Saturday, November 24, 2012

5 Subtle Signs of a Controlling Birth Assistant

Have you ever stopped to take a closer look at your relationship with your OB or midwife? Or hospital staff? You have chosen to enter into an intimate relationship with these people involving your body, vagina, breasts and children. Is it a healthy dynamic? Are you an equal? Are you respected?

Does your doctor care about you and your baby? Is she protective of you? Helpful when making pregnancy and birth decisions? Or is she controlling you? Does he want to satisfy other interests?

There's a thin line between a supportive doctor and a controlling one. And it's time to see the difference.

Obviously all doctors, midwives, nurses and hospitals are in a subtle role of authority and control simply by their nature. Many women approach their births feeling uninformed. Some women even believe it's not their responsibility to know about birth and to make decisions regarding their births. These beliefs add additional imbalance to the scale between the birth assistant and the woman.

It's also important to note that there are two kinds of controlling birth assistants. One kind is obvious, and often takes up most of the internet forums. We say this kind is rarer, easier to identify and condemned across all birth philosophies.

Everyone has heard of the woman screaming no and kicking at her violent, controlling doctor. Everyone has heard of the midwife who suddenly turns mean in the middle of a birth and forces the mom into unwanted situations. Everyone knows of the nurse who mocked a woman in pain. Everyone knows about the hospital that called a lawyer and forced a woman to consent to a c-section.

This kind of person is capable of crippling a woman with emotional abuse (and any helpers such as doulas and husbands), of using open threats and even physical force and violence to get her way.

But there's another kind of controlling birth assistant, and this kind is actually accepted in our culture. This kind of person might be dismissed as overly helpful, overly concerned and someone who is "just doing his job." The subtle behavior can even be abusive, or at the least dysfunctional, but few people identify it as such. This kind of person heavily influences the pregnant woman, her baby and the birth experience, though.

If you have this kind of controlling birth assistant, the dynamic will become more and more imbalanced, and your emotional strength will weaken as the pregnancy progresses. As anyone who helps those in domestic abuse situations or anyone who has been in one can attest...the control increases while your sense of normal decreases. Otherwise, everyone would immediately leave these relationships!

Perhaps the biggest obstacle to leaving this kind of controlling relationship is the overwhelming feeling that your doctor is "not a bad guy." He's not bad. He just wants what's best for you. Your midwife isn't violent, after all. She'd never hold you down or hurt you. She just thinks her way is safer.

These kinds of people are able to create an unhealthy relationship because they are subtle and careful with their behavior, changing reality in the pregnant woman's mind and securing their level of power in the relationship.

5 signs you might be in this kind of relationship

1. She reminds you that you're the pregnant woman. If you are constantly reminded that you don't have the medical degree, something might be wrong in your relationship. Although it's true that the people we hire for our births are expected to be educated and experienced (why else are we hiring them?) that doesn't mean you should feel helpless, stupid or otherwise put down. If you find yourself anxious when asking a question, you might have a controlling doctor. If you are worried you'll sound stupid when sharing your facts and decisions, you might have a controlling midwife. If the nurses treat you like a number on a cart, you could be in a controlling hospital.

What does healthy look like here? A caring birth assistant knows that you are the pregnant woman, and thus you are responsible for your baby, birth and body. A caring birth assistant will share all the information with you and encourage you to participate equally in making decisions. A caring birth assistant will not make any references to your educational level, career or lack of experience, and will support you in learning more about pregnancy and birth.

2. He doesn't like when you ask for second opinions or research alternatives. Does he say the internet is unreliable? Does she roll her eyes when you mention what another midwife said on a topic?  If you ask for an alternative, does she say this is her way of doing things, period? Then you might have a controlling birth assistant. If you don't recognize this, the subtle put downs and references to your incompetence will eventually lead you to isolate yourself from other resources, coming to rely completely on your birth assistant.

What does healthy look like here? A caring birth assistant wants you to learn all you can about your body, your baby and your birth. If you have doubts, she will acknowledge them. If you want to hire more birth assistants, such as a doula, he will support you and welcome the other assistants. If you bring information from the internet or a book, she will seriously listen to your concerns. If he is not informed on a particular alternative, he will learn about it. A caring birth assistant will acknowledge that she is not the ultimate authority, nor is she always correct, nor does she know everything.

3. You begin to feel insecure or doubted. Over the course of your prenatal meetings with your doctor, you begin to feel you are incapable of birthing without his help. After spending time with your midwife, you begin to think you cannot be trusted to birth your baby. You start to hear phrases such as, "Other women can do that, but your body is different." Or maybe your doctor looks at a test result and sighs heavily, shaking her head. Then says, "I just don't know if you can do it naturally." Your midwife performs a cervical exam and her shoulders droop. She tells you, "Your body is just not doing the right thing." You get online to tell your friends you are defective and your plans have to change. If you begin to feel broken, incapable and to doubt yourself, you might have a controlling birth assistant.  Medically unnecessary cervical exams before labor, additional ultrasounds, too much focus on weight and fundal height, etc, are all signs of control.

What does healthy look like here? It's true that sometimes our bodies do not function the way they are designed to, or that complications can arise during pregnancy and birth. Even in those circumstances, though, you should feel competent, capable of making healthy decisions and inspired to birth in whatever way is right for you. If a test result shows something concerning, the doctor should present it to you so that you are able to understand the situation and freely make an informed decision. Your birth assistant should not be using tests and exams to create an atmosphere of doubt and insecurity. (Such as unnecessary testing, too many ultrasounds, or other things that are not evidence-based).

4. You can't do anything without her approval and involvement. If you decide your stress is creating a false blood pressure reading and want to monitor at home, he will discourage it. When you mention attending a spinning babies class to encourage optimal positioning, she tells you not to go to anymore classes. If you want to take a certain test, you feel you have to jump through hoops and consider avoiding your doctor, or even hiding it from your midwife. If you want to decline a test, you brace yourself for put downs, eye rolling, confrontation and more. You start to talk with friends and family about your birth by saying, "The doctor is going to let me birth naturally." Or, "The hospital said I'm allowed to get into the shower during labor."

What does healthy look like here? A relationship comprised of two equal, respected people means both people feel comfortable making important decisions. A caring assistant does not encourage you to ask for permission. A caring assistant will not pout, act offended or get angry when you make a decision about your body and birth.

5. You are no longer sure of what you want. Subtle manipulation of your emotions and fears has led to you questioning your beliefs on everything small and big. Suddenly, you find yourself doubting what you wanted in the first place, or even preparing yourself to give it up. You start to minimize your desires, such as by saying, "A natural birth is the ideal anyways." Or you might remind friends and family that, "The risk of an induction is tiny, so it's not a big deal." Things you wanted become unnecessary. You begin to whittle down your list of absolutes. You start to take on a tone of resignation, and repeat to yourself and others, "A healthy baby is all that matters!" You begin to feel depressed, anxious or otherwise worried about the impending birth. You find yourself disconnecting from friends and family out of embarrassment, because you foresee your birth going differently and don't want them to know about it. You become isolated, insecure and impatient. You just want pregnancy to be over already. You're 37 weeks and you know your doctor isn't going to "let you" do what you want, so you might as well induce now.

What does healthy look like here? At every prenatal appointment, your doctor, midwife and other assistants should review your birth plan. They should understand it and support it. If they have concerns, they should bring them up respectfully and ensure that you make the final, informed decision. They should keep a copy on hand, without mocking, sighing or rolling any eyes. If you begin to share doubts or worries, they should encourage more learning and support you in determining what you want and preparing you for it. A caring assistant will not try to sell other options or try to subdue your enthusiasm and excitement. A caring assistant will not refer to pregnancy and birth as a medical emergency or disease, and will encourage you to be present, to experience it and to make lasting memories.

Is your birth assistant caring or controlling? Only you can decide this, and only you can choose to leave if your relationship is unhealthy or already abusive.


  1. YES!!! Thank you for this post. :-)

  2. Great post. I guess I had a dysfunctional relationship with the doctor that delivered my first son.

    Definitely got big sighs and eye rolls and condescending comments. Started taking my husband to appointments with me to try reduce the stress level. Was pressured into scheduling an induction "before anything bad happens to the baby" (I was almost 41 weeks and measuring "small"). The week before he was born was the closest I've ever felt to a nervous breakdown, and I considered "running away" (can a grownup run away?) and not showing up to my induction. I agreed to a saline lock instead of an IV because the doctor would not "let me" go without anything. Didn't "allow" delayed cord clamping even though I had made an informed decision that it was the safest option for us.

    Got out with only minor physical effects (tearing, low iron later in my son that probably wasn't helped by the cord clamping issue). Had a homebirth with a midwife for my next child.

  3. Great Job Guggie! Very important information and something we should all be talking about.

  4. Im having this problem and will be 38 wks this weekend. My midwife and I work together. (Im an obstetrical nurse and now ARNP who even trained with this of the main reasons I chose her as a care provider). I never ask a bunch of questions or complain about much and accept that anything Ive dealt with so far are just normal pregnancy symptoms, but yesterday she reared her ugly head when I mentioned GBS. The long and the short of it is I have a positive history but am currently negative and I asked about treatment. She gave me a smug response about how she'd treat me even though she shouldnt and that "the nursing stops there and you have to be a patient now". She even told me "I will turn off your monitor in L and D if I have to", to keep me from having control or asking questions. She literally threatened my autonomy. Because I am a care provider I know how wrong this is. And now I'm afraid she's going to make decisions during labor just to spite me that may be to the detriment of my baby. All this may sound dramatic, but in the last 6 months I've seen her do it to colleagues before, who wind up in splash n dash c sections because she sat on poor monitoring strips for too long arguing with people in labor. Im scared to death and I don't know what to do.

    1. That definitely sounds like a violation of informed consent. Be sure to document whatever you can and report her to the appropriate organization. And also, when you are ready, consider leaving a detailed review or blogging about this to warn other women who are trying to decide who to choose!