Although frightening and Orwellian, and not a topic that mothers preparing for childbirth want to dwell on (or should have to), I think it is nonetheless important for birthing women to consider the following: For a great many obstetricians, steeped as they are in the pervasive culture of medical authoritarianism, the very act of speaking up to decline a procedure can be, from that obstetricians’ perspective, evidence in itself, that the birthing woman is hysterical, irrational and incapable of making intelligent or safe decisions surrounding the care that she and her baby receive.
This is the double-bind that permeates institutional birth: women are bombarded with the rhetoric of informed consent on one hand, and then condescended to, or ignored when we exercise that supposed right.
After the birth, when mother and baby are sent home to repair and recuperate, the mother must make another difficult choice when integrating her experience into her consciousness and the narrative of her life. Either the staff and the system are wrong, which often necessitates a wholesale reevaluation of her view of medicine and authority, and a process of coming to terms with the level of victimization the woman feels she endured. Or, the staff and the system were correct. The latter often involves having to process the possibility that her body is indeed defective, and that she required or even deserved the treatment she received. This is a simplistic rendering, I know, and probably we all incorporate aspects of all of it. But this binary does I think exist to some degree, because I have lived it myself.
I have seen the psychological tactics of control and colonization at play first hand, in the hospital system. “Honey”, the kind OB says, crouching close to the woman’s face. “Honey, we need to get your informed consent to do X”.
The woman turns away, overcome by another wave of sensation.
“Honey, pay attention. We need your informed consent to do X now. Can we get your informed consent at this time?”
The woman cringes, exhausted, foggy from the marathon of birth, but faces the OB. “Do you need to?” she says. “Can it wait? I don’t really want to…”
“I understand that you may not want to, and it is *completely* within your right to refuse, but we are concerned about your baby, and you don’t want your baby to suffer, do you honey? So it would really make us feel SO much more comfortable, if we could get your informed consent to do X *right now*, because it really is so much safer to have this under control with X. You do want your baby to be safe, don’t you?” And on it goes.
Some women have wonderful experiences giving birth in the hospital. But many other women—far too many women–are broken (temporarily, for the most part. We mothers are ferociously strong) by institutional birth. Unfortunately, the culture of obstetrics seems still to view the fracturing of a woman’s sense of self, her physical and mental integrity, as an essential or unavoidable aspect of the birth process. And we wonder why postpartum depression is rampant.