Pregnancy and Birth
Ladies, please: less greedy, more breedy
8
In the news today we are treated to the kindly ‘advice’ of one well-meaning (male) OB, in which he encourages women to become “better at resolving the conflict” between career and family and have their children when they are biologically meant to, between age 20 and 35. Instead of picking apart everything that’s wrong with this advice, let’s turn it around and say what should have been printed but was (as always) completely ignored. [Note: The article's text has been partially copied and pasted with wording changed for satire. Italics indicate text I have added. Copyright of the original article remains with the author].
“The message that ages 20 to 35 are the best for a woman to have a child should be taught to all genders in schools and governments alongside education about the realities of and societal need to support teenage pregnancies and contraception parenthood, the leader of the UK’s maternity doctors has said.
Dr Tony Falconer, the president of the Royal College of Obstetricians and Gynaecologists (RCOG), warned against the pronounced trend towards older motherhood discouraging women from having children in their most fertile years by making it difficult for them to be mothers and work/go to school and said women and couples politicians and business leaders have to become “better at resolving the conflict” between their careers profits and family plans decency as human beings.
“It’s never our responsibility business[as doctors men] to tell people women when they should have their family, because there are all sorts of patriarchal constraints and societal pressures,” he told the Guardian in his first major interview since taking up the post in October.
But he added: “There’s no doubt that between 20 and 35 is the time to have your children. We are building up a difficulty for ourselves as a society by people’s expectations capitalism’s sexist limitations that they women will would be prudent to wait until they are older. That’s a very complex issue (and one few men in power care about), but it is a problem.”
His views on what he sees as the increasing problem of women waiting to have children society forcing women to choose between or compromise on matters of family and career could cause controversy.
But Falconer said there is strong evidence that women who leave starting a family until they are 35 industries that refuse to place any value on or make provisions for employees simultaneously undertaking pregnancy, birth, breastfeeding and parenting will have reduced fertility credibility and so find it harder to conceive hire and keep employees, even more so once they hit 40 men are required to more fully participate in childrearing.”
Now that, my friends, would actually be a radical concept in a progressive newspaper. Telling us we should have our babies earlier isn’t news, it’s recycled sexism with a big dollop of duh.
Birth rape: I’ll say it again
3
Writing about birth rape in March 2008 for feminist webzine The F-Word is what led me to birth advocacy and, eventually, becoming a birth doula. I am passionate about birth and making it a better, more empowering experience for all mothers, not just those who get ‘lucky’ and have straightforward labours or respectful attendants.
So it was with deep disappointment and even anger that I read piece after piece after piece arguing with, dismissing and even ridiculing the women who have chosen to use this term, some of the authors quoting my original story. In response, I have written another feature for The F-Word, which you can read here.
Luckily, at least one other feminist blogger agrees with me and has stood up for the victims of this heinous crime. I find it incredibly sad that so many others don’t.
The psychology of motherhood: nature or nurture?
3
As someone who firmly believes that many of the alleged psychological differences between the male and female sexes can be attributed to cultural reinforcement of popular myth, bad or ethically-questionable science and a healthy dose of plain ol’ sexism, it’s hardly surprising that I am instinctually repelled by claims that girls are ‘hard-wired’ to like pink things and be terrible drivers or that pregnant women and new mothers have diminished mental capacity and memory, otherwise known as ‘baby brain’.
On the other hand, as an advocate for mothers and someone who acknowledges and has experienced first-hand the powerful effect of hormonal changes on a woman’s mind and body, I do not deny that biology and its many processes may play a role in shaping who we are and how we live.
But just how much credence should we give to the idea that having children brings with it an overwhelming and inevitable shift in how we think? Is the psychology of motherhood subconsciously learned and culturally-ingrained or is it simply a case of biological design, wherein mothers are destined to expend more brain power on their offspring than on themselves or the world around them? Is ‘baby brain’ part of human evolution or a convenient theory to explain why women still undertake the psychological burden of parenthood, making them supposedly more naturally suited to be caretakers than professionals?
If you ask a group of mothers whether they felt less sharp or had bad memories while pregnant and within the first several months of each of their children’s lives, many will answer with a resounding ‘Yes!’ Anecdote after anecdote about forgetting a phone number known for decades or struggling to remember what that large rectangular thing in the kitchen that chills the perishable food is called soon follow. Mothers who work outside the home also sometimes report not being able to focus on their jobs because they are so busy thinking of and organising all the many things that need doing in relation to the household and children.
While I’m sure these things are true and that many women do indeed experience some element of memory loss in pregnancy and in the early years of parenting, I have to wonder if there isn’t another (series of) explanation(s) other than a decrease in mental acuity. After all, some women report not experiencing this phenomenon at all.
So is ‘baby brain’ just a stereotype perpetuated to remind women that their focus should be on their foetus or child, or an inescapable truism? Let’s look at the evidence.
First, there’s a question of whether our brains literally shrink during pregnancy. According to this news report and associated study (though a very small one, with only 9 participants), the late stage of pregnancy does seem to cause individual brain cells to decrease in volume, though not in quantity. One theory is that this may be because the body is busy pumping extra blood and other fluids around the body and to the foetus and the associated reproductive organs. Another study found that pregnancy “adversely affects ability to recall previously seen spatial locations” due to hormonal changes and concludes that pregnant women will likely have diminished capacity to perform certain cognitive tasks because of said changes.
However, this does not necessarily explain anecdotal reporting of memory loss or lack of focus. The authors of the above studies themselves conclude that their findings are speculative and the sample sizes were very small.
A much larger, more comprehensive study performed in Australia earlier this year concluded — after studying 1,241 women both before and after they had children (and comparing them to those who never had children at all) — that having a baby does not adversely affect memory or cognitive abilities. The head researcher said:
“Part of the problem is that pregnancy manuals tell women they are likely to experience memory and concentration problems — so women and their partners are primed to attribute any memory lapse to the ‘hard to miss’ physical sign of pregnancy.
Pregnant women may also shift their focus away from work issues to help them prepare for the birth of their new baby, while new mothers selectively attend to their baby.
But she said this shift should not be labelled a ‘cognitive deficit.’”
In the same article, a senior midwife notes that the physical and emotional stresses of pregnancy, coupled with lack of sleep and the shock of a major life change, are the more likely explanations for any reported memory lapses or concentration difficulties.
Moving on from pregnancy, we have also generally accepted the idea that women’s abilities for systematization and concentration decrease (even if only marginally) in the months and years after birth. Couple this with the oft-spouted stereotype that women are hard-wired for empathy and we go from the idea of a brain-addled new mummy as dubious myth to a widely accepted cultural norm, in the form of ‘Men Are From Mars, Women Are From Venus’, et al.
Dr. Cordelia Fine, a cognitive neuroscientist and author of “Delusions of Gender: How Our Minds, Society and Neurosexism Create Difference,” hits back at what she believes is the perpetuation of old sexism with new science. Dr. Fine attributes many of the studies’ stated outcomes to researchers using their own biases and belief in gender differences to influence not only the way the studies are conducted but how they are written. Knowing that the media do not generally dissect scientific studies at their core and instead take the best ‘plain English’ tidbits to create sensational headlines, some of these studies authors may be (wittingly or unwittingly) contributing to the idea that men’s and women’s differences can be explained by nature, not nurture.
In this New York Times review of Dr. Fine’s book, we see previous examples of biological differences used as rationale for all sorts of discrimination against women.
Experts used to attribute gender inequality to the “delicacy of the brain fibers” in women ; then to the smaller dimensions of the female brain (the “missing five ounces,” the Victorians called it); then to the ratio of skull length to skull breadth. In 1915 the neurologist Dr. Charles L. Dana wrote in this newspaper that because a woman’s upper spinal cord is smaller than a man’s it affects women’s “efficiency” in the evaluation of “political initiative or of judicial authority in a community’s organization” — and thus compromises their ability to vote.
Dr. Fine also examines the popular opinion that new mothers are ill-suited to return to work full-time and, if they do, how challenging they find it due to their hearts and minds remaining firmly in the home, even when they are at work. Her article in Neuroethics magazine, entitled “Will Working Mothers’ Brains Explode? The Popular New Genre of Neurosexism” is a must read for those interested in or concerned with the way women’s abilities are viewed upon returning to work after having a child.
So if we know that science is not always reliable and is, indeed, subject to societal influence, how do we know which studies to trust and which to throw out with the bathwater? When can we be sure that a woman self-reporting memory loss and a general feeling of being ‘a bit stupid’ is a neurological truth instead of an internalised stereotype?
The short answer is that we don’t and we can’t. If someone’s experience confirms previously-held views or theories, they will be hard-pressed to view it any other way. The longer answer is that we have to scrutinise these studies before accepting them as fact and learn to examine not only the source of the study and the possible motivations behind it, but what personal prejudices may influence the outcome. We must also question the use of anecdotes (even when they are numerous) that fly in the face of evidence-based research.
Having said that, I am not a proponent of telling other women how to rationalise their experiences or how to feel their feelings. If a woman thinks she’s hard-wired to look after her baby and to put the milk in the cupboard instead of the fridge when she is expecting, that is her truth and her prerogative. Likewise, I wouldn’t discount a woman who insisted she had zero cognitive dissipation and zero doubts about her abilities to perform her job or other duties just as well after she’s had children as she did before.
In my view, the prevailing idea of ‘baby brain’ is likely a combination of factors, some biological but mostly cultural. I’ll likely never know for sure if I’m right or not, as when it comes to nature versus nurture there are no cut-and-dried answers.
So what do you think? Or have you forgotten what we were talking about?
Risk vs. rights: the home birth debate
10On the BBC News website today, we learn that British medical journal The Lancet has published an article declaring home births “too risky” for infants and stating that, even though giving birth at home is associated with fewer risks for the mother (“shorter recovery time and fewer lacerations, post-partum haemorrhages, retained placentae and infections”) women should “not have the right to put their baby at risk.”
Well. Ain’t that sweet? It’s as if the women’s rights movement never happened! We are but pods, oh masterful overlords. Guide us in your infinite wisdom so that we may bear unto you the fruit of our wombs, and happily give of ourselves all that will never be granted us in return. Ommm.
But wait, hasn’t planned home birth been found to be just as safe as hospital birth for low-risk women? Yes. Yes it has. But that doesn’t matter because The Lancet has an explanation for those faulty data.
Data also frequently include misclassified cases, since studies usually look at newborn outcomes in relation to the actual rather than planned delivery location…Most studies also rely on different midwifery models for home delivery, which are not generalisable.”
Not generalisable? You mean like the different midwifery models and health care systems used (but not controlled for) in the AJOG study upon which The Lancet is basing its opinion? Comparing home birth in the UK (where trained midwives attend around 90% of births and where there is a free-at-the-point-of-use national health care system) with home birth in the US — where only 8% of births are attended by midwives (some of whom are not certified) and where affordable, accessible antenatal care is not always easy to come by — is like looking at apples and oranges and declaring them the same because they are round.
Putting aside the fact that the AJOG study conflates outcomes unique to significantly different countries with a cohesive, well-rounded, controlled study of planned home birth in nations under similar health care systems, there remains a big problem with any argument that gives ultimate authority to someone other than the mother: human rights. If you believe that all decisions about a competent person’s care should remain with the individual in question and that patients, no matter their ‘ailment’, have the right to take advice into consideration but ultimately reject it, without threat of censure if the desirable outcome does not materialise, then you can’t very well say that women, even those considered high risk, are ‘not allowed’ to opt for a home birth.
The reasons for this are two-fold: one, because the definition of ‘high risk’ is subjective and varies greatly from one trust, hospital and health care provider to another. Some women are told they are high risk because they are obese, or over 35, or because they had a previous caesarean section. Hell, my friend was told she was an unsuitable candidate for a home birth because there was limited parking nearby and her rug wasn’t washable! If parking spots and interior furnishings are enough to deny a woman her right to choose, what would become of those in more ‘sinister’ predicaments, like being old or fat? The concern is that maternity units will begin labelling otherwise healthy women as ‘high risk’ (even if they’re not) and refusing them home births due to their own staffing problems, convenience or biases. It already happens all the time (“If it’s a busy night you’ll have to come into hospital, dear”) so without an NHS-wide list of which conditions and situations would contraindicate a home birth, each woman desiring one would have to hope against hope that she was being correctly assessed by an objective, patient-centred, evidence-based, fully-staffed maternity service which, at the moment, the UK does not have.
Secondly, all of this is beside the point! Even if a woman was pretty unquestionably high-risk and would statistically be safer in hospital, it would be a violation of her autonomy, agency and, yes, her human rights, to be forcibly hospitalised for observation and interventions which she may not have consented to, ‘for the sake of the baby’. Take all of the arguments for being pro-choice and apply them here — until a baby is independent of its mother’s body, it is a woman’s choice what she does with it (and where and with whom).
The vast majority of births proceed normally (or would do if they weren’t interfered with) and need little medical assistance. Many births that would have been fine on their own are tinkered with, sped up or subject to impersonal, litigation-wary hospital policy, creating their own set of complications and crises. Some women, even if they don’t need or make use of the medical assistance, are comforted by having it on stand-by. That is how our current culture frames birth; Better safe than sorry! Just in case!
But some women feel much safer and at ease in their own environment, at home, and believe in their body’s ability to give birth. Punishing mothers for doing what is best for them on the minuscule off-chance of untreatable catastrophe for the baby is akin to berating a parent whose child choked to death on a piece of food while she was at work for leaving him with a trusted care provider who didn’t also happen to be a paediatric surgeon or emergency medical respondent.
Things happen. Tragedy happens. People die, including babies. It’s always horrible. It’s always sad. Sometimes it is preventable, sometimes it isn’t. And some people will never understand even considering taking that risk, no matter how small. I get that. It’s a visceral, emotional reaction to the cultural narrative we’ve become woven into; of harm reduction at all costs, of no child left behind and one loss being one too many.
But the thing is, there is ALWAYS a chance of complications, no matter which setting you choose. Women die in hospitals during or immediately after childbirth all the time, from haemorrhaging, fatal clots (often incurred after caesarean surgery) , infections (often acquired in hospital) or human error. In cases where a woman, or her baby, would have lived if they hadn’t been in hospital — if she hadn’t had the induction that led to the caesarean that led to the her fatal embolism or the baby’s respiratory failure — do we blame them? Do we ban hospital birth and say it’s risky? No. Because ALL birth carries some element of risk. Giving birth is giving life, and life comes with risk. Are we really so terrified of mortality, or so arrogant, as to think we can eliminate it completely?
Ensuring that pregnant women have all of the information and support they need to make the decision best for THEM (not some patronising attempt to strong-arm, scaremonger or strip them of their rights and give them to people who ‘know better’) — and then trusting and respecting that decision — is the only acceptable position on this, as far as I’m concerned.
And I am concerned. I’m very concerned about what this means for pregnant women’s rights. Are you?
What about the men? Allies, privilege and collaboration
3
There’s often a lot of talk within feminist discourse about involving men in creating change. At points, it does feel like we’ve done all we can to press for new laws, new attitudes and less cultural biases against women. So we surmise that, really, it’s men who need to be taking on more responsibility, creating their own brand of activism and making adjustments, not us. In many areas of women’s rights this is (somewhat) true. While men maintain the upper hand in all of the institutions that govern our lives, there’s only so much we can do before we get the rights we deserve. Ideally, we would have many men in our feminist revolution. If they don’t join or at least acknowledge our movement, it will continue to be more of an uphill struggle than a swift climb towards progress (short of violent protest and economic overthrow, of course, which I do admit to fantasising about on occasion after a run-in with a particularly virulent strain of misogynist or capitalist).
Why, then, does my visceral reaction to certain groups of men trying to get more involved seem to be: ‘Oh, sod off! What do you know about it? Stop making this all about you!’ I’ve noticed that this reaction happens a lot more when it comes to things that are and always will be the exclusive domain of women (pregnancy, birth and breastfeeding) than for things which have nothing to do with biology and everything to do with social conditioning, like gender roles.
For example, men who campaign for more involvement in their children’s gestations and births and demand more antenatal and maternity resources devoted to helping dads-to-be cope with becoming fathers. They want more attention paid to them at antenatal appointments, a bigger role at the birth and literature and support aimed at helping them help their partners succeed at breastfeeding. On paper and rationally, I know that men wanting to be more involved in these things is good, and fair. If it gives a father a greater sense of responsibility and attachment towards his child before it’s even born, I’m all for it. If it helps break down, in his mind, the cultural norm in our society that says babies are women’s business and men are only to provide for them financially and practically, all the better. However, I can’t help but bristle and feel a bit exasperated at the sense of self-importance and inflated vision of a father’s role in these areas that some men exhibit. Perhaps it’s because these issues, like abortion, are to do with our bodies, not theirs. It sometimes seems like just another way to assert control in an area where women should be holding the reins. It can bring to mind those who claim to care about equality but continually challenge the idea of female oppression by pointing to the substantially less common crimes or injustices against men (like male victims of female-perpetrated domestic violence and rape, or job discrimination), which can come across as just a way of saying, “Yes, yes, we know you’re oppressed, but you have been for ages and you’re used to it. But what about us?!”
Just like I can try to be an ally to people of colour and gay/queer/trans individuals, I cannot ever live their experience and know it’s not really my place to demand that greater (already precious and rare) resources be devoted to educating me and ensuring I don’t further screw things up for them. While acknowledgement from the majority/the oppressor is important in securing equality, so is the minority/oppressed’s need to feel safe in their own spaces and that they are creating change with their own voices and own grassroots empowerment; otherwise, ‘success’ will still feel like something that was done for or to that group to make the privileged feel good about themselves, not built on the movement’s own merit, for those most effected by it.
Fathers should be encouraged to ask that schools and medical professionals address them as well as mothers when it comes to their kids’ educations and health; that media outlets not portray them as helpless, bumbling idiots; to campaign for a longer and better paid paternity leave in the postnatal period; to require their employers to offer flexible working hours and situations so they can take an active and equal role in their children’s care; and to raise their boys without macho expectations and their girls without some preconceived idea of femininity. Additionally, all men who want to be feminist allies should be actively speaking out against domestic and sexual violence, the insidious nature of the sex trade, the gender pay gap, the objectification and sexualisation of girls and women and gender stereotypes that constrict both sexes, amongst others.
But when it comes to our bodies and what we do with them, especially reproductively, the utmost sensitivity and restraint should be exercised. Even if the aim is not to control but help and learn, remember that we have been fighting for the right to absolute authority over our bodies and childbearing decisions for centuries and have, in most areas, still have not been granted full autonomy in this regard. Our trust will not come easily. Our need for support from our partners but ultimate command of ourselves means, for many men, relinquishing the role of decision-maker or complete equal. Men may have to take a back seat at times and they should become comfortable with that, not feel threatened or marginalised by it.
Sometimes, it really is all about us.
Selling out on the postnatal ward
14
They say there are only two certainties in life: death and taxes. But in the 21st century there’s a third eventuality we cannot escape — advertising.
There’s been a bit of a fuss kicked up in the papers lately about the infamous ‘Bounty ladies’ and how these representatives are allowed to roam maternity wards up and down the country, handing out the free ‘goody bags’ that have become ubiquitous with having a baby in the UK. In addition to the goody bags, some of the Bounty reps also pester new parents to agree to and then purchase photographs of their new arrival, often before the baby has even had its first breastfeed or before the new mother’s stitches have set. They are also asked for their contact details, which are (surprise surprise!) sold onto third parties and used to market additional products, sent directly to the parents’ homes.
The pack contains a few inoffensive and even useful things, certainly — Child Benefit and Child Trust Fund forms, perhaps a ‘guide to your newborn’ or other inane pamphlet — but the rest of it is purely an exercise in corporate PR. It generally features samples of a particular brand of nappies, wipes, nappy rash cream, breast pads, toiletries and laundry tablets, with accompanying coupons and promotional materials. I’m sure that if it weren’t prevented by various ethics and health codes, a carton of formula would be in there, too. To some, it’s less Helpful Items To Get You Started and more Parenthood: What a Cash Cow! The fact the hospitals get £1 per bag handed out, amounting to a tidy profit for them, as well as Bounty, is just the icing on the capitalism cake.
My dislike of blatant marketing aside, this isn’t what disturbs me the most. Many of the mothers who called into Vanessa Feltz’s BBC London radio show on Friday morning to discuss it said that they’d thought the Bounty rep was some kind of hospital aide or auxiliary person and so didn’t feel they could say no, especially to the personal information. This is not to mention the fact that many of the callers said they’d just had cesarean sections and so were pretty drugged up on pain medication and not sure what was going on or who all of the people coming in and out of their rooms were. Even those who’d had vaginal births were, as is to be expected, extremely exhausted and overwhelmed. Women in the immediate postnatal period should not be having to think about whether they want to give their personal details to a spammer, or if they want to pay £10 (or however much it is) to have a single photograph taken of their newborn.
I remember when I had my first child in a birth centre attached to a hospital, the Bounty rep coming and giving me my free pack and asking for my details, all whilst I was attempting to change my daughter’s first Oh My God This Stuff Is Like Tar nappy and before my husband had arrived from his overnight sleep at home. I was in pain, hadn’t slept in two days and was being ignored by the overworked and understaffed midwives, who rarely came when I pressed the buzzer for assistance. I was in absolutely no state to realise she was trying to sell me things, nor did I have the energy to tell her to sod off. Thankfully, I declined the overpriced newborn photo but I was not pleased to begin to receive a mountain of junk mail a few weeks later. I didn’t make the connection between that and the details I’d given the Bounty rep until months later. I was angry that I’d been approached by someone peddling their wares under the guise of concern for new mums and that this lady had been able to wander round the maternity ward as she pleased, going into people’s rooms without being invited in, when my own husband had been kicked out the previous night when ‘visiting hours’ were over, as if he just come to be a spectator at the birth of his child and that was his bit done.
Looking back, that night I spent alone in my room — with a brand new baby in a bassinet next to me that I had to learn to hold and care for and breastfeed, so physically exhausted that I couldn’t lift my arms to wash my hair and with less than two hours’ sleep in 48 hours — was the loneliest, most terrifying and draining of my life, and that’s the night AFTER I gave birth! That my husband wasn’t ‘allowed’ to stay with me was so infuriating. He’d helped make this baby and now he got to go home and get some sleep while I, the one who pushed our 9-lb. daughter out of my body after carrying her for 9 months was supposed to just suck it up and look after her on my own?! It just seemed (and still seems) so cruel. According to this Times article, 70 per cent of parents think a father should be able to stay with his partner after the birth.
Having said that, I understand that with most women being put on wards after they’ve given birth, and not private rooms, this plays a big part in the decision not to allow fathers to stay overnight. The NHS worries about the safety and privacy concerns of other women on the ward, who may be wary of strange men passing by while they’re attempting to breastfeed for the first few times or get out of bed while wearing a flimsy hospital gown. There’s also the cost and practicality issue — the NHS is so stretched as it is, they worry that having to accommodate overnight visitors for each woman in the maternity unit would mean overcrowding, more money spent on reclining chairs or extra beds and possible conflicts over use of the already-oversubscribed toilet and kitchen facilities. I’ve heard many midwives, like this one, say that having fathers stay overnight would be a nightmare. So whilst I understand the reasons against it, I stand firm in my belief that it is not only unfair and cruel to the new mother, but that it sends a very strong message to the new dads that their role is really not all that important and that the mother is chiefly responsible for the baby, with him around as some kind of ‘happy helper’. While only women can give birth and breastfeed, there is no reason that a father couldn’t hold, rock, comfort, bathe and change his baby’s nappies in that first day or two, letting the mother get some well-deserved rest.
That’s why I think, really, that most women are better off at home. Not being left alone and separated from your partner at such a monumentally life-changing and emotionally volatile time seems like common sense to me. Unfortunately, not that many people want or are able to birth at home and the current system and attitudes towards home birth aren’t likely to change any time soon.
One possible solution (aside from the perhaps more unrealistic demand, due to space and finances, that all women have private rooms after birth) is to follow the Dutch model of postnatal care, called Kraamzorg. Under this system, all women who have had relatively uncomplicated births (i.e. not an instrumental or surgical delivery or other medical complications) are discharged within hours and sent home, where a maternity nurse meets them almost straight away. There, in the comfort of their own homes, women are given one-to-one postnatal care which includes checking on the health of mother and baby, breastfeeding advice, preparation of lunch and snacks, light housekeeping, emotional support and practical help with the shopping and visitors, and just allowing the family time to bond with and get to know one another.
We have this here, in the form of a postnatal doula, but it is a service that is not widely known and, because it is done privately, rather costly as well. It is a role that used to be played by a woman’s own mother, or other close family member, but which has become increasingly more rare due to changed family dynamics, work commitments and the logistical difficulties of distance and time that many families face.
Funnily enough, this is something that David Cameron suggested back in 2008 as part of a Conservative reform of maternity services and is probably one of the few areas in which I agree with him. The cost of implementing this system, while perhaps great at first, would be an absolute bargain in the long and even medium-term, as beds are freed up for labouring women or those who had complicated deliveries and with midwives free to concentrate more on those women than the ones who just need a bit of help with breastfeeding or need assistance going to the toilet but are often deprioritised on a busy ward. Breastfeeding rates flourish and postnatal depression rates decrease when one-to-one support is on hand in the first week or two after birth, showing how vital this kind of support in the period immediately after birth is. Until all fathers are taking the the paternity leave they are entitled to (which we know from previous discussions will only likely happen very slowly and with more legislation), an alternative solution and support system for new mothers is desperately needed.
What are your thoughts on better handling the postnatal experience for women? Do you think fathers should be allowed to stay overnight or would you rather they not be there? Are private rooms for all a realistic solution? What do you make of the Kraamzorg system, would you have benefited from and welcomed something like that?
Reclaiming Birth
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I wrote a guest post over at The F-Word last week, getting the word out about a march and rally called Reclaiming Birth, which took place today. The aims of the march and of the participating organisations can be read in this handout. In summary, they are:
- Ask the health service to provide more midwives so that every woman is supported throughout her labour and never left alone
- Provide access to at least one stand-alone birth centre in every local area
- Disseminate good information on and the option to choose home birth, birth in a midwife-led unit or birth in an obstetric unit in every area
- Maintain at least one case-loading midwifery group, free at the point of use, for every area
- Launch an inquiry into maternity care at King’s College Hospital Foundation Trust, London, which recently terminated its contract with the Albany Midwives Practice
Here are some photos from the event.
I was really impressed with the number of people there, including quite a lot of men and many, many children. One little girl, no more than 7 or 8, was leading chants and blowing a whistle while shouting “Choices! Choices!” and “We need midwives!” There were grandfathers, great-grandmothers, teenage boys with shirts reading “Born at home,” mothers of all different ethnic backgrounds…it was really fantastic. I felt inspired, empowered, invigorated and part of a community and a movement that really cares about women and their families.
If you want to help Reclaim Birth, please write to your MP, the Secretary of State for Health and to the Maternity Services Liaison Committee at your local obstetric unit. You can email letters directly through the NCT website. Please take a few minutes to send a couple emails, and then pass it onto others who care about birth and ask them to do the same. This is our chance to demand real change to the maternity services, providing women with the choices, continuity of care and positive birth experiences that every one of us deserves. Let’s make our voices heard!
A new kind of war story: PTSD in childbirth
11The following is a guest post from one of the most influential bloggers in my life. When I found her site I was just starting to get really interested in and writing about the intersection of mothering and feminism and the veritable minefield of hot-button issues out there. Among the nearest and dearest to me is birth advocacy. I’d written about birth issues before but Jill at The Unnecesarean helped inspire me to take that advocacy to the next level — activism. She is a fiercely feminist protector of women’s bodily rights, their choices and their lives. In short, she kicks ass. I am honoured to share her words on my site.
____________________________________________________
Via Lauredhel of FWD/Forward, who included the following warning:
WARNING: story of obstetric assault and PTSD symptoms. More accurately labelled “obstetric trauma”, not “birth trauma”.
In the article, How childbirth caused my PTSD, which appeared on Salon.com, Taffy Brodesser-Akner writes of being violated against her consent by a doctor while on Pitocin and Stadol.
The delivery of my son didn’t start with a rush of water, or cramps that left me hunched. It was a decision, an edict, and with it, the drip Pitocin, a drug that induces contractions. The contractions came big and loud, almost immediately at one minute apart. My cervix wouldn’t dilate, though. I was eventually given the narcotic Stadol, which caused me to hallucinate through a very long night. Twenty-four hours later, clear-headed but still not dilated, I told my doctor I didn’t believe the induction was working, that I wanted to discuss other options. But before I knew it, he began painfully separating the membrane guarding my bag of waters.
“He isn’t examining me,” I yelled at my husband. “He’s doing something.”
In a hushed tone, the doctor asked the nurse for the hook, a mechanism that breaks your water.
“Why did you do that?” I asked when it was done. “I thought we were going to talk about it!”
His voice was cold, flat. “You’re not going anywhere,” he said.
She discusses how the diagnosis of PPD she received a week after birth didn’t fit, as she “felt that [she] was stuck in fight-or-flight,” then received a PTSD diagnosis that seemed to fit her symptoms. When she searched the Internet for information, she didn’t find a warm reception.
Just around the time I was figuring this all out, the Wall Street Journal published an article discussing postpartum PTSD. It referenced a now-famous study by Harris Interactive for Childbirth Connection, in which 9 percent of postpartum women screened met criteria for a diagnosis of PTSD, according to the mental-health diagnostician’s Bible, the DSM-IV.
Not surprisingly, it elicited a giant eye-roll from bloggers. “Something about applying the term PTSD to childbirth irks me,” said Hannah Tennant-Moore, a blogger for Babble’s Strollerderby. “PTSD is most commonly associated with war veterans and victims of extreme violence; applying it to new mothers makes maternity seem like a pathology.”
Over on Jezebel Jessica Grose sneered, “Have we become so precious and hyper-conscious that something women have been doing for time immemorial is now ranked alongside war as a painful event?” She went on to say: “Certainly having a bowling ball of a baby shooting out your vag isn’t a picnic for anyone, but the hysteria surrounding something so matter-of-fact is troubling.”
The article goes on to quote a pediatrician from the University of Chicago claiming that “[f]ifty years ago, women were anesthetized for childbirth” and are now awake to experience what he calls “misadventure[s] in the delivery room.”
The pediatrician follows the cultural script of pinning the trauma on this trend of women being awake to witness the rare events in which “the mother’s life [is] at risk or the baby’s.” He stated that having a baby is opting into a normative experience and that it is difficult to find people to turn to when you’re one of “the other 2 percent” who do not have uncomplicated births, and “[w]hen you find it’s totally different from what you were told it would be, it’s traumatic.”
Rupturing membranes without consent while a woman’s body is being slammed with pharmaceutically induced contractions is not a mere “misadventure” of childbirth itself. This is a violation of patient rights, autonomy and human decency. It’s the act of a doctor who clearly would have preferred for his patient to be anesthetized as in pediatrician’s scenario of days past so that whole annoying “informed consent” thing wouldn’t get in his way. The obstetricians that the author consulted about her birth raised questions about the necessity of the induction in the first place.
Slapping women in the face with the unrealistic expectation line serves only those wishing to perpetuate the status quo and blame women for creating their own PTSD. While is it true that the rareness of death in childbirth contributes to a “couldn’t ever happen to me” factor that is exacerbated by the unrealistic “I can control this from ever happening to you” or “you or your baby will die right now/tomorrow/next week/next month unless you do everything say” sales pitches from care providers, the time has come for women discussing the trauma associated not with childbirth but with coercive over-management of childbirth to not be thrown into some sexist, ableist Cassandra metaphor.
Akner no longer feels like “the only person who survived a normal life cycle event damaged and ruined” thanks to the community that she has found, a community that will probably continue to increase in numbers concomitantly with the increase in the number of unnecessary inductions and cesareans.
Blog For Choice: Trust Women
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Blog For Choice Day 2010
Each year, NARAL Pro-Choice America poses a question to pro-choice bloggers before the anniversary of Roe v. Wade, and then asks them to blog their answer on January 22.
Blog for Choice Day provides us with an opportunity to raise the profile of reproductive rights in the blogosphere, all the while celebrating Roe’s 37th anniversary. Plus, it’s a great way to let your readers and the mainstream media know that a woman’s right to choose is a core progressive value that must be protected and advanced.
Last year more than 500 people participated in this effort. We hope you will join us this year!
If you don’t have a blog, you can still participate! You can post your response in a Note on Facebook, or tweet your response on Twitter and use the hashtag #bfcd.
This year’s topic
In honor of Dr. George Tiller, who often wore a button that simply read, “Trust Women,” this year’s Blog for Choice question is:
What does Trust Women mean to you?
I don’t know about you but I’m loving this year’s topic. To me, trusting women is the crux of the abortion issue and all of women’s reproductive rights, really. Because if we can’t trust women to make their own decisions about their own bodies and lives, what in the world is the government and our society doing even pretending that they consider women fully sentient human beings who should be afforded the same rights as men?
Regardless of what some people might think, the decision to keep or terminate a pregnancy is not an easy one. Sometimes a baby is wanted but not feasible and sometimes it’s the other way around. There are as many different reasons for choosing to carry a pregnancy to term as there are for deciding not to. Not all of them are selfless. Not all of them are selfish. But really, it shouldn’t matter why a woman exerts her choice to reproduce or not – all that matters is that the choice exists.
Trusting women to make the best choices for themselves, their health and their families extends not only to abortion, though, but to all aspects of their reproductive processes. Informed consent and real choice in childbirth is also being threatened with alarming regularity. The technologies invented and the methods adopted in the last several decades in an effort to improve outcomes and maternal satisfaction with the birth experience has swung from the useful, life-saving end of the pendulum towards the other side, where maternal and infant mortality rates actually rise instead of fall with excessive interventions and unnecessary surgeries performed, leaving scores of health-impaired babies and traumatised or dissatisfied mothers in its wake.
Trusting women means trusting them to know whether they’d like to or are able to become mothers, and when, and how many times. It means keeping public scrutiny and laws and judgment off their pregnant bodies. It means providing them with the tools, knowledge and support to make their own decisions in childbirth and allowing their instincts to flourish and guide them, with confidence. It means accepting that sometimes people will make choices that we wouldn’t make ourselves and trusting that they were the right ones for them at that time.
What does Trust Women mean to you?
The public policing of pregnancy
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Any pregnant woman who has ever ordered a glass of wine with her dinner, asked for a regular (non-decaf) coffee, or nibbled on a piece of brie from the cheese plate will know what it feels like to be watched, monitored and judged. Many women have told me stories of barmen asking if they’re sure they don’t want him to add some soda water to that pinot grigio, or a barista saying “You mean decaf, right?” with her eyebrow arched. Some women have even been refused service or kicked out of establishments for drinking a pint of beer or attempting to buy a block of cheese.
I know that one of my biggest pet peeves when I was pregnant with my first child was the assumption that I was completely helpless, vulnerable and unable to make decisions based on calculated risk by myself. While I acknowledge that heavily pregnant women are at a physical disadvantage in certain situations and do indeed have a decreased sense of balance, a harder time standing for long periods of time and shouldn’t be lifting a load of bricks or anything, it got ridiculous at some stages. I had people rushing forward to pry a door out of my hands and open it for me, or insist on carrying my one bag of shopping, which consisted mainly of a tub of ice cream and extra-soft toilet tissue. And on the occasions when I was only going to be on the Underground or bus for a stop or two and so politely declined the seat offered me, I would get annoyed, even hostile reactions. I had one lady absolutely INSIST I take her seat, even though by the time we had this conversation, she got her things out of the area and I heaved myself into it, I had arrived at my stop and had to extract myself from the tangle of bags and limbs to get back to the doors again. The patronisation from some quarters was palpable.
Don’t get me wrong; I always appreciated the offer and more often than not, took them up on it, grateful for the protection from being smashed and elbowed in the stomach during the rush hour commute. But as my bump grew and I got closer and closer to my due date, I got not only looks of sympathy but ones of distaste. I remember one man grumbling under his breath when I waddled onto the train carriage one morning: “Jesus, is she going to give birth here too?” and rolling his eyes. It was astonishing, and obvious that some people felt that I should be confined to my home, a la the Victorians.
Funnily enough, that concern seemed much less prevalent when I was pregnant with my second child and had my daughter in tow with me. There were many times when I genuinely could have used some help while trying to get my pushchair, shopping and massive belly out of a narrow shop while holding the heavy door open and had completely able-bodied and pushchair-less people wait patiently, not offering any help, while I struggled and heaved and got flustered. It was as if the fact I was already a mother meant I didn’t need any help or consideration at all. Kind of like “Well, you knew what you were getting yourself into this time…”
I know it’s hard for people (especially those who have never been pregnant themselves) to know what to do and that each woman is different in what kind of help she’d like or need, but I think it’s safe to say that offering = good, insisting or completely ignoring = bad.
Of course, none of this compares with what Samantha Burton went through. Burton, who was 25 weeks pregnant and had two older children, was hospitalised against her will in Florida last March when she questioned her doctor’s order for complete bed rest after he suspected an impending miscarriage. Burton, who simply asked for a second opinion, was then forcibly hospitalised and forced to submit to “any and all medical treatments” the doctors felt necessary to ensure the safety of her foetus, even though a) there is no clinical evidence to support the commonly-held belief that bed rest improves outcomes for miscarriages; b) she had two other children to care for and so bed rest wasn’t feasible; and c) IT’S HER BODY AND THEREFORE HER DECISION. For three days she was held captive until undergoing a forced cesarean section that revealed her foetus had died anyway.
Thankfully, the American Civil Liberties Union (ACLU) has taken up the case and will be following it and keeping us updated as it goes through the Florida Court of Appeals since it (amazingly) lost in the original trial, Burton v. Florida. So far, the state of Florida has (appallingly but not surprisingly, in a state with a nearly 40% cesarean section rate) defended its actions as simply “maintaining the status quo.” Sadly, the status quo in America (and increasingly in other places as well) seems to be about treating pregnant women as incubators and their rights secondary to that of the foetus residing in and dependent on their bodies.
Making sure that we are afforded the same rights to make decisions regarding our health, safety and care as anyone else (even if an onlooker or doctor doesn’t approve) is absolutely imperative in ensuring we have full human rights, let alone “women’s rights.” And part of exerting that autonomy is by being able to eat cheese, drink caffeine, have a beer or carry our own shopping, Pregnancy Police be damned.