This post was most recently updated on August 11th, 2021
‘She’s so kind, she spent 20 minutes telling me about why the induction is the best choice. I should do it really. I wouldn’t want to disappoint her’.
‘He was so gentle and caring and understanding. I’m sure what he says must be for the best’.
‘She’s told me that it would be dangerous to stay at home…but she was really kind and explained that the Delivery Suite isn’t so bad, really’.
‘He said he wouldn’t let his wife do that and he looked so concerned we didn’t want to worry him anymore, so we agreed to his recommendations’.
‘She said that she had done that when she was having her baby and it had all gone wrong. There were tears in her eyes. She really cares’.
‘She reminded us what a precious baby this is and after all the trauma we’ve gone through to get this far…she’s right, a healthy baby is all that matters’.
‘He looked after us so beautifully last time. I owe him so much’.
”He listened so beautifully to all our concerns and answered all our questions and reminded us that it’s silly to be thinking about my experience more than the safety of the baby and he’s right of course, we wouldn’t want to do anything risky’.
These are the kinds of things I hear parents saying quite a bit and they always remind me that being kind is just not enough. Meaning well is just not enough. Smiling and speaking gently is Just. Not. Enough.
There is a lot of talk in health care about compassion. And so there should be. It should pretty much be a core quality of anyone working in a caring role. Compassion means having a deep understanding and sympathy for another’s suffering. It also means wanting to do something to fix that suffering and take it away.
The problem is, compassion on its own can be a problem. If we believe we can make this all better, if we believe we know better, if we can’t bear to see present or potential future suffering, if even the idea of risk is frightening, then compassion can be dangerous.
Compassion needs to be tempered and balanced with empathy. The ability to enter into another person’s feelings, to see the world through someone else’s eyes. It is this ability that allows us not to get caught up in our own emotions and not get swayed by our own assumptions as to what might be right or wrong for this person. It is empathy which allows us to step outside of ourselves, just a little, and make space to really listen – and more than listen, understand WHY someone might feel the way they do.
So my plea to you wonderful, compassionate practitioners out there, whether you are doctors or midwives or nurses or lay supporters like doulas: Please try not to coerce with your kindness. Is this mother doing as she’s told because you’re so kind and she doesn’t want to upset you, or is she making a fully informed decision? Are you laying YOUR stuff on her or are you truly holding the space while she looks at the benefits and risks of all her options and then follows her heart? True kindness and care means trusting that those we care for can make safe, appropriate decisions for themselves, even if we disagree with them.
If you are a new parent navigating maternity care, I will remind you that you have the right to make decisions about the way you give birth and parent without being coerced. Coercion and persuasion can take many forms, but watch out for coercion through kindness, patronising platitudes and paternalistic persuasion.
If you’d like to continue this conversation, why not join me (Maddie), Verina Henchy and Emma Ashworth for our workshop for birthworkers – a session to ensure you are au fait with the law around maternity rights and tooled up to provide the best support to your clients. Book here: https://developingdoulas.co.uk/product/consent-rights-in-childbirth/
Well said my lovely Niece x. I do the same in my healing work ie empathise but tis rather important not to get emotionally involved as well. And yep listening is the key because letting the client do the talking is in itself an excellent method self healing for them.
For all the earnest talk about “informed consent” by birth professionals and birthing supporters in the community who are often exclusively focused on natural birth, when women sometimes do go on to require intervention, they frequently seem bewildered, uninformed and crushed by the difference between their expectations and the situation at hand. I can do as much as possible to provide informed consent in a neutral and empathic matter at the time, but as all of us well know, certain situations in labour and delivery require urgent action.
They have also been given suggestions for avoiding intervention – which is good – but without also being told that these may not work. Avoiding epidural anaesthesia and staying mobile may aid progress and help to avoid a malpositioned baby and instrumental delivery… But it may not. Yet it seems that this is where education as provided by a vast number of sources stops, again leaving women thoroughly unprepared when the obstetrician comes to recommending delivery by forceps.
It seems to bump up against the popular theory of ideal visualisation and choosing not to think about anything “negative”. If it were up to me, I would include relatively detailed information on what forceps are, why they are sometimes recommended and what the risks and benefits are, so that in a situation of fetal distress a woman knows “right, that is what is being referred to” rather than have to explain everything from scratch during a pressured and time-dependent situation.
Education is the answer imo. I regularly presented antenatal classes and tried to cover all possible outcomes with the facts rather than opinions and emotions on my part. Forceps, ventouse, cannulas, amnihooks, fetal scalp electrode, pinnards were all passed around with time for questions. Ultimately once given the information parents need to educate themselves and make their own informed choices. That is what a parent continually has to do to bring up a child responsibly after all. Of course the NHS budget no longer covers anything that involves health promotion type activities and concentrates on the ‘fire fighting’ aspect of health.
Do you then explain the possible risks of forceps delivery? Including long recovery time, potential internal damage? Risks to baby? Present both sides of the picture?? How about infantising women – this drip will get those contractions going nicely, or how about, you’ll never cope with the pain of induction, so why don’t you have an epidural at the same time?? Informed consent – means exactly that and not painting a picture that leads a woman down a path that a HCP wants them to follow without the true picture of both sides being painted.
I find coercing women with kindness is more unfair and leaves them even more traumatised and lets face it in the weeks and months and sometimes years that follow – the “kind” person is usually long gone.
Love this article. This is a reality for some women who I hear all about how they HAD to have X or Y intervention and it basically comes down to how they felt about the caregiver, not an informed decision. @TomPettinger, I completely agree with the point you make and I think you are emphasising the lack of informed consent from the pro-intervention perspective which is what informed consent is all about…info BOTH for and against but I wonder if the point was missed with regards to HOW this information is delivered?