Every so often I hear the insinuation that women (like me) who advocate for ‘normal’ childbirth are inordinately self-focused (even selfish) and that women who are dissatisfied with the treatment they’ve received in hospitals during labor are “uncheerful” and, possibly–according to the women in controversial pastor Douglas Wilson’s life–confused theologically.
Don’t get me wrong: Ricki Lake’s memoir, at least as it concerns childbirth, definitely looks at the birth experience as if it is all about her. But while there’s no question that medical advances (and, yes, c-sections!) save lives, it’s also hard to contest the fact that medical interventions occur at rates that are simply unjustified.
September 3, Labor Day, launched “Empowered Birth Awareness Week,” which, sponsored by ImprovingBirth.org, aims to raise people’s consciousness concerning the notion of “evidence-based maternity care,” the less than radical notion that what happens during birth (ie, continuous fetal monitoring, mandatory IVs, NPO rules that prohibit eating and drinking) should be medically indicated, not routine, and supported by sound medical research.
Henci Goer’s 1994 book, Obstetric Myths vs. Research Realities: A Guide to the Medical Literature, and her popular-level Thinking Woman’s Guide to a Better Birth make the research clear: inductions, mandatory continuous monitoring, and “once a c-section, always a c-section” are not justified by the evidence. But in the popular imagination, in malpractice hearings, and, unfortunately, in insurance reimbursement rates, practitioners are better off doing something rather than nothing.
Even though I’m a doula who believes birth is beautiful and even enjoyed laboring my children the old-fashioned way, I’m not going to say that it is easy or painless, because it is neither. Giving birth demands as much physical, emotional, and spiritual strength as a woman has, plus whatever she strength she can pull from the people around her, which means, of course, that the people around her have to be willing to offer that strength. The doctor who was present for the last 5 minutes of my first (12 hour) labor didn’t have that strength. Neither do many labor and delivery nurses, who, because of their training and because of hospital structures, simply have never seen a truly natural or ‘physiologic’ birth. My friend Annie who works as a nurse in a prominent university hospital says that L&D nurses are often loathe to handle the intense need for time and attention that an unmedicated birth requires. C-sections and epidurals make things much easier for the professionals.
Adapting birth culture to meet the needs of people other than women and babies has been happening for a long time. In the semi-historical novel The Midwife, New York City’s famous Bellevue Hospital (which housed the nation’s first-ever maternity ward) is described as a boon for obstetric education and research: no longer would doctors and medical students have to wait around in filthy tenements to learn from the labor and deliveries of poor women; they could collect the poor women there, get them cleaned up (which usually involved a pubic shave and disinfecting routine, later discovered to increase infection rates) and observe their births in a scientific manner: great for medical education, but not so great for women, who suffered greater rates of puerperal fever at the hands of the ‘medical men’ than at the supposedly dirty and ignorant immigrant midwives.
In their 1973 feminist classic, Witches, Midwives, and Nurses: A History of Women Healers, Barbara Ehrenreich and Deirdre English point out that while women practitioners took an extremely bad rap (the Malleus Maleficarum, which was a textbook for witch trials, focused on women healers and midwives as in league with the devil), they were, in fact, practicing evidence-based medicine–using time-tested herbal remedies, for example–at a time when many university trained physicians (virtually all male, of course) believed that illness was caused by an imbalance of “humours” and were inclined to perform dangerous, pointless, and often deadly procedures based on untested theories.
Which brings us back to why some people (like me) are a little bit “uncheerful” about where medicalized birth has gone: the discussion would be different if all these c-sections (33%, or more than double what the WHO suggests as an absolute maximum) actually resulted in safer outcomes for mothers and babies. But they don’t: the rate of maternal death has doubled since 1990, for example, with the US ranking #47 worldwide in maternal health outcomes. Women who are black have four times the risk of dying as a result of childbirth than women who are white. That’s a justice issue.
As I said before, there is no question that certain medical interventions save lives. 5-15% of women will need c-sections (in sick irony, many of those women are live in places where they’re unlikely to get them.) I, like many birth activists, am simply saying is that medicine is best when it’s evidence-based: knowing when to step in and how, and knowing, like the women healers of old, when simply to step aside.
This is about so much more than consumer choice–it’s about women’s, indeed, human!?–rights.
(This post also appeared at Sojourners)