Pregnancy, birth and baby: Negotiation skills will help!

When was the last time you went into any appointment with the attitude that you’re going to negotiate? Well, in pregnancy and birthing, not to mention raising your children your way, the ability to negotiate is critical.

When was the last time you went into any appointment with the attitude that you’re going to negotiate? Well, in pregnancy and birthing, not to mention raising your children your way, the ability to negotiate is critical.

This article shows you:

  • Why women are crap at negotiating (but well placed to be great at it)
  • What studies say about women and negotiation
  • Why it’s important to be able to negotiate during this incredible time of your life
  • Five pointers that you can learn and take with you today.

Ready? Ok, let’s get started.

Women are notoriously crap at negotiating, but well placed to be great at it

When it comes to negotiating for themselves, women are notoriously shit at it. Yet, when negotiating for others, they’re very good. This is extremely unfortunate, because women go through things – like pregnancy and birthing – that men do not. In these kinds of situations, there are three skills that are absolutely critical to having an experience you’ll look back on fondly. Those are: Being able to dig for accurate information in the face of someone telling you absolutes without data; negotiating for what you want; and backing yourself no matter what happens.

Each of these three skills are in fact negotiation skills.

One of the remarkable benefits that a woman brings to any negotiating table is a her intuition. If you’re empathic, skilled at reading emotion in others, and great at building relationships (as many women are!) then you are a potential powerhouse when it comes to negotiation.

Here’s why:

  • you pick up body language cues a long way in advance of other people
  • you understand the subtleties of the other parties’ positions more easily
  • once you know a few negotiation skills, you can very easily turn others’ reactions in your favour.

Negotiation is easy to learn. It takes a bit of courage while you’re practising; but once you’re skilled at it, you will wonder how on earth you ever did without it. It makes sitting at any table, in the face of almost any situation, calmer and more interesting. And it allows you to gain the information that you require in order to make clearer decisions.

Speaking from my own experience, it’s also beneficial because most of the people with whom you pull out this skill are not trained in negotiation. It can throw people for six when they encounter negotiation skills, and that’s almost always in your favour.

This is especially the case with the medical industry.

Doctors like to tell pregnant ladies what’s what, and to be held as gods. When they’re not. Then some of them – especially Registrars, who have limited knowledge and experience – get uptight and tense.

Thus, what you really need as a woman is every inch of your empathic, intuitive skill added to negotiation capability.

What do the studies say?

According to Harvard Law, men tend to achieve better outcomes in negotiation than women. This article asserts that because girls are more relationship-focused, they tend to accommodate rather than be assertive. Of course, you’ll note the assumption that negotiation is not relationship-focused, which is absolutely not the case. The very best negotiations are built on relationship.

Writing for Forbes, Carol Sankar argues that women often feel intimidated (especially in the workplace), and tend to view negotiation – in this case, in terms of their own pay or worth – as being greedy or desperate. She states that 68 per cent of women tend to just accept the pay they’re offered.

Sankar writes:

Why aren’t more women asking?

They are simply afraid to ask. We have been nurturing the gratification of “just getting in the door and taking something for now.” It is the way we have been conditioned to sacrifice our value in exchange for public recognition, with the optimism that it will take more time.

I want you to stash this key word in your brain box for a moment: Asking.

The United Nations takes a different view of women and negotiation. In particular, it acknowledges that while women play critical roles in peace negotiations, which often result in longer and more sustainable times of peace, they’re often excluded from the negotiations:

Between 1992 and 2018, women constituted 13 per cent of negotiators, 3 per cent of mediators and only 4 per cent of signatories in major peace processes tracked by the Council on Foreign Relations.

However, I suggest that it’s not necessarily that they’re being excluded. Perhaps it’s more that they’re not stepping up to the plate.

In a summation of Women Don’t Ask (there’s that word again), Linda Babcock and Sara Laschever point out some startling facts about women and negotiation. Among them:

  • Women will pay as much as $1,353 to avoid negotiating the price of a car […]
  • Women are more pessimistic about the how much is available when they do negotiate and so they typically ask for and get less when they do negotiate—on average, 30 percent less than men.
  • 20 percent of adult women (22 million people) say they never negotiate at all, even though they often recognize negotiation as appropriate and even necessary.
  • When asked to pick metaphors for the process of negotiating, men picked “winning a ballgame” and a “wrestling match,” while women picked “going to the dentist.”

According to those ladies, men initiate negotiations four times as often as women do!

And Dr Phil writes that while 40 per cent of businesses are owned by women in the USA, they receive only 2.3 per cent of the available equity capital needed for growth. He suggests that this is because, sing it with me ladies, women don’t ask.

But is it really all that simple? Is it all about the art of asking?

Yes, largely. But there’s a lot more to negotiation than being able to back yourself enough to ask a question.

An article at Wharton argued that women have innate advantages when it comes to negotiation. In particular, listening skills, being open, being collaborative, and the ability to build long-term relationships, are all in women’s favour. The article argues that the problem isn’t that women can’t negotiate. The problem is that they don’t.

The Wharton article also argued – correctly, in my experience – that negotiation takes practice.

It’s like any other skill, from shopping for bargains to playing a sport. Truly.

What you need is the right framework. Then the ability to practice.

Why is it important to be able to negotiate during your pregnancy?

Before we get into whys, I want to tell you a bit about my experience with pregnancy so far.

I don’t know about you, but my experience of pregnancy in Australia is that the entire medical process is hidden. On purpose. In fact, one of the key reasons why I engaged the services of a doula was to have a sherpa who could guide me through everything that goes on.

When I had my pregnancy confirmed by my doctor, I was told pretty much that if I wanted midwifery care that she would refer me, but that I didn’t have to do anything.

So I was left feeling completely and utterly lost.

It wasn’t until a good friend of mine – a male, I might add – told me about hypnobirthing, about Midwifery Group Practice at local hospitals (and what it meant), and about doulas, that I started to be able to see the landscape.

Along the way, I had some hiccups with apparently critical blood tests (because the GP didn’t communicate dates clearly to me). And I got lucky getting into Group Practice – though being a Squeaky Wheel is apparently the only way to really increase your chances of getting in.

Once I had engaged a doula, I also learned:

  • about publicly-funded homebirth programs (that nobody else talked about, despite their having better outcomes than hospital births)
  • about upcoming tests, what they meant, what they involved, and what my options truly were
  • about how to engage with the medical industry
  • about the kinds of questions to ask
  • about notions of creating the kinds of pregnancy and birthing experience you want to have, no matter what situation you end up in.

She’s also taught me a lot about what hospitals will and will not tolerate, and how far you can push them.

Being able to negotiate allowed me to stay in a low-risk bracket while refusing a drink-based Glucose Tolerance Test. You might not know for example that the Glucose Tolerance Test is derived from genetically modified corn. It contains ingredients and colours that are completely unsuitable for anyone with an amine intolerance. It contains an extremely high level of sugar, and will tend to return false positives if you don’t eat sugar in your diet.

Everyone will tell you to drink the drink “because it’s safe”. And that the false positives are not a concern (read the studies; they are, actually). In any case, the truth is that not everything is safe for everyone.

Like me, you might be sensitive to excipients in over-the-counter vitamin pills. You might have a history of reactions to vaccines in your family. You might have a whole lot of things going on.

But nobody will talk to you about these things.

You have to be able to ASK. That’s why I highlighted above the importance of the concept of asking.

Negotiation skills are as much “art of asking” skills as they are anything else.

What it gives you is the capacity to:

  1. Know what’s going on
  2. Do the research you need to, to understand ingredients, excipients, impacts, outcomes, and success/failure data
  3. Formulate questions to get enough information to make a properly informed decision about anything you to do, or put into, your body (because it impacts two of you, remember!)
  4. Approach any “appointment” as a “negotiation”, so that you know you are doing what you need to do.

Additionally, your intuition is strong when you’re pregnant. If you have a feeling about something, always follow the feeling. Sometimes that means saying no, telling people that something doesn’t work for you, withholding your consent, pushing for more information even if the other person looks at you like they hate you, or even delaying something because it just doesn’t feel right.

If you are capable of negotiating for yourself, then you are better able to achieve the pregnancy and birth outcomes you want.

As many midwives and doulas will tell you, it’s not how your baby is born, but how you feel about your birth experience that counts. Knowing this, don’t you want to pave your pathway yourself?

Five negotiation pointers to get you on your way

Negotiation is truly an art. You can study it easily with the right tools. Two of my favourites, if you want to go down that road on your own, are:

  1. The Jim Camp System of negotiation, which is amazing.
  2. Chris Voss’s relatively recent book Never Split The Difference: Negotiating as if your life depended on it. (That’s an affiliate link, by the way; though I wouldn’t recommend it if I didn’t use it myself).

Voss’s book leans a lot on the Camp System, and together the two are better than using one by itself. I wrote a little bit about Voss’s book in this post about conducting interviews.

My biggest tip for you, before we even dive into the pointers, is this:

Every interaction is a negotiation. Every single one: Every purchase, every meeting, every conversation. Knowing this, it makes your ability to practise much easier. 😉

Ok, let’s get into the pointers.

1. Know what you want.

This sounds simple and dumb, doesn’t it? But how often do you go into appointments or meetings without a clear idea of your own goal? What are you wanting to take away from the situation?

This doesn’t have to be complicated. It can be as simple as, “learn about all of the risks, with links to studies that I can read myself”. Or, it can be as simple as, “discover as much about this procedure as possible”.

Write down what you want, and why you want it. Be specific. Be clear. If there is any vagueness, rewrite it.

2. Research the person you’re going to be meeting with, if you can.

If you can’t research the person, then at least make yourself some notes about how to approach the likely personality you’re going to face in your negotiation. It’s powerful for putting you in a fearless position.

According to Chris Voss, there are three key negotiator types. The golden rule is: Treat people how they want to be treated.

This is all about relationship-building. You have to get into their world if you’re going to have a valuable interaction in any sense. As a woman, this is your greatest strength.

You’ll find the three types on Chris Voss’s website, here.

The Camp System goes much further, asking you to research the person you’re going to face. Then to tease out – if you can – what you think their goals are going to be. What do they want to achieve? How are they likely to want to achieve it?

In one business negotiation I went into when I was just practicing, I ran a simple Google search on the other party. This found an interview with him that was in the National Library of Australia, as part of a Vietnam War oral history project. There, I learned that he was a womaniser by nature, which is precisely why his first marriage failed. And he was this because he’d been an orphan and was always looking for the mum/fam he’d never had. This insider knowledge allowed me to play that weakness (clothing, approach, attitude, makeup, etc) to draw him into a position where he felt he had power, before I played my hand. He got really mad about it, and showed his entire hand by getting extremely angry, which told me everything I needed to know about whether to partner up on a project with the guy. (I didn’t.) He prided himself on his NLP skills, which of course didn’t work on me (I knew about it ahead of time, you see). However, until he showed his hand, the partnership looked like a good deal. Boy would I have regretted it if I hadn’t approached this negotiation correctly.

3. Do as much research ahead of time as you can – and know how to read it

No matter what your appointment is about, go into it prepared.

You want to know as much as you can about drugs, procedures, and risks – especially risks. This means being able to find and read articles in medical journals. It also means understanding (at least to a limited extent) the nature of risk, as presented in real terms.

For example, you might see some data that talks about a risk of 50 babies in every 1000. That’s a risk rating of 5%. But risk ratings aren’t just numbers of occurrences; they’re also comprised of likelihood ratings, and impacts. So there might be a 5% occurrence, but a likelihood of 0.02% and a significant impact of the same. That’s gives you very different information from your blank 5%.

As a risk manager, I can also tell you that risk is never categorised as Low vs High. It is graded on a scale. That scale is of occurrence, likelihood and impact, and given a number. Only a true scale gives you a true indication of real risk.

Also remember that if you hear about risk of what goes wrong, that you’re not hearing about what goes right. If there’s a 5% risk, then 95% of occurrences are risk-free. It changes the conversation dramatically, because you can then ask about likelihoods and impacts.

If you have any sensitivities to foods or drugs, you must do the work to locate ingredients lists, including excipients. And if you can’t find it, to ask them to give that information to you before you make a decision about anything.

Remember, too, that study design is important when you’re reading medical studies. For example, the Term Breech Trial was a deeply flawed study, but it is still the only study obstetricians will discuss. Some of its flaws included:

  • inexperienced clinicians
  • inactive mums in labour
  • use of medications
  • deaths of babies (including babies who died in utero before any delivery, despite the study being about delivery; babies who died from abnormalities)… excluding those meant risk of vaginal delivery vs caesarian was about the same

Here is something from the Better Birth Blog to keep in mind:

As Dr. Marek Glezerman says, Keep in mind that although something may be statistically significant, this does not make it clinically significant. At the 2012 Coalition for Breech Birth conference he pointed out that if a patient presented with a temperature of 99.4 you would not look around for a drug that had a 98% chance of lowering it to 98.6. So, if you find that, for example, vaginal breech birth increases the risk of bruising to 2.3% from the cesarean-born risk of 1.2%, that is statistically significant. It is twice the rate of bruising. But it is not clinically significant because you would not do a cesarean just to avoid a 1% risk of bruising. See? Keep in mind that figures must be examined from every angle. You can present the same information many ways and get very different reactions and perceived outcomes. Remember what Mark Twain said the three kinds of lies are: lies, damned lies, and statistics.

Dr. Glezerman also points out that 91% of medical procedures have no backup in RCTs (randomized, controlled trials). So just because there isn’t a great study out showing that something is safe doesn’t mean it is, or isn’t.

Then, when you’ve got your information, shape your questions.

A great tool to help you is the B.R.A.I.N. system:

  • B – what are the benefits?
  • R – what are the risks?
  • A – what are the alternatives?
  • I – what does my intuition tell me?
  • N – what if we do nothing, or wait?

4. Even if you want to talk, stfu.

As one of the studies referenced at the start mentioned, listening skills are critical. The best negotiators say very little, while effortlessly getting the other party to talk. The more the other party talks, the more in debt they are to you.

This is a tip from the Camp System of negotiation.

The Camp System references a system of payment and debt, but not in terms of money. It’s how much you are in debt to the other party:

  • how much time it takes you vs how much it takes them, such as your/their travel time to get there
  • how much you pay in order to have this meeting, whether that’s in parking, or fees of some kind
  • who instigated the meeting and why
  • how long you wait to see them
  • what emotional situation is at play
  • etc etc etc.

You can already see that, in a medical situation, you’re very much the underdog. You are the person who travels. You pay for parking. You probably pay fees. You are more emotionally invested. And so on.

So what you have to do is bring everything back into balance.

The only way to do that is by getting the other person to talk, and shutting the fuck up and not offering them anything unless directly questioned.

What you find is that many specialist doctors (particularly obstetricians) abhore being asked questions. This is because they’re “busy”: They have tight timelines, etc. This is why it is incumbent upon you to keep them in that room answering your questions for as long as you require them to do so. If you are not happy with the outcome, request another meeting, or another opinion.

One simple tip to keep them talking: Mirror what they say.

Imagine that your obstetrician says to you something like, ‘There’s a 4x increased risk of xyz’.

Your reply is then: ‘A 4x increased risk of xyz’.

Typically, they will nod and agree and explain further. Many people never even notice that you haven’t contributed anything. You can have entire conversations where you simply mirror what the other party says, and say nothing yourself.

If you don’t believe me, try it next time you’re in a conversation. It feels all kinds of weird, but it works.

In a negotiation, it’s the simplest way to get more information, while making the other person feel like you’re both on the same team. After all, you’re clearly listening to what they say, right?

Just be prepared, if you push back on them after doing this, for them to react negatively. You know, just in case.

5. Take notes, or audio record your meeting

Make sure that you have a pen and a notebook and you keep notes. Not only will this allow you to keep track of the other person’s arguments, but you can track key information, links, studies referenced, names of drugs, risks, and much more. Of course you’ll need it in order to make a decision. But it also shows the other party that you’re listening, and engaged in what they’re saying.

If you can, audio record your meeting. I’ve found that, when it comes to obstetricians, when you ask to audio record – and then present a digital recorder – they tend to (a) be on their best behaviour, and (b) remember who you are. You’re more likely to get more (and more useful) help, and offers of assistance.

Whatever you choose, though, make it Just What You Do. And if audio-recording, always, always, always ask for permission. It’s illegal not to (in Australia, anyway).

Also remember to make notes about how you feel about it.

So what do you do once your meeting is over?

The first is to reflect on how well it went. Were all of your questions answered? If so, were they answered to your satisfaction? If you feel dissatisfied with what you received from the other party, can you seek a follow-up, or a second opinion?

Also remember to reflect on how you feel. Has your gut instinct changed, or perhaps taken shape?

Who else might need to be involved in decision-making?

Whenever faced with a decision, unless I have made a decision ahead of time in some direction – which may be to buy time, or to get the other party to play its hand, for example – I always take my power with me and refuse to decide on the spur of the moment.

This is not for no reason: There is real power in “sleeping on it”: Sleeping after gaining information will facilitate your decision-making, and your brain will do most of it for you unconsciously.

Do you want to learn negotiation skills for your pregnancy?

I’m thinking about putting together a meaningful and practical course for mums, which will give them the negotiation skills they need to navigate pregnancy, the medical industry, and birthing, with greater ease.

If you think that this is a fabulous idea, please fill in the form to express your interest:

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