Is “Empowered Birth” a Feminist Fantasy?

Above: Lost in self-evaluation?

Did you have a good birth?

What thoughts and images come to mind when I ask that question? If your answer is yes, do you feel proud? If your answer is no, do you feel guilt?

For ten years now my work has been to help mothers “prepare for a great birth.” But a new essay by Sarah Blackwood has me questioning whether morality – judgment of what is right or good – belongs in birth at all.

Her essay is titled, “Monstrous Births: Pushing back against empowerment in childbirth.” My first thought was, “Who could be against empowerment?” and I deleted it. But it gnawed at me, so I retrieved the essay from the trash, read it, and have been wrestling with it ever since.

When Blackwood, now a mother of two, was pregnant for the first time, she was “seduced by these feminist ideals about childbirth and thought that the way I went about it would be representative of something about me and my strength.”

Her first birth, however, was traumatizing: a four-day induction ending in a c-section and life-threatening hemorrhage. She attempted a VBAC for her second birth, but nothing went to plan, and she had a second emergency c-section and complications from the surgery.

Since then, she says, “I prefer to hear, tell, and read stories about childbirth that give the lie to contemporary fantasies about empowerment. Birth is a monstrous thing, and it has no moral component.” I take “monstrous” to mean other, existing outside of the binary of good or bad, as well as potentially terrorizing.

In contrast, I was so moved by my own “good” births that I abandoned a career I loved in order to teach expectant mothers how to have them! Birth is influenced by so many factors. I have taught women and their partners the factors that encourage or hinder the natural progress of birth, as well as techniques for managing the fear and pain that often accompany it. Do these things, I say, and chances are very good that you’ll have the natural vaginal birth that you desire.

“There are no guarantees, however,” I caution. “Natural birth is wild, not tame, organic, not mechanistic. It can be influenced but not controlled.” But after the hours I spend teaching them how to maximize their chances for a “good” birth, this caveat is easily, unconsciously, brushed aside by these hopeful and excited parents. Rarely is it enough to prevent them second-guessing themselves, even feeling guilty, if they do not have the natural vaginal birth they desire – or worse, if they feel traumatized by their experience, as in Blackwood’s case.

To avoid the potential guilt associated with an unwanted outcome, Blackwood would have us say there is no good or bad in birth. But that is too radical. Not only does it invalidate all the good experiences, like mine and my clients’, it cannot inure us to disappointment. There must be a middle path.

I propose we talk about birth outcomes as healthy or unhealthy and allow space for luck.

From “good” birth to “healthy” birth. The body is supposed to work. We call it “health” when the body works. When it does not, we call it illness. Very often “good” personal choices, such as eating a healthy diet and exercising regularly, contribute to health. Whereas, “bad” personal choices, such as smoking and not managing stress, often contribute to illness.

But sometimes there is no moral component at all: non-smokers get lung cancer, while a two-pack-a-day-er dies at 97 of old age. So we are humble in the face of these calamities, whispering to ourselves, “There but for the grace of God go I.” We make room for being lucky or unlucky.

Birth is a natural process of the body, and it’s supposed to work, too. That means it is supposed to begin, proceed, and end in a way that is healthy to both mother and baby. As with our health at other times, the choices we make can contribute to healthy outcomes or unhealthy ones.

However, we make a mistake when we give all the credit for health, or all the blame for illness, to our personal choices. My births went well, and I gave all the credit to my preparation: the team I assembled, my relaxation skills, etc. I jumped to the conclusion that if I could do it, anyone could, if they followed my playbook. Maybe. Maybe I was also really lucky.

Blackwood’s births went badly, despite responsible preparation. To absolve herself of intolerable feelings of failure, she concluded that birth could not be anything more or less than a “chaotic biological experience.” Maybe there were choices she could have made to have a better outcome. Maybe not. Maybe she was just really unlucky.

She and I make the same mistake in universalizing and generalizing our births to make meaning for everyone. Birth, like health, is too idiosyncratic. We must do our best and, humbly, make room for luck.

What about you? What do you feel contributed to or determined your birth experience? Join the conversation by leaving a comment below.