Why We Don’t Talk About Birth As a Women’s Issue

The next generation: They deserve more humane maternity care.

Women’s bodies have been in the news lately.  Access to contraception – whether it should be a mandatory part of insurance coverage, who should pay for it, and what it says about women who take it – has dominated political talk the past week.

Also, two states have recently passed laws requiring ultrasounds – not the usual kind, run over the belly, but the trans-vaginal kind, which must be inserted into the most private part of a woman’s anatomy, while she is laying flat on her back with her feet in stirrups – before women can have abortions.  Twenty other states already have similar laws on the books, and seven other states have recently proposed them.

There’s another facet of women’s reproductive health that I’d like to bring into this discussion: birth.  It is well known that as our Cesarian-section rate has been rising, so has maternal mortality and morbidity (illness and injury) risen.  The US now ranks 40^th in maternal mortality in the developed world.

This is important, and it gets people’s attention.  But I think it’s wrong to see maternity care as just a health issue.  It belongs in the same category as contraception and access to abortion as an issue of bodily integrity and autonomy that has health implications.  The longer I study birth, the more I see it first and foremost as a women’s issue.

This opinion is not shared by more people because of a widespread misunderstanding of the inherent dangers of birth.  As long as parents believe that birth is dangerous, they will fear it and give up control of it.  Ina May Gaskin recently said, “You can make a lot of money off scared women.”  Here are a few ways that mainstream culture communicates that birth is dangerous and encourages us willingly to surrender our autonomy and bodily integrity in birth.

1. Obstetricians.  OB’s are specialists in the pathology of pregnancy and birth, and they attend about 90% of births in the US.  Like all doctors, OB’s are trained to look for pathology and that’s what they find, even when a midwife – who is trained in a different model of care – would not.  OB’s talk to one another, confirming one another’s biases.  They’ve been doing birth so long this way that their research also reflects and confirms this bias.  In Born in the USA Dr. Marsden Wagner writes, “Obstetricians have no idea what a non-medicalized birth is.  The entire modern published literature in obstetrics is based on observations of medicalized birth.”  There are many other voices talking about the safety of natural birth, but our culture is simply saturated with messages to the contrary.  Obstetricians are also implicated in the next two points.
2. Routine Interventions.  A timely intervention can be life-saving to a mother or baby, but interventions performed on every laboring woman who comes in the door – from IV fluids to being made to give birth in a certain position – are called “routine.”  Routine interventions communicate to a mother that her body is not sufficient for the job.  This increases her fear, which increases her pain and feelings of dependency on the medical model.  More importantly, routine interventions introduce risk and frequently disrupt the natural flow of labor so profoundly that a “cascade of interventions” ensues, further endangering mothers and babies.
3. Cesarian-Section Rates.  Before I had my own baby, I believed that if we had a c-section rate of 30% in America, it was because 30% of women and/or babies would die without it.  That made me afraid of birth.  But the World Health Organization has been studying c-sections as they affect maternal-fetal health for many years.  They determined and then recently reaffirmed that a c-section rate of 10-15% is optimal; c-section rates greater than 15% create adverse outcomes.  That is, more women and infants die in countries where there are section rates greater than 15%.  As noted above, that is true in the US, which is even scarier.
4. Hospitals.  A surprisingly under-appreciated fact of birth is that the same hormone that causes sexual arousal and orgasm, oxytocin, is the prime mover of birth.  So in Nature’s elegant economy, the same hormone that got you pregnant will deliver your baby.  The trouble is that oxytocin is highly influenced by the environment.  It likes a dim, warm, hushed environment that the woman controls and where she is free from observation; i.e. the opposite of what she experiences in a hospital.  Furthermore, fear (see previous points) negatively affects the release of this vital hormone, causing labor to slow or stop altogether.  This makes sense if you remember how most mammal mothers give birth in nature, where predation is a daily threat.  If she senses a threat, her labor needs to stop so that she can move to a safer location or until the predator has moved on.  A human mother’s logical brain, which tells her that the hospital is a safe place, is not actually in charge of birth.  A more primitive part of her brain is, and it doesn’t like the atmosphere of a hospital – the bright lights and the constant noise  – or its messages to her – the machines whisper that her body will break down; the masks and gowns suggest that her bodily fluids are dangerous; the strangers clinically touching her during this most intimate act of opening dehumanize her; the fact that they are treating her like she is sick undermine her trust in her body.
5. Media.  I’m referring both to entertainment and information media.  Film and television exploit the dramatic and comedic potential of birth.  It’s dramatic to have a doctor rush in and “save” a laboring woman.  It’s hilarious when a hapless father passes out when faced with the sight of a baby emerging from his wife’s vagina.  Folk tales would be nothing without dead mothers to force their children into the homes of wicked step-mothers or into the forest.  Even so-called reality television must create some drama for their viewers, so they focus on interventions and abnormalities, and find a way to leave the viewers in doubt about whether mom and baby will make it.  Most births happen in hospitals now, away from home, so this is the only window onto birth that most people see, and it isn’t real.  Information media also does not disabuse us of this misperception.  It trusts doctors implicitly.  Obstetricians are always consulted when birth is in the news; the news media therefore affirm their authority.  And how many times have you seen a headline like this one:  “Doctor delivers baby in airplane”?  Who is the star of that article?  The doctor who stood by while the mother’s body gave birth perfectly, or the mother?

These are just a few ways that fear is used to control women at precisely the time they are actually the most powerful!  Only when families – women and men – understand that birth is safe for the vast majority of low-risk mothers will they take their rightful place in the event:  no longer patients, but parents and empowered authorities.

Coming up:  Why You Can Trust Nature’s Design for Birth. 

Imagine!  How would it change how we perceive mothers and how mothers perceive themselves if every mother had a birth in which she felt empowered and honored?  How would it change the confidence with which we mother our children?  How would it change who we mothers are in the world?