11. "You do not have my permission."
[Editor's note: This article contains phrases to use in difficult situations, which may be triggering for women who have experienced mistreatment in labor or birth-related or sexual trauma.]
We recently shared the findings of a study published in the Reproductive Health journal that found that one out of six women report being mistreated in labor. The study authors wrote that mistreatment comes in the forms of "loss of autonomy; being shouted at, scolded, or threatened; and being ignored, refused, or receiving no response to requests for help."
This study broke our hearts. Your responses to it enraged us. So many women commented that they had experienced mistreatment during their births. In an effort to start to make things better, I have created this list of phrases to use if mistreatment becomes a part of your story.
But before I do, a disclaimer: I fear that by providing you with phrases to say, there is an implication that the onus of respectful care is on you. It is not. It is the moral and professional obligation of those caring for you to treat you well, and failure to do so is their deficiency, not yours.
With that in mind, here are 17 phrases to say if you are being mistreated in labor:
1. "It is really important to me that…"
Whether or not you have written a birth plan, your desires for your birth are incredibly important—don't hesitate to communicate them to your team. So often providers get caught up in the routine of how things usually happen, that we don't think to ask what specific requests you might have.
A few examples might be:
- "It is really important to me that you help me do immediate skin-to-skin with my baby if it is safe."
- "It is really important to me that you remember that my mother developed preeclampsia during her labor, and I am worried that I will too.
- "It is really important to me that you use ze as my pronoun."
- "It is really important to me that you keep the room as quiet as possible."
2. "We haven't met yet. Who are you?"
Hospitals are busy places, with many people working in them, and it is very possible that you will feel this during your birth. Every person that enters your room should 1. knock and 2. introduce themselves. If they don't, ask who they are and what their role is.
And, if you do not feel comfortable with their level of skill (i.e., having a student nurse place an IV in your arm), you can decline their care.
3. "Is this evidence-based?"
Brace yourself for an upsetting statistic: It takes an average of 17 years for new medical findings to make their way into clinical practice.
Now, this isn't all bad—certainly we want to verify new findings before implementing them, especially when they are big changes. But there does tend to be a "this is how we do things" approach in medicine, which means people receive care based more on "what we've always done," and less on what the research says we need to change.
If your provider tells you they think a certain intervention is necessary, it is okay to ask why. Try this:
- Is this evidence-based?
- What are the benefits?
- What are the risks?
- How much does this cost?
- What happens if we do nothing?
4. "Please explain before proceeding."
You may not love receiving tons of medical details, and that is, of course, completely fine. I had a client recently who tends to faint when blood is discussed. But do know that you can ask for explanations for all tests and procedures if you want them.
In addition to the questions above, try asking: "Please give me an overview of the steps you will take during this procedure."
5. "I need some time to think about this."
Labor is intense, and often in the heat of the moment, we say yes to something that we later wish we hadn't. It is perfectly fine to ask for a few minutes to process what you've just heard and decide how to feel about it.
If things are emergent and require immediate action, your provider will let you know.
6. "Please call the translator."
Translator services are almost always available for people that speak languages other than the one being used by your provider. Unfortunately, so often providers will think, "Oh, this is just a quick thing. I don't need to call the translator service for this."
According to LEP.gov, "All recipients of federal funds and all federal agencies are required by law to take reasonable steps to provide meaningful access to limited English proficient persons." And yet, a 2015 study found that over 65 percent of hospital patients who had limited English language proficiency had no documented usage of translator services during their stay.
If a language difference is preventing you from fully understanding what your provider or nurse is saying, you have the right to insist that translator services be used, every single time they speak with you.
7. "This makes me uncomfortable."
It is okay to send a loud-and-clear message about the behavior that you don't like.
Some examples might be:
- "It makes me uncomfortable when you tell me that I am not doing a good job just pushing."
- "It makes me uncomfortable when you ignore my partner, who is sitting next to me."
- "It makes me uncomfortable when you laugh at my birth plan."
8. "I'd like to discuss this in private."
You are entitled to confidentiality throughout your birth. If someone starts asking you personal questions or disclosing personal information in front of other people, you can remind them of your right to privacy, even if it results in an inconvenience such as finding a private room to speak in.
9. "Please lower your voice."
You should not be yelled at during your birth. Not ever.
10. "Please ask for permission."
I cannot tell you the number of times I have heard providers say, "I am going to check your cervix now." In other words, "I am going to put my fingers in your vagina now."
This is not acceptable in any circumstance, birth-related or not. Your cervix, your vagina, your body.
Instead, the conversation—not demand—should start like this:
"I'd like to do a vaginal exam to assess whether your cervix has dilated since we started Pitocin. Is that okay with you?"
11. "You do not have my permission."
If someone bypasses the request for permission, you have the right to state outright that they do not have your permission to proceed.
12. "I'd like a chaperone in the room."
One of the primary people who taught me to be a midwife was a man (male midwives are also called midwives). Every time he did a pelvic exam, he requested that a female staff member come into the room to serve as a witness, to help the patient feel more at ease.
You can request this—and not only if the provider or nurse is a male. If you feel that one person on your team is particularly problematic (for any reason, including the tone in which they speak to you), you do not have to be alone with them.
13. "I would like another provider/nurse to care for me."
If your provider or nurse is not treating you respectfully, ask for someone else. It may feel awkward, but remember that you are the customer here. You do not have to "deal with" someone who makes you feel uncomfortable.
14. "I am calling 9-1-1."
This one is reserved for situations where you feel that the care you are receiving is putting your health or life (of that of your baby) in danger. If you are reporting dangerous symptoms (difficulty breathing, severe headache, severe abdominal pain, heavy vaginal bleeding, the urge to harm yourself or the baby, or something else that is very concerning to you) and being ignored, call 9-1-1.
15. "I'd like to speak to the patient advocacy department."
Most hospitals have a patient advocacy department to support patients in understanding their rights. Ask to speak with them if things start to feel off.
16. "I am making an appointment with a therapist."
If you were mistreated during your birth, you may experience emotional distress afterward. Mama, you do not have to go through this alone. A therapist can help you process your experience so that it does not continue to cause you pain.
17. "I'm calling my lawyer."
In addition to emotional support, you may find that you would like to take legal action.
It is my sincere hope that you will not need a single one of the phrases. But mama, if you do, I cannot emphasize enough that it is not your fault and that you are not alone.