Dignity in Maternity Care- The Basics You Deserve

For most women, including me, pregnancy & childbirth are extremely vulnerable moments of life. There’s a cocktail of emotions one experiences: excitement, joy, happiness, a bit of nervousness. But what not many openly talk about is that amongst the crazy rollercoaster of ambivalent emotions, one major fear always hovering over the mind is of losing one’s dignity in maternity care and childbirth!

It might sound stupid but I used to be super paranoid about keeping my modesty throughout my pregnancy and hated the idea of anybody looking down below. I would get morbidly terrified imagining myself lying exposed on a stretcher surrounded by a semi-circle of people.  I had heard back then that one has to leave modesty right at the door, but for a private person like me, that was not acceptable.

I need to WHAT before leaving the hospital???

Never had I ever thought that my poop would be such an important topic for a dozen people. Of course, as a kid my mom used to worry about the constipated me, but that’s a different story all together!

I still remember that awkward moment when a day after delivering my twins, every nurse or doctor on duty would come to check if I had pooped or not! (Perhaps that was an important yardstick to see if I was ready to be discharged from the hospital). Anyhow, it was quite embarrassing back then for me to answer such questions.

Dignity- what’s that?

But Dignity for me wasn’t just limited to not being exposed or embarrassed; it also meant being respected and being given liberty to take decisions.

Indeed, respectful care is foundational to a woman feeling psychologically whole about the child- birth experience. Kind & friendly communication, active listening, protecting the woman’s privacy, seeking permission prior to invading the woman’s body space is what one hopes for in terms of minimum quality of care at a hospital.

Respectful care includes behaviours such as-

1. Warmth

Humane care, respectful communication and sensitive hearing can make a lot of difference to one’s childbirth experience. During pre-natal tests & examinations, the nurse would inform me about the vaginal examination and what she would do before she did it. She did not just “come and do it”. During the procedure also, she would keep communicating with me, talking about the next step, preparing me for what to expect. Trust me, it’s quite comforting this way.

2. Provision of caring & comfortable environment

Hygiene, cleanliness, ventilation, privacy, silence are a few factors that influence the comfort of a hospital setup. And surprisingly the environment can influence the performance of practices at a hospital as well. Basic aesthetics influence the overall decision also for many women, like me. Availability of nursing chair in the room, shower enclosure in the bathroom, overall less hustle-bustle were important for me to ensure a dignified childbirth and postpartum experience.

3.  Instilling a sense of calm and confidence in the mother

Besides the technical competence of staff and doctors, their intent to build a relationship of trust to calm the mother and strengthen positive feelings has a promising influence on the birthing process. I remember, during my surgery, there was a nurse who was soothing my hand, calming me down by saying positive words. It was so encouraging. She was trying to make me feel good about myself.

Autonomy in childbirth means the freedom to choose one’s own actions or decisions based on personal beliefs and willingness. It comprises-

1. Promoting coercion-free environment

Dignity in birth means being treated with humanity and respect, even when the woman makes a decision that may not be what a care provider recommends. There shouldn’t be name calling or shaming in such a case. Care should be provided less authoritatively so that women can make decisions freely, without fear of prejudgment or labelling by the hospital team.

2. Enabling access to information and decision-making

Access to information empowers women. It is an essential medium to take conscious informed decisions. Post my delivery, our twins were placed in the nursery for 24 hours. I was asked the following day, after being given a brief about their health status and feeding schedule, if I was ready to get the babies in my room. Having given an opportunity to decide as a mother was both satisfying and comforting. I felt the power of decision making that time.

But sadly in today’s times a lot of healthcare providers exist who are system-centered who approach childbirth as a service line in which standardization leads to efficiency. a large proportion of maternity care is not supported by best evidence or best practice, and women often feel pressured to go along with this care despite their personal desires. For example, a lot of women are completely unaware of childbirth options, non-pharmacologic methods of pain relief, use of nitrous oxide for pain relief during labor, continuous contact with their newborns, etc. I have known a lot of women who feel pressured to go along with the care despite their personal desires.

3. Promoting the presence of a companion

Undoubtedly presence of a companion during the birthing process is crucial in providing emotional support. He or she provides women with comfort and confidence during labor and delivery, and could also provide benefits to them. I have a lot of friends who had their mother or husband in the delivery room. They were offered guidance form the nurses on the use of massage, breathing exercises, dialogue and incentive to walk. But here also, one should be able to ‘choose’ the companion they want in the room.

Thanks to the rapport I shared with my gynaecologist, I confided in her about my fears. I was lucky to have chosen a hospital and doctor who gave immense importance to the aspect of dignity during delivery. While finalising the birth plan, I clarified a lot of doubts and was offered assistance and quality care end-to-end our from pregnancy to childbirth to postpartum.

In short, here’s what I think dignity in childbirth looks like: a woman and her family/support system are at the centre of the birthing experience. A recognition and respect for the knowledge that a woman’s body is sacred. Dignity in childbirth is the understanding that a woman is the expert on her body and her baby; the woman is making informed decisions about her care in respectful collaboration with her care providers.

And here’s what dignity in birth does NOT look like:

• “I wasn’t given any other options”
• “No one asked me…”
• “No one told me…”

Or being told-

• “I’m the expert. That’s my reason.”
• “Who is the captain of this ship?”
• “Those are nice ideas, but if you want a good outcome, you’ll leave these decisions to us.”

Comments like this are all too common when women share stories about their birth experiences. But if you ask me, most of us encounter such situations because of a false assumption that in order to achieve a positive outcome in birth, a woman must turn off her ‘thinking brain’ and submit to whatever the system demands of her. Many would argue that these behaviours have become so commonplace we do not even think about them as problematic. They have become so normal they fail to raise eyebrows.

As a first-time mom, you might feel things are supposed to go this way; that for hospitals, birth is a simple systematic process, like a factory.

But with the help of online communities like Together for Her, you can make an informed decision keeping your dignity, autonomy and respect on top of priorities.

Together for Her has created a number of resources for pregnant women to help them access the best care. ‘Together’ comes as part of a push for honest parenting, as a platform for mothers speaking openly about how their experience with healthcare providers has been.

Learn more about Together here and don’t forget to share your maternity experience/review by clicking here.

Go Mommy!