Eh, hypothetically, you're right - just say no, end of story. In real life, though, it doesn't always work so well.
Just so you know, I'm NOT offended or upset, just want to try to shed some light on this.
I ended up with an unnecessary c/s - completely iatrogenic. My birth plan clearly stated no AROM, do not offer drugs, basically just leave me alone (let me walk, eat, drink, whatever I want). It was signed off on by the OBs in the practice I was using, the OB nurse who taught our "childbirth education" class (what a joke, but anyway) looked it over and saw no problem with it (BTW, she also ended up being my nurse during my labor - two different shifts). Good to go, right? No.
Despite my birth plan clearly stating no AROM, I was REPEATEDLY "asked" if I wanted it - I would guess I was asked five times. A few of the times, I was told that I *would* want it eventually b/c it would speed up my labor, and that the doc was going to go lay down and sleep for the night, so basically I better do it now or wait until morning. Every time AROM was offered, I politely declined and reminded the nurse that my birth plan said no AROM. When I was told the doc was going to go to sleep, I said "fine, I'll see him tomorrow". The doc actually came into my room before he went to lay down to try to talk me into it. I still held out. Finally, in the early morning hours (I think around 5ish), I was "asked" again. I asked my DH what he thought I should do - he said "go ahead". Even though we had discussed it prior to labor and he knew his job was to remind me I didn't want it, even though I KNEW I didn't want it - I was just beat down. How many times should someone have to decline a non-necessary procedure? Obviously, *I* should have done it at least one more time, lol!
So I agreed. AROM was done, my ctx immediately got horrible - back labor. I toughed it out for awhile - sat on a birth ball, tried hands and knees on the bed, walked a bit. *I* didn't know what else to do, my mom didn't know, my DH didn't know. We asked the nurse what else we could try, she offered drugs (remember, my birth plan specifically says DON'T offer drugs, this lady has seen my birth plan and said she completely supported me in it). No thanks, I said, I don't want drugs. Fine, whatever, says nurse and she leaves. That's it - no more suggestions of what I could do. I got back in the bathtub, which helped a bit, she wants me to get out for monitoring. I eventually agree to a vag check (I wanted to know how much progress all this hard work was making). According to the nurse, I have now REGRESSED in my dilation. I believe her, b/c I can feel myself tensing during a ctx and suspect I may be pushing a bit during them. I found out later by looking at my medical records that she LIED to me - I had NOT regressed, in fact I had dilated maybe 1/2 cm more since last check (which she had also done, and she recorded the two checks, so it's not a matter of different measurements or an "oops" - she KNEW). So at that point, I agreed to the epidural.... thinking that I HAD to relax somehow in order to dilate enough to have this baby.
So I have the epidural. Now I cannot get up, cannot get myself anything to eat or drink, I'm basically stuck in the bed - have to have help to turn from side to side! I ask my mom for a drink, she asks the nurse, nurse says no b/c I could throw it up. I can't exactly get up and get myself the drink, my mom won't go against the medical flow, not much I can do about this. Eventually, I start vomiting anyway. At that point, I (somehow, not sure how I was lucid enough for this logic, lol) pointed out that since I was vomiting anyway, might as well let me drink. Nurse finally agrees, tells my mom that I can have a few sips of water. Again, mom follows orders. Same for food - I BEGGED for food, mom says no b/c nurse says no. Again, after I started puking, I was "allowed" A cracker. Yes, it did come right back up, but that was better (to me) than the dry-heaving.
Fast-forward to the actual pushing. I was, like they say, flat on my back, lithotomy position. I was told that the epidural was "turned off" once I felt the need to push, but I do not believe that anymore (based on the fact that LESS THAN three hours after my c/s, I was able to move myself). So I pushed and pushed, for three hours. During that time, I was "cheerleaded", despite my birth plan stating NOT to do it. I was not in any condition to ask them to stop - maybe a stronger person could have, but by this time I was just beat down and following orders, yk? Purple pushing, for three hours, with multiple threats of c/s. I freaked out at every mention, and the doc "allowed" me to continue pushing. I asked for help to get onto hands and knees (and, seriously, I think I deserve a medal for even THINKING of that by that point), and was told that if I could flip MYSELF over to hands and knees, the nurse would "help" me stay there. WTH??!! Needless to say, I could not accomplish this feat, so remained flat on my back. Now I wish I had thought to demand they help me, or at the very least help me on my side, but at the time, I could NOT think of these things - like I said, I congratulate myself every time I remember that I even thought to ask about hands and knees. So more pushing, flat on my back. Have I mentioned that we could touch DS' head? DH, my mom, and myself all rubbed his little head and saw what color his hair was, he was so far down. Almost there!
Finally, the doc (with an apologetic expression :eyeroll) said that we were going to "have" to do a c/s. No, baby was not in distress, I was not in distress (well, other than the distress from being repeatedly threatened with a c/s). The only reason for the c/s was that the doc felt we'd waited long enough. Yeah, I know I could have refused it - NOW. At the time, it wasn't presented as an optional thing. It took an hour from that time to prep me and get me to the OR, and I bawled my head off the whole time. The anesthesiologist admonished me to hold still, I was crying so hard.
There were a lot of moments in there where I *could* have just said no, and looking back I *should* have just said no, and I very much wish I *had* just said no, but at the time, it wasn't that easy. There were also times where I repeatedly DID say no, and it was ignored.
I have gone over and over and over DS' birth in my mind, and I know just how many times *I* made the wrong call, wasn't assertive enough, whatever. BUT at the time, I was doing the best I could. I did NOT expect for my wishes to be completely ignored - especially since they had been approved by both the docs AND the nurses on the floor. I guess I was naive, b/c I never imagined that I would be in the situation that I was. I thought that docs/nurses would have my best interest at heart, and they would do their best to follow my birthplan. Now I know better, and I will not EVER put myself in a situation like that again.
Had I had a doula, things might have been different. Had my DH and my mom been more committed to helping me "rebel" and less compliant with the hospital's policies, things might have been different. Had I been able to advocate for myself better, things might have been different. But none of those were the case.
Like someone else said, I shouldn't HAVE to defend myself while I'm laboring. If I decline AROM once, that should have been the end of it - in fact, I should not have even been ASKED about AROM. So many things went wrong, and I've been over and over what I should have done differently - I highly doubt that the docs/nurses have even given my DS' birth a second thought. Whereas I have suffered from PPD and PTSD from it, and have cried myself to sleep many nights, knowing that I SHOULD have just said no.
Like I said, I'm not offended, I just want to present a different side. I consider myself a reasonably intelligent woman (I was a National Merit Scholar - woo-woo, lol). I did educate myself before DS' birth, though admittedly not to the extent that I am now. I thought I had prepared myself for the birth - I just had not prepared myself for the hospital staff. I also recognize (now) that my personality is not such that I can assert myself easily. I tend to try to please "authority" figures, and so it was tough for me to repeatedly say no to the nurses or docs - though I did!
After my experience, I have come to realize that I will NEVER feel comfortable giving birth in a hospital again (barring TRUE emergencies). And I will not do it - that simple. I can't guarantee that I would be able to defend myself during labor any better the next time (I certainly HOPE I would, but can't guarantee it), and more importantly, I don't believe I should have to. I don't want to be pulled out of my labor-land far enough to sensibly defend myself, and so won't put myself in a position where I might have to.
So, while it sounds good in theory to "just say no", in practice it's not that easy. Apparently, "no" doesn't always mean "no" when you're in a hospital.
I've heard some good stories about births in hospitals, but I've heard many more bad ones. Based on my experience, there's just no way I could ever have enough trust in the medical "professionals" to relax enough to birth, even if I was in an amazing hospital. I'd always be suspicious and waiting for the other shoe to drop. Once bitten, twice shy, I guess.