Sunday, June 17, 2012

What are the basic needs of women in labor?

After panel 3 of the Human Rights in Childbirth Conference, the moderator abandoned the usual audience Q&A in favor of small group discussions. She challenged us to discuss one of the issues raised in the panel, then report back to the larger group.

I was sitting next to Jill Arnold, Chantal Gill'ard, and Britt Somebody (if it was you, please leave your full name in the comments!). Anna Verwaal's film had been the last item on the panel, and we first discussed why we resisted some of its emotional appeals. Then we turned to answering Michel Odent's question:
Now that we have discovered that newborn babies need their mothers, can we (re)discover the basic needs of women in labor?
I vounteered to be the spokeswoman. Here's what I reported back to the large group:


The four of us attempted to answer Michel Odent's question about the basic needs of women in labor. We enjoyed watching the film, but we found ourselves resisting some of its emotional appeals and its implicit assumptions that there's a right and a wrong way to give birth. We are searching for a series of truths or standards that hold true in all settings, that don't prescribe a certain way to give birth, yet that aren't so weak as to be totally useless.

Even if all women are given the most ideal, supportive birth setting possible, some women will still need medical intervention. So it's not solely about having a spontaneous, unmedicated labor. In addition, not all women desire or enjoy a "natural" birth or even a vaginal birth. Can we identify the basic needs of women in labor in ways that allow for a variety of birth experiences and a diversity of journeys?

We think we can. For those of you who like to think more left-brained, we came up with four key needs of all laboring women:

First, a right to autonomy.

 Second, a right to informed consent and refusal and the necessary information to make those decisions.

Third, real options to choose from. Autonomy and informed consent/refusal cannot exist without choice.
Fourth, being treated with respect & dignity.

If you're more of a right-brained thinker, these four principles can be boiled down even further into one simple question. This is the litmus test for what every woman deserves when she gives birth:
Was there love in the room?


  1. man I wish I could have been there!

  2. Wow!! Thats a powerful last question that REALLY drills down to it!

    I hope to keep that in mind for all my birthing Mamas

  3. Love these four features! I answered the question for myself as I was reading the post, and I came up with very unmedicated-birth centered things, and realized as I read your words, how skewed a perspective that was! I have to say, if I were going to boil it down to one sentence, I'd pick "respect" rather than "love" to be in the room, if only because love makes it sounds as though the OB/midwife should feel love for the mother or vice-versus when (for me) the fundamental feature should be respect. But then, I think respect is the foundation of love (and trust for that matter).

  4. I was at the Conference too, that first day you describe here. I see what you mean. And at the same time there's a point you mentioned that i find needs some attention:

    "In addition, not all women desire or enjoy a "natural" birth or even a vaginal birth."

    I am sure that every pregnant woman desires to enjoy the birth of her baby, her birth. And the fact that they "don't desire" a Natural Birth has to do with very rooted cultural-learned ideas: Pain is not good, pain is harmful, pain is unsafe, so it has to be controlled, silenced, numbed.

    It is logical a woman can not "enjoy" a natural birth if she is convinced (therefore her whole body too) that painful can not be. That means dangerous and in this way can not understand that it is simply part of the process that helps the baby to be born trough out her body. And can not even imagine how helpful that "pain" can be for her and how can she be use and manage it during labour.
    How can a woman "desire" having a Natural Birth when she had no access, for whatever reason, to receive the support and preparation to go trough that process is a way she can be the active part of it and in this way really Birth her baby?.

    We need to identify and understand the power and influence of ideas-concepts when it comes to Childbirth. An we know things can be VERY DIFFERENT when WE DECIDE to stop living so distracted and disconnected that we don't know anymore what is and what is not helping to support the ways that (really) care and protect the essence and the Seed of Life.

    The process of Childbirth is a Seed to humanity. What have we become?. Who do we think we are to dare to manipulate that precious Seed in such ways?...

    All we should do is first KNOW IT. Then RESPECT it. Then GUARD it, SUPPORT it and of course SERVE-CARE for it when it is asking for our help, and that is the fine line that has been crossed, over-crossed and even accepted and integrated as "normal".

    So here we are. Women knowing it has gone too far. Women committed to do what is needed, individually and together, to come back HOME, the only way back. Much love, support and inspiration for this necessary CHANGE IN PROGRESS!!! <3. Mar'ia-Jos'e Otero

  5. I agree with the commenter who said to use the word "respect" instead of "love". As a labor nurse, certainly I respect my patient and her choices, but loving her is a stretch. I think even love would be a stretch even if the provider delivering the baby has been the patient's primary care provider throughout her pregnancy. However, I definitely agree with the rest of these principles.

    1. I don't mean that the provider has to love the patient--certainly most don't have that close of relationships--but that the interactions in the room where the woman is giving birth should foster love, rather than fear, antagonism, or anxiety. I've been at births where the love was palpable. I wouldn't say that *I* was the one doing the loving, but I could really feel it present as the woman was bringing her baby into the world.

  6. I think that patient autonomy is the most important thing on your list. If a patient truly has autonomy then all of the other items will just fall in line. I'm an ob/gyn in a medium-sized midwestern community and had the pleasure of delivering a lovely first-time mom early this morning. I was cross-covering for another group (who tend to be very interventionalist) and this mom came in in latent labor. She had a 2 page birth plan full of check boxes and hadn't even discussed it with her providers. I discussed it with her and luckily was able to keep pretty close to it. Her labor was rather slow (changing a centimeter every 4-5 hours, although I only did 2 or 3 checks) and she declined anything to augment it. My nurses were impatient, I was sleep-deprived but we embraced her autonomy in the absence of any true need for intervention and she ultimately pushed out a 9# 5 oz beautiful boy from a crouching position (it's been a long time since I've done a delivery on my knees). This young lady had never met me but I hope she remembers me fondly, as I'll remember her delivery as one of the most pleasant natural childbirths I've attended in awhile.

    Sorry for the rambling post, it was a long night made even longer by a cord prolapse-->emergent c-section without anesthesia present (lived 30+ minutes away). Thank goodness for dense epidurals!!

    1. What a lovely birth you had the honor of attending--and thumbs-up for your patience with a slow labor. Care to contact me privately about where you practice? :)

  7. I love that you are chronicling all of this. Thank you for taking the time to do so.

    Thank you for omitting the part about me being a bit frustrated and crotchety during this discussion. This conclusion of the group that you report was probably apropos following a panel that tipped in the direction of looking at emotionality and perceived effects on a zygote of the mother's feelings and such, but there's one very glaring thing that we forgot that pregnant women need in labor.

    We obviously operated under the implicit assumption that this pregnant woman who will be basking in love and respect and all that also has access to high-quality medical and/or midwifery care and the necessary drugs, skill set and equipment required in case of an emergency.

    After that, love freely, man.

  8. When you said this after Panel 3, it was one of my favorite moments of the conference. I thought, "Who is that woman?" <3

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