There Is No Place for the Good Girl in the Birth Room

“I didn’t want to be difficult.”

“I trusted them. I thought they knew best.”

“I didn’t feel like I could say no.”

I have heard variations of these words from women more times than I would like.

Sometimes they are talking about something that happened during pregnancy. Sometimes it was an examination, an induction, a decision made in labour or an intervention that they didn't really understand but felt unable to question.

And sometimes, years later, they are still trying to make sense of it.

Why didn't I say no?

Why didn't I speak up?

Why did I just go along with it?

I think there is something much bigger underneath these questions.

Many of us have spent our whole lives learning how to be good girls.

To be polite. To be agreeable. To listen to people who are older or more qualified than us. Not to make a fuss. Not to be difficult. To trust the person in the room who appears to know more.

These lessons can run very deep.

And then we arrive in pregnancy and birth, perhaps for the first time, in a situation where we need to listen very carefully to ourselves.

Birth asks something different of us.

It asks us to inhabit our bodies. To listen. To make decisions. To communicate what we need. To ask questions. To sometimes say no.

And I think this is one of the reasons that independent midwifery can feel so different.

Not because an independent midwife has all the answers, but because the relationship gives us the time to talk things through properly. To look at the evidence. To discuss uncertainty. To understand what matters to you. And ultimately, to remember that your body is yours.

Pregnancy is a time to find your voice

Pregnancy can be a wonderful time to start noticing where you have been taught to hand your authority over to somebody else.

You might notice yourself saying yes automatically.

You might find yourself feeling nervous about asking questions.

You might apologise for taking up someone's time.

You might agree to something and only afterwards realise that you didn't actually want it.

None of this means that you are weak.

It means you are human, and you have been socialised in a culture where women are very often rewarded for being accommodating.

But pregnancy gives us an opportunity to practise something different.

You can ask:

Why do I need this?

What are the benefits?

What are the risks?

What happens if I wait?

Are there alternatives?

What happens if I say no?

Can I have some time to think about it?

These are not awkward questions.

They are good questions.

Your midwife is not there to make your decisions for you

This is something I feel particularly strongly about in my work as an independent midwife.

I sometimes hear the phrase “shared decision making” used as though the woman and the healthcare professional are equal owners of the decision.

I understand what the phrase is trying to achieve. Good maternity care should absolutely involve honest conversations between women and their healthcare professionals.

But ultimately, when the decision concerns your body, it is yours.

My role is to bring my knowledge, clinical experience, evidence, questions and observations to the conversation.

I might tell you that I am concerned about something.

I might recommend further assessment.

I might explain what the evidence says, where the evidence is uncertain and what the possible consequences of different choices might be.

I might encourage you to consider something you hadn't thought about.

But I don't own the decision.

You don't need to agree with me simply because I am your midwife.

And you don't need to disagree with me in order to prove that you are autonomous either.

Sometimes autonomy looks like saying yes.

Sometimes it looks like saying no.

Sometimes it looks like saying, “I'm not sure yet. I need some time.”

That is informed choice.

Consent is not a tick box

Consent in maternity care matters enormously.

It matters because pregnancy and birth involve some of the most intimate parts of our bodies.

Examinations, monitoring, medication, induction, assisted birth, caesarean birth and many other interventions should not simply happen because somebody has decided they are necessary.

There needs to be a conversation.

You should have the opportunity to understand what is being suggested, why it is being suggested, what the alternatives are and what might happen if you choose not to proceed.

Professional guidance from the RCOG emphasises the importance of informed consent and discussing the condition, proposed treatment, risks, alternatives and the consequences of no treatment.

And NICE guidance on intrapartum care is clear that women should be supported in their preferences and that their emotional and psychological needs should be considered alongside their clinical care.

This isn't about women refusing everything.

It isn't about believing that medical care is bad.

And it isn't about assuming that a physiological birth is always the safest birth.

It is about being an active participant in your care rather than feeling that things are simply happening around you.

And this matters because birth can stay with us

Birth trauma is real.

It doesn't always come from an objectively complicated birth. A birth can look straightforward on paper and still be experienced as frightening, violating or deeply distressing.

Equally, a birth can involve significant medical intervention and still be experienced positively because the woman felt informed, respected, listened to and involved.

The experience matters.

Recent UK research published in 2026 found that 40.6% of women in the study experienced childbirth as at least moderately traumatic, while 5.9% developed childbirth-related post-traumatic stress disorder. The study also found that lower birth satisfaction was associated with higher birth trauma ratings.

That is important.

Because it reminds us that birth trauma is not simply about whether something dramatic happened medically.

It is also about how the experience was lived.

Did you feel safe?

Did you understand what was happening?

Were you listened to?

Did you feel able to ask questions?

Were your boundaries respected?

Did you feel that your voice mattered?

These questions belong in conversations about maternity care.

The good girl can find herself in the birth room too

I think many women recognise this.

You are lying on the bed and someone suggests an examination.

You don't particularly want it.

But you say yes.

Someone recommends an intervention.

You have questions, but everyone seems busy.

You are frightened, but you don't want to be difficult.

You are told that something “needs” to happen, and you assume there isn't really a choice.

You look around the room at people in uniforms and with years of medical training and think:

They must know better than me.

And sometimes they will know things that you don't.

That is why we have skilled maternity professionals.

But expertise does not make your body somebody else's property.

You don't have to choose between trusting your midwife or trusting yourself.

Good care makes room for both.

Finding your voice doesn't mean becoming combative

This is important too.

I don't want women to leave this article thinking that they need to enter pregnancy ready for battle.

You don't.

You don't need to become suspicious of every recommendation.

You don't need to refuse something simply because it has been suggested.

You don't need to prove that you are independent by doing everything differently.

You simply need to know that you are allowed to participate.

You are allowed to ask.

You are allowed to pause.

You are allowed to change your mind.

You are allowed to say, “Can you explain that to me?”

You are allowed to say, “What happens if we wait?”

You are allowed to say, “I don't want that.”

And you are allowed to say, “I don't know.”

Those words are not rude.

They are not difficult.

They are part of having a voice.

This is one of the reasons I value continuity so deeply

When you have an independent midwife, you have time to build a relationship before you are in labour.

This is one of the things I love most about independent midwifery.

We can have these conversations during pregnancy, when you are sitting comfortably in your own home and have time to think.

We can talk about your previous experiences.

We can talk about your fears.

We can look at research together.

We can explore your options.

We can talk about what matters to you and what you would rather avoid.

And because I know you, I am not meeting you for the first time when you are having contractions.

That relationship matters.

The 2024 Cochrane review of midwife continuity of care found that women receiving continuity models were more likely to have a spontaneous vaginal birth, and less likely to experience caesarean birth, instrumental birth and episiotomy. Women also generally reported more positive experiences of their pregnancy, birth and postnatal care.

For me, though, the statistics are only part of the story.

There is something much more ordinary and much more human about being known.

When you know the person caring for you, it is easier to ask the awkward question.

It is easier to say you are worried.

It is easier to disagree.

And it is easier for your midwife to notice when something is different for you.

That is what continuity means to me.

Your birth does not have to be perfect

There is another trap I want women to avoid.

The idea that taking back your power means having the perfect physiological birth.

It doesn't.

You can plan a home birth and transfer to hospital.

You can want to avoid interventions and later decide that one is right for you.

You can prepare for a physiological birth and have a caesarean.

You can say yes to something you previously thought you would say no to.

You can change your mind.

None of this makes you less informed.

None of this makes you less powerful.

Autonomy is not about controlling every outcome.

It is about having a meaningful voice in what happens to you.

That distinction is incredibly important.

So how do you practise saying no?

You can start now.

Not necessarily by saying no to your midwife or doctor.

Start by noticing your own response.

When someone suggests something, pause before answering.

Take a breath.

Ask yourself what you think.

Ask what information you need.

If you don't understand, ask them to explain it again.

If you need time, say so.

If something doesn't feel right, say that too.

You might find these phrases useful:

“Can you explain why you are recommending this?”

“What are the benefits and risks?”

“What are my alternatives?”

“What happens if we wait?”

“What happens if I say no?”

“I'd like some time to think about this.”

“I don't consent to that.”

“I need you to listen to me.”

And perhaps one of the most powerful:

“I'm not ready to decide yet.”

You don't need to apologise after saying any of them.

For the women who have already been through it

If you look back on your birth and feel that you were not heard, that your consent was overlooked, or that you simply couldn't find your voice at the time, please be gentle with yourself.

You were doing the best you could with the information, circumstances and support you had.

You do not need to blame yourself for freezing, complying, becoming quiet or simply getting through it.

Sometimes our nervous systems respond to fear by fighting.

Sometimes by fleeing.

Sometimes by freezing.

Sometimes by going along with what is happening because it feels like the safest thing to do.

There is nothing shameful about that.

And if your previous birth has left you frightened about becoming pregnant again, you deserve support with that too.

A previous difficult or traumatic birth can shape the whole experience of a subsequent pregnancy. Talking about it properly, with someone who has time to listen, can be an important place to begin.

There is no place for the good girl here

I don't want women to become louder for the sake of being loud.

I want them to become more deeply connected to themselves.

To know when something feels right.

To know when they need more information.

To trust their instincts without being afraid of evidence.

To be able to listen to a clinical recommendation without automatically surrendering their autonomy.

To know that they can change their mind.

To know that they can say no.

And to know that saying yes can be just as powerful when it is genuinely theirs.

This is at the heart of the independent midwifery care I offer.

Whether you are planning a home birth, considering your options for a hospital birth, looking for a private midwife for pregnancy support, or simply wanting more continuity and time around your maternity care, you deserve to feel that you are part of the conversation.

You deserve a midwife who knows you.

Someone you can ask the difficult questions of.

Someone who will tell you what she sees, what she thinks and what the evidence says, without taking the decision away from you.

Because your body is not a committee.

It is yours.

And perhaps the work is not becoming a woman who never says yes.

Perhaps it is becoming a woman who knows that yes and no both belong to her.

There Is No Place for the Good Girl in the Birth Room

There Is No Place for the Good Girl in the Birth Room

Pregnancy is a time to find your voice

Your midwife is not there to make your decisions for you

Consent is not a tick box

And this matters because birth can stay with us

The good girl can find herself in the birth room too

Finding your voice doesn't mean becoming combative

This is one of the reasons I value continuity so deeply

Your birth does not have to be perfect

So how do you practise saying no?

For the women who have already been through it

There is no place for the good girl here

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