Sunday, January 21, 2007

Thoughts inspired by debates...

Jumping right on in because this bitch still has Sunday sessions to attend...

I have been fascinated by the debates that have gone down here at the NAPW Summit over vaginal birth versus c-section, midwives versus OBGYN and hospital births versus home births.

Basically, folks are debating the definition of what a "normal birth" is. The one thing everyone seems to agree on is that birth is normal.

I'm not a mother and the mothers I know have chosen variations on each theme...some did the midwife thing and others did the hospital thing (vaginal or c-section) and most had positive experiences. I was troubled to listen to stories about how the state stepped in and told women that they had to have a c-section because they had one previously, violated civil rights unnecessarily and interfered with medical decisions. But do those wrongs make the entire notion of hospital birth wrong? Isn't that absolute reversal just as dictatorial towards women?

I've never been one to see princess to pauper as more liberating than prince to pauper...y'all know a bitch isn't fond of absolute statements (wink).

But having attended several sessions that broke out into heated debates between midwives, OBGYNs...oh, and the doulas mind was whirling!

I thought of the women at the shelter I volunteer at and how they might absorb these messages. Most had hospital births (with the exception of the one car-based birth, the relating of which got my nerves so fried I might as well have been there). How would these women receive this debate over normal birth?

How would they feel if told that an experience they value as mothers was viewed as less than...wrong...damaging? Keep in mind that several of these mothers chose their future profession as nurses because their experience at hospital was so positive and nurturing.

Wanting to hear more from the medical doctor side of the debate, I sought out Annie Lyerly, MD, MA, Assistant Professor, Obstetrics and Gynecology Faculty Associate Center for the Study of Medical Ethics and Humanities, Duke University. She was seated at the next table!


Annie explained that what mattered most was how people felt about their birth. What constituted a "good birth" should be understood from the mother's experience. Annie Lyerly was upbeat and surprisingly positive. She explained that the issue was complex but easily understood when everyone, regardless of their personal opinion, took the time to listen to women.

If women want a hospital then listen to and honor that.

If women want home birth with a midwife and doula we should also value and honor that.

We need to remain focused on women and understand that we can't explore the risk factors of birth outside of what women say they value.

Thank you Annie Lyerly!

The best advocates for anything are passionate people. I can confess to getting riled up on a topic now and then my own self (wink). Regret comes from realizing that I'm speaking over and not for the very people I wish to advocate for...from talking at and not talking with...from waiting for someone to finish talking rather than listening.

We all need to listen to women, find out what we value and develop policy that empowers those things.

More too come...


Danielle said...

I am only 20 weeks pregnant, so I am really not there yet with the pressure and the controversy over certain kinds of births. I know it's coming, though. However, in my first trimester, I suffered morning sickness and ended up loosing 10 pounds from it- as a result, got a lot of condemnation for "starving" my child and that sort of thing. There is a lot of condemantion out there for moms regarding a lot of things- and 99% of the times, it's other moms doing the condemning! On all those "debates" you see- whether it's childbirth choices, breast vs. bottle, stay at home or work, etc, etc, etc- are there any men debating? Any childless women debating? No. At least, I haven't seen any. Women who have had children need to get over themselves and realize that if they don't want judgement, then it starts with them.

Saskia said...

Thanks for your thoughts on this conference... it's fascinating.

As you point out, the concept of a "good birth" or a "normal birth" is well worth discussion, but for many women, that discussion has become rife with self-righteousness, judgmental behavior, and the conviction that there is just one "right" way to do things.

If I may share my personal story: I had my first child just under two years ago, in Madison, Wisconsin -- a so-called progressive city where women have a wide range of birthing options. Being a nervous first-timer and an former academic who still relies too much on classes and book learning, I signed up for two different childbirth classes -- one through my HMO, and the other at a local left-leaning, feminist-based parents' resource center. I naturally anticipated that the resource center's class would be more woman-focused, more emotionally empowering. My naivete coming out, I guess... Despite the fact that I am a left-leaning feminist myself, I became rapidly sickened with the dogma being put forth by the class at the resource center. The messages were clear and strong: women who have epidurals are emotionally weak and under-prepared for childbirth, women who give birth in hospitals are wimps who are submitting to western medical patriarchy, women who fail to see childbirth as a spiritually transforming experience are stunted human beings, and every c-section is a tragedy (that would, of course, have been preventable if only the laboring woman had done a better job). My partner and I had decided to forego the services of a doula, preferring to have just the two of us forming our own little intimate support system, but the class leader and other class participants spent a lot of time trying to convince us that we really would regret not having a doula. Anyhow, the experience was an overwhelmingly negative one, and I came away from every class feeling a lot of self-doubt and worry. Not exactly how one should approach labor and delivery. (My HMO class, by the way, presented a lot of the same information, but without the judgmental overtones.)

And you're absolutely right -- there's a lot of classist baggage in the messages of the "enlightened" birthing advocates... but ironically, too, these same advocates often weirdly glorify/objectify the birthing traditions of indigenous peoples.

Thanks, again, for this post, and for exploring this issue. Your penultimate sentence says it all.

Shark-fu said...

First off - Danielle CONGRATS and many blessings to you and your family!

And all I can add to what you and Saskia said is YES...and we need to continue this debate while being inclusive of all genders.

I'm grateful to NAPW for creating an environment where a childless by choice woman like myself could hear various points of view and collect them all to take back to the women in my that they can make the choices that are right for them.

Good stuff!

Jade Souza said...

These criticisms of the natural chilbirth scene are certainly valid. No matter what your philosophy of birthing, it often seems that judgement is what prevails. As a survivor of two pregnancies I can testify that as soon as you are visibly with child everyone you meet on the bus and their cousin is eager to imbue you with their insights about birthing and parenting, which are usually firmly rooted in blame of Bad Mothers. (As we all know, Bad Mothers are the cause of every human problem on earth.)The threat of Bad Motherhood is enough to make any pregnant woman pre-eclemptic.
It is partially because of this phenomenon that after the birth of my first child I became a doula. I believe that every woman needs at least one person who's primary agenda is to support and trust the mama to make the right choices for herself and her child- and that is the doula's role.
It always saddens me when I hear stories of self-righteous doulas and childbirth educators who make mamas feel more judged. That is a poor representation of what childbirth educators and doulas do. The doula is the only person related to a birth who can have the mom's needs and desires as her exclusive interest. She is free from personal history, hospital policies, insurance demands, liability risks, the burden of medical advice-giving, and other potential conflicts of interest. Its a shame when a doula violates this awesome contract by being judgmental or dogmatic, precisely the approaches we are there to stand outside of.
As a doula I have had the privilege of attending births in homes, hospitals, and operating rooms. I have doula'd mamas who planned epidurals, and water births, and mamas who by virtue of being in prison had no part in planning their own birth. I've doula'd mamas through the ambivalent, the unexpected, the extraordinary, and the emergency cesarean. It is a privilege to be an agent of choice in the birth room, and any doula who fails to see this is missing out on the heart of our work. We are there to honor the mother.

Lori said...

"What constituted a "good birth" should be understood from the mother's experience
What constituted a "good birth" should be understood from the mother's experience"

A woman does have a right to make choices. However, there are always consequences to those decisions. I can decide to not use a car seat for my child to save time. However, the law then can ticket me. As a society we say the risk to that child's life is too great.

Legally, a pregnant woman is entilted to smoke. It will however harm her fetus - how much and how noticable may change - but harm will be done. Also, the second hand smoke will harm everyone around her.

Here is where I will sound oh so self righteous and annoy everyone I suppose. Entering a hospital in labor UNNECESSARILY consumes resources. Even if you have health insurance - it still means someone is paying money. When you have an avoidable c/s then everyone's premiums go up even those who have spent thousands of their own money in paying for out of hospital care.

The most recent number I saw was that 1 out of every 10 patients who walks into a hospital will contract an infection in the hospital. Those patients including women and infants in the hospital because that is where they feel "comfortable" then use antibiotics and contribute to antibiotic resistant bacteria - putting the rest of us at risk - like second hand smoke.

The practice of having 90% of US women birth in hospitals when only 20% of all pregnancies have any medical need to even see an OB results in an enormous waste of resources, time, money and lives.

There is also the issue of what is a healthy baby? (or mother for that matter.) Being alive does not constitute healthy. Children born by ceserean do not recieve proper bacterial colonization. They are at increased risk of diseases as they age including asthma. Women who have c/s have more difficulty breastfeeding. Babies born to mothers with epidruals or other narcotics are less responsive for some amount of time (varying from mere moments to months) Babies who get formula are more likely to have cancer, diabetes, and heart disease as they age. Someone has to pay for their medical treatment. The mother's who don't breastfeed are more likely to contract cancer, have osteoperosis and even develop rheumatoid arthritis and diabetes - someone has to foot the bill.

Even more frightening is Dr. Odent's research at on how the events from conception through the first 12 months can potentially affect our entire lives. Including, pitocin and the theory that children deprived of pitocin at birth may never learn to love themselves or others leading to more violent crimes including suicide.

Take a moment and think about that - the 8 year old with leukemia and the 16 year old suicide are potentialy the sequela of a "good birth" that involved medical procedures that could have been avoided. Walking into an OBs office starts off a chain of events and very few people are looking at the long term consequences.

Personally, I don't think anyone who made the best choice with the information they had at the time should feel guilty. On the other hand I know a number of women (my mother included) who had information available to them they chose to ignore because it wasn't conveinent to labor or breast-feed or whatever.

We have a money driven system that seems to be all about conveience. I favor a system with empirical research data and facts not platitudes made available. I think outcomes should be published.