There’s an epidemic sweeping the birthing world (well…the whole world really, but the birthing world is my focus). We’re not discussing the caesarean or induction epidemic…we’re talking about the epidemic of reasonable woman syndrome. OMG I hear you scream…not reasonable woman syndrome! How will I know if I’ve got it? How do I catch it? How do I prevent it? And what are the consequences of it?
The reasonable woman can often be heard saying things like:
• What studies can I use to convince my doctor to support me?
• If I allow [one non-evidence based intervention that I don’t really want] then my doctor will see that I am reasonable and will allow me to decline [one other non-evidence based intervention that I don’t want]
• I am a little bit upset, a bit sad, somewhat disappointed
• That doctor / midwife / nurse was a bit rude, a little abrupt, not very nice
Do you see the words that signify reasonable woman syndrome? Convince, allow, a little bit. The reasonable woman doesn’t tell the OB what will be happening. She doesn’t get “bloody angry” at the midwife who coerced her or the OB who was an obnoxious bully. Because reasonable women don’t have strong plans or emotions. We are flexible and nice.
I must now come out and confess: I have suffered from reasonable woman syndrome. For my first birth, my complete terror at the thought of being in hospital overrode any other emotional thought – so I wasn’t so worried about being reasonable, just getting out alive.
For my second I had a bit more knowledge behind me. I knew how hard it would be to achieve the birth I wanted in the hospital and I had already experienced birth trauma and obstetric violence. So I wanted to do everything that I could to get everyone on my side. By being reasonable. Because if I’m reasonable then they will treat me with more respect, right?
No-one ever bullies a reasonable woman - do they? Image courtesy of Wikimedia Commons.
I had a very firm plan and it was totally backed by evidence and was very reasonable. It was questioned by every single OB and midwife I encountered over my pregnancy. Did I stand up and say “this is my plan and I’m sticking to it”? Nope. That would be unreasonable. I smiled, nodded and said that I would give consideration to what they had to say. Because that’s what a reasonable person would do, right? Even though they never gave me any new information to think about – just the same stuff that I already knew and had considered when writing my plan. And even though I had no intention of changing my plan. But reasonable women are nothing if not flexible – so I must give the appearance of being flexible.
I allowed a stretch and sweep at 42weeks 2days as I felt that by that stage I was pushing things in terms of appearing reasonable. Let me be clear - I didn’t want a stretch and sweep. But I didn’t want to be bullied into an unnecessary induction either (let’s leave aside the fact that a stretch and sweep is actually an attempt to induce…). By this stage I was also a bit worried that others were going to see me as unreasonable. My partner felt that I was putting too much pressure on him by continuing to be pregnant (because pregnancy is so tough for men!) and I was concerned that my doula would start to think I was a total loon. Did having a stretch and sweep done show my care providers how reasonable I was? Nope. 2 days later I was told what a crap mum I was for not consenting to an (unnecessary!) induction. I was told that I must not care if my baby died. So I allowed a non-evidence based intervention that I didn’t want for no benefit to me at all. Don’t worry – I learned my lesson!
Many women agree to unnecessary interventions so that the doctor will see that they are reasonable and will allow them to decline continuous monitoring. Image courtesy of Wikimedia Commons.
How do you catch reasonable woman syndrome?
It is often triggered by a previous case of power imbalance infection (and also from day to day living in a patriarchal society). Power imbalance infection has started to completely eat away at our maternity care system. It’s worth noting that reasonable woman syndrome also often develops as a result of abusive domestic relationships – “If I am reasonable and give him what he wants, that will placate him and he will stop abusing me.” That puts it in a different light, hey?!
Many women who suffer from reasonable woman syndrome have previously been subject to obstetric violence. They are often told by others that the reason they suffered disappointment (because reasonable people don’t use the term obstetric violence) was because they were unreasonable. Had unreasonable expectations; didn’t follow the doctor’s very reasonable orders; or made things difficult for the lovely midwife who was just doing her job. Now these women wish to be seen by their care providers as “reasonable” so that their care providers will not abuse them.
How fucked up is that?
Can you prevent reasonable woman syndrome?
The only way to prevent reasonable woman syndrome is to address the cause. Set the boundaries of power and control early in your relationship with your care provider.
Make sure you hire a care provider who understands that the decision making power should always rest with the birthing woman; who knows that the OB should NEVER hold more power than a birthing woman.
Use firm language – it’s okay to know what you want and to strive to achieve it.
Learn about birth and learn about yourself – knowledge is power.
Surround yourself with people who understand that following your instincts is not unreasonable.
Stop concerning yourself with what other people think about you – it says more about them than you.
Stop being concerned about being seen as reasonable - chances are good that you ARE being reasonable, even if others don't think so.
Pregnant women must be acknowledged as having the right to make decisions about their pregnancy and birth care. Image courtesy of Wikimedia Commons.
What are the consequences of reasonable woman syndrome?
If reasonable woman syndrome is left unchecked here’s what will happen.
RANZCOG and the AMA will start to truly believe that they hold all the power.
They will start to limit women’s rights to choose where, how and with whom they birth their babies.
They will ensure that every woman is exposed to power imbalance infection.
They will ensure that reasonable woman syndrome becomes the norm and those who don’t have it yet will be singled out.
Obstetric violence will become simply a normal part of birth.
Women will no longer expect respect, but will wonder if the OB who respects them is actually a “bad” OB.
Hmmmm...sounds like we are well on our way.
Perhaps it’s too late to stamp out reasonable woman syndrome. It has really taken a hold of women and our maternity care system. Or perhaps it’s time to band together and remind the world:
My body, my birth, my choice, my responsibility.
And that there’s not a single unreasonable thing about that statement!
There's nothing unreasonable about expecting your right to birth where you feel most comfortable to be respected. Image courtesy of Wikimedia Commons.
Part of the problem is that in Labor & Delivery departments, a female dominated area (as in the female RN's that take care of the laboring woman until the last minute,) too often the nurses are not supportive of their patients. They believe they know what's best and buy into the paternalistic attitude of the doctors. Too many times I was told in report, this mom, these people, ask so many questions! Questions are interpreted as a challenge to authority. I as an RN and educator got in trouble countless times for trying to advocate for my patients. Case in point - "how dare you tell a mom she can refuse pitocin AND that birth without an epidural is truly
natural birth and very doable!" My answer always was women have a right to make informed choices and it is my duty to give them the information and education that will empower them to do so!