We were talking in a WhatsApp group among colleagues today because one of them assisted in a birth where the woman had expressed a preference against an episiotomy.
According to him, the baby ended up suffering complications and may have sustained a permanent injury due to the way he was born.
And he alleges that it was her fault.

This raises a thousand reflections.

The way I see it, either this woman is crazy for wanting to sacrifice the health of the baby she carried for nine months just to avoid a procedure.
And in this case, she is just that: crazy.

Is it really possible that a doctor would respect a wish at all costs, even if it resulted in injury to the baby? I don’t think so, and in this scenario, the doctor should go to jail.

Or, a third scenario: the woman did express her preference, but this had nothing to do with how the baby was born with injuries.

The conversation that followed this story was wild.

Some doctors—who are also mothers—proudly stated that they were the only ones in their prenatal course not to have a birth plan.
Others (male doctors) literally said that women should just do what the doctor says, end of story.

Amid these extremes, of course, were some good points that made me think a lot.

Firstly (and I don’t have an answer to this): how is it possible that the majority of doctors—okay, we are interns, but still, doctors who work with pregnant patients all the time—can think that women are crazy for wanting health professionals to respect their wishes?

We are trained not to have a paternalistic approach.

We literally have courses and exams on empathy, the importance of the patient’s perspective, and their experience.
We also work in prevention, which is primarily done by informing patients, helping them make the right decision, but above all, making them the protagonists of their own care.
We have endless discussions about advocating for our patients in primary care.

And then, to hear such things just really makes me sad.

This idea that "the doctor knows it all" and is always right—then why are women so terrified of doctors in the first place?

This is the real issue.

Women are so afraid of the medical system that they sometimes make decisions without truly understanding the consequences.
And that’s incredibly sad because it shows that we, as a medical community, have failed them.
If they don't feel safe trusting us with their care, it means we did something wrong.

In my opinion, childbirth is a unique moment in a woman’s life that should be experienced with respect, information, and autonomy. While medicine has brought incredible advancements, birth has become increasingly medicalized—often unnecessarily. Interventions such as inductions, episiotomies, and labor acceleration are frequently performed without solid clinical indications and, even more concerningly, without women being properly informed.

Informed consent is not a courtesy—it’s a fundamental right.

The World Health Organization (WHO) has long advocated for respectful maternal care, ensuring that women are actively involved in decision-making and are not subjected to unnecessary interventions. It’s important to emphasize that humanized birth does not mean rejecting modern medicine. Rather, it means using it wisely, ensuring that every intervention is truly necessary and performed with the woman’s consent.

Science supports this approach. For example, routine episiotomies do not prevent severe tears and may actually increase the risk of complications such as more extensive lacerations, infections, and long-term pain. Additionally, the indiscriminate use of synthetic oxytocin to speed up labor can increase the risk of fetal distress and emergency C-sections.

The key issue is not being against medical interventions but ensuring that they are justified and carried out in a respectful, informed manner.

For healthcare professionals, childbirth may be just another delivery, but for each woman, it is one of the most defining moments of her life. Humanizing birth means ensuring not only a safe delivery but also a positive, empowering experience for both the mother and her baby.