"Best of" Week: Birth Activist's Jennifer Zimmerman
Sunday, September 27, 2009 at 7:21AM
“Women Need to Educate Themselves”
I often hear this phrase from childbirth educators, doulas, and birth advocates. It is said when these women speak of the increasing cesarean rates, or when they hear of a woman or a baby who was treated cruelly during birth, or when they find out that yet another woman has scheduled her induction or c-section for a reason that seems less than medically legitimate.
As a mother who has given birth, I find this phrase emotionally charged. It may be well intended, or perhaps spoken out of the almost hopeless frustration that can be caused by working so closely with women who often make choices that seem to be the “wrong” ones. Regardless of why it is said, it stings when it is implied that you were such a mother who didn’t school herself in childbirth knowledge sufficiently.
The problem with the current maternity system is so much bigger than women not being smart enough to navigate it. Birth education is not like math or science. There is no agreement even within certain groups. For example, take the natural birth movement. Will you do Bradley, Lamaze, or Hypnobabies? Will you deliver in a hospital, birth center, or at home? Will you hire an Ob, Family Practice Doctor, Midwife or have an Unassisted Birth? Will you hire a doula, invite your mother, sister or best friend, have only you and your partner, or give birth completely alone? Will you plan a water birth, squat, or assume a hands and knees position? Will you cut the cord after it stops pulsating, after the placenta is naturally expelled, or wait for it to fall off on it’s own? Will you try to breastfeed in the first 10 minutes, within the first hour, or allow your infant to crawl to the breast in it’s own time? There are hundreds of more questions I could ask all pertaining to natural birth. There are no right or wrong answers to these questions, there is only individual choice based on the current knowledge and feelings of the participants in the process.
Are first time mothers really not educated about childbirth? Do women have some sort of aversion to learning about the process of giving birth? Perhaps in some cases, but I don’t think that is true for most women. I think women do educate themselves about birth when they are pregnant with their first child. How do women do this though? From what I have seen, they watch TV shows about birth, they read books about it, they talk to the women in their lives who have already given birth, they ask their care providers questions about it, they attend childbirth classes through their hospital or take additional classes, and they go online to discussion boards for women who are due around the same time as them and share information. These are valid ways of learning about a subject, and these women do get an education this way. However, I think when these people state that “these women need to educate themselves”, they perhaps feel that the education that these women have received is not a good one, and that these women should have somehow realized this and searched further until they came across the correct information.
Is the current state of the maternity system the woman’s fault though? Should we really insinuate that the increased c-sections, the intervention cascades, and the birth traumas, and all of the problems associated with giving birth in this country are because women have not educated themselves about childbirth? I don’t think so. I think the fault lies with the system. There is a great lack of transparency when a woman chooses who will be on her birth team. Is this a good hospital, a good midwife, a good doula? Will this hospital give me what they promise, will the nurses be supportive of my wishes, will this homebirth midwife try to speed up my labor with so called “natural” augmentations? Will I be listened to, will I be pressured into doing things I don’t want, will I be hurt, will my baby be in my arms after it’s born? There is no way to educate yourself enough to find these answers because the information is not readily available to us. Things like rates of interventions, or satisfaction with a certain care provider, or how often a woman felt she was not in control or her own experience are not things that they print on the hospital brochures or are advertised on the midwifes websites.
I don’t think it is possible for people who have tried hard to learn about a subject to know that there is more to learn. If things go wrong and you are dissatisfied with your experience, such as having a c-section that you don’t feel was truly medically indicated, or being mistreated by your care provider, or being separated from your baby for lengths of time with no apparent reason as to why, or having a procedure done that you never consented to or didn’t want, or getting bad advice about breastfeeding and finding yourself having problems nursing because of it, you may hear the phrase “this is why women need to educate themselves”. I heard that phrase several times after my birth experience turned into a traumatic ordeal and I complained about the treatment I encountered at the hospital I gave birth at. At first I tried defending myself, as I had thought that I was pretty educated. I had read books, taken a childbirth class, watched “A Baby Story” on TV, and frequented “babycenter.com”. But I even dug deeper than that, and I read books other than “What to Expect When You’re Expecting”, and I researched hospitals on the internet and picked one with a birth tub, birthing suites, and midwives. I even hired a doula and asked my midwife several questions about the upcoming event making sure she made notes in my chart about my preferences. I was educated! I was prepared! And I was horribly mistreated, had procedures I didn’t want forced on me, and my baby was taken from me seconds after he was born not to return for over 20 minutes, not to breastfeed for 3 hours after the birth. It was not the wonderful natural waterbirth I had planned for. And when I told my story and people pulled out the “education” line, I fought back with my list of things that I had learned about birth and had tried applying. I was then countered with different questions, questions to prove that I lacked a real education about childbirth. According to my inquisitors, apparently I had read the wrong books, taken the wrong childbirth classes, and chosen the wrong type of care providers. I didn’t hire the right kind of doula, or watch the right TV shows, or visit the right websites. If I had educated myself properly I would have known that having the midwife make notes in my chart was inferior to having a birth plan, and that my husband should have been properly trained in being my personal bodyguard, and that we both should have learned the common manipulations that hospital staff use to get patients to comply. How can a woman know that there is more to know when she has never given birth before? Even I, who I suspect knew more than the average woman, didn’t know enough for some people to be satisfied that my own ignorance is what caused my birth trauma from happening, and a good education would have prevented it.
So you see, this phrase may seem well intentioned and it may seem obvious and true to the speaker of it. But to me, just a woman who gave birth, who tried her best and failed to get the birth she wanted, it feels like blame. Blaming the woman for not changing the maternity care system is barking up the wrong tree. Lets place blame squarely where it belongs. Lets support women and be kind, knowing that “when you know better, you do better” (Maya Angelou). Knowing that childbirth is not simple to navigate in this system of being made to blindly choose providers and birth settings. Knowing that women are trying to educate themselves, but often don’t know what to do with the enormous amounts of conflicting information out there about childbirth. Also realizing that there is no one size fits all in birth. There is no perfect type of provider or birth setting, there is no correct answer to every question that arises in birth. There is just doing the best you can do with the knowledge you have at the time and hoping that you get lucky and you are treated with kindness and respect on the day that you have your baby.
This post originally appeared on Birth Activist on January 17, 2008 and was submitted by the author for “Best of” Week.
More of Jennifer’s favorite posts:
Does a Laboring Woman Have Any Rights?
My Son Tells His Birth Story
Jennifer Zimmerman is an advocate for informed consent and refusal and mother friendly maternity care. She blogs at Birth Activist and also volunteers for the organizations Solace for Mothers: Healing After Traumatic Childbirth and CIMS The Birth Survey. She enjoys activism, art, writing and learning, especially the lessons her son teaches her.
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Reader Comments (17)
Thank you! I am sorry about your birth experience, and I know it is also difficult to admit these things when we are supposed to focus only on how lucky we are to have healthy babies -- which of course we are -- but not to the exclusion of the knowledge that some of that magic of this heroic act may have been stolen from us. Education means nothing at all when it comes to dealing with medical staff and policies that position any mother who stands up for her wishes and needs during childbirth as misguided, selfish, uneducated and to blame for problems they encounter during labor and birth! I appreciate your work to turn this focus back to the structural and everyday ways that mother's wishes are submerged under narratives of risk, fear, personal responsibility and citizenship (as in the idea that you are a selfish patient, mother and citizen if you use hospital resources in ways that are not mandated by medical staff) and away from blaming mothers.
Thanks for this post. I also read up about pregnancy and childbirth before I even got pregnant. I thought that I was educated and knew what to expect. I wanted a natural birth and ended up with a c-section. When my daughter was 9 months old I joined LLL and over the next couple of years I got a real education about pregnancy and childbirth from women who had very similar experiences to my own. It infuriates me when people blame women for high c-section rates, scheduled c-sections, low breastfeeding rates, etc., especially when the medical community does everything it can to make pregnancy and childbirth a medical problem that can only be solved by MDs and surgery.
Thank you for reposting this. I am another of those who educated myself as best I could, chose a reputable birth center and midwives, and ended up with a c-section. Yes, there are women out there who know little about birth. It is not their fault when they end up mistreated, either. "Educate yourself" does sting to those of us who did so. I imagine it would sting to those who didn't, too. Blaming the victims gets us no closer to a better system.
So true! Often, it's not what you know or don't know; it's what you don't know you don't know! And it is terribly hard to even find out.
This is so true. People like to say that as long as women "educate themselves" and "pick a care provider who can meet their needs," they will have a super duper awesome birth expeience and everything will be hunky dory. And if things didn't go well, well, you know, you could have just "said no." It's as bad as telling a woman who got raped that she shouldn't have worn that short skirt, or gotten a ride home from that shady guy. Don't blame the victim. That is cowardly, because it refuses to acknowledge that there are serious problems needing fixing.
Great post, thank you for saying this. It's not the individual women who lack education, but the entire, flawed system that needs to learn to treat women as human beings and not numbers or statistics.
I found this vitally honest and compassionate. I hope everyone in the birth community reads it. Thanks to Jennifer for writing, and to Jill for sharing.
Education doesn't grant discernment as to who's lying.Also doen't help when you've been threatened and are terrified.
Oh, Jennifer, you're said this so well altho' it really should have a lot of swear words mixed in there! It is such a *^%%##$%%%
cop out to say "women need to get educated" when the *^%%&$$#*#@ so called "care" providers are lying through their teeth.
Pregnancy only lasts 9 months. . . are women supposed to have a 4 year midwifery degree in their back pocket to have a baby?
Lots of midwives end up with unnecesareans, too, when they have their first baby. Often a cesarean is just the luck of the *^%$%((*^^%% draw. I have two sisters. Both of them had two cesareans. I had 3 pretty good vag births. Am I smarter than them? No, the truth is I'm just more scared of needles than they are and I lucked out in my first birth by living with a farm woman who kept me home till my birth got really active. That's why I'm such an outspoken advocate for VBAC and a board member of ICAN because, deep down, I know that "There, but for fate, go I."
Gloria Lemay, Vancouver BC
What a great post!! It is so true!!
And it's the truth.... women DO need to educate themselves. But honestly, how on earth are they supposed to do that when it is so hard to find the information you need, and when they find it and ask about it, the entire medical community lies about it?!?!
Like many of the previous commenters, I was educated before my first. I spent my whole pregnancy reading everything I could get my hands on about childbirth. Seriously, EVERYTHING. Unfortunately, the things I was able to get my hands on were not the right materials! I went in confident in what I wanted, and I had full confidence in my doctor (5 different women had recommended her to me) to help me have the birth I wanted. I also knew that she went to medical school and I didn't, so she knew more than I did. I asked her if an epidural would have any negative effects-- she told me there is a slim chance it could strike a nerve, but besides that, I was golden. I believed everything she said, because she was the one with the medical degree.
It was after my labor was augmented with pitocin (I had no idea what pitocin was!) 2 hours upon arrival at the hospital (which my doctor sent me to before I even knew I was in labor), I was given the epidural, and eventually had an unnecessarean that I thought to myself "I am so relieved my doctor and the hospital nurses knew what they were doing.... I could have died!"
Then I got pregnant with my second. My fear of needles and knives was what drove me to start researching VBACs. And it was then that I started to get a "REAL" education.... when it was practically too late. I had already had an unnecesarean, so it has been an uphill battle this whole pregnancy.
Now I'm due in 2 1/2 weeks, and I'm on the defense. My husband is ready to punch doctors if necessary. :)
And I'm meeting with a newly pregnant friend (her first pregnancy) next weekend to watch documentaries, recommend and discuss books, and start her off with a "real" education. I don't want ANYONE to go through what I went through, so now I am a strong birth advocate and I'm passionate about educating first time moms past the basics!
In my experience as a nascent doula, if a mom's childbirth education was delivered by someone who wants mothers to be enabled to have a say in what happens to and around those moms during birth, then those ladies tend to have better births. I haven't ever met an independent childbirth educator who wasn't motivated to enable mothers through education. One of my favorite Lamaze CBE's in Tallahassee talks about the particular joy she gets from seeing 'lightbulb moments,' those instances where parents latch onto something they'd never known possible, usually something involving their options, and using that moment of realization to springboard themselves out of passivity.
That being said, I find myself nodding in agreement with Gloria - mothers being misled by care providers is a difficult issue.
Yes, yes, and yes again. To be educated, you must have teachers, right? And who were my teachers? My mother, who had 4 twilight sleep births? My sister and sister in law, who both had c/sects for ALL their kids? A Baby Story, in which it seemed about 80% of births ended in c/sec? My midwives, who were not honest with me about hospital policy in order to protect their own privileges to practice? The hospital, that mysteriously was unable to let me use the birth tub or the wireless monitor? Birth books that both told me I was fully responsible for not noticing anything that might go wrong and that "birth is unpredictable" so that really, birth plans were a waste of time and I was not going to be in any kind of control (so why bother)?
I was told half-truths, filled with guilt and fear, and treated like meat in a grinder. I refuse to hold myself responsible for those things. I did not fail. I WAS failed.
I love this post. I have an MPH with an emphasis in health education/promotion. As much as I believe that education on these issues is important, I will be the first to say that getting an "education" on a health matter is no simple thing, and also not guarantee of anything. It is simply a piece of the equation. For instance, you can help people learn about nutrition and exercise all you want, but if their neighborhood lacks healthy, affordable foods and safe places to exercise...well good luck to them. The ENVIRONMENT and the influence of society are very strong predictors of outcomes.
Why education of women alone doesn't work:
-Care for laboring women in hospitals is complicated....even if a woman has read a great deal and attended different childbirth classes, that does not prepare her for every single situations in the hospital.
-Education based on expert advice- Whose expert advice? The information is conflicting, whether it be OB's, midwives, childbirth organizations, whatever
-If expert information is conflicting, what should a woman do? I have heard people say that women should do their own research, meaning look at original studies or reviews of studies. Great...except the majority of people are not prepared to do that. With the average American reading at an 8th grade level, reading and understanding research studies well enough to make personal decisions is a little beyond reach. Add in the need for an ability to interpret methods and statistics, and well, you get the picture
-If one's agency is reduced by the healthcare setting or providers themselves, knowledge becomes
less helpful.
I completely agree that system wide changes and transparency are critical to changes in outcomes. Education is important, but it is limited.
This one is soooooooo tough. I'd sooner cut out my own tongue than say this to a woman who is hurting, or still processing. And yet... it's true.
But it's not the *only* problem.
Frankly, the entire system needs to go down in flames, to be ressurrected in a kinder, gentler, slower, more thoughtful form.
JMO, YMMV. Natch. =)
I educated myself the best I could with the information I had at the time, under the circumstances. However, I did naively expect my care-givers to know about childbirth, after all they were supposed to be the experts (Ha!). 12 years later and I had the benefit of the internet when planning my VBAC but still did not find out what I know today, another 4+ years on. Personally I don't get annoyed at the idea that I did not educate myself, as I know that we are 'educated' about birth on so many levels.
What we need is a ban on the kind of sensational births we see in the media and better education about what our bodies can do, Toni Weschler should be part of the core curriculm for our teen daughters so that we are less naive about our natural cycles. I plan to teach my children about physiological birth the way that generations before us used to do. The break in our education came about once we let science take over. Medical science can be a life saver but it's not essential in normal, everyday, physiological birth. I think that we should stop beating ourselves up for the way we have all been let down as a society, learn from it and regain faith in our human bodies. As women we are working together now to pass on what we know, it will take time but I think we will get there. Let your inner lioness ROAR!!!
Great post and so true. It is a sentence that is even said in the unassisted birth places. 'Well, she didn't have a UC because she really wasn't educated enough' or GASP 'She didn't listen to us'. It is so hard to step out of your own truth and look at someone else in theirs.
I am wondering though, and no disrespect to you, Jill, how can we approach women who feel that 'What to do when you are expecting' for instance is a good source of information when we feel a woman is going into her birth with too much trust in the system? Because I think, even in the most educated woman, that unless she has some mistrust of the system and takes this into consideration when looking at her options, she will be setting herself up. Saying anything against the system seems to be synonymous to being a conspiracy theorist!
I often feel I have to stay away from first time moms because I find them often so closed to different information. This based on my general observation in my community, and on being a doula. With many of them for instance, discussing homebirth seems impossible, so I leave that after I get the feeling it won't go. But I want to bring up the Lamaze website and Childbirth Connection for instance, because there is such great information there for a mom to use. As a doula, this is a little easier with clients, but with the young women in my community it is hard. Maybe I just need to grow some more grey hairs? :-)
Evenso, my point is that even with all the great info out there, and even if I could share some of it, if the mom just trusts that her caregiver also knows all the right things and will act on them, she is in for a surprise most of the time, and I feel that this is a part that is difficult to 'educate' a woman about. How can I support a woman through the conundrum of creating a safe place for her while at the same saying that it really is not safe and that you need to be on your guard when giving birth because the system sucks? That alone will set her up! She needs to be able to trust to feel safe.
I hope this system somehow collapses at some point in the near future, but I don't think it will. What is happening though, is that more women are choosing homebirth, and more women are getting educated to be vocal about the woes of the system. So while blaming a woman who just gave birth for not being educated is absolutely the wrong thing to do, we have to acknowledge the fact that when we are not giving birth, our education is very important in changing the climate. Because I think it is changing. Slowly. Through education. Education of moms who had a bad birth experience and turn around and say 'Wait a minute' and hire a doula for their next birth, or a have a homebirth with a midwife. How do we avoid that first bad experience?
Thoughts?
All true. Maybe instead of asking women to look at the trees, they should be looking at the forest. 99% of Ameridan women go into hospital to have their babies. AT LEAST 33% of them have a C/S. Most of the rest have varying degrees of interventions and separations and intrusions. The other 1% birth out of hospital. C/S--3-11% Other interventions, separations, intrusions--?, but scarce.
Hmmm.