Mothers are often expected to be joyfully self-sacrificing.  When I taught college students, I was perpetually surprised that they saw Shel Silverstein’s book The Giving Tree as a beautiful allegory about the satisfaction that mothers feel in turning themselves from thriving, powerful, productive beings into stumps in order to satisfy the whims of their children.

Pregnancy is a training ground for this.  Pregnant women are expected to give up autonomy as others work in what they feel are the best interests of the fetus.  If women don’t comply, they are punished.

Legal punishment of pregnant women has been extensively documented by National Advocates for Pregnant Women , but the conditioning of women to behave passively and properly often operates in much less formal channels.

Take popular sources of information on pregnancy, birth, and health.  Many discuss what a woman might or might not be allowed to do or what hospitals/health practitioners may or may not let her do.

For instance, a Web MD article on labor says,

“As your contractions get stronger, you may…not be allowed to eat or drink. Some hospitals let you drink clear liquids. Others may only allow you to suck on ice chips or hard candy.”

It is not illegal for a woman to eat or drink while pregnant.  In fact, a Cochrane review on eating and drinking in labor concludes, “women should be free to eat and drink in labour, or not, as they wish.”  So what is the reason for having a hospital policy determine what a laboring woman will be “allowed” to eat or drink?

Another WebMD article provides a list of questions women should ask about labor and delivery.  These include:

  • Are showering and bathing allowed during labor?
  • Does this birth center/hospital allow water births?
  • How many people are allowed to be with me during labor and delivery? How many people are allowed to be with me during a cesarean delivery?
  • Are eating and drinking allowed during labor?
  • Is video taping allowed?
  • Can my partner cut the umbilical cord?

Here’s a quote from the Mayo Clinic’s web article on vaginal birth after cesarean (VBAC):

“It’s also important to keep in mind that some hospitals don’t allow VBACs. Anesthesia must be available at all times in case a C-section becomes necessary, and not all hospitals can afford this luxury. Talk to your health care provider early in your pregnancy to make sure VBACs are allowed where he or she does deliveries.”

What they don’t mention is that is is not legal to force a woman into a cesarean against her will. (And why would anyone give birth in a hospital that was not equipped to do an emergency cesarean?)

Still another WebMD article on labor and delivery says,

“If an emergency arises, your doctor has a responsibility to ensure both your safety and your baby’s safety. You may still be allowed to share in some decisions, but your choices may be limited.”

When does a woman give up her right to make decisions about what happens to her body?  What happens if she chooses to make her own decisions anyway?

Websites also present what health practitioners might or will do to women in labor or giving birth, without presenting these interventions or procedures as things a woman can choose or refuse.

Here’s the Mayo Clinic on amniotomy, which can cause labor to become more intense and painful and raises the chance that the woman or her infant will develop an infection:

“If your health care provider believes the amniotic sac should be opened during active labor — when your cervix is at least partially dilated and the baby’s head is deep in your pelvis — he or she might use a technique known as an amniotomy to rupture the membranes. During the amniotomy, a thin plastic hook is used to make a small opening in the amniotic sac. The procedure might cause some discomfort.”

Nowhere does it say that this should be discussed with the person who will undergo the procedure and face the risks it involves (this is not say there are never good reasons for doing an amniotomy, just that this is not a decision that should be made at the sole discretion of a person not actually getting the amniotomy).

In an article on poor treatment of women during labor and birth, Henci Goer quotes an obstetrician who says in his written materials,

“The decision as to whether and when to perform [a cesarean] is made at my discretion and it is not negotiable, especially when done for fetal concerns.”

ACOG actually has a committee opinion addressing women’s autonomy.  In what I have found typical for ACOG, the official policy is more liberal, flexible, and supportive of women’s autonomy than most actual practice seems to be.  The committee opinion states,

“Efforts to use the legal system to protect the fetus by constraining pregnant women’s decision making or punishing them erode a woman’s basic rights to privacy and bodily integrity and are not justified.”

In reality, when women resist a practitioner’s interventions, question their recommendations, or do not behave in the way the practitioner desires, they are often threatened or punished, both legally and more infomally.

Goer notes, “Women frequently are denied their right to make informed decisions about care and may be punished for attempting to assert their right to refusal. ” One women she interviewed said,

“[The obstetrician]  informed me that IF I got an epidural and IF I made progress over the next two hours, he would let me continue. If not, he would [cesarean] section me stat.”

A medical malpractice site in Illinois documents a case of an obstetrician who felt entitled to punish a birthing woman in a number of ways:

“[Dr.] Pierce, who was filling in for [the plaintiff's] doctor, arrived at the hospital four hours after she got there, scolded her for not calling first, and wouldn’t give her any pain medicine. He is accused of telling a nurse that the patient deserved to feel pain for failing to let them know that she was coming to the hospital.”  (The physician also forced the woman to birth in an awkward position, told her to shut up, and forced her husband to hold her down while he put in stitches, among other things).

There was this widely documented case:

A woman in New Jersey refused a c-section during labor. She gave birth vaginally, and the child was healthy. But the baby was taken away and placed in a foster home, because the woman allegedly “abused and neglected her child” by refusing the c-section.

Anecdotes abound in mothers’ discussions on various websites. From the What to Expect forums:

“Actually I have had a bad experience with my first child. I brought a birth plan and it seemed like the nurses were punishing me for it! They were super rude and making really mean comments.”

“I have heard stories of people and even read about these things happening in some of the books I have read that OB drs and labor nurses will often be rude and mean to those coming in with birth plans. That nurses will often do things to punish women who come in with birth plans such as constantly bugging them about doing things they said they don’t want to do, messing up IV’s on purpose so it hurts more, insisting on monitoring. My cousin even had a nurse tell her that if she didn’t submit to what the drs and nurses wanted, they would strap her down to the bed, give her a sedative, and report her as mentally unsound so they could hold her baby for 72 hours in the nursery away from her with even the possibility of them being able to take her baby away entirely!”

From Mary-Rose MacColl’s website:

“Some of the women I met had appalling experiences and sometimes chilling stories to tell about contemporary maternity care. Some were punished or abused or neglected by obstetricians or midwives just because they wanted something their carers didn’t like – to hold their babies straight after birth, to save their cord blood, or – like the woman Freedman met at the barbecue – to avoid an injection of synthetic oxytocin to deliver the placenta, or not. “

Pregnant women are human beings who don’t leave their own humanity at the door while they incubate a fetus.  But they may be punished for acting like it.

 

See also: The Pregnancy Outcome Blame Game

 

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