Sunday, December 07, 2008

Do your homework

In Homework is the mother of prevention, Monica Dux argues that careful research and preparation during pregnancy are important, and that adopting a "wait and see" attitude might leave you with undesired results.
Despite all the rhetoric about the importance of consent and respecting the patient's wishes, my experience of giving birth in a big hospital is that women are encouraged to take a passive role, to defer to both their doctor's opinion and to the institutional imperatives. If you argue, you are often told "that's just the way we do things."...

Many of the medical procedures that are routinely offered — such as episiotomies, epidurals, and forceps — are significant interventions that can have consequences for the health of the mother or the baby, and for the progress of the labour. Waiting until the maelstrom of labour engulfs you is not the time to investigate whether these procedures are right for you. If you do, the likely result is that you will simply agree to whatever is suggested.
Dux is a writer and co-author of The Great Feminist Denial. Read the rest of the article here.


  1. Truly informed consent is a beautiful but rare thing. All women should know what's going to be done, why it's going to be done, and what good (or bad) it will do, and they should all have access to a care provider that most closely meets their needs. But first, you have to figure out what your needs are! Don't just do your homework - dare to question the status quo. And ask REAL questions. Never take someone's word for anything!

  2. I have a huge problem with this article. How she, a self-identified feminist, can write an article on the unnecessary interventions women are subjected to in hospitals, and blame it on women for not "doing their homework", with no critique at all of the system (let alone any mention of alternatives, like home births, one-to-one midwifery care, etc) is utterly beyond me. Way to blame women for what's actually wrong with the system.

    I don't disagree that being informed is a good thing, but I think the salient point is that, actually, we shouldn't have to be. If you end up in a hospital emergency department because you've been in a car crash, no-one expects that you should be informed because if you're not, the doctors might do something harmful to you; give you treatment that's not in your best interests.

    Women should be offered genuine choices and genuine information from the moment we find out we're pregnant. We shouldn't be routinely subjected to unnecessary interventions with no evidence to support them. And suggesting that it's women's fault for not "doing their homework" ignores the ACTUAL problem, which is that we're getting inferior, non-evidence-based care. Which is what she, as a feminist, ought to be focused on.

  3. I’ve been looking for discussions of Monica Dux’s article, because I thought it was one of the more interesting articles about childbirth I’ve read for a long time. With two beautiful home births behind me, natural birth is a pet project of mine!

    Rebeka I also think that the medical system is the problem, but it’s still a good idea for women to do their homework. Unless things change tomorrow and I doubt they will there are going to be a lot of women giving birth in hospitals. And even if you birth with a midwife isn’t preparing and informing yourself still a good idea? Have you read the Great Feminist Denial? I bought it after seeing that article in the paper and it has a great section on what’s wrong with birthing in Australia. You ought to check it out.

  4. Hi Ruby, I did actually agree in my comment that being prepared is a good thing.

    And I have read The Great Feminist Denial, and the birth section was pretty good (I suspect more due to Dux's co-author, Zora Simic).

    I found the book as a whole problematic, but that's probably off-topic here.

    My issue is not with women preparing themselves for birth - clearly, that's no bad thing. My issue is with a feminist commentator writing an article that basically blames women for the things the system does to us, instead of blaming the system.

  5. I think this is especially true for the "I'm going to try to have a natural childbirth (in my world that means no epidural) but I'll wait and see what happens." I think women need to be educated on what childbirth really is and then if they want a non-epidural birth they need to actually prepare. I hear too many women do nothing to ready themselves and then say they "caved" and had an epi - how did they expect it to go otherwise?

    And just to clarify I'm not really anti-epi other than the fact that it's so overused.

  6. "I think women need to be educated on what childbirth really is and then if they want a non-epidural birth they need to actually prepare. I hear too many women do nothing to ready themselves and then say they "caved" and had an epi - how did they expect it to go otherwise?"

    Of course you could also look at ridiculously high rates of induction, and conclude that the reason so many women "cave" (ugh, loaded term) and ask for an epi is because (a) they're subjected to induction for no real medical reason, and induction is well documented as more painful than labour is without chemical "assistance", and (b) that hospitals generally provide an environment that does not give a woman adequate emotional support to labour without needing artificial pain relief.

    The reason, in my view, why women find (despite their desire for a natural birth) that they can't cope with the pain has nothing to do with a lack of preparation, which is in itself a recent, middle-class concept, but is because they are subjected to unnecessary interventions, and do not get the support they need to labour without them. Blaming women for this because they're not prepared is completely unfair.

  7. Rebekka, preparation isn’t a new idea! You need to realise that in traditional cultures women did prepare! From a young age they watched other women give birth, they helped and participated, and they had all sorts of traditional knowledge passed on from older women. In modern society we don’t get any of that, so we have to find ways to make up for it.

    I hope I’m not being rude, but I also think you are a little confused when you talk about the middle class thing. I know it sucks, but home birthing and hiring private midwives can be really expensive. Working class women often end up birthing in public hospitals because it’s cheaper, and once they are in the hospital system we all know what can happen. So they need to prepare and inform themselves as much as anyone. We should be encouraging all women to take control of their own birthing experience, no matter what their background.

  8. Ruby, once again, I'm *not* arguing against preparing for birth!

    I'm arguing against women who haven't read the requisite number of books being blamed when they suffer unnecessary interventions.

    And when I said preparation was "middle class", I was referring to the idea that preparation for birth consists of reading books - "doing your homework" as Dux put it. Sorry if I didn't make that clear. This is definitely a middle-class, and a relatively recent, phenomenon.

    Watching other women give birth is a completely different experience from reading What to expect when you're expecting - or even some of the more radical birth books. Dux didn't suggest that women should be with other women experiencing physiological birth. She suggested that women should do "research" - like you would if you were buying a new car.

    Yes, all women should be knowledgable and supported, but if you're critiquing the culture of birth (as Dux, a feminist commentator, seemed to be trying to do), rather than trying to support women who want a positive birth experience, then the focus should be on what's wrong with the system. Not on what women are doing "wrong".

  9. I just re-read the article to make sure and it doesn’t say anything about reading books. Isn’t “do your homework” just a way of saying “do your preparation”? But what’s wrong with reading books anyway? There are some good ones and if they help you then why not read them? And why is reading books middle class? Don’t you think working class women read?

    I think there’s a big difference between blaming women for the hopeless medical system which obviously isn’t their fault and encouraging them to take responsibility for their own birthing experience. I just finished Monica Dux’s book which I thought was very positive. I think the article was too and I’m still not sure what your problem is with it. I’m glad when someone stands up to talk about this stuff.

  10. The article doesn't mention midwives. It doesn't mention home birth.

    It focuses on women's so-called lack of preparation as the *reason* for unnecessary interventions.

    Those are my problems with the article.


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