What happens when you show up to a prenatal appointment and your favorite care provider in the practice says something that leaves you feeling stunned, betrayed, or feeling helpless? You have built what felt like a respectful, trusting relationship with this provider, and they’ve been so nice up to this point. Maybe you misheard it? Maybe what you were saying wasn’t clear. But, no. You confirmed your birthing choices with them and they said something like “I wouldn’t recommend that if you were my daughter…” or “you want to have a healthy baby, right?”
Language matters and it can be difficult to navigate when you are depending on an expert to interpret their knowledge and experience into medical advice. You can’t prevent someone from using coercive language, but by understanding what your expectations are of your care provider first and then learning to recognize how you feel when someone else is using coercive language you can respond in ways that keep the power and ultimate authority where it belongs: within yourself.
What is your care provider’s role?Keeping your power begins with your beliefs. This is no less true when it comes to protecting yourself against language that is coercive during pregnancy and birth. Before you dive into what makes a statement or situation coercive, you need to take time asking yourself what you believe about the role of your provider.
In my experience, it comes down to two basic beliefs: you believe your care provider should offer emotional support alongside medical advice or you believe they are strictly medical advisors responsible for providing recommendations based on their knowledge and experience. Likely, you fall somewhere between these two beliefs. Being honest about where you fall on this spectrum is essential to having empowering, productive conversations with your provider.
If you believe your provider should be offering emotional support you might ask questions like “what would you do in this situation?” You might find yourself seeking the provider’s approval for your medical choices, asking them for reassurance, or feel concerned that you won’t have a good experience without them at your birth.
On the other hand, if you view your provider as strictly a medical advisor you’re likely to ask what evidence supports a suggestion made by a provider, be less concerned if one specific provider attends your birth, seek emotional support from friends, family, or doulas.
Having an emotionally supportive provider is like the icing on top of a cupcake. It can make things smoother, sweeter, and more pleasant, but it isn’t the foundation. Foundationally, you need a provider that can explain your options in pregnancy and birth without bias and supported by evidence.
What makes it coercive?With your beliefs clarified, you can dive into recognizing coercive language when it’s happening. Most of us can identify when someone is overtly threatening or trying to intimidate us. But what happens when your provider offers to pray with you and then tells you that attempting a VBAC is like wandering into the middle of a busy road? It’s easy to assume that coercion is overt, obvious, and intentionally malicious. And don’t get me wrong – it sometimes is all of those things, but you aren’t fully prepared or protected if we don’t talk about the other types of coercion.
What I see much more often is what I like to call soft coercion. This is sprinkled into pleasant conversation with some southern charm. “How’s your mom doing? Oh great! I know you mentioned wanting to avoid an epidural, but nobody gets a trophy for birth. Let me do the work so you can be comfortable.”
I’m not picking on providers here (or my fellow southerners). Interactions like this have much more to do with unrecognized biases and fears by the provider than intentional manipulation. But the thing is, intention doesn’t really matter. All that matters is the RESULT of the language being used. Is the language your provider uses resulting in you feeling informed and confident or trapped and afraid? If it’s the latter, you are likely on the receiving end of coercive language (even if it’s wrapped in concern for you or your baby).
It’s helpful to think of coercive language on a spectrum from soft to hard that can look like this:
- Emotional appeals: this can be as simple as unsolicited “I” statements like “I wouldn’t do that if it was me” to statements like “we just want a healthy baby, right?” This type of language can be especially confusing because it seems reasonable on the surface. This issue here is that these statements do not center the decision making power on you, the birthing person. Instead, this language appeals to your fears, or forces you into thinking that going against what your provider is suggesting will disappoint them or make you seem “difficult” or not concerned about the health of your baby.
- Not presenting choices accurately: this type of coercion happens OFTEN in pregnancy and birth. Choices outside of the routine are either completely withheld or are presented as inherently wrong, risky, or dangerous. This can sound like “you have to give birth laying on your back,” or “you can’t do ‘xyz’ at this hospital – it is against our policy.” You can easily fall victim to this type of coercive language without knowing your rights as a birthing person, knowing the right questions to ask, and doing extra research. Birth Monopoly’s Cristen Pascuci has an excellent post about this titled “You’re Not Allowed to Not Allow Me” here.
- Intimidation/threatening: on the “hard” end of the spectrum is intimidation and threatening language. This language is more overt and may illicit a strong sense of fear and helplessness. Things like “there won’t be room here if you leave now,” or “we won’t give you an epidural until you consent to a cervical check.” This type of language is a huge red flag if you encounter it prenatally. Unfortunately, you’re more likely to experience this coercive tactic while in labor. This is where the Keeping Your Power® concept really shines. You will be prepared to stand in your power even when facing hard conversations in the middle of labor.
What can you do when you encounter coercive language?You might be thinking yourself “Now what?” Having clarity on some of your beliefs and understanding more about the different types of coercive language isn’t worth much if you don’t know how to put it into practice. Don’t worry – I’m going to outline a few actionable steps to help you prepare and protect yourself against coercive language.
First, check into your body at each appointment with your provider. Do you feel tense? Knots in your stomach? Did you suddenly feel flushed and sweaty after something your provider said? Maybe even nauseous? Your body is providing you with important information here. Coercion does not signal safety to your brain or your body. Your body might be priming for protection mode if your provider says things that feel coercive. Don’t ignore the physical signs.
Next, check into your belief system. If you don’t believe your provider’s main role is giving you emotional support, don’t ask questions that open that door. You need medical advice here.
And if your provider offers up suggestions based on what they would do, or what choice they would want a loved one to make, you have a few options:
- Ignore the statement
- Redirect the conversation back to your options for your specific situation
- Directly ask that they not provide suggestions unless they are grounded in evidence
Last, remind yourself (and your provider if necessary) that you are the ultimate authority on your body, pregnancy, and baby. You are the one who is able to weigh the risks and benefits of each choice against your specific beliefs, values, and goals.
Unfortunately, coercive language is commonplace in most birthing cultures. Perceived power differentials, paternalistic ideologies of care, the pathologizing of birth, and defensive practices (to reduce legal liability risks) prime many care providers to feel they need to convince you to make very specific choices when it comes to pregnancy and birth.
Understanding your own beliefs, values, and goals when it comes to birth is the first line of defense when it comes to Keeping Your Power® in these situations. Learning how to recognize coercive language when you hear it is the next step. And finally, having actionable tools in your toolbox will help you navigate difficult situations when it comes to getting the medical advice you need to meet your birthing goals.