The Institution of Pregnancy "Care"

I want to talk about what I see as the institution of pregnancy "care" here in Australia, and my experiences of it in Queensland, specifically; I can't speak for how other parts of the country might be different. And yes, I deliberately put quotation marks on "care," because the level of so called care, can be questionable in some instances. The other important thing to note is that any and all of the standardised care is optional; you have the right to accept or refuse ANY of it. I want to make that clear because so many of us have no idea that we're even allowed to say no.

During my first pregnancy, I followed the rules, and did mostly what was expected; three ultrasounds, multiple blood tests, every scheduled MGP appointment, routine doppler, blood pressure, etc, etc, etc... And so much of it felt out of alignment, unnecessary, and quite frankly, a waste of time, for me personally. Not to say that that standard of care can't be the right choice for some women and babies; but it's important to note, that the current standard of care is a blanket solution, a one-size-fits-all approach, rather than individualised care for each woman and baby.

During my first pregnancy, I would take time to tune in to my baby and my body, I would listen to my intuition, and mostly, I could already know what each test would confirm. Out of the three ultrasounds I had, I feel like only the dating scan at 7.5weeks pregnant was useful to me; the other two didn't give me any more information than what I already had inside myself. Out of the blood tests I had, none of them really felt useful, and it was a lot of my body's hard work in creating extra blood volume for pregnancy being taken from me so carelessly (in hindsight). Perhaps the two third trimester blood tests had some value; the first of which showed a drop in hemoglobin appropriate for pregnancy, but had my midwife talking about an iron transfusion nonetheless, which allowed me to focus on nourishing my body more appropriately; and the second one which showed my body stabilising and having levels within a normal range for a normal physiological birth, which contributed towards freebirth feeling like a safe choice for me. Interestingly, the routine doppler monitoring at each appointment was always as expected, except for the one day my baby's heart rate was higher than usual, but it wasn't unexpected for me because she had been having a bit of a dance party in there that day, and I felt intuitively that all was well.

So all of that to say, multiple tests and monitoring did not tell me much more information than what I already knew and could feel from my baby and my body. Because of that, I've found it interesting to consider the institutionalised care that is offered in the public maternity system, and how outsourcing our inner knowing to machines and maternity professionals, could rob us women of being the professional in our own bodies. I am the professional in my own body; and I am the professional in my own births and babies - as are you!

I went into my second pregnancy as the authority in my own body and baby, and chose not to seek any external testing for the first several months. Instead, I focused on just enjoying being pregnant, without all the running around at the beck and call of various medical professionals. In fact, my first GP appointment was at around 19 weeks, seeking a referral for a mid pregnancy scan - ONLY that referral. I hadn't been to a doctor since we moved house when my oldest was about 7mo, so it was a new doctor, not the one I saw during my first pregnancy. And I was pleasantly surprised by how I was treated; he didn't bat an eye that I hadn't sought medical input in my pregnancy up until that point, and he outlined my options moving forward, filling me in on the midwives and other maternal care systems in our area (being a small rural town, women are expected to relocate to the coast for birth, as I did during my first pregnancy). I signed a release form for my old GP to send my records through to my new doctor, and also agreed to a blood test that could be done that day, in clinic. As I was planning to freebirth several hours from the nearest 'birthing hospital,' my main concerns were any conditions with my baby that would need medical assistance at birth, and any conditions in my body that could impact a safe, hands-off birth. I felt that the 20wk morphology scan, and a blood test would establish my baselines and allow me to make an informed decision about my birth.

Prior to pregnancy, I had dropped in to the local privately practicing midwife one day when I was in town and saw her shopfront was open; she had also given me an outline of what maternity services looked like in the area and what my "options" were. (Those options being the two closest birthing hospitals on the coast, either public or private health services). As a privately practicing midwife, she told me she doesn't support women to homebirth, and her work was purely antenatal and postnatal support, as well as working for Queensland Health in the local MGP. As a mother of 3, she confided to me that if she ever had a fourth baby, she would love to consider homebirth for herself, but "not out here." She didn't consider home a safe option for birth, unless it was within a certain radius of medical support. It was truly wild to me in that moment, to be talking to a midwife who had less belief in birth than myself, and because of this, when my GP suggested a referral to the local midwife, I declined, telling him I'd prefer to continue with the virtual support I had been accessing with the trusted support person from my first pregnancy and birth.

Despite all that, I was automatically referred to the local MGP, and soon had multiple midwives from the next town over, as well as the local one, trying to ring me and trying to get me to book appointments with them (the midwives group consists of midwives from several local small towns). How bizarre that they automatically felt so entitled to my pregnancy, just because of one GP appointment! In amongst the papers I had been given regarding my scan referral and my release of records, I discovered an MGP referral that stated: "Does the patient consent to this referral? No."

Absolutely wild behavior. So I had a form stating my lack of consent, verbal non consent given to my doctor, and still, multiple health professionals blowing up my phone for care that I'd never opted in to! I was mostly just astounded that they all felt so entitled to me, just because I was pregnant. Unfortunately, I let it destroy my peace for a couple of weeks, but ultimately, I knew that any and all of it was completely optional, and I didn't just have to go along to get along like I did during my first pregnancy. With the support of some strong voices in the home birthing community, I was able to write a letter to my doctor and the clinic regarding this breech of my personal information to third parties without my consent, and the referral was revoked. While that was in progress, I still had the local midwife reaching out to me every other day until I finally texted her back, letting her know that my phone number had been given to the MGP without my consent and that I wasn't seeking her services at this time. Her response? Quote: "Thanks for letting me know do you plan to continue seeing the GP for pregnancy care? Where do you plan to birth so I can update them that we wont be providing care pregnancy care." Wild. How entitled to women's bodies, babies, and births do you have to be to think that is an appropriate response to someone declining your medical services? I left her on read.

After my ultrasound, I had a follow up appointment with my GP for results of my scan, blood test, and also my revoked referral. It was all handled professionally from his end, but I was angry that it had even had to come to that point for something I hadn't consented to in the first place! Of course, by then, he'd also retrieved my medical records from my previous GP and discovered my first birth was a freebirth, so he had to quiz me about that. I told him my birth plans weren't set in stone yet and I was open to whatever was the safest choice for myself and this baby this time around. I was also prepared to tell him that since he wasn't invited into my birth space, he didn't get a say in any of the choices I made for my birth, but it didn't come to that, haha! Doing his due diligence, he asked me about what I was doing to ensure the safety of myself and my baby for an unassisted birth, so I outlined some of the red flags I would be looking for prior to and during labour, and what my plans of action would be. It sucks that I had to justify myself in that way, but he seemed satisfied that I knew what I was talking about and didn't lecture further. I think he just needed reassurance that it wasn't a crazy whim to birth unassisted, it was a considered and conscious decision, with many contingencies and not at the expense of the wellbeing of my baby or myself. For me, it's not "freebirth at all costs," it's "freebirth as long as it remains the safest and best option for myself and THIS baby." Because every pregnancy will require reassessing to determine the safest birth choices for that baby.

I was thankful that that was my last touchpoint with medical care during my pregnancy, but also was thankful to know that they would be there if I needed them for any reason during the rest of my pregnancy, birth or postpartum. My blood test was normal, showing expected decreases in some markers as blood volume expanded during pregnancy, but was a timely reminder to get my nutrition back on track after letting some of my healthy habits fall to the wayside during those pregnancy sickness months when all I could do was survive. I cleaned up my eating and refocused on supplementation, taking charge and responsibility for my own health and pregnancy, and declining further blood tests; instead choosing to keep in tune with my body. I had in my mind certain symptoms or concerns that would change that for me and have me choosing follow up blood work, but due to my diligence in nourishing my mind, body, and spirit, none came up. Remember, any and all of the standard of care that is offered from the maternity system is optional, and doesn't necessarily benefit you and your baby. Choose what's right for you!

It occurs to me that the grooming to outsource that authority of our bodies to someone outside of ourselves is systemic in our society, and starts much earlier than our first pregnancy. Consider this: from the time we start school, we are told when to eat, when to pee, when to sit still, when to move; our childhoods and ingrained food values were also affected by the diet culture and values of our own mothers and other female figures in our lives. Or we can go right back to our own births, and how that has groomed us to be compliant in the system. For myself, a 32 week NICU baby, my first go at bucking the system was a "failed" induction for pre-eclampsia. While there are absolutely times when a baby is safer out than in, a medical induction at such an early gestation was maybe not the best course of action for both me and my mother; resulting in an emergency c-section, NICU and ICU stays, and the beginning of the grooming to compliance for a small baby, separated from her mother at birth, and kept separate in a small plastic box with tubes and wires helping me to survive. Our whole lives, right from birth for some of us, we are taught that someone else knows best. That we couldn't possibly know our own bodies well enough or even have done our own research to choose for ourselves. It's institutional; taught to us in every area of our lives. Is it any wonder then, that we fall pregnant for the first time and immediately outsource that knowing to peeing on a stick, and going to the GP to ask what to do next (like I did, for my first pregnancy).

It's such a journey of unlearning to reach a point where you can fully own all your decisions, whether they align with what anyone else thinks they know as "best." But we can take back authority of our own bodies, and with that, responsibility. No outsourcing decisions, but also no passing blame when things go wrong. We can seek input or guidance, but don't have to take another persons truth on as our own. We get to be discerning and find what's true for us. (And if that happens to line up with all the medical guidelines for pregnancy and birth in this country, then more power to you!) And if it bucks the status quo, then you get to own those decisions as your own, and take radical responsibility for your own life!