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 hospital...is 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] Gentle Birth, Gentle Mothering 110-114.