Autonomy is defined as (1) the act or power of making one’s own choices or decisions, (2) the state of being free from the control or power of another.
This is a new conversation for this group of consumers. This group of consumers for the past 100+ years have been forced to comply with those placed in authority over them because this word was unknown to them despite its origin.
Tides are changing and this can be a VERY GOOD thing.
Women are flocking to autonomous care providers who offer truly autonomous care.
In a truly autonomous care environment, women are free to choose for themselves what will and will not happen to their body….even if their care provider doesn’t agree with the decision.
No, this does not mean that the care provider has to continue offering care….Because they (the care provider…in this instance a midwife) are also autonomous and while they have the freedom to respect the mother’s decision, they also have the freedom to say, “Because that is your decision, I will need you to sign this form stating that you understand the risks associated with your decision.” OR “Because that is your decision, I don’t feel comfortable continuing on as your midwife.”
It also means the midwife can choose to share a list of other midwives who might be okay with your decision or not.
The midwife who chooses to sever her contract with you agrees to hold confidential all conversations she had with you up to and including the reasons for severing the contract AND how she feels about your choices and the midwife to whom you might transfer care. If she chooses to speak with anyone who had nothing to do with your care about those confidential conversations, she has violated HIPPA and your basic constitutional right to privacy. If she chooses to talk to others about your new midwife in any way that is detrimental to your new midwife’s reputation and/or standing in the community, your previous midwife has lessened the value of the midwifery profession within your community by slandering another member of her profession. This is true for all professions when there are times of backbiting, rumor mills and gossip. (It happens because we’re all human so please don’t assume that this is happening. Simply be aware that it can happen.)
For the expectant and birthing woman who is choosing autonomous care it is important to know and understand that your circle of influence (aka support system) – family and friends – may not understand why you are making the choices you’re making. They will question your decisions without understanding their level of ignorance in regards to the topics because they may only know the man-made baby delivery system of care that has dictated to women what will happen to their bodies while pregnant and during birth for the past 100+ years.
They do not know what they do not know so you – the expectant and birthing woman – may be expected to teach them or refer them to the appropriate information. This requires that you educate yourself and know the reasons why you are making the choices you’re making. Sometimes your decision is an intuitive knowing and it’s okay to say that.
It is also important for the expectant and birthing woman to know that all these conversations with those outside of your care team will be discussed with others….a sort of gossip that will spread like wild fire throughout your community with all manner of things being taken out of context and will impact you and all members of your care team. You may be told things like:
- “A real midwife wouldn’t allow you to make such dangerous and irresponsible decisions.”
- “Doesn’t your midwife care about how your choice might harm the baby?”
- “This is why birth needs to happen in the safety of the hospital under the care of a trained medical professional.”
- “Your midwife is obviously uneducated and therefore dangerous.”
- And many other comments and assumptions that will blow your mind and harm your psyche.
None of what will be said about your choices will leave you feeling loved, supported and understood.
None of what will be said about your choices will leave you feeling educated and responsible.
All of what will be said will increase the likelihood of you experiencing a degree of postpartum depression. Why? Because it will shed a light upon your “support” system that proves they are not the type of support system you thought they were. It may become clear that their support is only present when you are complying with what they have decided is “good” for you. All the while happening during a time in your life when you need their support the most; leaving you alone and vulnerable.
Again, they may only know the man-made baby delivery system of care where women have been told what to do for 100+ years. The intent is not to cause harm….sadly, harm is precisely what is caused.
Choosing autonomous care means taking full responsibility for your choices. ALL choices have consequences. Your care provider can help you know and understand the consequences of doing and not doing something as it pertains to your prenatal care and birth. They are not to be your only source of information and they are to share only what they know to be true not any assumptions of what they believe might happen or might be true. Forcing someone to make a decision while using fear tactics is called coercion and IS NOT a form of informed consent.
The ultimate in autonomous care is freebirth (aka unassisted birth) because it removes a care provider from the picture altogether. Freebirthers may take full responsibility for their pregnancy and birth OR they may hire a care provider for the pregnancy and take full responsibility for the birth. In a truly autonomous care relationship, the freebirther will feel safe telling the prenatal care provider their plans to freebirth.
To better understand why this makes Kansas one of THE BEST states for giving birth at home, I encourage you to read MAKING MIDWIVES LEGAL: CHILDBIRTH, MEDICINE and the LAW written by Raymond G. Devries. A good book to read to better understand the safety of home birth is SAFER CHILDBIRTH? written by Marjorie Tew.