Choice

This very moment you are demonstrating to yourself that you have the power of choosing. 

Among a myriad of other things you could be doing right now, you have made the choice to read this blog post so thank you!

If this is your first time with me, welcome and congratulations on deciding to try something new today. I hope I’ll see you again next week.

If you are familiar with my blogs, your decision is based on knowing that this’ll take you a few minutes to read. You know my repertoire and you know that it is very likely that you’ll be reading about massage, pregnancy, birth, midwifery, aromatherapy, babies, womens’ rights, freebirth, postpartum and the wider impacts of industrial maternity systems as I see them. You never know, I might even throw in some controversial opinions or some of the many seemingly random topics that occupy my busy mind. 

Perhaps you’ll agree with me, perhaps you’ll not.

You get to decide whether you react to how you feel about what I am saying or respond.

Maybe you contact me to let me know why you think I’m wrong and we have a mutually respectful debate. That’s a response. Or you might go on a little rant to your friend about how outraged you are at my opinions and avoid reading anything else I publish in the future. You might even leave a disapproving comment on my social media, who knows. These are all reactions. My preferred reactions are of course likes and loves on social media. Laughs and wows are fine reactions, too. We all like the approval of others. By far my favourite responses to publishing my posts are the many DMs and emails I have had since starting this series of blog posts of people thanking me for speaking out and for saying what they can't. 

Regardless of what I want most to happen every week, I can’t control it. I can’t control you. You are free to choose to do whatever you want and I am free to either write these blogs or not and that’s just how it is. 

How would you feel if I told you that you always have freedom of choice in all areas of your life, no matter what? 

Are you finding yourself in agreement? Is your inner voice saying ‘of course I do!’ or are you thinking that a statement like this clearly exposes my privilege, my ignorance even? I mean not everything in life is as simple as deciding what to read. How can I be so flippant as to imply that your choice of reading material is in any way representative of all the choices you'll ever make? It is hardly a life or death decision, is it?

And, yet, it could be, who knows. I came across an article about how to keep bears off your property and out of your house recently. I hope this 'How To' will remain in the category of useless trivia but I can't be sure of what lies ahead. 

In the long run every decision you ever make defines the course of your life. Where you are at any moment in time and who you talk to, the things you learn, even the trivial ones, determine your trajectory. 

The little choices provide the pixelation for the big picture and you choose the colours.

Here's an example: Lena and Gerald and I went to a comedy gig last night. It was Laura Ramoso at The Limelight and if you don’t know who she is, check her out on Instagram (@lau_ramoso). Our choice to go and see her was a result of Lena sharing one of @lau_ramoso's reels with me. It was one where she impersonates her German mother. Lena tells me that Laura’s ‘My German Mother’ sketches are on point and I have to agree. Not only am I a German mother, I also have a German mother and in almost three decades of living in Belfast, I have been able to observe my own Germanness through the lens of Northern Irish culture. Our family is a mini melting pot manifested in our one and only daughter who sees me as her German mother. It’s quite funny, really and I often wonder what that would have been like, to grow up with a foreigner for a mother.

We had the most amazing time, the show was hilarious. Comedy, of course, depends a lot on the responses of the audience. The same show could tank with one crowd and have another in stitches. Laura Ramoso is a particularly brave comedian. She improvises with members of the audience a lot and this is what got me thinking even more about the impact of our choices and the amount of variables that can impact the outcome of our actions particularly when we are inviting other people into our business. One of Laura’s sketches depended on a stranger’s most likely response to being handed a particular object, she clearly had a script for that and, boy, it was funny. But I can think of a number of things that the random member of the audience could have done instead of going for the hook and I am sure so can Frau Ramoso. Laura had to trust herself in her ability as a comedian. I am sure she invested hours and hours of study and further hours of writing and then more hours of rehearsing. She knew she could carry off whatever came her way. She would be able to improvise no matter what direction the situation would take. What got me was realising that the impact of her choice to involve an outsider into her space depended on her ability to pull it off. It occurred to me that getting a stranger involved meant adding a variable. It meant she gave up some of her control to achieve a particular outcome and it worked. It worked because she was in charge of the situation. She was able to direct the events in the direction she wanted them to go. She also had a team behind her who took care of sound and lighting and who could have jumped in if Laura needed them to nudge the unfolding of the story back on track. But ultimately she was the main curator, she was the one in the spotlight and she had to surrender and accept the things that were out of her control. 

Laura Ramoso’s is in the business of making other people laugh, of course, but the same thing applies to every other business including the business of giving birth. There could be a huge pay off in inviting others into your space or you could fall flat on your face, each are possible. And in the example of doing a sketch alone on stage with the support of her own team versus adding a stranger to the mix the person most effected by how it would go was Laura. She was the main character.

I am using this analogy because the issue of taking responsibility for all of our choices comes up with my clients a lot. It is inevitable because of how many factors are at play now in an average pregnancy. There's also the story of 'informed consent' and women find themselves at a crossroads frequently.

When I was still a registered midwife I'd always say to women that the most important choice they'd make in their pregnancies was where they'd give birth. I used to elaborate on your different choices. 

'You can give birth at home, in a freestanding midwife led unit, in an alongside midwife led unit or in an obstetric led unit'. These were the words that rolled off my tongue at every 'booking appointment'. Of course freestanding midwife led units are more or less extinct and the alongside units are scrambling for business in an evermore medicalised environment. The only light on the horizon are the birth at home teams and the continuity of care teams that are sprouting up and I would really love to see their birth outcomes published on social media rather than the names and weights of the babies born within the team every month. Women deserve to know what induction of labour and physiological birth rates are in those teams. 

If I was still having these types of conversations as a registered midwife now, I would feel obliged to let women know that by choosing to have the kind of pregnancy surveillance that they are opting in to by booking in for pregnancy care they are likely to experience stress and fear in late pregnancy. I would have to tell them that it is possible if not likely that they will be exposed to attempts at coercion if they are at all feeling attached to the idea of having a physiological birth. I would have to point out to them that, though this is not for everyone, one of their options is to go it alone. I would signpost them to wild pregnancy and freebirth resources so that they can decide for themselves what they want to do. 

This is my message to women now and most women by far will opt to book in for routine care. Having made a conscious choice and opting in knowing that their chances of intervention are high, those women are happy to go along with what they are advised to do by their midwives and doctors or they are willing to advocate themselves. We talk about the fact that the midwives will have to offer the interventions, it is part of their job. Some midwives will be open and well informed about the evidence. They will have perspective on 'risk' and others won't. We talk about bias and I always openly declare my own bias and the resources I have used and evolved with over the last twenty years. Women examine their own biases and they choose from there. There's no judgement, least of all self-judgement and if it sneaks in, then we talk about strategies for practicing self-compassion.

The problem lies where women are unaware of how modern maternity care works. They could be very happy with everything up to a certain point assuming that they are waiting for labour to start, go in to hospital when it does, meet a midwife who will support them through labour and then give birth. They assume that caesarean sections are possible but less likely than a spontaneous birth and they are in for a rude awakening. 

I have many women sitting with me who get stunned by the system at around 36-38 weeks. That’s typically when they are told rather nonchalantly that they are being booked in for ‘a sweep next time’ or for ‘induction at term’. Others get caught in the headlights when they are told that the ‘baby is getting too big’ and they need to be induced within the next few days. Or the problem that they are 'too old' to carry their babies past ‘term’ might have escaped their attention through their entire pregnancies only to be railroaded within days of the prescribed induction date as was the case with a client a few weeks ago. Intuitively she felt that she should wait but she was afraid to go against medical advice. 

She was told by her doctor that waiting increased her baby’s risk of dying in the womb and that induction of labour was the solution. Risks and possible outcomes specific to induction of labour had not been discussed with her in detail. She was told nothing much about the process of induction of labour and the associated disadvantages. She was only told that induction increased her chances of having a caesarean section. The advantages of waiting were not explored with her and the disadvantage of waiting was presented to her as allowing her already massive baby to grow even bigger. This would further increase the risk to the baby. 

None of this is true. Induction of labour in healthy women has no effect on the rate of stillbirth (1) and the risk for a ‘big baby’ is not associated with the baby’s actual size but rather with the baby’s suspected size (2). In other words the providers add the risk by thinking a baby is big. 

I feel so much compassion for these mamas because the last few weeks of pregnancy are late in the game to be embracing all the variables and pixelations that have shaped your big picture thus far. The sooner in pregnancy you can get on board with an in-depth birth preparation program delivered by someone who sees all the factors at play and who is fluent in physiology and in medical pregnancy the better. If this is something that sounds good to you, join Tara and I for our signature program 'Born Through Yoga' on June 29th. 

The sense of responsibility that comes with declining an intervention often feels overwhelming to women but many of my clients have never really thought about the idea that opting in comes with just as much responsibility as opting out. 

Just like our comedian was going to have to carry off her show regardless of whether she opted to add another variable to the mix or not, so does every mother who ever gives birth to a baby. There’s no dodging it and we cannot predict the outcome. In all of our lives there are things that are out of our control and in order to have the resilience to cope with anything that life might throw at us we need to accept the fact that we don't get to decide our fate. We can only control our responses to the situations we find ourselves in and we have the choice to be brave enough to live from the heart and choose in truth to ourselves. 

The truth is that there's a worst case scenario with induction and there's a worst case scenario with waiting. We can't control everything, there are too many factors and we cannot possibly know the mystery of life.

What I do know is that regardless of what you choose in the context of most routine protocols it is most likely, by far, that your baby will be in your arms unharmed so try your best to cancel out the noise. Tap into your gut and choose without fear. Focus on the 996 babies out of every 1000 babies who make it through the entire pregnancy and birth.

Get perspective.

For instance you most probably drive your car with your baby in your belly. Do you focus on the worst case scenario associated with driving your car or do you look forward to arriving at your destination? If you ride a bicycle, your risk of the worst case scenario is higher, still. Do you think about it every time you cycle? Do you go for walks or ride the train? 

Birth is no different, don't overthink it. 

You are free to do whatever you want you just have to choose it. 

Even if it doesn't feel like it, you can say no thank you to induction of labour. You can ask for your doctors and midwives to provide you with evidence to support you in your decision making. You can say that you'd want to know what they can do for you instead of induction of labour. 

It is not selfish to consider your experience of your initiation into your parenting journey with this baby. How you feel about giving birth to your baby is going to be part of your, your baby's and your family's big picture forever. 

Got questions about any of my services or feel like sharing how you feel about the idea of free choice? Send me an email to [email protected]

References:

1. Dahlen, et al (2021). Intrapartum interventions and outcomes for women and children following induction of labour at term in uncomplicated pregnancies: a 16-year population-based linked data study. BMJ Open. 2021;11(6):e047040. Accessed via: https://pubmed.ncbi.nlm.nih.gov/34059509/

2. Big babies: The risk of care provider fear. Dr Rachel Reed. The midwife thinking blog. Accessed via: https://midwifethinking.com/2019/09/02/big-babies-the-risk-of-care-provider-fear/