Blessed Are the Un-Cheerful?

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, 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)

Where’s the Controversy in Saving Lives?

I have to admire Melinda Gates’ chutzpah. In her recent TED talk and on her blog, Impatient Optimist, she insists that “contraception is not controversial”–when, in the last year, it has been explosively controversial, with many Christians (not just Catholic Christians) seeing the “contraceptive mandate” as a real threat to religious freedom. Yesterday, the law took effect, meaning that most employers must now provide free birth control coverage in their health insurance policies. Whether it constitutes a threat to religious liberty remains to be seen: faith-based groups with religious objections to the law have a “safe harbor” until Aug. 1, 2013. Whether HHS will create an extension of this harbor remains to be seen.

Regular readers of this blog know where I stand on health insurance. As to the contraceptive mandate specifically, I’d prefer not to wade in those particular waters–David Gibson at Religion News Service has a good piece if you’re interested in the question of whether the mandate kills religious freedom. However, I do want to consider two small points about contraception that leans me toward the (self-identified Catholic!) Melinda Gates point of view:

Point 1: contraception doesn’t take life

Point 2: women want contraception

Frequently, discussions of birth control come back to the question of eugenics and attempt to suggest that Margaret Sanger and other early birth control advocates wanted to keep poor people and immigrants from having babies. While it’s always dangerous to speak in general terms, it seems to me that Sanger (and others) were attempting, in good faith, to answer a need, a call for help–not to impose their will on less-educated, less-wealthy women. Here is the tri-lingual (English, Yiddish, Italian) poster from the early days of the movement:

Despite these efforts, the very unfortunate discrimination in Sanger’s (and others in the early birth control movement) thinking seems to taint contemporary discussions of birth control, perhaps understandably so.

But even that history doesn’t change this: just meeting current demand for contraception could cut maternal deaths by 1/3. Which means maybe 100,000 lives per year–or more–just by meeting the unmet, self-identified needs of women.

Where my family and I are headed–Malawi–the contraceptive prevalence rate is just 40%; recently, Malawi’s Vice President pledged to try and raise the rate to 60% by 2012, partly by raising the legal age of marriage and partly by enacting policies which–with help from organizations like the Gates Foundation–will increase access to contraception.

This is not the wealthy, white, West forcing the Pill–much less sterilizations or abortion–on Africans, Indians, or anyone else. We are talking about working in partnership to help women meet their self-identified needs. It’s not about rejecting God’s gift of fertility. It’s about stewarding it well in a complicated world.

I just don’t see the controversy–religious or otherwise–in that.

“when women die in childbirth it is a violation of their rights.”

I’ve been inspired in the last week by reading about the women who are petitioning Uganda’s highest court to declare that “when women die in childbirth it is a violation of their rights.”

So far, their bids in the lower courts have been unsuccessful, but they’re pressing on.

$60 million. That’s what it would take to hire enough medical workers to meet Uganda’s needs–specifically, to staff village health clinics that lack people and supplies to the degree that an estimated 16 pregnant women die needlessly each day.

It’s not that the money is not available, say analysts–Uganda spent more than ten times that amount on Russian-built fighter planes last year, though they were not and are not at war–it’s that the Ugandan government isn’t making maternal health a priority.

A woman in Uganda has a 1 in 35 lifetime chance of dying in childbirth; just 42% of births are attended by skilled practitioners.

By contrast, a US woman’s lifetime risk of dying in childbirth is just 1 in 2100; virtually 100% of births are attended by skilled practitioners.

“The point here is not the money,” said Samuel Lyomoki, a lawyer who has joined in the call for action– “the problem here,” he said, “is a lack of commitment.”

But for the women pursuing an official declaration of their right to birth safely, commitment doesn’t appear to be flagging. Their willingness to speak up and insist that the government calls maternal death by its right name–a violation–may be what it takes to provoke the will to end preventable maternal death in Uganda as well as the rest of Sub-Saharan Africa.

Because a more peaceful world is delivered by more midwives, not more munitions.

{Adapted from my recent post at Sojourners’ God’s Politics blog–original post here.}

“Ekizibu” –A Short Film About Midwives in Uganda

The American Way of Eating

I had my first post on the Sojourner’s ‘God’s Politics’ blog–a review of Tracie McMillan’s American Way of Eating.

Here’s an excerpt, but you can click through to read it all here.

I love great food. Last night, I made fresh linguini with organic whole wheat flour and local, free-range eggs, and topped them with from-scratch meatballs made with organic beef, fresh parsley from my garden, fresh Parmesan–you get the idea. And in a few days, I’ll be celebrating a special occasion at one of the finest restaurants in the Northeast, where the produce is local and seasonal and sustainable and where the experience of eating is a little like visiting a museum of fine arts where you get to taste all the masterpieces. Yesterday, I planted the first spring vegetables in my garden. I’m a member of Slow Food USA, for cryin’ out loud.

I’m just waiting for the James Beard foundation to give me a badge for being such a morally superior eater.

Except I’m not.

(Read the rest here! And leave a comment, if you’re so inclined.)