The Birth Post Part II — The Sequel

The Birth Post Part II — The Sequel

This post is a follow-up of last week’s “The Birth Post”, in light of several discussions I had with people on facebook in response to my piece. First of all I want to clarify that while I chose a homebirth, the focus of my post was intended to be about why birth is a feminist issue. In my situation it was through my homebirth midwife that I was able to have a feminist birth, where I felt empowered and in control of my body and choices, but of course there are other ways this can happen too. Continuity of care is the important thing before, during, and most importantly after the birth. Group midwifery practices in hospitals are great, birth centres are great, and hospitals can also be great. However they so frequently aren’t great, which is why I chose a homebirth.

The key issue is all about choice. Pregnant people need to be given more impartial information so that they can make informed, independent choices. Sure they can’t force you to do anything. But they make a damn good attempt at making you feel as though you have no choice. Whenever I tell people my birth story I start with, “so I was 2.5 weeks overdue…”, and invariably people respond with, “but I thought they didn’t let you go past 11 days over?” Why is the word “let” a part of this dialogue? From the moment you get pregnant it begins: “OK get this scan this blood test this glucose resistance test this other scan”. No one tells you why, no one tells you the implications, no one says, “you don’t have to if you don’t want to, these are the risks if you do/don’t”. Sometimes when I or other people have asked “why?”we’ve been met with “it’s just routine”. When one friend of mine pressed as to why they wanted to do an internal examination (she wasn’t even in labour yet), the staff eventually said, “yeah ok, I guess we don’t need to”. You lose all agency unless you educate yourself and are strong enough to stand up against these “standard” procedures.

While discussing this on facebook someone raised the issue of risk in regards to choice. They said: “Yes we do make choices, the right to make choices is fundamental but sometimes those choices have unintended unforeseen lifelong outcomes.” Sadly this is true. We can make the wrong choices, but my point is that that can happen either way. Babies die in hospitals, babies die from induction drugs and during caesarians. They can also die in home births. My point isn’t that one choice is better than another. It’s that we need to have real choice in these things and not just be ordered around by the hospital (who has a mixed agenda).

Secondly I want to talk about bullying and harassment. I recently attended a focus group regarding the revision of the nurses and midwives code of practice. They agreed that calling someone up to disapprovingly ask them why they haven’t had a certain test or scan during the pregnancy constitutes as harassment. And responding to someone’s decision to refuse a scan with irritation or annoyance, as happened to me, constitutes bullying. It’s amazing how quickly, with all this disapproval being directed your way, you can forget that it’s your body, pregnancy, and birth we’re talking about, not theirs. So many of my friends who have recently birthed have had similar experiences:

“I declined one scan and the doctor rang me at home on a Saturday night insisting I return to hospital! I made a complaint to the safety and quality area citing harassment as I had already made an informed decision to decline which had been clearly communicated to staff. Should add, to those of you reading this: I work in the health sector and I’m really pro-using technology to improve health outcomes so I wasn’t being a wacky dippy person, I just didn’t think we were going to use the results of the scan to make any useful decisions.”

“With regards to the scans we refused some of the tests and scans and it was amazing how much they hated hearing that. We had to repeat ourselves to every bloody person we encountered.”

“36 hours after my waters broke I was bumped from my hospital because my labour was too slow (20 hours in, which is short for my family! I was fine). After an hour strapped in an ambulance on bumpy roads I’d un-dilated 3cm and baby was in shock–no choice but surgery. I dearly wish I’d had a home birth or an independent midwife to help me navigate my choices in that situation. It’s very hard to make clear decisions when you’re being told you are risking your child’s life.”

It seems that as soon as you get pregnant you get put on this conveyor belt that carries you through the system and spits you out the other side with a baby in your arms. Anyone who chooses to take a different path at any step along the way is regarded as at best naughty, and at worst a bad, irresponsible mother. “This is best for the baby” sometimes actually means this is just what we want you to do for insurance purposes/because my shift is about to finish. The whole pro-choice debate regarding abortion is structured around the mother having the right to choose what’s best for her. But in birth it becomes “what’s best for the baby”.  As a friend said, “A healthy baby matters, but so do our bodies, our consent, our informed choices”.

Finally I wanted to talk briefly about medical intervention. As my wonderful mum pointed out in response to a comment about the UK’s publicly funded homebirth program, homebirths and low intervention births are actually less of a strain on the public health system:
“Modern medicine (and thank god for it) is there when needed, but not for a completely     normal birth that might come a little early, late, or just be a wee bit slow. If the rates of     intervention in the UK are anything like they are here, it’s little wonder the NHS is suffering. Something like 35% of public patients have caesars, but more alarmingly, it climbs to over 50% for private patients! When Holly had to have that caesar she was forced to wait in a queue and I felt so angry knowing that a whole team of highly trained medical staff…and a highly sophisticated operating theatre, were taken up in performing unnecessary operations while those in need were having to wait. It takes just 1 midwife and a comfy bed for the average vaginal birth.”

But as someone on one of my feminist facebook groups said, the issue is that we approach birth as a problem, as something that needs to be fixed:
“The WHO proclaims ‘birthing is not an illness’ and that we should describe birthing women as mothers not patients. Women in Australia feel pressured to assign an obstetrician but you don’t need one unless you have a pregnancy or delivery complication. It’s like asking an athlete ‘who is your orthopaedic surgeon?’ on the assumption you will break a bone. We have one of highest rates of caesarean section yet we all know that the mantra of Healthcare (and birthing in particular) is that intervention breeds intervention. So the midwifery model of care is about trying to avoid (where safe) any intervention. For example, having a medical induction begets pain which begets pain relief which begets reduced ability to push which begets surgery. While many women hope for a ‘natural’ non-interventionalist approach to their birth, sometimes it doesn’t pan out that way. And that’s ok, it’s not a failure. But starting with the assumption that we need intervention and an obstetrician (ie assuming their will be a complication) is unhealthy and disempowering.”

If you have anything to add or anything you want to challenge, please post in the comments below. Dialogue around birthing is important!

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2 thoughts on “The Birth Post Part II — The Sequel

  1. When it comes to choice, pregnant people are so often told the risks with “natural” options but informed choice means also being told the risks of medical interventions and the comparisons between the two, as well as the relative benefits.
    This can be where a good midwife comes in (like the one you had) but it also just needs to be standard.
    I had a combo of both totally uninformed pressure and amazing empowering choice.
    When I was in labour my amazing obgyn registrar told me quite clearly about risks and benefits and although I had al the interventions in the end (including epidural and Caesar) I didn’t feel bullied or pressured, and I was given time and privacy to make decisions. They told me that I could keep going without interventions and in a totally non-alarmist way told me of the risks and benefits, they also told me of the risks and benefits of having interventions.
    At the end I was exhausted, and I perhaps could have kept going but I chose a Caesar where I knew I’d be awake, where I could have instant skin-to-skin, where neither Bub not I were in distress, and the reason I feel so confident in my choice is that it was mine.
    But I got lucky, my obgyn reg was someone I went to high school with, someone who knows me, someone smart and considerate.
    It shouldn’t be a matter of luck, though, but routine.

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  2. That last point is the key one for me, coming from the Canadian system where you chose ONE OF an OB, family doctor who does births, or a midwife. You choose according to the risks (or lack there of) associated with the pregnancy/birth. I chose a midwife (which is way cheaper for the government), had a single appointment with an OB when a complication arose, and then returned to the sole care of my midwife. My birth was potentially high risk, so I chose to birth in a hospital, but I was under the care of my midwife the whole time. I had continuity of care, my views were respected, and I cost the system a whole lot less than if I had chosen an OB from the start.

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