Milli Hill is the founder of a positive birthing movement that aims to empower and give agency back to birthing mothers. Below is her step-by-step advice on what actions to take to assert control over your own birth.
If you are a health care professional, midwife or doctor, it goes without saying that you can be part of the change. You can spend some time thinking about the part you play in the drama of the modern birth room, and challenge your own views and assumptions about how birth ‘is’ and how birth ‘can be’. You can work towards more personalised, individualised care, with more eye contact and less screen contact. You can talk with your colleagues, openly and honestly, and you can check up on your personal biases and on your privilege and how this may cloud your perspective. Most importantly, you can raise your empathy game, asking yourself on a moment by moment basis how the women in your care actually feel. If that last bit annoyed you or made you feel defensive, bingo: you are not currently doing this enough. If you’re really mad at me now and absolutely insistent you are the most empathic practitioner you can be, then – keep doing what you are doing. I believe you.
But I’m not talking to commissioners, politicians or obstetricians in this book, although I hope they are reading and listening in. I’m talking to women who birth: those who are pregnant, those who have had one baby and might have another, those who are hopeful to be mothers one day. You are the ones who have to actually perform the seemingly impossible, mind-bendingly miraculous, utterly everyday task of bringing a new human into the world, out of your very own body. You are the ones who deserve the best possible chance to enter the tunnel of labour or birth feeling tough and supported, and emerge the other side feeling triumphant, powerful, ecstatic, energised, proud and full of confidence in your abilities. You are the ones I care about, whose birth stories keep driving me to repeat the mantras: birth is a feminist issue, birth can be different, birth can be better, women matter too. And no, you cannot shoulder all of the responsibility to improve birth, or even to improve your own birth. Women may have superpowers, but change often happens painfully slowly, and it may take years or even generations to turn birth around and get it back onto a course that truly serves every woman as an individual. But you, you are where this change starts. The change starts with you. Here’s what you can do.
Be an adult
Refuse to be infantilised, patronised or mansplained in your maternity care. Behave in the same strong grown-up way that you behave in other areas of your life, such as your career or your relationship. Watch out for signs that your status is shifting away from ‘woman’ and towards ‘girl’ – this might be signs from you such as feeling small, not feeling heard, feeling petulant, feeling like you are ‘being naughty’ – or want to be. Or it might be signs from others that they are trying to place you in this role, such as calling you a ‘good girl’, talking to you in a stern or infantilising way, or placating you with trivialities such as ‘this will all soon be over’. If you feel this happening, try to centre yourself and remind yourself that you are a grown-up. Demand proper explanations, ask for evidence, ask to have risks and benefits clearly explained, and, if necessary, remind others of your human right to be the key decision maker in the birth process. Vote with your feet if you need to and change care provider – even during labour you can ask to be attended by somebody different. Remind yourself that it is OK to be clear, strong and determined in your maternity care – in other words, stand up for yourself – just as you do in other areas of your life.
Know you matter
You are important, and your experience of birth is important. Refuse to let what you want and need be sidelined, minimalised or dismissed. Caring about yourself does not mean you care less about your baby. It goes without saying that you have the safety and best interest of your baby at the heart of everything you do. That’s a given – but what else matters? This will be different for different women – for example, you need to give birth where and with whom you feel safe, but this won’t be the same for everyone. Allow yourself to consider what is truly important to you. Speak these needs aloud. Write them down in a bullet-pointed list. If necessary, laminate it!
Birth plans are not pointless. They are a clear expression of what you want and need – this could only be pointless if you didn’t matter, and you do matter. For this reason, be extra wary of the motivations of anyone who insists on telling you that you are wasting your time. Make a plan, discuss it with your care providers, and ask them to document that they have done so. Creating your plan is a process in itself, during which you can consider all your many options and learn about your choices, and your rights. It’s a chance to think clearly about what you want to happen in every eventuality, not just in the ‘perfect birth’ (if such a thing exists!).
Build contingency and secondary plans into your birth plan, and remember that, as an adult, you are well equipped to cope with disappointment if you don’t get the birth you want. However, don’t be afraid to ‘shoot for the moon’ – visualising your ideal birth may help you to get it – and as they say, if you miss at least you will be among the stars.
Challenge the ‘language of permission’
Prick up your ears for any time you hear the imbalanced power dynamic of maternity care coming your way in a phrase like, ‘you are not allowed’ or ‘they don’t let you’. Remember: you are allowed. Nobody can tell you what you can or cannot do with your own body, and nobody can do anything to you and your body without your full permission. Knowing this does not mean you have to decline anything and everything or start a war with your care providers. It just means that you get to have that confidence and feeling of safety inside that comes from knowing that you are in the driving seat. If you hear the language of permission, call it out. Help confine this inaccurate way of viewing women’s maternity rights to the history books.
Know there is no right or wrong way to give birth Giving birth like a feminist means birthing your way, not my way or anybody else’s way. Different well-informed women will come to different conclusions about what is the best choice for them. There are no boxes to tick, or points to be given out. Conforming to one set of choices does not mean you qualify to be a certain kind of woman or be in a certain kind of club. You can mix your choices up, too – be a formula-feeding, elective-caesarean-choosing stay- at-home-mum or a home-birthing tandem-feeding high-flying city analyst. Refuse to be put into boxes and resist the ‘mummy wars’ – which are almost certainly driven by the media rather than women themselves. On the whole, women are usually open-minded and supportive of other women’s choices – we are all in the mother ship together and there is a certain kind of solidarity that comes from this somewhat wild and intergalactic ride. Drop the guilt – it’s your body, your baby and your choice.
Watch out for polarity
Polarity is a ‘Thing’ right now. Think politics. Think Trump. Think Brexit. Think pink and blue gender-coded kids. Think veganism, abstinence from alcohol, clean eating, the list goes on. Going to extremes has become the way it’s done, and birth has fallen into this trap somewhat. Dialogue about birth tends to become ‘birth wars’, with the ‘your body was made to do this’ brigade on one side and the ‘take all the drugs’ bunch on the other. Beyond these polarities are further extremes: all the medical help going, no medical help at all; freebirth, or elective caesarean, for example. Don’t get caught up in this. Be unique. Be an individual, with individual, specific needs. There is room for nuance in your birth choices. There is room for you to make decisions, and then change your mind. Maybe your body was made to do this, but it didn’t feel like it on the day. Maybe you thought you were made to do this, but in fact, you did have a genuine health issue that meant
modern medicine saved you or your baby’s life. Maybe you wanted all the drugs, but in the end you only had a few, or none. Maybe you weren’t coping in labour, and then suddenly, you were coping, and then you weren’t again. Maybe you hypnobirthed and yelled your head off from beginning to end. Maybe you hated some of it and loved some of it; maybe you were afraid, and lost control, and totally nailed it. Let birth surprise you – allow it to be complicated, real, and human.
Demand the best care you can get
Relationship-based care from a midwife you know and trust is the gold standard that every woman deserves. Ask for this. Raise your voice and say what’s important to you. If you have health complications that mean your care is obstetric led, then relationships are still important, so build them with your doctors, and try to get continuity too. If you cannot get the kind of care you want, keep asking – perhaps there is another way? Can you change to a different trust or hospital? What if you ask for a home birth? Do you have a nearby birth centre? Persist. Doors may open. Either way, consider hiring a doula or, if you have the budget, an independent midwife. If you don’t have the budget, get in touch with them anyway, as many have access funds or reduced fees for people on low income. Making conscious choices about your care will improve your chances of having a positive birth experience.
Think of other women too
Feminist issues need feminist activism. You may not be able to change things for yourself. Perhaps you have already had your babies, or maybe you feel you are banging your head against a brick wall in terms of the lack of choice currently available to you in your local area. Keep going. By asking for things to be different, you are paving the way for a different kind of maternity experience for women of the future. It is only when women ask for the unavailable that providers will begin to see just how many women want the very thing they are failing to offer. It is only when women complain about the care they receive that providers will hear their voices collectively getting louder, and harder to ignore. By saying what you want and don’t want in the birth room, and saying it clear and strong, you are doing not just yourself but women of the future a really big favour. That’s true feminism.
Finally, remember that while you cannot control birth, you can certainly influence it. It’s OK to try to do this, and it’s OK for your birth experience to be important to you. A healthy baby is not all that matters. You matter too.
Milli Hill, Give Birth Like Feminist