where she wants

In the United States, there is a certain attitude in our birth culture that hospital policy and physicians always know best. It seems that we've forgotten that women know how to give birth and that the laboring woman is no longer the authority of her own body. Just look at the language: "They won't allow me to eat in labor." "My doctor let me move around." "I can refuse that?" Without really knowing it, women often judge their birth experience based on whether they were allowed to follow their own intuition or not. A woman who gave birth over a decade ago told me that she wanted to be upright and moving during her labor but the hospital staff actually forced her to stay in bed. Unfortunately, this is still happening today. Many women are also not taking personal responsibility by becoming informed about their rights.  (In all fairness, there are many doctors, midwives, nurses, and hospitals doing excellent work to bring autonomy back into the birth world. There are those who are advocating for individualized care instead of blanket routines. There are those who understand that no one delivers babies, but that women give birth. There is also a shift among women as they are becoming more informed and vocal about their options and rights.)

As a doula in the US who has only done hospital births, much of what I do is to help a woman achieve her goals and maintain her rights. Without a voice reminding a woman that she has every right to get up and move around as she pleases, it can be difficult to not just automatically fall into a cascade of routines. There have been situations when my only role as a doula was to comfort and support the mother because the hospital already honored her wishes, but often times my role includes reminding the family of their right to refuse unnecessary interventions. When I was in Haiti working at the birth center, I watched midwives function completely different than what I'm used to in the American hospital culture.

For the three births I was in attendance for, there was only a total of three internal vaginal exams performed. One woman didn't have any, one had one, and the other had two checks. The midwives' view was that internal exams are invasive, can introduce harmful pathogens, and that a woman's progress often can be just as accurately determined by assessing things like her behavior. There was also a sense that having a woman lay down and be in such a vulnerable, unnatural state, would slow or impede labor. We often forget this in the hospital. I had a client in the states whose obstetrician came in early in the morning. The woman had finally relaxed enough during the night to get some sleep and was still asleep when the OB came in. The OB opened her legs, and broke the woman's water before she was ever fully awake and able to consent to what was being done to her (another person's hands in her vagina with a hook that looks like a crochet needle). As people in the medical field, we often don't think much about how a patient might view these things because we are just doing our job. However, the patient's experience, privacy, autonomy, and individuality was not lost in this small Haitian women's clinic.

The first woman who gave birth while I was there was walking around the waiting room in pretty active labor. It was late in the night and no one else was there except two other patients in their own rooms. As the contractions got more intense, she ended up on the floor in the waiting area. It became difficult for her to move and I could see that birth was very close. I asked the Haitian midwife, "Should we help her move into her room and get her on the bed?" The midwife looked at me and said, "She can give birth where she wants. If this is where she's comfortable, we will bring the stuff out here." Where she wants. If she is comfortable. Clearly, giving birth in a waiting room in a hospital isn't feasible, but it's her attitude that surprised me. It was surprising to finally see what respect for the woman's choices looked like in action. The staff of the clinic quickly got the birth supplies and a stool out into the waiting room. The midwife sat on the hard tile floor. The woman was upright and in a position that felt natural to her. She wasn't forced to move for the convenience of others. Her labor wasn't impeded by invasive and unnecessary exams or interventions. Everyone around her trusted that she could do what her body was meant to do. There was skilled personnel quietly nearby to facilitate and act in the case of an emergency, but to only intervene when necessary- a model that has proven to work in many countries. It was so refreshing and honoring to be a part of culture that so respected and empowered the women that it served. Those three words have stuck with me, the epitome of the type of culture cultivated at Olive Tree Projects: where she wants.