Sunday, October 28, 2007

Comments about To The Contrary

I part ways with Lynn Griesemer over the father's role in unassisted births. We've talked about this, and she has more of a "daddy delivery" philosophy about unassisted birth. I don't think men should be "front and center" in births. Women should be. After all, they are the ones giving birth! It's really not that hard to catch a baby, yet when men (or doctors) do it, they get all sorts of glory and acclamation. My husband's role at the birth was to sit in the other room and wait as I birthed our daughter (and to be errand boy when I needed food & drinks). Now, that was exactly what I wanted and needed him to do, so it's not like I resent that in any way. The most significant thing he did for me--more important than any coaching or catching or delivering--was giving me blessings when I asked for them. (LDS lingo here...let me know if you haven't a clue what I'm talking about.) The blessings gave me absolute certainty that both I and Zari would be perfectly healthy and that the birth would go smoothly. There is no machine, no test, no care provider who could do that!

Even though Lynn would not identify herself as a feminist, I do agree that birth issues are noticeably absent from almost any feminist platform. That's a shame, I think. The National Organization for Women has recently made some statements about birth issues, including a statement against VBAC bans, but otherwise feminism has been oddly silent on the birth side of "reproductive rights." I also think that the almost exclusive focus on abortion has alienated many women who are concerned with the rights of childbearing women. Women need more opportunities to unite, and unfortunately the abortion issue is one really good way to keep women divided.

Dr. Healy claims that she supports patient's rights to refuse treatment, yet she undermines that by her statement that "when you’re making that decision for a child, it’s a very different situation." Is it different? Pregnant women have the same medical and legal rights as non-pregnant people (with the very disturbing exceptions of court-ordered obstetrical interventions). This is the same double-talk that ACOG uses in its statement against home birth: "Although ACOG acknowledges a woman's right to make informed decisions regarding her delivery, ACOG does not support programs or individuals that advocate for or who provide out-of-hospital births" because "the American College of Obstetricians and Gynecologists believes that the the safest setting for labor, delivery, and the immediate postpartum period." ACOG's active opposition to out-of-hospital births stands in direct contradiction with its claim to support women's choices in health care.

It's kind of like saying "We support your right to choose any color of car you wish. But you can only have a blue car, because we believe that all other colors are unsafe. In addition, we will actively oppose any car manufacturers who promote, sell, or distribute non-blue cars. We can do this, because we have a monopoly on the $33 billion-a-year business of car manufacturing, sales, and advertising. But remember, we support your right to choose!"

I agree with other commenters that Dr. Healy skimmed over the issue of babies dying in hospitals. Yes, it's true that neonatal deaths are fairly uncommon anywhere in developed countries. But her comments imply that a hospital is the only place that the low death rate can be ensured, and that any infant deaths that occur in hospitals are unavoidable.

The doctor also shows a blatant lack of knowledge about unassisted birth, or home birth in general, with her claim that first-time mothers do not make that choice. What irks me is that her statement will be taken as factual and authoritative, simply because she is a physician.

I am also puzzled by her comment that "you don’t know the health of that baby until that baby arrives." Isn't that one of obstetric's main claims--that it can monitor, assess, and predict the health of babies during pregnancy and birth? Why else all the monitoring during pregnancy (ultrasound, screening tests, etc) and birth (electronic fetal monitoring)? Is her statement an admission that the standard obstetric care really cannot predict outcomes with any accuracy, let alone avert them? Or is her comment meant to mean that women birthing at home cannot know whether or not their baby is healthy while it is in utero? Because certainly women can and do feel their baby kicking and moving, listen to the heartbeat, and keep track of the baby's growth. Read that way, her statement implies that a physician has a better knowledge of the unborn baby than the mother herself.

Of Eleanor's comment--which I find immensely condescending and anti-woman--let me just say that safety, satisfaction, and empowerment are not mutually exclusive. In fact, the factors that bring unassisted birthers pleasure (privacy; security; complete freedom to move about, eat, drink, and vocalize; not feeling observed or monitored or pressured to birth in a certain amount of time; lack of drugs and interventions and their known side effects; absence of stress and fear; optimal hormonal levels that help the mother experience ecstasy and bliss; ability to focus on labor and not on outside distractions) also enhance the safety of both mother and baby. The pitting of fetal safety versus maternal satisfaction is a cornerstone of the obstetric worldview, as Robbie Davis-Floyd notes in Birth as an American Rite of Passage. The midwifery paradigm, in contrast, perceives the mother and baby as an inseparable, mutually dependent unit. What is good for the mother is good for the baby, and vice-versa.

I fear that this discussion of safety is quickly turning into a dissertation itself, but let me briefly add some insights from Sarah J. Buckley. She argues that the safest, easiest, and most ecstatic births are ones that are undisturbed:

"Anything that disturbs a labouring woman’s sense of safety and privacy will disrupt the birthing process. This definition covers most of modern obstetrics, which has created an entire industry around the observation and monitoring of pregnant and birthing women...On top of this is another obstetric layer devoted to correcting the 'dysfunctional labour' that such disruption is likely to produce. The resulting distortion of the process of birth—what we might call 'disturbed birth'—has come to be what women expect when they have a baby and perhaps, in a strange circularity, it works."

In contrast, undisturbed birth and its “optimal hormonal orchestration provides safety, ease, and ecstasy." She explains: “When a mother’s hormonal orchestration is undisturbed, her baby’s safety is also enhanced, not only during labour and delivery, but also in the critical transition from womb to world....[I]interference with this process will also disrupt this delicate hormonal orchestration, making birth more difficult and painful, and potentially less safe.” She uses two analogies to explain the optimal conditions for undisturbed birth: lovemaking and meditation, both of which necessitate privacy, quiet, and freedom from feeling watched. “If we were to consider giving birth as the deepest meditation possible, and accord birthing women the appropriate respect, support, and lack of disturbance, we would provide the best physiological conditions for birth.” [1]

I also want to say that childbirth was definitely something that I embraced and enjoyed in many ways. Some parts were challenging, some were very very exhilarating. Pain was present at times, but so was immense pleasure, experienced in the form of an incredible endorphin rush between every contraction. Five minutes after the birth, I said, "that was hard work, but definitely doable." Distance runners experience this same mixture of pleasure, pain, exertion, and exhilaration. I can say this from personal experience, since I am very close to running a half-marathon. My longest run so far has been 10 miles.

Now, in case you are tempted to dismiss my experience by figuring that I must have an unusually high pain tolerance, let me set the record straight: I was known for my extremely low pain tolerance growing up. I would scream and wail over every little thing, so much that my mom didn't believe me when I broke my wrist and waited 10 days before taking me in to the doctor!

Eleanor's disparaging comment about enjoying labor and birth is destructive and indicates either some very traumatic personal experiences giving birth or very strong cultural programming that birth is inherently and inescapably traumatic.

And the final panelist...where to start? She reiterates that choosing to birth at home unassisted is selfish, yet her own childbirth preferences (using drugs, including general anesthesia) confer no physiological benefits to mother or baby during normal labor, and also pose many significant risks, as Dr. Buckley has thoroughly documented. We could very well argue, with much more substantial evidence than any of the panelists had, that any mother taking drugs for pain relief is selfish--caring more for her own experience than for the baby. (Not saying that I want to use this label, because there is too much woman-hating and guilt spreading out there already).

This concludes tonight's episode of "Rixa writes, raves, and rants whilst remaining reasonably restrained in her responses."


  1. Hardly a rant or a rave - and I'm not just saying that because you summed up all of my thoughts when I read that article, either!

  2. Thank you for posting this so soon after the previous post. I've been stewing since that post. I found you from an unassisted board, I think, and I thank you for your blog. I am so grateful that there are articulate people in addition to the solid research to continue to champion that right of a woman to birth in the safest way for her and her baby. Maybe someday "they'll" start to listen.

  3. NO KIDDING Rixa, the silence by feminist organizations about birth choices is truly astounding. Was it NOW or some other group who declared that method of delivery of a baby is a medical decision, not a human right?
    And that birth choice is NOT a reproductive right? It's in PUSHED but I don't remember details at 6:00 am.
    Ugh. I find it disturbing how little feminist thought (thought: as in theory) contemplates the lack of social support for this aspect of the choice made by the vast majority of women to birth and raise children, even--especially!--since the choice is ours to make completely freely.

    Obviously I'm not the lone feminist who made this choice! But even a pro-family feminist forum like, which advocates for parental leave and free healthcare, neglects the waste, abuse, and paternalism in US maternity care.

  4. Yes I know that it wasn't exactly ranting or raving, but I was going for the alliteration.

    And welcome Karin!

  5. Oh, yes, the horrors of labor are deeply culturally ingrained. It's a mental assoociation, a reflex in people's minds: birth = bad pain

    When I casually brought up homebirth to my husband, his only question was about pain (and screaming). Even men are hung up on this idea that birth = bad pain that we must avoid at all costs. Huh, are freaked about our labor pain.

    I have yet to meet a mother or pregnant woman who had or was planning on having a natural, midwife assisted, home-birth, or unassisted birth.

    All these women spoke positively of epidurals...that epidurals were necissary, it's what you do. "why would you want more pain than necessary" they ask me when I bring up my interest in natural birthing.

    Movies show women going so crazy with pain they beg for drugs. That horrid show on TLC presents pitocin and epidurals as the norm.

    The media and cultural teachings the birth is frightful, painful, impossible are so strong. Thank you, Rixa, for sharing your story and your research.

  6. Well, I like your ranting :-)

  7. I'm not a mother yet, but am very interested in home birth. I agree that women should be at the center of birth, but I can understand why many women would want their husband/partner with them, and to even have him help catch. I can't imagine going thru labor and delivery without my husband to lean on and hearing his gentle voice. And I know he wants to be there too.

    I understand your husband helped you in the way you needed him to, but I don't think all women desire the same level of privacy as you do.

  8. My mother, who had 4 natural childbirths herself but would have chosen the drugs in a hearbeat if she had had access to them, has MANY times told me that you don't get a medal for doing childbirth without drugs. I was astounded that she would say something like that because it shows that even after 4 births, she really doesn't have a clue about what birth can truly be. She had all her babies in military hospitals in the most naked, demeaning circumstances imaginable. To her, birth is something to be endured, not enjoyed. I fear that many, many women feel the same way because of the brainwashing they have received from the media, the medical profession, and society in general. This "interview" did nothing to change tha. How very sad.

    Great ranting, Rixa. Thank you for being such a strong voice for sanity in the insanity of the birthing world.

  9. I think that you made some good points.

    I think that a lot of the comments are right on. Many women are scared of birth. IF they could understand that birth can be enjoyable, beautiful and let go of that fear. Trust in themselves and their bodies, than that would make a HUGE difference in the birth world.

    Education is a huge step in this. I wish that colleges or high schools would teach positive birth information to help empower women from a young age. Get them thinking about it in a positive way before they get pregnant.

    Blogs even can educate women! So thanks for all you do. :)

  10. Disclaimer: This is my opinion. That is all it is--opinion.

    I completely disagree with the tone of your first paragraph. You make birth sound like some kind of competition to be in the spotlight and to get the "glory." I understand that perhaps you work best/feel more at ease in complete privacy with your husband in the other room. And I am sure that you and your husband were in agreement on how you personally arranged things, but I definitely don't think it should be just what the woman wants. Unfortunately that is what your paragraph seemed to portray birth as--all about WOMAN. Isn't marriage and family about partnership and unity? I hope that my husband has the opportunity to experience as much as the birth as possible (of course only if he wants to) because he has to miss out on so much of the other experiences (even if they are unpleasant experiences, they are still amazing). I think it is very dangerous to make birth a woman's power struggle, especially if it means excluding men. I am surprise by the emotion that this evoked out of me. I am normally very passive when I read your posts. You are great at getting people to think about things. Thanks!

  11. I'm interested that several commenters assumed that my first paragraph was meant prescriptively, as if I was saying that is what ALL women should experience. I was merely laying out my take on birth and how I interpret it based on my own experiences.

    I was specifically disagreeing with the idea that somehow the father is the star of the show if he's the one catching the baby or helping the mother--which is more the way Lynn sees it, as well as other writers such as Marilyn Moran. If you read Moran's books, the books focus far more on the father than on the mother! It's all about his "right" to a certain experience and to his proper role (Moran was a devout Catholic) as head of the household, etc.

    Not at all saying that fathers should be excluded if both they and the mother want his active participation. But still, no matter how helpful or supportive the dad is, the mother is the one bringing forth the child!

    I didn't need any help in the form of telling me what to do, or back rubbing, or telling me I was doing great, etc. Some women really want or need this from their husbands. And if they do, great. And if they don't, great.

    For me, Eric's presence in the room was distracting. I needed to focus all of my concentration on the birth, and his being there took away from my ability to do so. He helped in other ways, just not "directly": getting me things to eat and drink, fetching me towels after the birth, filling the tub up, taking pictures afterwards.

    1. I'm a few years late on this but just wanted to add my experience. Before coming across your blog and reading about your first birth I had always assumed I wanted, no NEEDED, the father in the room with me. In fact, a few weeks ago I was telling a friend of mine that I don't care if he is uncomfortable being there, he has to be there because I want him there. But, as I read about your experience I started to think about why it was so important to me to have him there and I realized that I somehow thought he would be able to get me through the labour/birth and that I was not capable of doing it on my own.

      Your story has encouraged me to consider that when the time comes I may feel more comfortable being on my own (with him and the midwife in another room until I ask for them) if only because it will give me the privacy to focus on myself and my child. I haven't decided one way or the other but I have started to discuss all the possibilities with daddy-to-be and am excited to see how it all turns out.

    2. Eden, I'm glad this has made you look at your beliefs/assumptions and really examine why you might want him with you...or not with you! I don't think there's any right way for husbands/partners. I wish there weren't so much pressure on them to have to perform a certain way during their mate's labor.

  12. Another thought: if the woman and her husband have varying degrees about what level of participation she wants during labor, it's very important to be careful that her basic needs are respected. So yes, marriage is about sharing and compromise. But birth itself is a very delicate hormonal process and so if the husband wants something that would disrupt the woman's ability to birth successfully, then her needs come first.

  13. I enjoyed reading your thoughts. :) The "discussion" was pretty lame in my opinion, and I especially rolled my eyes at the part about "you don't see first-time moms choosing home birth" because my first was born at home. ;) But I do know people who had their first babies in the hospital and were so dissatisfied that they chose home births for future children... but they would readily say they wished they had made that choice for their first one, as well! ;)

  14. Absolutely one of the best written things you've ever done, this perfectly summarized all the little thoughts I had about this interview, if it could even be called that!

    I totally got where you were coming from with the first paragraph in question. For you, you did what would have optimized your total surrneder and non-distraction. To make birth plans that focus hugely on, to be quite frank, anything other than the primal needs of the birthing woman is interference. I think alot of people DO get too into a "groovy experience" and invite 17 pals and plan all these candles and special songs and then dont know how to back out of it, so strong is our social conditioning about offending guests or even our mates. I think that if someone planning a homebirth doesnt not have a really, really clear idea of what they are going to want, they need to be in a safe situation to have lots of options to change their mind and have someone be a quiet and trustable person to keep them hydrated, fed, whatever needs come up.

    I have long thought it such a shame that feminist groups stay away from birth issues, I am guessing it is left over stuff from the earlier waves of feminism that had all of motherhood wrapped up as rather lowly and disdainful, and abortion rights became front and center. Thank goodness for feminist mothers, raising up the next generation--now we need to unite and get some exposure!

    Great job, Rixa as always :)

  15. More questions floating around in my head:

    The issue of men being "included" in the birth experience, or of men "experiencing birth." What does that mean? Why do we say a man is "part of it" when he gives back rubs or catches the baby (or whatever) but not if he simply witnesses the birth? If a man watches a woman give birth, is he "experiencing" it? Can he ever really, since he is not in her body?

    It's interesting that Eric is assumed not to have been included simply because I asked that he stay in the bedroom while I labored in the bathroom. He did witness Zari's actual emergence; I called him into the room when her head came out. Before that point, it's not like there was a lot of exciting things to watch anyway! Just me sitting on the toilet between contractions, then draping myself over the birth ball and roaring. Repeat repeat repeat. Then I was sitting on the toilet at the very end with my hand between my legs (feeling Zari's head slowly emerge). Again, not much to see anyway.

    I think that the language of inclusion/exclusion is so flawed when it comes to birth, because birth is not a team sport! (With all the spectatorship, cheering, & coaching implied with the sports analogy).

    I think a lot of this stems from our late 20th century/early 21st century cultural expectations of fathers' roles at birth. If they aren't running around helplessly (you know, the standard comic relief in many Hollywood birth scenes) then they're supposed to be "coach dad," telling the woman how to breathe, holding her hand, cheering her on. This evolved historically when the natural childbirth movement was fighting to allow fathers at hospital births. After enormous initial resistance on the part of the medical community, fathers slowly were allowed into delivery rooms. With the advent of childbirth education classes such as the Bradley method, fathers were taught that their presence was essential to coach the woman through her labor. With the increase in nursing shortages, the entry of fathers into delivery rooms worked out quite well--they could take over some of the roles that nurses previously had filled.

    Well enough musing for right now...back to dissertation writing.

  16. I, too, find it demeaning when men (be they doctors or not) catch the baby and are exalted as heroes, as if they did all the work. >:/ I remember a story not too long ago abotu a woman who gave birth on a plane, and everyone was congratulating the doctor who happened to be on the flight and assisted in the birth. They praised him for doing "such a great job." OKay, so what did the WOMAN do???

    Just more proof that in our culture, women are nothing more than baby vessels. It's the MEN who do all the IMPORTANT stuff.

  17. Hello Rixa,
    I read your blog for quite a while but it's the first time I comment it.

    Michel Odent says in one of his book ("Le fermier et l'accoucheur" - sorry, I'm French speaking) that the role of men during birth will be the central theme of discussion when (and... if, should I add) our birth culture will change. I agree.

    My first baby was a hospital birth where my husband acted somewhat like a 'protector' and did pretty much what was expected of him by the medical staff. He was physicaly there but wasn't part of it if I may say.

    Our second baby was born at home with a liberal mw. My husband was happy to make some decisions and to be 'the host' instead of 'the guest' like he was at the hospital. But still for me, he was not much different than another witness...

    For our third child, we were just the two of us and he sure was part of that birth eventhough he didn't have to constantly BE there FOR me. I was alone most of the time but at one point he came towards me just when I wanted him with me. No words exchanged. It then became a very sensual/sexual birth where we did very intimate things. We were a couple giving birth.

    Only with the birth of my third child did I truly understand that birth really is sexual. I agree that it is not a team sport but that day, we 'needed' each other to watch this baby come into the world the same way we 'needed' each other to 'create' him a few months earlier...


  18. Bienvenue Dea and thanks for your comments. (Vous etes francaise? canadienne?)

  19. BTW the English title of the book is "The Farmer and the Obstetrician." I really like it, and I referenced it heavily for one of my comprehensive exams.

  20. Wonderful post, in all ways. I had to smile at the discussion of husband participation in birth. My wonderful hubby curled against my back on our bed, in the same position in which we sleep, and dozed through labor with me. One could certainly not call him an "active participant," especially as I kept having to squeeze his hand to see if he was still somewhat awake. He'd sqeeze back and we would both snicker. (note: mine was a midwife attended homebirth, but they mostly left me to get on with it however I wanted, too)

    I agree that a woman's needs are the primary consideration in birth. How sad that something so empowering has been taken from women, and so few women even realize the fact. And I agree, where are the other feminists?

  21. Oh God yes, that comment about the husband being front and center drove me nuts too!

    Hands up anyone whose husband was in the room and was calm and reassuring and helpful during birth... Anyone? Anyone?

    Mine, despite attending 9 months of centering classes with me, was a gibbering wreck. Love him as I do, I did not find him to be a rock. I wanted to slug him.

    As a rule, from girlfriends I have spoken to, most men - even one who had read "The Birth Partner" five times - were almost worse than useless. The sight of their wives in pain reduced them to panic...

    And did I read a study somewhere drawing parallels between fathers in delivery rooms and a rise in C-Sections?

  22. Bah - can't find it anywhere - I think it was based on anxiety about not reaching the (artificial) labor milestones established by hospitals, which contributed to mothers losing faith in ther ability, and so, on and so forth and C-section...

    I'm a freestanding birth center birther, btw, and while my previous comment might be seen as anti-guy, it's more anti their role as coach, and how, well, unsuited they are to it. Roaring and squatting aren't really confidence boosters from their perspective, but are very helpful to the process from ours...

  23. "Roaring and squatting aren't really confidence boosters from their perspective, but are very helpful to the process from ours..."

    Haha! So true! Michel Odent has some fascinating (and very controversial) perspectives on fathers. He argues that often the male presence--especially males who tend to think linearly and rationally--has the potential to inhibit instinctual birthing.

  24. "Hands up anyone whose husband was in the room and was calm and reassuring and helpful during birth... Anyone? Anyone?"

    Well, mine was pretty great - much to my shock, actually. Our first birth together was my second birth. Since I was in major labor denial, we ended up with an accidental living room UC. He was calm, reassuring, and supportive and overall made me feel safe an loved and calm through it all.
    Our 2nd birth together was a more standard labor and a hospital birth center birth. I was continually surprised at his intuitiveness. I needed a lot of back counterpressure for back labor. Some of the happiest memories of our entire relationship are of me burying my face in his chest with his arms around me and his hands on my back. I never felt so safe and supported ever in my life. He didn't say much, maybe an occasional "need a drink?" or "that was a long one" but he radiated security and love and set the mood. I remember our labors together as being very intimate and reinforcing our closeness and bond. I can't imagine having birthed without him.
    During that 2nd birth a friend of mine was present as the support person for my oldest son, also present. She did a great job of staying out of the way and being really unobtrusive, and making sure my son was content. After the birth, she commented that she didn't feel my husband was very sympathetic, I guess since he wasn't anxious about me or saying "oh you poor thing" type comments the whole time. The last thing I want during labor is sympathy! While I found him just being there and quiet and confident and holding on to me as the ultimate in support, she felt he didn't care enough because he didn't act "sympathetic!" I don't know if my husband is just unique (quite possible - he has a lot of other qualities I don't hear a lot of other wives talking about!) or if there is a way to promote that kind of intimate support.

  25. Thanks for your comment drjen! It sounds like you're married to a real gem. I think we have this programming that men are supposed to behave in a certain it movies? TV? It's funny that she thought he wasn't sympathetic enough!

    My husband actually tried to be more "hands on" (tried rubbing my back, etc) but I didn't need or want it and asked him to please leave me alone and I would let him know if I needed anything. I appreciated the gesture; it just didn't happen to be what I needed at that moment. Being alone, but able to ask for something when I needed it, was perfect for my needs in that moment. It's funny because of the two of us, he is definitely more emotional and communicative and sensitive. I'm the one who just says what she means and doesn't think about subtext or all the hidden meanings of gestures or words.

    I think the whole fathers'-role-at-birth boils down to:
    - good communication before and during labor about your needs & your expectations for what he should be doing or not doing
    - the individual couple's dynamic
    - how the woman reacts to labor (some women, like me, crave privacy and don't want to be touched or talked to. Others are social birthers and love a huge group of women chatting away with them. Others love human touch and cuddling and find comfort with their spouses).

  26. That's agreeable upon my experience also.

    It's nice you put up this kind of subject. This blog will be one of the many that I visit everyday.

    Til then,

  27. A lot of this has been on my mind too. I like how you think (not necessarily everything you think) and how you inspire people to turn these issues over in their minds for themselves. Good for you! Keep on deconstructing these deeply-held "beliefs" about the childbearing years.
    ~ Kimberly

  28. I think it is so hilariously double-minded to say on the one hand, women have a right to their bodies and the choice to arrange for an abortion *where infant deaths definitely occur-- by choice and on purpose,* ok to respect that choice; and then on the other hand to say women who choose to birth in some way that *might but is not intended and likely won't* result in infant deaths, ok to disrespect that choice. Where is the sense in that?



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