I am frequently told stories by clients, or witness conversations between pregnant people and their care providers that perplex me. On one hand, care providers often seem to feel they have a duty to ensure my clients comply with the care pathway they deem to be ‘appropriate’. On the other, my clients seem unable to work out how to disentangle themselves from care that feels anything but appropriate for their physical or mental health.
There is a power dynamic at play here, and anyone who is either giving or receiving maternity care – or any healthcare for that matter – needs to understand what impact this power has on them as service users and what responsibility goes with this power as care providers.
Perhaps, to even up the balance a little, when we are talking to doctors and midwives we could remind ourselves that we already have a lot of the skills we need to make active choices – choices that suit us and choices for which we do not need permission. We can remember that our choices do not need to be justified or explained if we don’t want to.
Choice in maternity care could be likened to browsing in a shop. Sometimes, we wander into a shop on a whim; looking, maybe touching the products, perhaps even smelling them. We may like what we see, or already be realising these products are waaaaaay out of the reach of our purses. Often, a shop assistant will say ‘can I help you?’
A variety of thoughts and feelings might be stimulated in those seconds before we respond. Sometimes, if you’re anything like me, you might feel judged by the shop assistant, especially if you are in an expensive clothes shop and you’re wearing your tattiest jeans and that T-shirt, with what you have just realised is probably your lunch, smeared down the front. Most probably my response will be, ‘just looking thanks’ as I make a hurried exit.
Once, in a rather fabulous clothes shop in London I was a fingering a beautiful silk scarf. The shop assistant didn’t ask if she could help me. She just said, ‘beautiful, isn’t it?’ You know what, if I could have afforded it, I would have bought that scarf there and then. Her warm, genuine smile made me feel safe to say, ‘oh, it’s far too much for me to justify, and really not very practical, but yes, it’s really beautiful!’ I left knowing that one day, when I did have the money, I would go back to that shop, not just because I loved their wares, but because that assistant, with her words, facial expressions and body language, made me feel safe and made me feel like her equal.
Sometimes, we go shopping for a reason; with a necessary purchase in mind. These days, there is almost always a lot of choice and it can feel pretty overwhelming. Recently, our fridge broke down. So I went to the local Currys and surveyed the plethora of products as far as the eye could see. I found the fridges, and did a bit of random opening and closing of doors and looking at price tags.
Along came the salesman. I always find these interactions interesting. In these interactions, both parties have information that is pertinent to an eventual sale. Some sales people realise this, and some don’t.
‘Can I help you?’ he said. ‘I hope so’, I say. ‘I need a fridge, and fast, I’ve got a cool box of food slowly warming up at home and a broken fridge waiting for the dump’. And here it was; the request for information that was important to me:
‘Great, how much are you looking to spend?’ ‘Are there any features you’ve seen that you’d particularly like included?’ ‘Have you seen any models that you particularly like?’
Ahhh, how nice it feels to be asked what is important to you. How good it is to have someone ask what your personal parameters are – what feels possible and what is impossible, with no judgement attached. How refreshing to be asked what my wishes and desires are!
I asked about a couple of models I was interested in. In true doula style I included questions about the pros and cons of each model and we had a productive conversation that included him making sure I was aware of other models that were not on display in this store. I appreciated him ensuring that I knew what all my choices were. He got the sale. I hadn’t felt ‘sold to’, just supported in my decision-making process. 5 star service!
Some purchases are even simpler. We know exactly what we want. Because this is what we have bought before and it has worked for us or given us pleasure, or because we have done our research, talked to someone we trust or just ‘know in our bones’ that this is the product that will solve our problem or suit our needs. We merely need to walk in, pick up the thing we want, pay and leave. We do not need, or desire to have a conversation with a shop assistant about why we are buying said product. Nor do we need to justify our decision or ‘prove’ we are choosing safely or appropriately. We know what is best for us and crucially, we are grown up enough to take responsibility for our own decisions.
Sometimes, we just need to know one piece of information: ‘is this the model that has the ice-maker?’…’Great, ok I’ll take it’. In these situations we don’t appreciate up-selling or persuasion to change our minds.
It’s not nice when we feel ‘hard sold’ to, is it? The car salesman who blinds us with jargon, the double glazing salesperson who won’t leave til you sign, the woman on the make up counter who shames and judges you into buying that expensive foundation. How would you feel if a shop assistant started telling you which fridge to buy, or neglected to tell you about the other brands or types available?
And imagine, just for a minute, what an outcry there would be if doctors started telling us our babies might die just because we are exercising our rights to make a choice…oh, wait….
Now I am aware that having a baby is not like buying a fridge. The decisions and choices you make along the way have the potential to have hugely more far reaching consequences. I completely understand why some people might feel safer just putting themselves in the hands of their care providers, without questioning or having an opinion on what is right for them. But many of us have clear idea of what is healthy and appropriate for us and our babies and we are ALLOWED to have opinions about our care.
So perhaps it might help to remember that all health care is an offer. All suggestions by your care providers are just one product on the shelf. There are almost always alternatives. Productive and healthful conversations can ensue when ‘maternity customers’ ask questions. When it feels like this doctor or midwife is only offering us digestive biscuits or fridges without a wine rack, we deserve to know what the alternative are. Because it’s not just about preferring chocolate bourbons – you have information that means you may know that the bournon choice is actually safer for you, whatever your care provider thinks.
Remember, you are absolutely within your rights to say, ‘just browsing thanks’, ‘no thanks, that’s not for me’, ‘what else have you got?’, ‘What are the pros and cons of this one?’ or ‘I’ll take this one, please’.
Useful analogy? Or angered by my words? Whatever you think, I welcome your comments, so leave me your thoughts below.