Competitive Spirit

The first official running race I participated in was this one: a half marathon (21 kilometers), when I had just turned 59. I loved everything about it! The camaraderie; the cups of water; the corny posters; the feeling that I couldn't do it and then I did!

I still love running races. I've done a bunch of them since then. The first in-person one I did since the beginning of Covid was last October. My smile lasted about two kilometers, when I lost myself in the joy of hearing all those other runners' feet pitter-pattering in front, beside and behind me. Then my self caught up with me and I spent the next two hours or so agonizing about my life and all the things that were going wrong and have gone wrong in the past.

Am I an impostor? Was the main question I kept asking myself. The jury is still out on that one. Because here's the thing: as soon as I say I'm anything, especially these days as the social media is ready to pick up and amplify any little piece of horse shit that escapes my mouth, as soon as I say I'm a midwife or a caring person or whatever, a witch and the like, then .... then I am that. And I necessarily have to be the BEST at whatever it is I've said I am.

And if I'm not the best, then I'm an impostor.

We live in an age of experts.

Experts, apparently, study stuff. They know about stuff and they can tell other people how to do things. But there are so many, many experts out there it's hard to know who to believe. So a regular person just finds the expert they agree with and build a game plan from there. But that leads to some difficulties: first of all, you can't just pick any expert. Some people do actually know more than others about any given subject. As a lay-trained midwife, I know that I don't have as much technical knowledge as an OBGYN... so I shouldn't represent myself in opposition to them. But I do, or rather, we do ... we seem to be living in an age when we are all projecting images of ourselves that are larger than life, and better than the puny reality.

The second difficulty with finding an expert to guide you on your way is the problem of responsibility. If you're following an expert's advice and things go sideways, who are you going to blame? Yourself? I don't think so. If you've already decided that you need an expert to help you do whatever it is that you want to do, then you've already given them some degree of responsibility. 

So, if we do away with experts? Well, no one is going to do brain surgery on themselves I hope. But maybe we could tweak the idea a little bit. Maybe we could add some humility to the picture. Perhaps we could reduce our need for experts, trust ourselves a little more, and remember that living life isn't actually like running a race. No one really wins: it isn't really about the survival of the fittest.

Conspiracy

Conspiracies abound: are we are being controlled  by giant lizards? No, most of us would agree that we are not. Is the exhaust from planes flying above the Italian skies affecting the Italians, making them doll-like and unable to oust Berlusconi? A surprising number of seemingly rational people I have met actually believe this. Did man reach the moon? What evil was behind 9/11? Is Big Pharma out to drug us all, whilst stealing our life savings?

Of course not! We are rational, sensible human beings. Then why do we believe that the simplest task needs a multitude of experts? From conception to birth to early childhood education and beyond, we are confused and abused by lowly-qualified experts telling us which way is the right way.

The Birth Conspiracy is this: an understanding, created by all of us, that we cannot function without experts. We cannot give birth without birth experts. We cannot labor without assistance, without classes and checklists. We cannot make our own decisions, or accept consequences for our own actions. It is a way we can avoid responsibility for our lives. Those of us who are experts want and need to control the process. It is very hard to sit on your hands and wait while a woman labors. It is much easier to interfere, to preach, to suggest, and to control.

The doula sits uncomfortably on something between a fencepost and a pillar here, protecting the birthing woman from well-meaning experts who do not understand the truth about birth. She is in great danger of becoming an expert herself, and there is only one way for her to prevent this from happening. She should gain as much knowledge as she can about the birth process and how it unfolds in different environments. She should take this knowledge with her to every birth, to every meeting, to every workshop. With all of her knowledge and experience, she needs to remember only one golden rule, that is, that the woman she is accompanying is going through HER experience. The doula can hold her hand, literally or figuratively, but she needn't teach, judge, or convince. Then she is overstepping the bounds of the Birth Companion and becoming just another expert.

Owning Our Practice

When we are working with such an elemental and mysterious thing as birth, it is often hard to tell where the lines that define ourselves and others can or should be drawn. I was speaking with another very experienced doula the other day who took exception to something I said. I suggested that inexperienced doulas may not be as successful at preventing unnecessary cesareans as a doula who has had years of experience working in a hospital environment with many diverse clients.
She countered, and rightly so, that the essential role of the doula is to offer companionship and respect, and those qualities will triumph, whatever the outcome.

I agree. To a point. Love works wonders. But a combination of things are at play, especially in a busy hospital that may or may not have a sensible approach to natural birth. A younger, less experienced doula may not know quite how to respond when a resident reaches for the amniotomy hook as she is doing a vaginal exam and prepares to do an amniotomy, all without saying anything to the laboring woman. Although we don't like to admit it, it is true that even the presence of a more experienced doula will help doctors to exercise caution. A less experienced doula will not know the policies and protocols of the various hospitals as well as a more experienced one. She will not have built relationships with the medical staff she is working alongside. All these elements can and sometimes do lead to the inexperienced doula accompanying a woman along a very different path than the one they had hoped.

That said, is that not our ultimate mandate? To accompany? To be a companion as the woman makes her journey? If we are beside a woman and her partner as they are becoming parents, and we are there to support, to love and respect, as the woman moves through labor, is that not sufficient?

Yes, if the environment she is birthing in is a sane and healthy one. Definitely. But what if a woman is birthing in an environment where the professionals are overworked, the infrastructure is crumbling, the focus is on risk instead of health, statistics are distributed as freely as narcotics, and the emotional and spiritual side of bringing a child into this world are more or less ignored? Then, possibly, a birthing woman needs more than a companion in love. She needs a watcher, a guardian. Experience, skill, humility, and an open heart are the foundation blocks that a doula can build her practice upon. And one important rule is: never stop learning. When you have a chance to change your mind, change it. When you feel you know enough, know you are wrong. The responsibility is great, the stakes are high. Ego should not take part in the miracle of birth.

Birth Conspiracy?

I remember seeing a medical student who was attending his first birth. It was a normal, natural hospital birth. The woman was on the bed, her husband was by her side, I was next to him, there was an intern helping with the delivery, a nurse, the physician in charge, and a young medical student. The baby came out, everyone was happy, the new parents were exhilarated and crying, and then the medical student exclaimed loudly: “Look! Look! Look at its little toes! Look! They’re like real toes. They’re just like real toes!”
The attending physician looked at him and whispered: “Philip, get a grip!”, but I was hoping that that simple amazement and wonder would stay with him throughout his career.
For some people, this story may be full of problems and issues. What do I mean by a “normal, natural hospital birth”? Can a woman have a natural birth in a hospital? I remember hearing from an obstetrician that among some women in our city a “natural” birth was when you didn’t wear much makeup when you gave birth. What is a normal birth? If a hospital has a 90% epidural rate, does that mean getting an epidural is normal?
And certainly, we can’t have trained professionals going gaga over newborn’s toes, can we?

We are living in an age when we are terribly concerned with our health, yet it is an age when human life expectancy is at its highest. We worry and fret endlessly about our children, but have difficulty finding time to spend with them. We are living a life that is far from nature, yet we yearn for the “natural” and the “green”. We are so divorced from our own bodies that a surprising number of pregnant women do not know where their cervix is or how a baby is supposed to come out.
In our world, human life has become so complicated that every simple activity has a huge structure built up around it. This structure is built upon a foundation of information supplied by an army of experts. Simple processes such as eating, healing, making love, giving birth, breastfeeding, caring for children, have all become complicated and institutionalized. When a woman decides she wants to have a child, one of the first things she will encounter is the structure we have built up around birth. She will be met with a mountain of information and much of it will be conflicting.
In the birth world everyone wants to have a little piece of the birth experience. The birth practitioner wants a piece of even the most physical and elemental. Here is an example: It is often very tempting to do a vaginal exam. Why? We want to know what’s going on; if the baby is moving down, if the cervix is opening, where the baby’s head is positioned. What most practitioners will not admit is that this intimate physical connection with a woman is important to them: it is an amazing thing, to feel a baby’s head coming down the birth canal! But how often is it really necessary? Does the laboring woman actually want to have so many exams? How many vaginal exams are done for the sake of the birthing woman, and how many are done for the attendant?
The birth practitioner, or any birth “expert”, also wants a little piece of the bigger picture: we want the woman to have a natural birth, with no epidural and no interventions. Or perhaps we want her to have an epidural so that she can be more comfortable. Or we are convinced that surgery will be less risky. Either way, we want to convince her that we know best. In fact, we do know best: we are more educated, we have seen more births, we have seen more pregnant women and we know what to do.
Or do we?
The Birth Conspiracy is this: It is an understanding, created by all of us, that we cannot function without experts. We cannot give birth without birth experts. We cannot labor without assistance, without classes and checklists. We cannot make our own decisions, or accept consequences for our own actions. It is a way we can avoid responsibility for our lives. Those of us who are experts want and need to control the process. It is very hard to sit on your hands and wait while a woman labors. It is much easier to interfere, to preach, to suggest, and to control.

Interested? You can order your copy of The Birth Conspiracy soon - watch this space!