When I talk to women about birth the stories are varied but there can be some very common themes and terms such as ‘wasn’t allowed’ can feature very strongly. Women can sometimes feel restricted but birth assertiveness is important to say what you need, to ask questions and to gather more information.
I am passionate about women being able to move in labour, to get into positions to aid labour and to be more comfortable – being off the bed and able to rock, sway, sit, stand, lean and wander as you need to means that you can feel that you have more control, helping you to work with your contractions rather than battle with them, it means you can rest and conserve energy, it means you can be guided by your body to give your baby the space he needs do get into a better position and to ease his manoeuvre through the pelvis and down the birth canal.
Keeping a labouring women on a bed when she doesn’t feel comfortable there can mean she ends up feeling like a patient, to be told what to do and then feeling disconnected from what her body is asking of her. With an epidural, women usually need to be on a bed but you can move around on the bed, especially when it comes to birth and gravity is needed. So unless there is a medical need, the bed can be used as you need it – to lean against it, to rest on it and to be free to move about as you need to. And this includes when labour is induced and if a baby needs to be closely monitored.
I don’t hear it as often as I used to but I still hear it “all my plans to be active went out the window because I needed to be induced/my baby needed to be monitored”. I also hear of women who have laboured off the bed with induction and monitoring, I have supported women in labour who have stayed off the bed and I have done it myself: due to a heart defect my third baby needed to be monitored in labour – first with a belt monitor and then with a head clip and throughout I stayed either on a birth ball or standing and leaning against the bed.
Every midwife and every maternity unit is different – some are flexible and focused on being led by the labouring woman; others are more about following protocol and, from attending births and from talking to mothers, care can be inconsistent but women’s needs and expectations can be also be so different.
As such it is important to feel that you can be assertive, to say what you need to feel more comfortable, supported and better able to labour. Even the most intuitive, responsive and experienced midwife cannot read your mind, she is not going to always know what you need especially if a busy ward means she has to look after more than one woman in labour.
It is ok to say: I am going to labour here; I am eating; I need to wander; I need to focus; please rub my back; please don’t touch me; I don’t want to do that; I need quiet; I need to be cosy; I need to be naked; I need to just breathe; please don’t leave the room; please give me some space; I need pain relief; I’m ok as I am; please can we wait; I need reassurance; I am doing this.
It is ok to nest and to make that room your own, so you feel comfortable using it.
It is ok to stay off the bed if there is no medical urgency.
It is ok to be assertive and empowered, it is ok to have a voice.
Your midwife is a trained professional to support, reassure and guide when needed. Her experience means she can make professional judgements and step up when her clinical expertise is required. Your midwife is there to observe you, to make sure both you and your baby are healthy and safe, and to respond to your needs so you can birth your baby. Midwives are brilliant professionals who will work with you and support your needs when labour is straightforward and if it becomes more complicated.
And this is all backed by the Royal College of Midwives – the top ten tips for midwives includes: wait and see; get her off the bed; build her a nest; listen to her and be positive with constant reassurance
The thought of being assertive in labour can be challenging, there can be fear of taking control, there can be concern about causing upset but this is not about challenging anything. It is about feeling empowered and supported enough to say what you need in order to feel more comfortable, calm, safe and able. And it is about working with your midwife and asking for her support.
Labour can be amazing, brilliant and pretty magical but it can also be tough, raw and long – ask for what you need because it is too important not to.