Consent During Birth

This is a post about consent, and I know you’re probably sick of the subject. But if you stick with this and read all the way to the end, you will be rewarded with a shiny purple box, and humorous post-scripts!

Most of us learn the word “consent” in the context of sexual intimacy; we’re taught that sex should never take place without it! It’s a simple message that’s easy to agree with. But, “There has to be consent!” does nothing to teach us how to GIVE consent, let alone how to withhold it or be sensitive to our partners’ consent and refusal. “There has to be consent!” is just about as effective at preparing us for sex as “Just say no!” is at preparing us to deal with drugs and alcohol.

Theoretically, consent and refusal seem simple to say and to hear. You might think “If it feels right, I’ll say yes, and if it doesn’t, I’ll say no.” You might think “If my partner says yes, I’ll keep going, and if my partner says no, I’ll stop.” No problem, right? Then you start getting some real life experience, and it turns out those imagined moments for checking in, for saying and hearing “yes” and “no,” don’t just happen. They don’t sprout from flirty repartee or blossom in the heat of passion. You have to MAKE that opportunity for yourself and your partner. It’s surprisingly easy for a whole sexytime to pass, without your own explicit consent registering in your conscious mind, let alone that of your partner. Giving, withholding, and hearing consent are SKILLS and it takes practice to be good at them. Practice that no one really wants to start right as things start feeling sexy (or not).

And you know what? I’m not going to get in to how you should develop those skills for sex, because that is not what I’m writing about today. I mean, you definitely should do that, but this whole sex-oriented introduction to consent has all been a gateway to the context I want to discuss: consent during BIRTH.

Now I do realize that at first pass, sex and birth seem like fundamentally different experiences. Surely the best part of a third date is not comparable to the often-dramatized ordeal of birth, right? Well, actually, no! Fundamentally, sex and birth are very similar. Both have the potential to be empowering, affirming rites of passage. Both have the power to bond partners closer than ever before. Both should take place in a safe place, a comfortable place, with an environment that enhances the experience. Both can take unexpected turns, and suffer significantly from a breakdown in communication. Both are better when you go into them with education and reasonable expectations. Both make people vulnerable in unique ways. And, absolutely, the folks involved in both should take their cues from consent.

Let’s focus for a moment on consent during birth: Why would a person even need to think about that? Well, most people simply don’t know what’s likely to happen during their birth experience. Kind of like most folks don’t really know what to expect the first time they have sex. You might assume that everything is going to be fine, only to be faced with something you weren’t expecting, in a moment where you’re not in a frame of mind to clearly give or withhold consent.

Sticking with the sex analogy, let’s consider how this might happen. You could be totally educated about how sex works, comfortable with your partner, and enjoying yourself immensely, when suddenly, the unexpected strikes. Maybe your partner is into some dirty talk that is a huge turn-off for you, but at this point everybody is naked and vulnerable and it feels awkward to mess with the flow. You’re unsure of whether you want to consent. Maybe you feel like you just want to get it over with, and that’s not going to lead to a satisfying experience.

Well, if you think it feels awkward to speak up to your trusted partner, when the two of you are alone and you’re enjoying yourself, you can imagine how much more challenging it might be to speak up to a medical authority figure, with an audience, while you’re in labor. What might be the medical equivalent of tone-deaf dirty talk? It depends on the person – maybe you don’t want someone giving you a vaginal exam without telling you why. Maybe you don’t want to be given medications as a matter of routine. Maybe you don’t want someone trying to stretch your perineum (the area between the vagina and the anus) to make room for you baby to come out. Maybe you don’t want someone squeezing your tummy to help your uterus contract immediately after birth. All of these practices are common, although you might not be aware of them, even as an experienced parent. I’ve heard many parents say something like “I didn’t like that, but I didn’t know what to say to stop it.” Or, “I didn’t want that, but I assumed I had to because the doctor said so.”

First of all: No. You do not have to do anything you don’t want to with your body during birth, just as you don’t have to during sex. You’re the boss of you, period.

Second: I am so tempted to just give you a script of “ways to say no” to prevent you from being that parent who didn’t know what to say. But I know that won’t work! Because those little moments for consent and refusal don’t sprout up and blossom at the right time, every time. You might not remember a script, and it might feel inauthentic to you to just parrot some doula from the internet.

So here’s what I’m going to do. I’m going to try to teach you what your own consent already sounds like, and what it doesn’t. As promised, a shiny purple box is coming up very soon! Take a look at the phrases on the left, which sound like consent. If you find yourself thinking/saying these words during your birth, fantastic! That’s a reassuring sign that you feel in control, which is a great indicator of a positive birth experience. Now take a look at the phrases on the right. You might be surprised at how neutral, or even positive, some of these sound. But these are not words of enthusiastic consent, and if you find yourself in a “right column state of mind” during birth, you might be headed down a path you will regret. These phrases are NOT likely to be interpreted as refusal, though. When you hear yourself saying them, that’s a red flag that you need to pause. Even if you really feel like you just want to get it over with, take that pause. Ask for a minute to think, to talk to your partner, or to rest. Look within and decide what you need, then advocate for that. Let your doula know what you’re feeling. And get your birth experience back on track.

PS – all of that advice applies to “right column state of mind” during sex too, you know.

PPS – except the part about your doula. I don’t think anyone has a sex doula.

PPPS – If you were hoping for a script of ways to clearly withhold consent (aka just say no), stay tuned for an upcoming post. Because it turns out I can’t resist giving you that list even though I know it might not work.

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