you are not necessarily any better off than you are when blindly following the advice of a care provider. If you want to be empowered, you must question everything (including this blog post!) and come to your own conclusions. The second you stop thinking for yourself is the second you risk becoming disempowered.

Working through any list of dot points (like the one above) is totally fine as part of an ongoing process – a work in progress which is your own journey to empowerment. But, once you’ve exhausted the ‘How to Plan a VBAC’ list, keep going! Stay open to the possibility that, with every layer you work through, you get closer and closer to an empowered birth.

>> Your destination: Is ‘a healthy baby out of your vagina’ all that matters?

Birthing a blog

As a woman who has birthed three beautiful babies, but also as a CARES volunteer, I have spent much time over the past five years fantasising about how one might make the world a better place for women to birth in. If only we could band together, share strength from one mother to another, and not feel afraid to ask more questions, or feel selfish for wanting a positive birth experience and a bit sad about our awful ones. As a culture, we are quick to keep the parts of ‘birth’ all neatly boxed and labelled, and are encouraged to throw a lid on top of it all once the job is done. In this modern, fast-paced, and technocratic life, there is little space for something as ancient, wild and humbling as birth.

And so, this brings me to the concept behind this blog… In a culture so unaccustomed to speaking about birth as a rite of passage, and about women’s experiences of birth in general, I hope this blog will be a space for women to reconnect with each other so that we can once again share our stories and learn from one another. Let’s chink our glasses as we indulge our thirst for knowledge, shrug off the shroud of fear which holds us back from asking the tough questions, and let’s make the ‘wrong’ decisions if they are the right ones to make as mothers.

At a time when the world wants us pixelated and stored in clouds, it is easy to be distracted from our primal nature – birth brings this to the fore, and it can either be confronting, or it can be empowering. It is a matter of being at peace with the ancient technologies of our bodies, and learning how to respect this as a technology which has served us for many, many generations.

Let’s never forget this – let’s pass the wisdom on. What I’m talking about is not the sort of information you get at a hospital antenatal class, and it’s unlikely to pop up in a ‘childbirth’ google. This is the esoteric stuff we would have once been told by our village elders. It is the cultural joining of the dots which allows us to see the place birth holds in our lives universally and across all time. When we can free our minds of parenting fads and bell curve charts and celebrity postpartum weight loss regimes, we will remember these things. And, when we do, we’ll see that we are slowly making birth welcome in the world again.