Revised Expectations, or, The Politics of Birth

I've been reading a few books about natural childbirth. Most of them are pretty practical but there is one called "Spiritual Midwifery" by Ina May Gaskin that reads as if you're on an LSD trip. It was originally written in the seventies and it contains a lot of stories written by women who birthed on a commune in Tennessee attended by midwives.

Here is one of my favorite quotes. I think it captures the tone of the book:

"If all your life you never do anything heavy, there's certain passages in life that are heavy. Having a baby, for instance, is one. If you be a total paddy-ass all your life, they're going to have to knock you out when you have your kid, because you're going to be too chicken to have it. And if you do something that builds character ahead of time, you'll have enough character that you can have that kid, and it will be a beautiful and spiritual experience for you."

So the above quote is actually from a man, which gets my hackles up a little bit, because hey buddy, you've never had a kid so maybe you should keep your mouth shut about what it takes, and what it's like. But looking beyond that, I like the quote. First of all, who can resist a description of childbirth as "heavy"? Secondly, it resonates with me because every time I've had to do something hard, I mean really hard, I've drawn on the strength I've gained from previous hard experiences. I've been able to do things that I didn't think I could do ahead of time, and it turns out, I'm stronger than I think. As a semi-recent example, I never thought I'd be able to jab a 1.5-inch dart-sized needle into my hip every night for 9 weeks. Turns out I could, and did.

All along I thought that the heavy thing I'd have to face would be the pain and the uncertainty that comes along with natural childbirth. But now I'm beginning to realize I might be wrong about that. The real thing I might have to face could be something totally different. I think what I'm facing here is the dilemma of being trapped in a medical model that doesn't mesh very well with a humanizing approach to birth.

When we found out we were having twins, I had to change a lot of my expectations. I could no longer have a midwife, and instead had to find an OB. I could no longer expect to deliver in the local birthing center, and instead had to prepare for delivery in the local hospital. Those are unavoidable constraints when you are pregnant with twins in this town. I also knew that I would have to labor with two monitors on my belly, and an IV line ready to go in case I needed an IV at a moment's notice. I found an OB who is pretty laid back and reasonable, and she let me know about those non-negotiables in the beginning so I could prepare myself for them. She's also okay with me having a doula, she doesn't do routine episiotomies, and she doesn't have any intention of inducing me if I go past an arbitrary deadline (not likely with twins, but it's still an attitude I appreciate). So I think my OB is pretty cool, generally, but today we had a discussion that I'm struggling to process.

I was surprised when she explained that in cases with twins, she and her partners all strongly encourage an epidural and tend to push for that during labor. They believe an epidural is necessary with twins because of the amount of manipulation that is often necessary to get the second twin out quickly. I took a stab at what she meant by manipulation: reaching way the hell up inside of me to yank out that second baby? She said "yes, this is really common, and women just can't endure that without an epidural. They just can't." She then let me know that even though our local hospital has these nice birthing suites where people deliver, I won't be able to deliver there. I will have to deliver in the "c-section room", i.e. the operating room down the hall. This is hospital policy for all twin births. This is your typical freezing cold, stainless steel, bright lights type of room. My OB did say that maybe we could wheel the birthing bed into the operating room so that I could try to birth in a better position than flat on my back with my feet up in stirrups on a cold, narrow table. Oh, and it gets kind of crowded if too many people are in there, so I might not be able to have anybody besides my husband with me.

I've read all of the literature on how epidurals increase the chances for a longer labor, forceps or vacuum delivery, tearing, episiotomies, c-sections, and some minor negative consequences for babies. Beyond that, though, I had some personal reasons for wanting to avoid an epidural.

How possible is that going to be when the doctor in charge, the person with the power in our relationship, is strongly pushing me to get the epidural? Even during today's discussion I felt a hint of judgment in terms of what it takes to be a good mother. If I am a good mother who cares for her babies' health and positive outcomes, I will choose an epidural. If we need an emergency c-section and I don't have an epidural in place, I might have to get a general and this is bad for my health and bad for the babies' health. So basically, the message is that if I am willing to place my babies' health above my own selfish desires to have a natural birth, I will choose an epidural.

Hard to fight against that message. Nobody wants to be a bad, selfish mother before her children are even born.

This kind of thing is what I mean when I refer to the politics of birth. Birthing is something that only women do. Women have done it well throughout history, even birthing breech babies, even birthing twins. Birth is no longer under the control of the people who do it, though. The (male) medical establishment has taken over birth and dictates how it should occur. Women who give birth in U.S. hospitals with OBs generally have little control over how it happens. Even the choice to either have an epidural or refuse an epidural is not a free and open choice when one considers the power relationships in place when doctors and nurses encourage laboring mothers to consider epidurals, and when one considers the culture that surrounds the mystique of birth, shaping women's expectations of what it is supposed to be like. How many movies or tv shows have you seen in which birth is a calm, positive, natural, mother-guided event? How many movies or tv shows have you seen in which labor is portrayed as something agonizing, in which women routinely lose control, in which doctors must swoop in to provide relief / save the baby?

The idea that women are strong and capable is missing from our current rhetoric surrounding birth.

The interventions that doctors use don't come from nowhere. I know that my own OB is concerned with protecting my babies' health and my own health, and I know that her motivations for doing certain things stem from that concern primarily. But I have also read a lot of controlled studies, and I know that not all of these interventions are uniformly positive in all cases. The U.S. has the highest c-section rate in the world, at 30% now. We also have the second-highest newborn mortality rate among the developed nations, according to a June 2007 study by the World Health Organization. (The highest newborn mortality rate occurs in Latvia). My motivations for wanting to avoid the Pitocin / epidural / c-section snowball are not solely grounded in some selfish desire to experience a particular type of birth. They are also grounded in my knowledge about what types of births are best in terms of newborn health outcomes.

The thing is, I know I'm talking out my ass because I haven't done it yet. I can only read the stories and listen to the stories of the many women I've known who did labor naturally. I have no idea what it would be like for me, and how I would handle it. I just feel frustrated and disappointed today because I can feel the chance of finding that out slipping away.

From Hathor the Cowgoddess: