I’m trying to unravel my complicated responses to the article that came out in the Guardian last week about the Freebirth Society. Of course, the article has snowballed and it seems everyone I talk to now is indignant and shocked about the phenomenon of “freebirth” that the articles seek to condemn.

Let’s try to have a look at this Gordian knot of issues, and try to understand what exactly is happening.

Essentially, this phenomenon, specifically the Freebirth Society, is a product of a perfect storm that was created by a few very different variables. Obstetric violence is a reality. Although women are subjected to violence during birth all over the world, the affluence we enjoy in our part of the world gives us extra time to contemplate on what birth would look like if there wasn’t pervasive infantilization, abuse, or even just downright rudeness to contend with while we are producing a new human. Finally, add in the social media, where opinions and indignation can spread like wildfire, and you have fertile ground for a movement such as this.

One of the difficulties with this article and its offshoots, is that the authors confuse the Freebirth Society with the tiny but growing movement of women who are trying to find a way to give birth that doesn’t include routine unnecessary (and dangerous) interventions (see this article in the New York Times), that also doesn’t put themselves or their babies at risk. But let’s make no mistake: both the FBS and the community of women who are trying to find a more moderate path are reacting to a real problem in the real world.

What is the problem? Our c-section rates are too high (at least double the recommendations by the WHO). Our epidural rates are close to 100% for first time mothers. In the US, maternal/infant mortality rates are abysmal, especially for women of color (across economic lines) which indicates that perhaps modern obstetrics is not serving us well. And the fact is that thousands of women go to their doctor’s appointment and get ignored, or have their first baby and get manhandled, or have a c-section for a fatuous reason, and these women want something better.

Manhandled? I’ve heard doctors speak sexually to birthing women. I’ve seen hundreds of procedures done to birthing women with no consent asked or given. I’ve seen hundreds of vaginal exams done without consent and for absolutely no reason, it seems, except to shame the woman that her body isn’t working properly.

Fatuous reasons? “Your baby is too big” (then it’s a seven pounder). “You’ve been seven centimeters for two hours”. “Our software shows a high risk of shoulder dystocia.” “I’m leaving for vacation next Tuesday so come in on Friday to have your baby”.

Here’s the problem, though. Shit can and does happen. It isn’t always groovy to have your friends and some nice music. That’s why humans have always had midwives: women, usually older, who have witnessed many births and can tell when something is going sideways and can know what to do or when to get assistance. Unfortunately, the women who are turning from modern interventive obstetrics are also turning from midwives who, they claim, are just handmaidens to the obstetric machine. This is becoming more common, as the younger generation of midwives graduating from medical schools are trained with the same eye to risks and precautions that the young physicians are, and they graduate looking more like their physician colleagues than midwives from even a generation ago.

The percentage of women giving birth outside the hospital (this includes those who have a registered midwife in attendance) in Canada is less than 3%.1 We don’t know how many of this population are choosing to give birth outside the medical system with no registered medical professional in attendance, but let’s give it a generous number of 1%. Internationally, that number seems to hover between .5% and 2.5%, but these also include women who didn’t plan to give birth outside the system (for example, those who birth precipitously).

So why are we making such a fuss about such a tiny portion of women? I believe the same three variables I mentioned above are at work seeding and maintaining our outrage, with another important one added in to create a perfect storm in a teacup. Obstetric violence is real. It is true that obstetrics is one medical field where informed consent is often lacking; where unnecessary drugs and procedures are common; where the medical staff are usually not interacting with someone who is ill. In a way, it’s easier and more sexy to write an article about a small portion of women who are doing something really dramatic about a problem that everyone knows is endemic and isn’t going away very soon. Our affluence and ridiculous amount of leisure time make us more vulnerable to such sensationalist articles, and we need to be enraged about something, so why not get all het up about some independent-minded women?

And, of course, the social media make it easy for everyone: the FBS were champions at identifying who wanted to hear their stories, and making them accessible. And who wanted to hear their stories? Those women who were seeking a different way to give birth: one that didn’t include “being talked down to”, “too many vaginal exams, by several people at a time”, threats that the “baby will die”, overeager active management of the third stage resulting in dramatic PPH… the list goes on.

And the journalists, on the other hand, witnessed the train wreck that was the dissolution of the FBS social media empire, and rushed in to “investigate”. I am critical about how the article was written, and of some of the “facts” presented. First, I don’t believe that the absolute devastation of losing a child or having a child born with severe developmental delays should be described in detail in an article. Simple as that. In my opinion, that kind of sensationalism does no good and can only do harm. How? It doesn’t accurately tease out the physiologic facts from the drama. Yes, 17 minutes of shoulder dystocia is unthinkable (who was counting?). But do we really need thousands of people convinced that birth is an absolutely terrifying and dangerous event? Or do we want to focus on the matters at hand? Further, the statistic produced at the end of the first article may be true, but it isn’t backed up with evidence. And it uses the same dramatic anecdotal “facts” that the FBS does to convince people of the truth.

There’s one more piece to the puzzle, however. Look at the title of this article! “Influencers made millions pushing ‘wild’ births – now the Free Birth Society is linked to baby deaths around the world.”

We don’t actually know if giving birth without a medical professional in attendance is safer or more dangerous than giving birth with a doctor or midwife present. The data has not been gathered, and all we have at this point is polemics. We all have our opinions: I have mine, you have yours, and your neighbourhood OBGYN has theirs. But until we can actually look at the data and draw our conclusions, we are left with stories. For some, the most shocking part of the story is that the state of maternity care in our affluent society is pushing women to make possibly risky decisions. For others, it is that babies are being born either still or severely compromised, and our hearts are breaking. For some, the shocking part of it is that women are continuing to be maltreated in hospitals and birthing centres, and then demonized for making unpopular choices. And for some, and it seems the journalists are playing to this crowd, it’s that a woman who was passionate about her belief that women should give birth in a joyous manner, used her talents as an influencer and an organizer to “make millions”.

There are bigger problems in the world, to be sure. But we all get born, and I have worked in this field for almost all of my adult life. Here are my three suggestions:

First, that we pull our heads out of the sand and look at the real state of obstetrics here in Canada, and ask the question: is it really serving young families?

Secondly, that we gather actual data on out-of-system births so that we have facts instead of emotions upon which to base our opinions (and policies!).

And, third, that we recognize that the phenomenon of women choosing to birth outside the system is here to stay. How can we best serve these women? By alienating and demonizing them? Or by asking them what they want, what they need, and how (if at all) we can help?

1

https://www150.statcan.gc.ca/n1/daily-quotidien/220928/dq220928d-eng.htm

Cesarean Awareness Month

It's funny they would have a month for a surgical operation. I have the same feeling about Black History Month. Like, if it's important, shouldn't we learn about black history every day we learn about history? Like, shouldn't the history books be rewritten? They're certainly biased....

I digress. Let's deconstruct history another way:

Pithiviers, France, is remembered by some French Jews as the place where their relatives or friends of the family were sent after the Nazis occupied France. There was an internment camp there where families were separated and the adults were sent to Auschwitz to be killed.

We also remember Pithiviers as the place where Michel Odent was head of the maternity ward from 1962 to 1985. Here, he fashioned his notions of natural birth, by creating an environment where women could give birth in an undisturbed way. He provided singing sessions during the prenatal period, birthing pools, and skin-to-skin contact after birth.

Years ago, I was part of a group of birth workers who brought Dr Odent to Montreal to speak. I remember being so shocked when he suggested that there was a causal relationship between the murder and violent crimes rates in some cities in the world, and the cesarean rates. Effectively, he was suggesting that if you have your baby by cesarean, then they are more likely to become a violent criminal. I immediately took a dislike to him and his silly ideas, and, more importantly, I asked myself why there was a whole room of healthy, young women absolutely worshipping his words? There he was, a shrunken old white guy, talking about how babies needed to go through the vagina and arrogantly proclaiming that women who have cesareans are going down the path to hell, and dragging their newborns along with them.

Fast forward a few years and I was up on the stage. We were doing a little panel about VBACs. A woman stood up from the audience and said that she was newly pregnant with her second, hoping for a vaginal birth after a brutal c-section with her first. She wanted advice from a midwife on the panel. This is what she got: "If you want to give birth vaginally, you have to put your big girl panties on and fight for what you want."

And I remember teaching a class to a group of doula students, and the woman teaching with me said that, generally, women who have repeat cesareans have a lot of unprocessed resentment to deal with, and if they dealt with it their chances of VBAC increases. 

So, in a nutshell, three birth professionals said: women who birth their babies by c-section are driving up the crime rates because their children are more likely to be criminals (also, in an article he wrote in 2008, Odent suggested that cesarean birth may produce more male homosexuals); that women who want a vaginal birth after a previous c-section should somehow grow up so that they can achieve this; and that women who have c-sections may be dealing with repressed feelings, and that repression or other negative feelings such as resentment could be the reason for the surgeries.

If we look at these criticisms from a feminist perspective, they seem very similar to the rape dilemma - don't wear provocative clothing, don't go out at night alone, don't drink, or you will become a victim.

There's a feeling amongst the "natural" birth movement that a woman can have a "natural" birth if she wants it hard enough. We can read of powerful, transcendent, wild, free births where a woman moves through portals to meet her child. These are lovely, indeed, but not everyone can have or would want to have that experience.

In my opinion, giving birth is a very private act. It is so varied, the ways in which we birth, almost as varied as, for example, the shapes of our noses, or the leafiness of our labia. Some women want to birth alone, or just with their partner present. Others want their children there too. Some want a doula or two, and a midwife. Other women prefer a physician, and they want to be in a hospital. Some want to have a midwife follow them, and they want a water birth in the birthing centre.

All of these possibilities should be respected as valid, informed choices. So why are they not? Because, often, if a woman chooses to be followed by a medically trained midwife or a doctor, she ends up giving up her right to informed choice and she gets put on a conveyor belt where she is no longer the central person in this sacred, primal event, and she gets things done to her. The birth process gets put on a schedule; the body is examined time and time again; this or that intervention is done until finally all the options have been exhausted and she is wheeled into the operating room.

Yes, having a doula present will decrease your chances of c-section by a decent percentage, especially if you are a mid- to high-income woman living in an affluent country (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003766.pub6/full) 

Women choose to go the hospital to have their babies for many different reasons, and none of these reasons are an excuse for an unwanted and unnecessary c-section. What could these reasons be? 

• they want the security of being in a hospital
• they wanted to have a midwife follow them but couldn't find one
• they don't have health insurance and/or can't afford a midwife
• they don't have a home that is suitable for a home birth (think abuse, living with a lot of other people who aren't supportive, and those kinds of things)
• they don't know their options
• they are forced to because no one will attend them at home because they're carrying twins, or have had several c-sections, or they're obese, or are substance abusers
• they are followed by a midwife but get transferred to the hospital because of government regulations (labour too long, pregnancy too long, suspected this or that)
• covid-related issues reduce their choices

Any number of these women could end up being part of the 25-30% of women who give birth in the hospital who end up with a c-section. The WHO suggests that 15% is a reasonable rate. I insist that here in our affluent country, a c-section rate of 5% would adequately save the lives that have to be saved by obstetric surgery.

How can you avoid an unwanted c-section? Ask questions. Hire a doula, or find one for free. Contact me and I will do my very best to connect you to the people you need. Find a midwife. Get a doctor who hears what you're saying. Say no. Don't do anything that seems wrong. 

Let's work together to put the Cesarean section back where it belongs - in the realm of emergency surgery!

Women's Bodies and Other People's Values

In Quebec, we are experiencing an interest phenomenon. A provincial politician is trying to be Le Pen. She is stirring up xenophobic and racist emotions rather effectively with some doublespeak that pretends to be about secularism and feminism. The target? Religious Muslim women. The fallout? Pretty well everyone who is not .. erm .. well, let's just say that anyone who looks a little different has experienced annoyance if not rage at this political acrobatics.

I am used to people using women's bodies as a battleground. From my days as a sexual abuse counsellor - and a direct action activist - to my days working in hospitals with birthing women, I have been witness to the phenomenon of the woman's body being argued over, manipulated, commodified, objectified, ground up and spat out.

And it has grown up, this violence against women. Back in the seventies, as a rape crisis worker, it was pretty clear what was happening. If you were a woman, and you were alone at night, or walking home from work, you were a target and you could be raped. If you were a prostitute or an indigenous woman, you could be raped AND killed. Simple. Violence against women.

But today, the violence is coated in pretty words. What do you call it when someone puts his hand into a woman's vagina without asking her or looking her in the eye? Its called rape. Birth rape. Doctors who manhandle and abuse women when they are giving birth say that they are saving lives. They are not. They are exercising their power.

Politicians who make silly rules about what women can or cannot wear may say that they are doing it "for the women" (yes, in South Africa they say that rape is "for the women" too, when they are raping a lesbian to convince her to change her preferences). They say they are doing it for the Muslim women's enlightenment and freedom. 

They're not. They are also exercising their power.

I suggest we ban the type of clothing that overweight, middle-aged Quebecoise women wear, when they should know better. Oh, the tight T-shirt over a middle-aged belly! Oh, the tight jeans over hips that should be covered! Oh, the dyed blond badly-styled hair! The polyester double-knit suits! The shoes that Cinderella's sister wore!

But it's different, you argue. Those badly-styled garments do not speak of a deeper moral code - a code that oppresses women (we are speaking of Islam here). They are just off-the-rack, cheap garments, bought without a shred of moral judgement or thought. Yes, you're right. It heralds the victory of the mediocre fat lady; the no-brainers; the thoughtless violence; the amoral assholes who parade as sensitive do-gooders.

I went to a birth once with a lovely student of mine who wore a see-through spaghetti strap tank top and a fake leopard-skin miniskirt. It was a Montreal summer - hot and humid. In the greyish hallways of the hospital she looked like an angel from heaven - hot, sexy, and happy. The birth was a lot of fun: the birthing mother didn't take any shit from anyone and she gave birth on her hands and knees, even if the physician couldn't handle seeing her vulva "upside down". After the birth we ordered sushi.

Another of my fondest memories was a birthing woman who was dressed completely top to bottom: hat, wig, robe, undershirt, bra, panties, stockings and socks. She removed the panties and stockings to give birth but everything else remained. Her husband, who was not allowed to look at her, sang throughout her labor, and told jokes. She laughed that baby out. The room was full of love.

I have seen women's legs held down, women's bellies jumped on, women yelled at and berated. I have listened to doctors, nurses, and midwives tell women what to do; what to say; what to feel; how to move.

When will we rise up against this banal mediocracy?