politics of birth

I just found an interesting article that looks at how we view birth and how we view who should be the decision maker in birth.  I found this paragraph in particular interesting, because I just was having a conversion with a friend who was not "allowed" to push on her hands and knees.  Which, I of course, thought was ridiculous.

"The politics and power relationships of the labor and birth process may be seen to revolve around the word "allow." To allow is to make possible through a specific action or lack of action, or to consent to or give permission.1 The concept of allowance gives the power to the healthcare provider, whether physician, midwife, or nurse and makes the laboring woman dependent upon this allowance. Allowance removes some aspects of choice and consent from the woman and makes her dependent upon the actions and beliefs of the healthcare provider. To define the services one offers to pregnant women using the phrases "I allow" or "I don't allow" transfers all control to the provider. To "allow" ambulation during labor is to give a tacit approval and to not "allow" a trial of labor after a previous cesarean birth (TOLAC) is to imply that TOLAC is dangerous and imprudent. To "allow" an action implies an authoritarian relationship, similar to a parent and gives political power to the healthcare provider. The concept of allowance signifies that the healthcare provider is the expert, that the provider knows what is best without discussion and that the provider will always make the best decision for the woman. This language extends to nursing also; nurses are "allowed" to perform some procedures in hospitals and not in others. More respectful language would imply mutual consent between the parties in the discussion, or political cooperation and compromise.

Compare the statement "midwives are allowed to attend TOLAC and vaginal birth after cesarean" with the statement "midwives are qualified to attend TOLAC and vaginal birth after cesarean." Similarly, compare the statement "laboring women are allowed to ambulate during labor" with the statement "laboring women are encouraged to ambulate during labor." The emphasis moves from permission to active voice."

I would love to be a fly on the wall of physicians offices and see how they offer alternative choices to women. Do they "allow" women to move, or do they encourage it?  What if a doctor doesn't agree to a different type of care, like delayed cord cutting, how do they respond to that?

As I thought about these questions, the words permit, allow, offer, and provide all began popping up in my head.  All of these words entail a power structure that is pretty inherent in our medical system.  We, the patients, are allowed or permitted or have certain choices.  This seems wrong to me.  The doctor/care provider is not our parent.  They are not here to teach us right or wrong.  I think they should be here to provide us with choices.  To offer us their expertise and opinions, but at the end of the day, we are the ones that make the choice based on what we feel is best, no matter what the doctor feel is best.

Unfortunately, our system is very steeped in this hierarchal manner.  I would love to hear others ideas on how to help change that.  I think the increase in homebirths is definitely a sign that more women are wanting a different relationship with their care providers.  As well as the increase interest in alternative medicine.  Women are looking for ways to gain that control back in their lives.