Stuff White People Like: Talking About Birth
Friday, December 4, 2009 at 7:28PM I intended to post the comment I left on Pamela’s blog (She’s blogging again!) a few days ago prefaced with something like “Please critique fiercely. Send it to a sociologist or a picky friend. K thx.” I’ve had it in the queue along with some historical stories of interest and after this conversation, which is still going, I’m posting it now.
Pamela, I have so many ideas that I’ve been sitting with for over a year. I’m reluctant to dig in because, well, among other reasons I really don’t want to come across as a white woman defining and speculating on the experience of people of color.
The one thing I have arrived (it’s a theory in work) at is that white privileged women are more likely to shocked by medicalized birth, not solely because they came in with preconceived notions that it should be different, but because it’s a window of time in which we are profiled, discriminated against, told our bodies are defective and insufficient, our rights to bodily autonomy are repeatedly violated and there doesn’t seem to be any way of navigating and changing “the system.” It can be a microcosm of the societal oppression of females, which many of us felt we previously had some control over because of education, privilege, whatever.
As an emergency service or if used for personal preference (i.e., preferring an anesthetized birth), the medical birth system is great. It fails in its desire to control the births and bodies of ALL women, using drugs and procedures to standardize and expedite the birth process, and it ultimately places the self-interest of the physician or hospital above that of the patient as evidenced by the collective justification of hundreds of thousands of unnecessary “medical” procedures performed each year on women who are not told the real reason for their cesarean/induction/augmentation/intervened upon birth.
While I can’t speak to the experience of the women of color in the medical birth system, I feel somewhat comfortable speculating that the reason why white women speak up so much more often is because we were more likely than women of color to be raised with the idea that our bodies are not broken, defective or property of anyone else… or at least that’s what we’d convinced ourselves until we got pregnant. When we come face to face with someone arguing otherwise without any solid scientific evidence to fall back upon or trying to get us to throw in the towel before even trying, it’s really disgusting. I personally don’t mind trusting medical authority, but it had better be backed up by data and facts, not anecdote, personal preference, opinion, a half-baked appeal to the authority of “the system” (as in “it’s just the way we have to do things”) or plain-old demanding compliance with the established patriarchal value system.
That’s what I arrived at after my hospital experience of refusing unnecessary meddling disguised as prophylaxis or “preventative medicine.” I walked away thinking about how much harder it probably would have been to negotiate for a regular old vaginal birth if I hadn’t been (any or all of the following) white, middle class, educated, English-speaking, insured, average-weight, neurotypical and able-bodied. Wouldn’t it have been harder to self-advocate if I didn’t come in with a heaping helping of privilege on my side?
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Reader Comments (89)
let me add that I have worried about the next meal, next pay check, and next house and that in no way left me to want a c-section. where do people suppose that those of us who are "less privileged" cannot have our own healthy opinions. Of course, I am now privileged enough to have the internet and a home and share these experiences. My friends who are struggling to find medical care and who have struggled to support themselves discuss birth often. They are curious as to how they can achieve the best for their children the same as it is everywhere. My section-8 neighbors are like me,at times, bogged down by life could simply allow life to run them but I've seen my other neighbors who are in the top 1% of economic class in america parent their children the exact same way. I feel lucky to have such extremes in my home town. The better birth, prenatal, and post-natal discussions are simply held up as long as someone continues to look for the best. Hopefully by best birth you are talking about a holistic better for mother, child, family, community. Unlike the c-section for vanity crowd that thought best was in out surgery does not seem better to me because there are simply different health and mental risks with cesarean. It was $22,000+ added medical costs from c-section. So even on an economic level it makes absolute sense to consider less medical intervention.
Concerning "informed consent," I was never given an option of whether or not I was going to be induced or given a c-section. The doctor nearly said that he had confirmed my pre-eclampsia and that I would need to drive to the hospital immediately for an induction. The next doctor, after the prescribed 12 hours of labor, and 2 hours of pushing was no longer under their ideas of "NORMAL BIRTH" they walked in and began prepping me for c-section. That hardly seems to have anything to do with my socio-economic status nor my own views of birth. All it had to do with was the doctors prescribed agenda.
The opposite of normal or natural birht is a induced labor ending in c-section as I had with my first child. Unlike the presupposed ideas of Dr. Amy in where medical western medicine is the end all to birth concerns, my c-section added to the pain of childbirth/ It has not made my recovery from cesarean easy or pain free nor safe. In my own experience it actually added to a severe case of post-partum as well as internall scarring that still prohibts some abdominal exercies.
Feminist Breeder, you misrepresented what I said, what you said, and the post on my blog. Please stop.
"There is a need to define normalcy in childbirth. When hospitals cross the 50 percent mark in cesarean section rates, it is clear that they have found another standard of normalcy for birth and women suffer as a result of unnecessary cesareans."
First of all, the C-section rate is not 50%. Second, modern obstetrics is not interested in defining "normalcy." That's the obsession of "natural" childbirth advocates. Modern obstetrics is only interested in producing the safest outcomes, and, of course, modern obstetrics is the only system that is able to produce the safest outcomes for both mother and baby. Midwifery itself can only exist embedded within modern obstetrics. Without recourse to obstetricians, a substantial proportion of midwifery patients and their babies would die.
Dr. Amy, if you have to misrepresent what people say in order to be right, something is wrong with your argument. "THE cesarean rate" (which is a meaningless term without more qualification) is not what was being discussed. You of all people shouldn't be chastising others on precision in statistics. Hospitals have crossed the 50% cesarean mark. In fact, a few in Miami-Dade County have. So, what is the problem with that statement of fact? Nothing.
Medicine has to define what is within physiologically normal range in order to know when to intervene. It is the central premise of all medicine, including obstetrics. Why has ACOG had to make statements saying that elective inductions and elective cesarean sections should not occur prior to a definitive confirmation of 39 weeks gestational age? Because NOT delivering before that point is physiologically normal, and the evidence indicates that the trend of "modern obstetrics" to induce and do elective cesareans before that point was to the detriment of both mothers and babies, and has made our outcomes worse recently, instead of better.
No one is saying all medical interventions are bad. You keep on repeating that we have lower poor outcomes due to modern obstetrics. You are the only one arguing about this straw man argument. Modern obstetrics as a whole is not monolithically good or bad. All of its practices need to be examined to see how they effect outcomes, just like the New England Journal of Medicine did, if you follow my link above, and just like the US Preventative Services Task Force did, and just like the birth advocacy community will continue to do.
Your crusade against this examination of evidence of individual interventions and intentional exaggeration of risks is still "neither evidence-based not patient centered, often to the detriment of both women and infants".
And, what happened to the conversation about privilege? No one is saying we need to educate women of color to follow our luxury of caring about natural birth. We want to include their voices in the conversation, and both Tamika and Mai'a have confirmed that we need to listen better. We also need to make sure they are included in our attempts to improve practices and outcomes, while not assuming their values and social contexts are the same as the dominant culture.
Jill-o- I hope that my own comments aren't too caustic, especially that shaved pussy comment. I expect that the Chicago Dr. in your recent post would have approved of Ms. Masterson's squeaky clean agenda. As an aside, he is the man who delivered my mother.
Mai'a- I have seen what you mean from the other side. I am from a white upper middle class family of doctors, architects, and bankers. My dad had lots of anecdotes about black women in labor and the way they interacted with doctors, down to the accent which he used for his stories making doctor into docta. He did his residency in Chicago.
As far as medical care goes many people are despised for racial, educational, and economic factors. These people are considered unable to make decisions about their own bodies, and are frequently used to test out new tactics and treatments. This is internationally recognized.(link provided Teuter) The root problem for obstetrics is that there has been an overreach in which now otherwise autonomous white women recognize that they are being disenfranchised. Without this overreach, there would be much less of a neo-natural birth movement because it is so easy to ignore the demographics in which we do not circulate. So now that it's a given that all women, not just the so called minorities or the poor, are loosing their human rights, it's turned into a public issue. Informed consent equals being informed of the material risks of an intervention in standard practice and in research. When not given an opportunity to make an informed consent in standard practice it is recognized as criminal assault and battery. In research, it is much more grey.
http://ohsr.od.nih.gov/guidelines/belmont.html
"C. Applications
Applications of the general principles to the conduct of research leads to consideration of the following requirements: informed consent, risk/benefit assessment, and the selection of subjects of research.
1. Informed Consent. -- Respect for persons requires that subjects, to the degree that they are capable, be given the opportunity to choose what shall or shall not happen to them. This opportunity is provided when adequate standards for informed consent are satisfied.
While the importance of informed consent is unquestioned, controversy prevails over the nature and possibility of an informed consent. Nonetheless, there is widespread agreement that the consent process can be analyzed as containing three elements: information, comprehension and voluntariness."
As an educated white woman I know that I did not have the opportunity to give an informed consent for my 2 hospital births because I was not provided with adequate information, and was actually LIED to. (Yes that is another anecdote, and not scientific.) It is also unacceptable that any family, regardless of background, would be subject to this type of tyranny, but it is especially odorous that the so-called minorities are bearing the brunt of this abuse because they are less able to access alternative care such as midwifery.
Because doctors/nurses/hospitals refuse to acknowledge the physical and psychological damage they are doing, and because they are actively seeking to further restrict access to midwifery, we are seeing this backlash. And, it is very important IMO to question whether we would be seeing such measures being taken if it was mostly minorities seeking midwifery care. Is the real issue here racism and eugenics? Is the medical community up in arms because they they are afraid of a few perfectly good middle class white babies dying? Or is the issue really not being able to bill for the services leading up to the deaths of those middle class white babies?
"Medicine has to define what is within physiologically normal range in order to know when to intervene."
But it defines that range by outcome, not by philosophy.
Consider: how do we know what blood sugar level is normal? It's not written down anywhere. People don't come with instruction books and default settings. Normal blood sugar was defined by testing blood sugar levels of large populations and comparing levels with outcomes. We don't arbitrarily decide that normal blood sugar is x by incorporating all possible blood sugar levels found in nature. We know that above and below certain levels, people become sick. Those become our reference points for normal.
How do we know how long a "normal" labor lasts? It's not by insisting that any length of labor that is observed in nature is normal. And it's not by looking at all possible lengths of labor and averaging them together. It is by comparing lengths of labor with outcomes. Beyond a certain length of labor the chance of a good outcome for mother and baby becomes lower than for shorter labors. And because we know that the chance of a good outcome begins to drop after a certain point we define anything longer as abnormal.
How do we know how long a "normal" pregnancy lasts? It's not by insisting that any length of pregnancy that is observed in nature is normal. And it's not by looking at all possible lengths of pregnancy and averaging them together. It is by comparing lengths of pregnancy with outcomes. Above and below a certain length of pregnancy the chance of a good outcome for mother and baby becomes lower. And because we know that the chance of a good outcome drops off on both sides of this range we define shorter pregnancies as premature and longer pregnancies as postdates.
"Natural" childbirth advocates are completely caught up in the naturalistic fallacy, the idea that because something is natural, it must be good. Death is a natural part of childbirth. We are not interested in recapitulating that. We are interested in 100% healthy babies born to 100% healthy mothers and that is a distinctly unnatural outcome.
I sat down to reply and noticed that MomTFH actually said most of what I was going to say! That’s always a treat.
Amy, you have put a lot of energy and time into these threads. I can tell this is a really important topic for you and I want you to have your say. I don’t want to shame you about your communication style in case it’s just how you talk to people on a regular basis, okay?
We know that thousands of OB-GYNs have reported changing practice because of fear of litigation and this ultimately hurts patients. Pretending that everything is hunky-dory in OB sounds farcical. How would it not be subject to the same attitudes and oppressive cultural structures that permeate society? Can we lay the “Dr. Amy, Great Online Defender of the Profession” shtick to rest for a bit, please?
I’ve already asked you to stop lumping anyone that criticizes your profession into one homogenous mass of people. Please. No more on this thread. The whole “X people say ____, you are one of X people; therefore, you are silly” argument is rude.
Let’s stay on topic without derailing it. You have the floor on a popular blog about birth and women’s rights issues and we’re talking about issues that are very important to you. Plus, the blog owner WANTS to hear more of what you have to say on this topic (racism and birth issues). If you want to come back as the woman that wrote that first comment earlier in the thread, then please do.
Thanks.
I rarely step into discussions. Ironically, the only times I have stepped in have been when people complain about other women getting epidurals and making other "bad choices." *sigh*
"Natural" childbirth advocates are completely caught up in the naturalistic fallacy, the idea that because something is natural, it must be good."
Straw man. Stop it. Arsenic is good? Mercury is good? Women losing a baby and getting a fistula from obstructed labor is good? NO ONE IS SAYING THAT! My entire post was about outcomes! Who are you talking to?
This is a complete waste of time. You ignore all of the good points, distort the evidence, and fight against imaginary people, while doing all of the things you criticize others for doing. Go back to your own blog.
"Pretending that everything is hunky-dory in OB sounds farcical"
Where did I say everything in OB is perfect?
Please don't put words into my mouth. I am merely pointing out that your empirical claims are factually false. If you wish to show that they are true, you must provide scientific evidence.
Dr. Amy, are you talking to yourself? Don't put words in my mouth? Almost every post you make does that. It's called a straw man argument. When are you going to answer even one of the times I point out that you do that?
C'mon, you are smarter than this. You are looking more and more ridiculous.
Go.
Amy:
I'm not exactly sure how your response to me answered anything. Yes, of course, most people are aware that they have the right to informed consent. However, it is the DOCTOR'S responsibility to provide the information necessary, based on the situation at hand. If a physician lies about or omits information, the patient is not receiving informed consent, no matter how badly they wanted it, or how earnestly they consented, based on the information that they were given.
If the doctor states that there are no alternatives to a section, or that there are no risks to an epidural, or, hell, that there are no potential complications from a vaginal, unmedicated delivery, then they're giving misleading information and that's not working with the patient to achieve proper informed consent.
I also, again, never said that most women were not satisfied with their care, or that most women did not receive informed consent: I said that I feel that it is perhaps the biggest issue facing the area and that a lot of issues for all parties would be better resolved with true informed consent.
Informed consent according to the AMA:
"In the communications process, you, as the physician providing or performing the treatment and/or procedure (not a delegated representative), should disclose and discuss with your patient:
The patient's diagnosis, if known;
The nature and purpose of a proposed treatment or procedure;
The risks and benefits of a proposed treatment or procedure;
Alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance);
The risks and benefits of the alternative treatment or procedure; and
The risks and benefits of not receiving or undergoing a treatment or procedure.
In turn, your patient should have an opportunity to ask questions to elicit a better understanding of the treatment or procedure, so that he or she can make an informed decision to proceed or to refuse a particular course of medical intervention."
Informed consent according to ACOG:
"All three [criteria for disclosure] can help to illuminate what needs to be shared in the signifi- cant categories for disclosure: diagnosis and description of the patient’s medical condition, description of the pro- posed treatment and its nature and purpose, risks and possible complications associated with the treatment, alternative treatments or the relative merits of no treat- ment at all, and the probability of success of the treatment in comparison with alternatives."
"Please don't put words into my mouth. I am merely pointing out that your empirical claims are factually false. If you wish to show that they are true, you must provide scientific evidence."
OK, now I've completely lost the thread of what the empirical claims are and I've tried to backtrack to find them. That there can be something called normal in childbirth? That c-section rates are too high? That modern OB care is not evidence based?
It seems that Amy agrees that "not everything is perfect in OB", which is news. I think there's some value in establishing common ground and working from there, eh?
I just spent an unprecedented 12+ hours off the computer. I'm disappointed that we're not back on topic.
It might be good to point out on this thread that falling back on the defense mechanism of "Everything you say is crap unless you have citations; therefore, I am the most righest of them all" is a very elitist tactic. You are more than welcome to demand compliance with this specific form of discourse on your own forums. My concern is that lots of people do not speak up in general because their feelings will be shot down or their ideas laughed at because they don't have the academic literacy to make something sound presentable or they don't have access to full-text of journals. I honestly do privilege certain ways of communicating, but I encourage everyone to say what they need to say or want to say. Your truth is just as valuable as anyone else's truth.
That's why it was actually really difficult for me to tell you, Amy, to knock off some of the stuff that seems to be derailing the conversation. Your words are just as valuable as anyone else's. I think you have some really interesting points on race, class, privilege and birth. Are people here just jumping down your throat too much for you to make your points or are you enjoying derailing the conversation?
To wrap up the naturalistic fallacy/ you need OBs thread, here is a comment I left more than a week ago on another blog.
[This was a quote from another comment] “There is a big focus on having a “natural birth”, but a failure to recognize that maternal and neonatal death and injury are all part of nature.”
Two things here.
1. This is a red herring in any birth discussion that amounts to “Look at the crazy wimminz who want metaphysical communion with Nature and don’t care about their babiez.” It’s a way of putting down the view of the views of anyone who hasn’t gone to medical school, even though it’s their body that is affected.
2. A frequent accusation on blogs frequented by physicians is that anyone calling for change in obstetrics is clearly leaning on the naturalistic fallacy in forming their arguments, that a reduction in the use of unnecessary procedures on women in childbirth is a desire to return to a healthy, natural past which never existed.
If you listen to what most maternity care advocates are calling for, its accountability, transparency and the judicious use of obstetric interventions as needed and as wanted. The decline in maternal mortality was multi-factorial and clearly partially attributable to access to emergency obstetric care. To deny that would be unreasonable.
I understand your defensiveness and I can assure you that obstetricians and their skill set are highly valued. OBs Gone Wild are not. Decisions about a woman’s care made based on defensive medicine which are dishonestly sold to the patient as “playing it safe” are not appreciated and are unethical. But every woman that I know personally that gave birth out-of-hospital had a solid contingency plan that included transfer to a hospital where they would be cared for by… obstetricians.
As the cesarean rate and induction rates continue to rise and VBAC rates drop due to fears of litigation, I believe more women will continue to seek out-of-hospital options to avoid giving birth in hostile territory. I’ve sat there before and tried to reason at 37 weeks pregnant with doctors and CNMs who saw POTENTIAL LAWSUIT before they saw REASONABLE PREGNANT WOMAN. Hopefully women can be viewed as competent and capable of making their own decisions about their and their fetus’ bodies. Wouldn’t that be great?
Tara said- "Women are not told that u/s weights can be off significantly. They're not told that AROM in a non-engaged baby could quite possibly lead to cord prolapse. They are not told that epidurals can lead to drops in blood pressure and maternal and infant fevers. They aren't TOLD these things, even when they ask. They aren't told the potential effects of a C-section on later pregnancy.
Now, are ALL OBs/midwives/etc. denying this information? No, of course not. There are a great many care providers who do provide it when asked. However, there are enough that don't give the information that it's a crisis, and something we need to fix before...I can't even ponder the end result. "
I personally experienced this at a "childbirth education" class this weekend. The women in the class were asking good questions about the AROM and c-sections for "big babies", etc, and the so-called educator failed to mention that AROM can cause prolapsed cords and other complications, as well as increasing infection risk for mother and baby, and that "big babies" are often misdiagnosed because ultrasounds aren't reliable indicators of size. Of course, she certainly didn't even define what a big baby is according to medical guidelines vs. your doctor's opinion. How can women make informed decisions when they aren't informed???!
Sara:
Agreed. Isn't it sad? I am asked repeatedly why I have a mistrust of OBs, and it's frankly because of what I've experienced with them firsthand, in addition to stories like that. I would have to say that I have never been treated like that by another surgeon. For pete's sake, my surgeon actually discussed the risks and benefits of removing my gallbladder under epidural because I asked the question (I hate anesthesia and you could tell he thought I was slightly crackers but he did it anyhow - I chose general *grin*). When I had my knee surgery (yay soccer!), they took the time to answer all of my questions and gave full alternatives, including no surgery, minor surgery, more major surgery, etc. For both of those procedures, while I did find other information suggesting other choices, I never was overwhelmed with the lack of information I was given.
As for the topic here, I think it's even worse with underprivileged women and/or minorities. It's clear when you look at the rates of arrest for drug use while pregnant that minorities are overwhelmingly being prosecuted, despite the evidence regarding usage rates. Should people use meth while pregnant? Well, no, but the fact that they are the vast majority of prosecutions should indicate something about who they are receiving care through.
In addition, many of the cases regarding forced treatment in pregnancy regard women who are disadvantaged. In general in health care, poor and/or minority women are often given less options and pressured into treatment or a lack of; I can't imagine the situation is much better in pregnancy and childbirth.
I am LOVING these stories, though, about other doulas and activists!
Jill:
"If you listen to what most maternity care advocates are calling for, its accountability, transparency and the judicious use of obstetric interventions as needed and as wanted."
Yes.
@jill
i love your work. and im so glad that i get to read more of it.
i admit i have a problem with the language of 'normal' and 'natural'. it didnt really hit me until i was preggers and was reading all of this birthing literature (and i was birth geek before i got preggers) and it dawned on me that 'normal' and 'natural' were western sociological constructs. what i mean by this is: yes, obviously, there are plenty of brown women who give birth without medication or medical intervention around the world. i currently live in cairo, egypt and have spent most of my time in the past few years living in the third world (and i intentionally use the phrase 'third world'). but most third world women that i have talked to dont call their unmedicated births 'natural' or 'normal'. that is a western paradigm that we use to frame many third world women's births.
--and it should probably be noted that i lived in chiapas a couple of years ago. and the c section rate there is 80 percent.
--for me, in order to understand the meaning of a word, i have to understand who is using the word and who is the intended audience. and natural and normal are words and concepts that are used by globally privileged women to globally privileged women. (just to keep privilege in perspective, the average usa income is 39,000 dollars, which is in the top 3 percent of all incomes globally. so even though that is considered barely middle class in the states. it is a very elite income.)
--i approach natural and normal the way that i approach the word exotic. when someone calls sushi exotic food, they are assuming that no japanese are in the audience, or that the experience of japanese people in the audience who consider sushi to be everyday food to be irrelevant. in other words they are rhetorically erasing japanese people.
--i consider the natural birth movement to be racist. that may sound harsh. but i judge a movement by its leaders. who are almost all white in the natural birth movement. (most movements in the west are racist...) the gatekeepers are white. almost everyone else i have talked to (and i have conversed with white midwives both in the states and in the third world) does not consider race, class, gender, sexuality, and other forms of social marginalizations to be a salient factor in critiquing medicalized birth or natural and normal birth.
--in reading natural birth movement literature almost all of it is geared toward white women. it is rare to find more than one or two pictures of women of color in any book, unless those women are 'exotic' and 'indigenous' and 'untouched by modern society'. some sort of rousseau-like romantic savage. to some women those pictures and descriptions of the exotic may be appealing. to me, they remind me of the racist cartoons and literature i grew up with in the 80s.
--the reason that you dont hear more from women of color speaking out against the medical establishment is multi-fold.
1. we are screaming and crying and yelling against the establishment. but white women's racism allows for them to only see us as the 'angry woman of color' (think of the media treatment of michelle obama during the election). which is such a racist trope, i.e. sapphire. and then our 'tone' is critiqued. and we are told that white women can't 'hear' us, if we talk so angry. so white women who are the gatekeepers for the natural birth movement dont want to feel threatened by angry women of color. this shit happens all the time.
2. black women (and not just black women, but that is who i am most familiar with) live with the spectre of protective child services. considering that black children make up 15percent of the usa child population, but make up 34 percent of pcs populations, black mothers must think long and hard before they decide to challenge the medical system. when i was in labor, i was told that if i didnt follow the doc's recommendations, they may have to call pcs. yeah, thanks for the informed consent.
also take a look at the studies that show strong racial bias among social workers. http://www.msnbc.msn.com/id/21775847/ns/health-behavior/
for a lot of woc speaking up involves a lot more risk than with white women (no matter the socio economic class) and when we do speak up we are less likely to receive back up support from (white) women in the natural birth movement.
3. women of color are not primarily sharing their stories and strategies with white women but with each other. and thus they are not necessarily plugging into the natural birth movement, because their social networks arent plugged into the natural birth movement. and why woudl they? is there the assumption that the natural birth movement is friendly and welcoming to women of color? where is the evidence for that?
ok...
thanks for reading for a sec ;)
Mai'a,
I'm really getting a lot out of your contribution here. thank you for sharing.
As a doula and future midwife, I'm very concerned about falling (however unconsciously) into the types of racist patterns you've described from your experience. Do you have thoughts on how this can change from within the natural birth movement, defined broadly?
Dr Amy says:
"At its most basic level, natural childbirth is about achieving self-actualization and self-actualization is a luxury that very few people can afford. Self-actualization also presupposes a culture that values individuation and autonomy, and scorns subsuming individual needs within the collective good.
Natural childbirth depends absolutely on living in a wealthy society. Advocates never have to worry about where their next meal is coming from, how to obtain or afford the basic necessities of life, how to stay safe in a dangerous world of gang violence, or tribal warfare, or war.
Natural childbirth presupposes a world with easy access to birth control and abortion. Every child is a wanted child, and every birth a celebration.
Natural childbirth depends absolutely on the assumption that high quality medical care is only a short drive away (and everybody has a car to get there). It can only take root in a society with low perinatal mortality, because only people living in those societies can pretend that perinatal mortality is intrinsically low and that childbirth is inherently safe. "
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
How many of these statements are applicable to the Amish women, the Mennonite women, the other religiously inspired subcultures like quiverfuls (and *some* LDS, adventists, etc) who typically birth at home with midwives? Are they not practicing "natural childbirth"? One would hope all of us could recognize that the universe of "natural birth advocates" and "home birth clients" spans a wide range of social and cultural groups, with varying attitudes toward women, families, children, and "self-actualization". Some privileged women choose this from among the many options that are financially and logistically possible for them; others may find their options more limited by their cultural structures (which may limit their range of choices from either direction). Broad generalizations that attempt to neatly confine the psychology and motivations behind "natural childbirth" to a tidy little box, are just generally......unhelpful.
"wide range of social and cultural groups"
Wide? Only if you think white, married, relatively well off is "wide."
Mai'a,
Black women are the frequently given court-ordered cesareans (source forthcoming). When I was working through the system, I kept thinking, “This is hard but they are basically listening to me.” They tried to scare the shit out of me with story after story but their words weren’t matching the data, the risk percentages, the published practice guidelines. I took the leap and refused the heavily recommended planned cesarean.
The back story in a nutshell: I gave birth without an epidural and with narcotics. At the last minute (within the last week), by a chance meeting with an acquaintance, I met a home birth midwife who sat down with us for a few hours and we talked. It blew my mind that she gave us accurate data on risks like shoulder dystocia down to the percentages and they furnished nothing but anecdotes at the hospital. Her apprentice was our doula and we set all of this up within about a week. After weighing all of the information I had, I decided that it would be best more me to not be stuck in bed, so I decided no epidural. It was all a quick weighing of risks and tools/services available to us rather than a cultural indoctrination.
The whole thing was very weird, very stressful and there were plenty of dead baby threats during labor, even though we’d already done the informed consent deal earlier. There is clearly some social construct within middle class U.S. society that values and likes to label natural birth as a way of complimenting the mother. It started in the hospital with the nurses and the doc who originally put me on the books for a cesarean… all amazed at this natural 10 pound baby. Natural natural natural. Then friends (that I would not associate with any kind of natural-loving subculture) talking about how I was so strong. More natural comments. There was a huge disconnect between how my birth was received socially and what actually happened. There was a certain victorious feeling associated with that birth (in addition to the obvious “Hey, a baby! We made this awesome little person! She’s healthy and so am I. We made it!” feelings) but it had more to do with making it through a system that, with all of the good things it has to offer, fails women and babies. In fact, I had a belly laugh when our friend from Tijuana responded to my husband’s e-mail about our birth with something like “Wow, Jill gave birth like 99 percent of the women in Mexico.” As in “I thought you rich Americans would do something totally different.” Later I found out from a friend in Quéretaro before actually having explored Mexico’s dismal cesarean stats that everyone over 35 gets a cesarean and it’s not common for middle or upper class women to use a midwife.
The reason I keep asking people to define natural birth is because there seems to be such a wide difference in opinion as to what it means. I’ve felt that many, many times over the last year in talking to people that we’re on different wavelengths. I’m not sure if it’s the difference between chasing an ideal and rejecting much of what the medical hegemony offers.
Normalcy in birth was a new concept for me. What I’ve been trying to say, I guess, is optimal. I see value in defining optimal because the medical establishment seems all too happy to define it as it works for them. The problem I see with defining it is the same that happens when discussing breastfeeding. Sure, breastmilk is usually best. That’s not a moral judgment. If a woman can’t breastfeed, is told she can’t breastfeed or would prefer not to or would prefer not to full-time, there are other ways to feed an infant. It doesn’t make breastmilk any less optimal just because there are alternatives.
Two years ago, when my second baby was born in a local birth center, I still didn’t realize that there would be so much whiteness out there in the birth world. The birth center was always full of women coming up from Tijuana (I was eavesdropping) for prenatals. The doula we hired for that birth is black. I did get a pretty big shock when I got more involved online and realized we’re all white. Actually, it’s not that shocking in that white voices always seem to rise to the top. I don’t know… I’m still figuring a lot of stuff out.
Dr Amy, you have sidestepped the question:
How many of your statements about "natural birth" are applicable to various religious subgroups that mike up a significant minority of home-birthing women? Are these women practicing "natural childbirth" by your definition, or something else?
Thank you Mai'a. Thank you so much. And not just for the information, but for taking the time and emotional energy to write it.
I think what you are trying to say, Jill, is either "optimal" (as you said) or physiologically normal, which specifies that the body is functioning as a body would be expected to be in that circumstance, as opposed to pathologically. That is in no way the same thing as "average" or "most common". An induced (almost half, and the rest are above half, according to LTM and other sources I can provide), augmented vaginal delivery with pitocin, an epidural, directed valsalva pushing in the lithotomy position without a doula and no nutrition by mouth, which is by far the way an average privileged woman in the United States delivers. And it also does not imply that anything that happens in nature, like a three day obstructed labor, as much of an outlier as it can be, is normal (a straw woman argument that surfaced upthread).
"Within normal range" is another term you will see used in the medical field, but t hat usually refers to a lab or screening result.
(Sorry for the triple post, I had to catch up)
"If you listen to what most maternity care advocates are calling for, its accountability, transparency and the judicious use of obstetric interventions as needed and as wanted. The decline in maternal mortality was multi-factorial and clearly partially attributable to access to emergency obstetric care. To deny that would be unreasonable.
I understand your defensiveness and I can assure you that obstetricians and their skill set are highly valued. OBs Gone Wild are not. Decisions about a woman’s care made based on defensive medicine which are dishonestly sold to the patient as “playing it safe” are not appreciated and are unethical. But every woman that I know personally that gave birth out-of-hospital had a solid contingency plan that included transfer to a hospital where they would be cared for by… obstetricians."
THIS! Repeated for truth. RIght on, Jill.
All right, last comment in a row, I promise.
IndianaFran, thank you for bringing up religious groups. One of my favorite fellow student midwives is a poor single mom who is a Jehovah's Witness. She had a breech baby, was committed to home birthing, but it is illegal in the state of Florida. She tried to keep the position of the baby, who she had figured out had flipped to breech very late in pregnancy, from her midwife by becoming suddenly very resistant to any sort of checks or maneuvers, but the midwife eventually figured it out and was pretty pissed at my friend. (Let's just say labor may have started). Interestingly enough, however, one of the main reasons she was committed to a home delivery wasn't that she was wedded to some non-interventionist ideal, but she was afraid she would be pressured into possibly accepting blood products with a cesarean delivery, which was against the way she observed her religion. The midwife insisted on a transfer, and they hurriedly arranged for a blood-free surgery. I can imagine that can be very difficult to get a physician to agree to, especially if you were a woman who was trying to knowingly go against the medical norm and the law (and risking her midwife's license) to deliver a breech at home, but I am happy she was able to find a good, open minded surgeon.
We have to listen to these stories to make birth better for all women for all reasons.
Mai'a - thank you so much for your post! It'd be interesting to see where the conversation on this topic would turn if it was brought up in a primarily WOC safe space like Racialicious or Love Isn't Enough?
As for the rest: watching "Dr. Amy" side-step questions, never really provide answers, pick and choose, latch onto the slightest OT disagreement in a thread and use it as part of her argument, and be so obtuse there's just no way it isn't deliberate... I am convinced she's not a real person and in fact some sort of 4chan troll that has managed to pull the wool over all of our eyes. One day she's going to be exposed on some news network and we're going to feel really stupid for ever getting caught in her endless cycles of pointless internet arguments. I mean, what real, educated doctor actually has the kind of time to devote to following around every random conversation on advocacy blogs because someone risked saying her name three times into a candlelit mirror? If it looks like a troll, smells like a troll and walks like a troll...
(Oh PS way back to my original comment. I was re-reading it and realized that the terrible 2am grammar makes it look like I'm implying that socioeconomic privilege has nothing to do with breastfeeding [et all] rates. That's totally not what I meant, as if it was it would be a mind-numbingly ignorant thing to say - since it totally does. So, really, I'm not quite the idiot that made me sound like. ;) I was just going through my point so fast I missed out on actually explaining it. )
oh before i leave this post i wanted to leave some suggestions/ideas/brainstorm about what can be done in terms of centering marginalized persons in birth advocacy, midwifery, etc.
here are some things that i do:
1. connect with and support organizations and persons who *do* focus on pregnancy and birth and folks who are marginalized by class, race, nationality, sexuality, etc.
for example:
doulas of color ning
napw -- national advocates for pregnant women
ictc -- black midwives
2. realize that birth advocacy is done by women of color but a lot of what i have seen and the woc i have worked with -- are connected through the reproductive justice movements and the anti violence movements--
for example-- incite!
sister song
radical doula blog
spark
3. know the material and psycho-social realities of being a person who is marginalized in your communities. how does protective child services, welfare, medicaid, and other governemnet assitance work? what are the non profit organizations that work in your community? what are the childbirthing cultures in your community? what are the organizations of color in the community? what do they see as the primary issues to be focused on? what do you know about stereotype threat? about the countries of origin of the immigrant communities?
4. support women of color entering into birth work. support woc leadership. birth work and activism work primarily through relativiely informal networks. look at the networks that you are a part of. how many people of color are there? how many people of color are in your communities? what (other than the good intentions of white folks) would allow a poc to feel comfortable in your networks? and if woc wouldnt feel comfortable in your networks and communities, then why are you a part of them? look at your blog rolls, list serves, google reader, the books on your shelf, magazines...
5. i worked as an anti racism trainer/consultant for a few years. and one of the exercises that we did with organizations was for them to imagine a 'what if'...
'what if you wanted to create a movement that was predominantly white and middle class. what would you do?'
start brainstorming. make a list. really go with it.
for starters: only advertise/promote in predominantly white and middle class communities.
see movements centered around women of color as not being relevant.
not research/talk about/advocate around issues that are central to woc communities
okay now. imagine doing the opposite. like:
promote in woc and working class com's
see movements centered around woc as being very relevant
research/talk about advocte around issues that are central to woc communities.
the first list is what is actually going on at the moment in the natural birth movement. the second list is a beginning of how a movement could be accountable to *all* women.
6. recognize that racism and classism and structural oppression are the status quo. if you are going to create movements that are focused on empowering all women in their reproductive choices, then you are making a decision to go against the status quo. frankly, that means a lot of discomfort, conflicts, losses, betrayals, and sleepless nights. but it also means, a stronger movement, seeing differences as a strength and not a weakness, solidarity, comraderie, and reproductive justice. and discovering again and again how amazing women are.
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i just thought that people might read this thread sooner or later. and i didnt want them to leave with the: oh, but what can *i* do about that? helplessness that seems to infect conversations about race.
look at this way. white middle class women have been the ones who have set the agenda for the natural birth movement for decades. and that agenda may not be (and isn't) the same for women who are marginalized. i can't separate the physiological aspects of birth from teh sociological and racially structural aspects of birth. so when i think of an optimal birth, one of the first things that come to mind are issues around stress and identity and how these interconnect with the body. for instance, breastfeeding. i dont know if i 'breast is best'. i know it was best for me. but i also know mothers who are survivors, who were triggered by breastfeeding and felt that breastfeeding disrupted the bonding process and caused a rush of stress hormones that seeped into the breastmilk and affected the babe. i trust those mothers. and can see how even on a physiological level -- breast was not best for that dyad.
one of the things i have loved about working in the anti violence reproductive justice movement is that (informed) consent is primary.
if a man convinces a woman that unless she has sex with him, she is going to die. even if she at the time felt that she was making the best choice available, if later she finds out that he was lying. and she says that he raped her, because of the manipulation of information. then it was rape.
and the same thing goes for birth.
i do feel that he reproductive justice movement diminishes the birth experiences in its work in general.
and the alternative birth movement diminishes the necessity of reproductive justice.