Power Imbalance in Labor: Allowed vs Supported, Remember the Mother

How does an imbalance of power in labor happen? It is pretty common in the birth world for women to ask if their care provider will “allow” them preferences. A few examples are:

Will I be allowed:

• movement during labor and pushing
• to wait on spontaneous labor to begin until 42 weeks
• to eat and drink during labor
• intermittent monitoring

Why is the difference in language between allowed and supported so important? Why does it matter?

Support imparts dignity, and allow takes it away. Support humanizes. Allow dehumanizes. Support restores balance of power. Allow leads to imbalance of power in labor.

When we use the language of “allowed”, it is a small step toward forgetting the laboring woman is a human being with a right to body autonomy. Let me explain.

When allowing is the practice instead of supporting, it can become automatic to perform procedures without first asking permission or giving the right to informed consent.

Here is an example of how quickly allowing vs supporting can lead to an imbalance of power:

“It was very important for the laboring mother to have freedom to change positions during pushing and that her modesty be protected. Her care provider said she would “allow” her to push in whatever position she wanted and honor her wishes for modesty.

It was time to push; the care provider demands the mother push in stirrups. May her legs be supported instead? Yes, but do not put them down. No sheet was allowed for the mother’s modesty.

In the end, this care provider’s “allowing” was not supportive of the mother’s preferences. The mother’s authority over her body took second place to her care provider’s preferences. There was an imbalance of power.”

The care provider delivered the baby. The patient and baby were physically healthy. Healthy baby, healthy mom” is what matters.

Ummm….not so fast

Dear Care Provider, It did matter to the Person the body belonged to. The betrayal of Support she felt left her with trauma. Did you forget about the person in the body? Was she “allowed” a choice? Would she be supported if given one?

We can do better.

Dear Laboring Mother, This is your birth. Your body belongs to you as do your birth preferences. It is a privilege to support you and your preferences.

Let me say that again:

It is a privilege to support your preferences and your birth; You allow US into your sacred birthing space, onto your holy ground.

Those present are not there to allow you to have your wishes. We/they are there to support your preferences. This is Mother Friendly care.

I am repeating myself, I know. You are worth it. Your labor is worth it. The way your baby is born matters.

Listen to your care provider. If you have doubts about their support of your wishes, trust your intuition. Not “allowing” may begin a cascade of interventions that leads to trauma.

Infrequently, interventions are necessary. They should only happen after full informed consent, after an understanding of risk vs. benefit, and when chosen out of your knowledge (not out of feeling no choice).

Your voice deserves respect and validation. Your birth is sacred. Your birthing space is holy ground. Let’s protect that space.

Never forget, you and your birth are worth it.

For more information on birth trauma, visit Postpartum Support International.