Wednesday, July 07, 2010

All that matters...

And all that matters is that you have a healthy and safe delivery... no matter how it's done.

All that matter is a healthy baby and healthy mommy.

Whatever happens, what matters most is a healthy baby girl and a happy mama and daddy.

In the end, all that matters is bringing a healthy baby into this world, by whatever means necessary.

These are all real statements I came across one day last week.
I find these statements both tyrannical and tautological. Tyrannical because it leads to a restriction of choices in the name of safety. Tautological because *of course* mothers want their babies to be born healthy and want themselves to come out of the process unharmed.

The "healthy mom/healthy baby" rhetoric, if followed to its logical end, leads down several ridiculous and contradictory paths.

First, it allows widespread abuse and manipulation of birthing women by negating anything that happened in the course of the birth, as long as the mom and baby survived. (Because in this context, "healthy" is a euphemism for made it out alive, not necessarily thriving and vibrant and injury-free.) It excuses any and all deviations from principles of evidence-based medicine and informed consent. And ironically, it often leads to greater net harm. Why? Because the "healthy mom/healthy baby" rhetoric is usually used to justify increased medical intervention. Pressured to have a c-section you didn't want or need? Encouraged to have an induction for dubious reasons? Given an episiotomy even though you clearly said you would rather tear? You should be grateful, because all that matters is that you have a healthy and safe delivery... no matter how it's done.

Second, it creates a false dichotomy between Good Moms who do the Right Things (like doing whatever their care provider says without asking questions) and Bad Moms who care more about The Experience than their own and their baby's wellbeing. You know, the hedonistic, selfish, narcissistic moms who'd rather listen to Enya and labor in an Aquadoula than have a living baby.

Third, it creates an artificial hierarchy of women's wants and needs, in which the mother's--and especially the baby's--health cannot coexist equally with other goals. Goals such as feeling respected and honored and joyful during the birth process, being able to make decisions about their care, and emerging from the birth feeling powerful and confident.

Fourth, the healthy mom/healthy baby idea opens the door for dictatorial top-down decisions. Because if the most important thing is a healthy mother and a healthy baby, then logically anything that adds additional risk to mother or baby should not be allowed. Let's follow this logic down its slippery slope to the final, authoritarian end:
  • No epidurals or pain medications except for surgical births, because they add medical risk with no medical benefit (no one has ever died from the sensations of labor, but there are a host of risks--from minor to deadly--from epidural anesthesia and IV narcotics).
  • No elective inductions.
  • No elective cesareans.
  • No home births (if you believe there is increased risk to the baby).
  • No hospital births for low-risk women (if you believe there is increased risk to the mother and/or baby from standard hospital and obstetrical practices).
  • No VBACs because they have a slightly increased risk to the baby.
  • But no repeat cesareans because they are riskier for the the mother and sometimes the baby as well...So if you have a cesarean, you are not allowed to have any more children, since both VBAC and ERCS carry risks, and risk to either mother or baby is not acceptable. After all, the most important thing is a healthy mom and healthy baby.
See how ridiculous this is becoming?

I'm not saying that I don't value a healthy mother and healthy baby. On the contrary. It's just that the "healthy mom/healthy baby" rhetoric serves as a smokescreen. I'm thinking back to a comment by a family physician whom I am honored to know. She attends births as part of her family practice and has four children of her own:
I know as a mother that I would do anything to have my children whole and healthy (and I'm so blessed that they are!). I would have 10 cesareans, I would take any intervention, I would walk on hot coals. But it doesn't mean that we should require everyone to have every intervention known - or even that that would be the safest for everyone. I would take any intervention to have a healthy baby if it was needed, but that doesn't mean I should have every intervention no matter what.


  1. AMEN. This is a fantastic post.

  2. Rixa, this was a GREAT post and hit me RIGHT where I am at.

    At 35 weeks pregnant (I'm now at 37) I was told I was possibly preeclamptic by my midwives. Fortunately, I have AMAZING midwives that put me on a regiment of herbs (for my liver), swimming, rest and relaxation to get my blood pressure down. It worked magically, and I no longer have ANY of the symptoms AT ALL. (Sidenote, had I been with an OB, or been transferred to one as "high risk", there was already talk of inducing me early...)

    Anyways, I was lamenting on my blog that I was devastated by the thought of foregoing my natural waterbirth and was terrified by the possibility of transferring to an OB and a hospital. My commenters, although awesome and supportive and full of love for me, were nearly ALL along the lines of "all that matters is that he's healthy" and I felt a lot of judgment, that people were surprised that I wouldn't just RUN to an OB's office and beg them to rush me into surgery for my baby's sake. I also got the vibe (whether real or imagined) that there were actually some people (most of whom had not ideal births themselves) who were somewhat glad that my plan wasn't working out, like it was their small way of saying "I told you so..."

    All that is to say, this argument of "all that matters" didn't ring very true with me, I did NOT find it comforting, and it left me feeling self-doubt and angry, because I knew I'd be putting my son at other risks (Oregon has a 33% c-section rate), as well as possible problems with breastfeeding, etc. I could go on and on about these.

    I wanted to scream "OF COURSE I'LL DO WHAT IT TAKES FOR MY BABY!" as though I had to defend my mother-instinct already, but after doing so, I regretted it and wished I'd stood my ground more (on my blog) and not backed down from my goals quite so easily.

    Luckily, there are doulas and midwives who read my blog who were supportive and offered their own advice and feedback for lowing my blood pressure, and I felt they truly fought with me for the health of my and my babe.

    I am so thankful that my midwives, more than anyone, knew how desperately important the birth process is and they did everything in their power to make it happen just as it should.

    I am on schedule to stick with the plan for a waterbirth at some point in the next 3-6 weeks, and I couldn't be happier because I know that this decision IS best for both me and baby.

  3. Pardon the grammatical errors. I notice that if a comment gets too long, blogger has a heck of a time letting you go back and edit, so I left it as is... :)

  4. Beautiful post. Rachel, I love your comment. I am so happy your midwives were educated enough to find ways to help your body do what it needed to do to function as it should. Best of luck with your birth!

    The journey to birth DOES matter. I am forever changed by my natural birth. Whoever says "all that matters is a healthy mother and baby" is missing a very big part of the picture. Yes, of course, a healthy mother and baby is SO important! But, a healthy pregnancy and labor/delivery is equally as important. It is best not to meddle with nature when it doesn't need meddling...if interventions are truly needed, then by all means, use them! That's why God gave us the knowledge to create those interventions. But we need to get rid of the catch-all attitude about birth (and medicine) in general.

  5. Wonderful, smart, powerful post. Thank you.

  6. You're certainly right that, in real-life usage, the 'healthy mother' part of 'healthy baby, healthy mother' "is a euphemism for made it out alive, not necessarily thriving and vibrant and injury-free." And 'all that matters is a healthy baby' (usually the mother doesn't even score a mention) is an awful thing to say.

    BUT ... actually ... your post made me realize that 'in the end, all that matters is a healthy mother and healthy baby' would be an awesome philosophy if the speaker really, truly meant "healthy." In that version, he or she would be saying: it's not about the caregiver's convenience or preferences; it's not about routine or rules; what matters is the physical and emotional (and perhaps even spiritual) well-being of mother and baby. I could get behind that!

  7. Thank you so much for this post. I too cringe whenever I hear these oft spoken words.
    Yet another perspective people should think of when spouting off these phrases, is the one of the mother whose baby is NOT healthy or NOT okay. These words seem to imply that if the mother or the baby are not healthy or not okay, that the birth experience is not important because the "only important thing" is no longer a factor. I know this comes from a different angle, but as a mother of twins who passed away shortly after birth (for reasons that could not be avoided), I want to scream when I hear, "As long as the baby is okay...".
    I would submit that in such cases, the birth experience is absolutely just as important--as those mothers will be dealing with grief of one kind or another.
    I am grateful that I had care providers who respected my body and my babies and handled us with care. That birth experience was just as beautiful (although tragic) as my 2 home births.

  8. It gets worse. It's not just that the mom is alive and the baby is healthy at the time of birth--it's that the baby is eventually healthy.

    My daughter had a really rough start. One minute APGAR of zero (5- and 10-minute were both 6), had to go to the NICU, had a blood transfusion. My first sight of my daughter was of her grey, limp, not breathing, being resuscitated by the nurses.

    I'm traumatized. But every single doctor or nurse that I've talked to doesn't understand. My daughter is healthy *now*, so why should her condition her first few days of life matter?

    She was full term and I had a picture perfect and natural labor. Yet all of that was marred by her presentation at birth and anemia. And even though my birth did not result in a "healthy baby", I'm *still* not "allowed" to mourn it.

  9. This is one of the big reasons why I have decided that when I do get pregnant, I will remain mum about my birth plans to the majority of my family and friends. I don't want to face the "Don't you care about your baby's health?" comments from either side of the debate.

    Another reason...well, I don't know how all my children will be birthed. I am going to decide based on my intuition and spiritual promptings, but I am educating myself on all my options before I get pregnant.

  10. Wow, this is a great post!

    I wonder in what other area of medicine this kind of thing would ever happen. If you were abused, mistreated, neglected, or overmedicated/intervented to the detriment of your mental and/or physical health...who would be standing in line telling you to just forget that they left a surgical instrument in you, after all, you're alive! Who cares that the doctor told you to shut up, or quit crying, or wrestled you to the bed, or cut your GENITALS without permission (or with permission, but without real medical need), who would tell you to just stop thinking about it, gosh, and be happy you're alive!

    And why are these things not lawsuit material? Lawyers would be all OVER it in most any other field. Malpractice? Trauma? PTSD? Lasting pelvic injury? Money money money!

    The patriarchy, it burns.

  11. This is brilliant. I get so tired of the statement "all for a healthy mom and baby". Really? What about mental, emotional, spiritual health of the mother and baby? Thank you for such a well-written piece.

  12. Thank you for breaking this down, at long last! Brava.

  13. Yes. This.

    May I add one? Healthy babies need healthy mothers to take care of them, not mothers physically and/or emotionally traumatized. In the case of c-section, I don't think in any other situation is someone who had major abdominal surgery two days earlier considered 'healthy'.

    My husband and I have debated this healthy baby card a bit in the past because he has a hard time dealing with my continuing grief, disappointment, guilt and pain over our daughter's traumatic birth, while his sister uses the healthy baby card to deal with her own unnecessarean plus repeat section history. Good for her, I say, but I told DH that if you take the "all that matters is a healthy baby" card to its conclusion, then what she is saying is that it wouldn't have mattered if she had bled out during the second c-section and left two young children behind.

    I also read a similar reckoning of the healthy baby card by a woman who had given birth to a stillborn and had a traumatic birth with a live baby afterward. She made the astute observation that the healthy baby card also denies the experience of mothers who bravely and valiantly gave birth to dead babies. She herself considered her stillbirth experience much less emotional scarring than her traumatic birth even though she of course grieves her dead baby.

    In my case, even though/because I had pretty much every intervention thrown at me during labor after transferring non-emergently from home, neither of us were actually 'saved' from harm. My daughter ended up in the NICU for 36 hours due to shoulder dystocia, low APGARs, and a collapsed lung, and I was in pain every single day for 9 months from an episiotomy that healed strangely and had to be surgically revised.

    I think what medical professionals often don't get is that their interventions, even those that may actually save physical lives, can leave deep emotional scars that can't be discounted.

  14. I am thinking one area of birth that needs to be considered is the "future health" of mom and baby. Purple pushing causes all sorts of problems, such as rectocile and urinary problems. Some women end up with physical therapy because of flat backed or forced pushing. Other practices are like this, not looking at the future health in days to come and the long term effects. C-sections make future births more risky, and there are adhesions and scar tissue that can cause problems. It's all a risk assessment, and moms are often not given the full picture of risks.

  15. I don't think the mentality of deferring to the "experts" is unique to childbirth. Many of the posters here have not been sick and in the hospital for non-maternity care, but let me tell you there are all kinds of interventions in hospitals that patients receive at the discretion of the caregivers in the hopes of regaining health. In fact, many of the indignities and losses of autonomy in other areas of the hospital are far worse.

  16. I agree with you Anonymous. People tend to think that if their doctor prescribed it, then it must be fine!

    I am someone who went through some very unnecessary and traumatic medical tests as a toddler to diagnose a speech delay. If these people had performed a simple hearing test on me in the first place, then I could have been spared all the unnecessary tests and labels. The reason I wasn't talking was because I couldn't hear very well, and the reason I couldn't hear very well was because of multiple ear infections!

    And of course, people who know about this will tell me, "Well, you're fine now, that's what matters." I still have some emotional issues that stem from those doctors/specialists that I'm still working to resolve.

    Does no one see the importance of emotional and spiritual well-being anymore?

  17. Great post Rixa, very well said and I agree 100%. As you know, when I was in labour with Xavier and fighting to not have a c-section, they tried to play the guilt card by saying "don't you want a healthy baby?"
    Luckily, I saw it as a way to try to manipulate me into consenting and since then I cringe each time I hear it...

    I know that for some it seems like the right thing to say, but in many cases it is a way to dismiss the situation, and feels passive-aggressive.

  18. MY husband and I have been talking about that very line and how ridiculous it is. Why do we even need to say it? We don't. All moms want a healthy baby. In fact, women who pursue natural and home birth do it because it is safer! I feel like doctors (and midwives?) say it to shame women into not speaking out.

  19. Ultimately, it all comes down to empowerment. I went into my labor wanting it to be med-free, but after 24 hours of active labor and no end in sight, I opted for an epidural. I was exhausted and dehydrated. Do I regret that? Not a bit. (It was amazing, in fact.) But the difference between my care and the standard care, I believe, is that my midwives' SOP was non-interventionist. They forced nothing on me. Even though the homebirth/natural birth mamas may see my birth as a "failure" because it was medicated, I see it as my choices and well-being being completely respected. Had I been "strongly encouraged" to get an epidural, however, you can bet that I wouldn't have a healthy perspective on my experience.

  20. I'd also like to add: first-time births because they have a slightly higher risk of uterine rupture than subsequent births.

    Wonderful post!!!

  21. Meghan--sounds a lot like my SIL's birth. It makes such a difference when it's *you* who's the locus of control and decision-making.

    I think the heart of what I'm trying to get at in this post is that the "healthy mom/healthy baby" statement is used to silence women, to tell them how they're supposed to feel about the birth of their baby. It doesn't leave room for the individual woman's feelings, which might often be complex and a bit contradictory. Just like it can be oppressive to insist that all women view birth as incredibly empowering and positive, it's oppressive to insist that you cannot have any feelings other than gratitude for what happened to you.

  22. Telling a woman that the experience she has while giving birth doesn't matter is like telling her that the experience she has while having sex doesn't matter... that all that matters in the end is that she conceives and gets pregnant. Yet we all know that how a woman is treated, viewed and touched during sex matters INCREDIBLY so does how she is treated, viewed and touched during birth matter.

    I know a few women who talk about their births being "birth rape" and I think it was because their care providers were in a position of control and focused mainly on the physical aspects... just getting the baby here... and not about the emotional, spiritual or mental experiences of the baby and mother.

    Thanks for this post Rixa, you articulated what I've been steaming about in my head for long time!

  23. Excellent, excellent, excellent. Especially your follow-up comment about “how you are supposed to feel.” I'm new to your blog and so you've probably covered much of this ground elsewhere, please forgive. But a few thoughts...
    Immediately following my recent cesarean, I felt immense gratitude. But six months later, in the calm light of day, with no oxytocin rush, I'm fairly certain it was unnecessary--or rather, that there was no one experienced or wise enough to guide the way through a natural delivery.

    I’ve grown increasingly angry about having fallen into an unneccessarean trap and find myself dwelling on the what ifs. I had 100% faith in my body to birth my baby. I still have 100% faith in my body. What is obvious to me now is that the medical establishment doesn’t share that faith, and further—they just don’t have the skills to safely and sanely help women birth babies.

    But what are we supposed to do with all this? Surely there is a place for gratitude in this process of healing—and in the job of parenting? One option is to refocus on our blessings. Do these pithy statements have a place? Well, yes, in a way. I am deeply grateful to be alive, that my baby is alive, and that we are all relatively healthy. Gratitude goes a long way in being happy.

    Another option to channel that energy into real action, real change - not just for our own subsequent births, if we have them, but to inform and change the culture that has created this situation.

    Nevertheless I find myself thinking radical thoughts … for this business of clueless men being in charge extends to other arenas. How do men get the idea they can go about telling women they know more about their bodies? What about so much mis-advice from (male) pediatricians on breastfeeding? Or that mothers should just “calm down” or stop “fussing” over their babies?

    In my experience, I do not believe anyone on staff was manipulative or malicious. Perhaps this is because I gave birth in France, and the hospital fees and surgery fees were ridiculously small; there is no litigious malpractice machine here as in the States. I do believe that people get stuck in the prevailing belief systems. What is required is a paradigm shift. Everything in my doctor’s training, and the (medical) midwives’ training, pushed them to observe, and interpret those observations, through a particular filter. If I couldn’t have a natural birth, going in to the hospital healthy and fired up to go - at 8cm - well, it just goes to show that no one at the hospital had the skills to help turn that baby and get her to tuck her chin. They just didn't know how. All they knew how to do was Pitocin, epidural, forceps, c-section.

    Childbirth is not the only arena where this occurs. It is a problem with modern Western medicine. A few years ago I went to see an orthopedic specialist about a knee problem. He advised stopping activity that caused pain (walking?) or having surgery. Further, he explained that my knee pain and hip pain were “totally unconnected.” Through working with a talented physical therapist and an osteopath I observed a pattern of movement and found a non-surgical solution. Moral? If you go to a surgeon, he’ll tell you you need surgery. If you go to a chiropractor, you'll need adjustments. And so on. People work within their realm of knowledge. Which when it comes to childbirth (and breastfeeding) often appears rather limited.

    We have to enlighten them. How?

  24. Thanks for this wonderful post. I had what I consider to be a totally unnecessary augmentation leading to distress to c-section. The experience was very traumatic, not unlike the sexual assault I experienced as a young woman. I was violated, shut up, victimized (they slapped my hand as I tried to move the curtain for my first glimpse of my baby). It was horrible, totally unnecessary, and completely routine for those in the operating room. They were making jokes the entire time. My path to healing has led me to think about the huge scale of our problem. It's not even limited to our own country, the whole world seems to have lost it's trust in women's bodies to birth babies. It matters how babies are born, and it matters how mothers are made as well. Are we celebrated, and treated with honor, respect and loving care? Or are we "made" into mothers with shame, defeat, powerlessness and coercion? I wanted my first birth to be a holy experience. It started that way but in the blink of an eye (due to an arbitrary 24 hour rule for ROM) I went from being a laboring mother in charge of her body (at a birth center)to being a ward of an institution. It was a cold and violent experience. My next births will (hopefully) be at home, for I have learned the medical establishment has no interest in the health of my body or my spirit. I heard many of these same comments,"you should be grateful""your baby is perfect, what do you have to be sad about?""the birth doesn't matter". I even heard this from a good friend who is a doula. It is shocking how we are expected to put it all away, and do it so fast. My own suspicion is many of those suffering from postpartum depression may actually have post traumatic stress disorder like I did/ do. My "problem" is not hormonal, it is a normal and justified reaction to an extreme violation of my body. So, thanks for speaking up. We have a lot of work to do, but we are not alone.

  25. Very beautifully put. I remember awhile back, it might be on this one or another blog, there was a mother who was willing to share the comparison of a "bad" birth resulting and a healthy baby and a more positive experience birthing her still born as a challenge to the "all that matters is a healthy baby" mantra.
    From my experience, I had a mediocre birth (vaginal and quick but a big mess w/ epidural) and a very not healthy baby - neither related to each other, so I don't know where that puts us in the continuum.

  26. After thinking about it for another minute I have something else to add. My almost 3 yr old son has a severe heart condition that only becomes apparent in the first hours to days after birth as the fetal circulation closes up and the baby becomes cyanotic (blue). He was born at a hospital and was able to be stabilized for transport to an appropriate facility pretty quickly.
    When I mention wanting a home birth, I'm sometimes asked - aren't you scared with what happened to A.? I'm sure its possible that he could have been born at home, maybe the MW would have left before there were any symptoms and I wouldn't have noticed in time to seek out care. But its also possible, that I could have caught symptoms soon enough to get him to a hospital and coming from home instead of straight from another institution would have empowered us as parents more in a way that would have improved the outcome. There's also a chance that he could have been born in another hospital setting and not gotten the intervention he needed fast enough to survive. The same could be true for any choice made throughout his treatment - a certain choice could have improved his outcome or caused him not to survive.

    I guess my point is that you can't necessarily always be "safe" and there's not necessarily an optimal choice that will prevent any harm. A more acute setting does not necessarily equal safer.

  27. I am ashamed to say that I have thrown the healthy baby card at mom's in the past. This post has absolutely opened my eyes to how terrible it was of me to say that. I will be sharing this with one mother in particular, whom I threw that card to, and apologizing for my thoughtless comment.

  28. I am so happy I read this article. I was given "dont you want what is best for your baby" at the hospital when my 9.9lb baby had low blood sugar after 30 hours birthing time. I still to this day, believe that if they would of allowed him to have food he would of been fine and not been in the NICU for 5 days. To which I called child protective services on them because they told me to leave the room, put up a screen around my child and were doing tests which were not approved by myself or my husband. He is perfectly healthy and now a year old.

    We are expecting our second in 5 weeks and we are doing a planned home water birth.

    I believe that most woman do not think they can say No to their Doctor because that is the "doctor" and they know best. It is very empowering to know all the directions a parent can go when it comes to a birth. Whether parents decide to be at a hospital, birth center or home, to know what you want, why and stand up for yourself and the baby, is what every parent should experience.

    Thank you for the post and thank you for @hypnobabies for providing the link.

  29. The "healthy baby" rhetoric drives me nuts. I was at a birth recently where the mom entered Triage in transition (a VERY precipitous labor) and the nurses were freaking out because they lost the baby's heartrate for a second. The husband tried to say "it's because she moved and the belt fell off" but they took that as an opportunity to start an IV on the mom and say "Everything we're doing is for the health of the baby."

    The midwife came in, discovered the mom had gone from 4 cm to complete in 30 minutes, and got them to back off. The mom delivered a beautiful baby 60 minutes after she arrived at the hospital, and everything was just fine the whole time. But hearing them tell her she was getting an intervention she didn't want because it was "for the baby" - which it didn't need - just makes me think they've rehearsed that line over and over to get women to submit to anything for their convenience. Or - maybe they're just trying to feel useful.

    Thankfully that smart midwive didn't feel like she had to earn her paycheck and that mom had a beautiful birth without a single tear.

  30. Rixa, I am pumping my fist and going "YES!" at this post! It makes so much damn sense that I honestly don't know how I didn't make this connection myself! I'm posting this on Facebook.

    I completely rejected the "healthy baby" rhetoric after my C-section. Sure, HE was the picture of health, amazingly so, and continues to be today. Me, on the other hand? I nearly DIED in a river of blood because of surgical error in a C-section that ultimately, could have been so easily avoided. It still chills me to the bone to think of what might have happened if I hadn't been able to call 911. What if I'd slipped in the blood that I gushed all over my bedroom floor, hit my head, and fainted before I ever reached the phone? I'd be dead, but AT LEAST MY BABY WAS HEALTHY.

  31. I agree that there are serious problems with hospital births and the rhetoric that women are subjected to through the medical system. However, I disagree with your interpretation of the saying, albeit cliche. (And it matters who is saying it.) I've said it before and what you're saying assumes an agenda that I definitely don't have. I said it before I knew a whole lot about the troubling facts regarding hospital births. I've witnessed other women using the line for the same reason: to offer consolation to a woman who may have just gone through a traumatic experience while birthing her baby. Many women, sadly, have the kind of birth they didn't want. We say this line to remind them not to self-blame and wallow in guilt -- we're hoping to offer relief so they can revel in the beautiful, healthy baby they have. I will also add to this that the saying probably offers little comfort and is perhaps flawed for that reason. We're just trying to let other women know that we care.

  32. Oh, I think I yelled AMEN! Out loud many times while reading this! Thank you!

  33. Thanks for this post! I recently found out I'm pregnant with my 3rd baby and I've chosen a midwife for my obstetric care for exactly the reasons you stated. I want this birth to be an experience, not a procedure! :)


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