The Importance of Clear Instructions during Childbirth

Kindly supplied by Caroline Corley

Inspired by reading Laura’s article, I decided to share one of my funnier examples of when I experienced communication misunderstandings during childbirth.

A brief background of me is that I am a 49 yrs old female, married for 12 years, together for 19 yrs, and I have 9 and 4 yr old kids. I am a member of MENSA, an ex-lecturer and a passionate motorbiker. I was diagnosed with ASD in 2020. I am currently a local Vaccination Team Volunteer.

I had a breach, overdue daughter by cesarean in 2011. Having previously had alcohol addiction issues, I had been part of a group called SWANS. I had weekly visits to group ante-natal with other “addicts”. It was a vital and very comprehensive support until my daughter was 1 yr old. It was very different when I had my son in 2016 as I was pretty much left to my own devices because I had one child already.

Now, I am a very smart person. I learn very easily and quickly as long as I have had clear training. But, and this is an important but, I need clear, concise, step-by-step instructions for anything new.

So, with my son, I went into hospital at 38 weeks for induction due to placental complications. I had been experiencing practice contractions for a couple of days. They were milder than the actual contractions I had with my daughter so I was not concerned. I had even been out for lunch with my friends the day before.

Once at the hospital, they announced that I was actually in real labour and was dilating. As they organised a delivery room, my waters broke. Everything progressed very quickly from then on. We got to the pushing stage and I was really struggling and overwhelmed. This is the part I have never done before. I try to remember the correct breathing techniques I had learned. I was also trying to listen carefully to instructions from the midwife. I was distracted by sensory overload. Three times I passed out before we figured out there was a communication issue.  I follow instructions literally and do not make assumptions about what people expect me to do if they have not told me to do it. This is especially true when I am in a heightened emotional state and do not trust my own judgement.

When the midwife instructed me to push, the steps were:

When you feel the contractions, breathe in deeply. Hold your breath. Then push out with the contractions.

At no point had the midwife told me to breathe out. I was holding my breath as I pushed and then passed out from holding my breath during the pushing part. Once we figured this out, the midwife changed her instructions to include “breathe out while you are pushing” and things became easier.

My family and I still laugh about the absurdity of someone in MENSA forgetting to breathe. In my defense, I was following instructions involving my breathing that were incomplete. Now that we know about my autism, we still laugh, but in a slightly different way.

When people provide instructions, they make generalized assumptions about the reader’s/ follower’s prior knowledge/skills. I call these the ‘but everyone knows’ and I will talk more about them another time. In the meantime, to try to get a primary aged child to write some instructions for a simple task. You must then follow the instructions exactly. You end up unconsciously ‘filling in the gaps’ of the instructions as you ‘figure out’ what they were trying to tell you to do. These are the unconscious skills that I do not possess. If a step, or part of a step, is not written down then it does not get done. That includes common sense tasks such as breathing!


  1. Ruth on March 7, 2021 at 11:31 pm

    Really enjoyed your post Caroline which explains the importance of providing ‘full’ instructions. I am sure your article will help others to recognise how important it is to fill the gaps when instructing people who are ‘literal’ thinkers.

    Thank you for taking the time to provide such an informative blog for our website.

    Best wishes


  2. Reem Ginns on May 5, 2021 at 4:45 pm

    Hi Ruth, my son is autistic. The other day we were making tomato soup. We chopped the tomatoes and put them in a pan which we then put on the cooker whilst we opened up some garlic cloves to add. The tray of tomatoes were about two meters away from where we were preparing the garlic. When the garlic was ready, I said ‘ok! Now throw these into the pan’ – he had a momentary puzzled look (which I had come to recognise- it’s very slight) and then threw the garlic across the kitchen as accurately as he could into the pot of tomatoes! ?. We laugh together a lot. Thank you your story

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