Understanding Medical Interventions at Birth: A Trauma Informed Perspective for Doulas and the Women They Support

In today’s birthing landscape, tension often arises between the medical system and more holistic or natural birth communities. This friction can be especially heightened when trauma survivors navigate pregnancy and birth. As a trauma-informed doula or birth coach, one of the most powerful tools we offer our clients is context — helping them understand not only what is happening in their care, but more importantly, why. Let’s dive into why doctors recommend certain medical interventions, why some in the birthing world push back, and how we can hold space for clients—especially trauma survivors—by offering compassion, knowledge, and advocacy.

1. Why Do Doctors Make the Decisions They Do Regarding Medical Interventions?

To understand medical decision-making, we have to look at the structure of modern obstetric care. Most OBs work within hospital systems that emphasize risk management, safety protocols, efficiency, and standardized care. From the lens of medical training, interventions like inductions, fetal monitoring, or vaginal checks are based on one central goal: to ensure the safety of both the birthing person and baby.

Doctors often make decisions based on:

• Clinical guidelines and protocols: Many decisions are guided by evidence-based protocols that aim to reduce risk and poor outcomes. These protocols are not personalized but rather designed for population-level safety.

• Risk prevention: OBs are trained to anticipate and prevent complications before they occur. This can sometimes lead to a "better safe than sorry" approach.

• Time constraints: Especially in hospital births, systemic time pressures (like shift changes, staffing needs, or bed availability) can influence decisions.

• Legal liability: Unfortunately, the fear of litigation plays a significant role in some interventions. The phrase “defensive medicine” refers to decisions made more to avoid lawsuits than based on medical necessity.

While this may not always align with the individual’s birth preferences, it’s important to understand that OBs are often operating within a system that prioritizes safety through measurable outcomes — even if those outcomes sometimes come at the cost of personal autonomy or emotional wellbeing.

2. Why Do Some in the Birthing Community Oppose Medical Interventions?

In contrast, many in the birthing community—especially midwives, doulas, and birth advocates—see birth as a physiological process that, in most cases, unfolds safely without intervention.

Here’s why some push back against routine interventions:

• Over-medicalization: There is concern that birth has become overly controlled and pathologized. What is a natural process becomes treated like a medical emergency.

• Loss of autonomy: Many birthing people report feeling coerced or not fully informed before consenting to procedures.

• Trauma history: For survivors of sexual trauma, medical interventions—especially without full consent—can feel like violations and re-traumatize.

• Desire for empowerment: Many seek to reclaim their birth experience as an act of empowerment and connection to their bodies, which can feel undermined by excessive medical oversight.

The tension often lies not in whether interventions are ever appropriate, but in the how and why they are used — and whether birthing people are truly partners in those decisions.

3. Helping Clients Understand the Role of Vaginal/Pelvic Checks – A Trauma-Informed Approach

Vaginal and pelvic checks are one of the most sensitive parts of OB care — especially for survivors of trauma. These checks can feel invasive, triggering, and disempowering if not handled with care. As trauma-informed doulas or birth coaches, it is our role to help clients understand not just that they can decline checks, but also why they are sometimes suggested, and how to navigate the process with agency and support.

What Makes a Doula Trauma-Informed in This Context?

• Consent is central: You always remind clients that consent can be given or withdrawn at any time, even in labor.

• You prepare them: Explain ahead of time what a pelvic check involves — how it is done, by whom, and what information is being gathered.

• You validate: If a client expresses fear or discomfort, you don’t minimize it. You hold space, listen, and explore their needs.

• You offer options: For some clients, having a support person present, choosing a particular provider, or requesting minimal checks can make a huge difference.

• You empower choice: Whether a client chooses all the checks, none, or selective ones, your role is to support them in making that decision confidently and from an informed place.

4. Why Are Vaginal/Pelvic Checks Done During Labor and Delivery?

Let’s be honest: "Because it's routine" isn’t a valid reason — especially not for someone with a trauma history. Here’s what you, as a doula, can explain to help clients make truly informed choices:

What Are Providers Looking For in a Vaginal Check?

1. Cervical Dilation: How many centimeters open the cervix is (0–10 cm). This tells them how far along the person is in labor.

2. Effacement: How thin and soft the cervix is becoming. A cervix that is 100% effaced is paper-thin and ready for delivery.

3. Station: Where the baby’s head is in relation to the pelvis — how low or high the baby is, measured from -3 to +3 station.

4. Positioning: The provider may try to assess the baby's position (anterior, posterior, etc.) and whether adjustments in laboring position might help.

When Are Vaginal Checks Usually Done?

• During prenatal visits (late third trimester): To assess “readiness” for labor — though this has limited predictive value and is completely optional.

• On admission to labor and delivery: To determine if labor is active or if admission is appropriate.

• Periodically during labor: To assess progress and determine next steps (e.g., whether to break the water, give Pitocin, or continue monitoring).

• When there’s a question of pushing stage: If the birthing person feels an urge to push, a check may be done to confirm full dilation.

• If there are concerns: Slow progress, decels in fetal heart rate, or other complications may prompt a check.

Are They Always Necessary?

No. A birthing person can decline or request minimal checks. Some midwives and birth centers do very few checks, relying instead on physical and behavioral cues (e.g., vocalizations, contractions, body posture). However, in hospital settings, they are often more routine due to the medical model of care.

Supporting Trauma Survivors Through These Checks

As a trauma-informed doula, here’s how you can support a client facing the possibility of vaginal checks:

• Provide education early: Don’t wait until labor to talk about it. Discuss options, alternatives, and preferences ahead of time.

• Help them write a clear birth plan: Include specific language like “Please explain each check before doing it,” or “Only perform checks with verbal consent and my doula or partner present.”

• Use grounding techniques: Breathing, holding a hand, or making eye contact can help clients stay in their body.

• Protect their space: Advocate for privacy, respect, and slow, gentle communication from staff.

• Debrief afterward: Whether it was empowering or upsetting, talk through the experience and help process any feelings.

Final Thoughts

Birth is not just a medical event — it's a profoundly physical, emotional, and sometimes spiritual experience. For trauma survivors, the need for safety, control, and understanding is paramount. As a trauma-informed doula, your role is to bridge the gap between medical systems and deeply personal needs. By offering education, advocacy, and unconditional support, you can help your clients reclaim their voice and power in one of the most vulnerable — and transformative — moments of their lives.

If you're a survivor, or someone supporting a survivor, please remember: You have the right to understand every procedure, to ask questions, to say no, and to shape your birth experience in a way that feels safe and sacred to you. You deserve care that sees all of you — not just your body, but your story, your history, and your healing.