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Your Body, Your Birth, Your Choice

As a birth worker, I am privileged to be present at one of life's most intimate and vulnerable times. My role is to help navigate the journey of new parenthood as my clients gain self confidence. The best way for that confidence to grow is by claiming ownership of your birthing body, what is known as having bodily autonomy.

At its core, bodily autonomy is about having the deciding vote on what happens to, within, and around your body and personal space.

I know that sounds like a big word, so let's break it down. Autonomy is a kind of independence and freedom from outside control or coercion. Still too technical? At its core bodily autonomy is about having the deciding vote on what happens to, within, and around your body and personal space. It means being able to move through the world belonging only to yourself, with the freedom to make the choices that are right for your body.

While bodily autonomy is something that is threatened in many aspects of our daily life, the experience of being pregnant can present a unique challenge. Not only is your body quite literally being changed by the baby inside of you, there is an increased reliance on outside professionals to keep your body healthy and well throughout the pregnancy and as you give birth. We tend to put more value on the information that our doctor, or even the internet gives us to make decisions.

With all of this in mind, I hesitate to approach my doula role as an "expert" because I truly believe that you are the expert in your own body. Instead, I hope that as birth workers we can promote bodily autonomy, where clients feel able to trust themselves to know what is right for them at each moment in the childbearing process.

So, what does that look like in practice?

The greatest tool we have to promote bodily autonomy is consent. Okay...okay...I know. Another loaded term. When I say consent, I'm talking about a consent mindset. Approaching a client relationship with a consent mindset means allowing your client to set boundaries for themselves. You make space for your client to tell you how they would like to interact, and what makes them feel most comfortable. You may work with them to navigate situations where they feel uncomfortable, and help them discover ways to stay firmly rooted in their power.

A basic way I use this consent mindset with birth clients is to always ask before touching them in any way. Hugs, massage, positioning in labor, counter pressure; I always get confirmation that my touch is welcomed before proceeding. These may seem like fairly obvious boundaries, but some are not so clear. I find it is also important to seek consent before discussing topics that could be emotionally triggering for clients.

For example, when a past client disclosed on her intake form that she had experienced a miscarriage in the past year, I made a mental note that we should discuss the experience at some point in preparation for this birth. However, before starting that conversation I asked, "Are you comfortable discussing pregnancy loss today? Is it something you'd like to talk about with me?" That question gives her the power to consciously engage in the conversation, and prepare herself from any pain the discussion might bring.

As a doula, I also help prepare my clients to own their bodily autonomy with other care providers who may not be consciously working with a consent mindset. Let me give you an example: During a hospital birth, my client was being monitored every 20 minutes for high blood pressure. This meant that an annoying BP cuff was squeezing her arm on and off for hours. It was creating irritation and I noticed she was uncomfortable with it but hadn't said anything to the nurse. After the next reading, I suggested we take it off. She looked at me confused and said, "The nurse said they have to monitor, I have to wear it". I helped her unvelcro, massaging her arm and then 20 minutes later we put the cuff back on briefly to get the reading.

While this is a minor illustration of bodily autonomy, it highlights the amount of power over us we give to medical practitioners during pregnancy and labor. While taking off a BP cuff is a small act, it gave this parent a sense of control over her experience and made her an active participant in her care, not a subject of hospital protocol.

Unfortunately, I have been witness to much more egregious violations of birthing parents' autonomy, from nonconsensual cervical exams to coercive labor inductions. It is my hope that as birth workers we can support our clients to ground themselves in their autonomy and power, to trust their bodies, and the rely on their intuition as a guide so that in small ways and large ones they may have birth experiences that empower and affirm their unique strength.