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.