The Shaming of Mothers

More and more evidence is coming out about the dangers of cesarean section. Every time I scroll through my birthy friends' Facebook posts, I see another mega-study that confirms what we knew all along: c-sections are dangerous. Of course, this surgery can and does save lives. But it cannot be true that over one quarter of our childbearing population can't deliver vaginally. 

I believe that for a well-fed, healthy population such as ours in the industrialized worlds, the necessary c-section rate should hover around 5%. Do the math: this means that at least one in five women are suffering unnecessary surgery. This surgery sets the tone for a woman's mothering - it isn't always a traumatic event, but it definitely is a physical handicap and a hurdle that many mothers would rather not have to face. 

I don't want to write about the reasons for these unnecessary trips to the operating theatre; the reasons are varied and complicated. I DO want to talk about how we are making women feel when we constantly post about the dangers, risks, and unredeemable damage caused by cesarean section.

Giant study links C-sections with chronic disorders 

Let's shout it out and make women feel really bad about how they birthed their babies. Let's make them feel even worse about an unexpected c-section than they already do. While we're at it, let's talk about how to have a VBAC: all you need is perseverance, inner peace, and you have to be in tune with your body. Right?

Women are having c-sections they don't want. Women are going to the hospital, sometimes with a doula and sometimes (usually) not, and they find at a certain point in their labor that they are not performing well enough, and they are scooted down to the OR. Most women do not want surgery. Most women want a vaginal birth. Many women want to have a vaginal birth even after a c-section. Just one VBAC support group on Facebook has 8,796 members. 

I am asking all of you to spread the word to not spread the word about how damaging c-sections are. Women who have had an unwanted cesarean birth KNOW that they are damaging. Let's try a little tenderness and spread the word instead about loving the mother, home birth, undisturbed birth, midwifery care, all the good things....

First Do No Harm

Why do I feel I have to justify myself when I say that doctors and hospitals are damaging women and babies? I have a little bird on my shoulder that says "Oh, but you don't want to seem like you are against saving lives".

We have some fantastic tools at our disposal now in the field of medical care. We have antibiotics. We have surgery. We have anaesthetics. We have ultrasound. But these tools are being overused and mismanaged.  Women are being hurt and babies are suffering because of our indiscriminate and irresponsible use of methods and materials that should be reserved for special situations.

What are the effects on mothers who want a vaginal birth and come out of the hospital with a scarred uterus? What are the long term effects on her mothering instincts and choices? What are the long term effects of cesarean section birth on newborns? What are the long term effects of epidural medication on newborns? Artificial oxytocin?

What happens when a mother in full labor suddenly becomes quiet and calm because of the pharmaceuticals coursing through her system? How does the baby feel when that happens? Is there a correlation between epidural medication and later drug use? What happens to the part of the brain that responds to addictive substances and behaviours, when the birth process is augmented with artificial oxytocin and opiates?

What happens to a marriage when a man witnesses his wife being treated like an animal? How does that compare to the bonding that takes place when a man sees his wife in full triumphant labor and birth?

What happens to little girls who are born by cesarean section? Are they more likely to birth that way? Is there a cellular memory of the movement through the birth tunnel? What are the long term effects of cesarean section on sexuality throughout a woman's life? Is she more or less likely to be fully orgasmic later into menopause?

Is there a correlation between asthma in children and induction of labor? Is there a correlation between autism and epidurals? What health problems are we seeing that may be connected to our new way of giving birth?

The average cesarean section rate in Canada is conservatively reckoned to be about 20%; higher in some places and lower in others. One in five children are now born surgically. This is a huge scientific experiment that is not controlled, or monitored, or even admitted.

Over 90% of first time mothers in hospitals in Montreal are taking epidural medication.

In spite of recent studies that show the contrary, the majority of women carrying breech babies are delivering by cesarean section.

Forty one weeks is considered standard for induction, Bishop's Score be damned! And if a woman is over forty, she is likely to be induced at 39 weeks.

We need to get these figures down and we need to start examining the effects of our modern tools, methods and materials on the mothers and babies who place their trust in us.

Radical Doulas

One of "my" doulas was at a clinic the other day and she met a resident who apparently had worked with me in a hospital birthing room some months ago. The resident made two comments about me: "Rivka doesn't like me because I'm a man". And "she concentrates on the woman - we are just there as technicians to catch the baby".

Funny, I like men generally. I wonder if he could think a little deeper about why I may have given him the cold shoulder. Was he treating my client with disrespect? Was he reading the situation closely? Did he have the woman's best interests at heart? Was he acting according to protocol, to science, or to "ghost protocols" (those ones that get left over at hospitals because they are too hard to change)? Was he working from his heart? Did he ask my client to lie down when she was pushing perfectly well in a squat? Was he scared?

And "she concentrates on  the woman". Well, hello, that is what a doula is supposed to do. We are not there to make friends with the medical staff. I have very cordial relations with many of the nurses and physicians I work with. But I do not go into a hospital to make friends. I go into a hospital to provide my client with a safe place to give birth. That means that I make every effort to create a peaceful environment in which the woman can let go and do her work of birthing. I don't have to joke and laugh with residents. I can quietly whisper to the woman so that she is feeling good. I'm not interested in staring at her vulva as it opens. I've seen it lots of times, it is doing perfectly well, and there is no medical need for me to do so.

If a woman is undergoing an intervention that I do not approve of, then I will definitely put my back to the staff and direct all my love and attention to the woman. Women DO undergo unnecessary interventions in the hospital, far too often. I am not talking about women who go into the hospital with a clear plan to be induced, have an epidural, and be happy. I am talking about the HUGE number of women who actually believe they can give birth naturally in the hospital environment.

These women are often treated badly by under-experienced residents.  If a woman has a small leak of amniotic fluid, that's no reason to admit her to the hospital two weeks before her EDD and then break her waters twelve hours later to stimulate labor. If a woman is happily pushing in a supported squat, there is no reason why she should lie down just because the doctor hasn't caught a baby that way. If I see a resident reaching for the amnihook, with his hand in a woman's body, I will say something. That something might be said in a gentle voice, but it probably won't be friendly. And the woman on the bed will appreciate my interference. I am not against a justified AROM. But you never insert something in a woman's vagina without telling her what you're planning on doing.
Do you?

Radical doulas, we need to stand up and speak out. Women are being treated badly in our hospitals and I am ready to take a stand.

I am taking notes of occasions where my clients have been abused during labor and childbirth. Please start to take notes too and we will start to create a manifesto.

Power to the birthing woman!

Birth is Political

Like everything else. Birth is political.

I am on the train right now going through lovely Ontario, on my way to a conference. I will be presenting two workshops tomorrow. One is for birth attendants, exploring the ways we can assist women to have natural births in the hospital setting. One is for anyone who is interested in setting up and maintaining a volunteer doula program, on zero funding (Montreal Birth Companions has been going for close to ten years now, and we have assisted up to 100 women a year).

The conference has been the subject of some controversy because of one of the speakers. Emotions and opinions are strong and heated.  Everyone believes they know best. Best for the woman, best for her baby, her family, and the world at large.

I, too, believe that my opinions count. I believe women's bodies are made to give birth, that most women can retrieve their physical knowledge of how to birth, and that if well nourished women are given the right kind of care and a safe space in which to do it, they can usually give birth to healthy babies without much problem. I believe the physiologic need for surgical intervention should probably hover around 2 to 5 per cent, for women who have had good prenatal care. Our present rate of 25 to 30 per cent is a crying shame.

But I also know that my opinions are hotly argued against by others who consider themselves more educated, more scientific, and more knowledgeable.They may even consider my opinions to be dangerous. Or, indeed, inconsequential.

Most of my activities don't rock any boat. When I sit quietly in a hospital room and surround a laboring woman with love, and watch closely as the doctor, acting in good faith and confidence, persuades her to take an unnecessary epidural, or a needless induction, I am being a good citizen.

When I coordinate a volunteer doula for a refugee from Somalia who has been circumcised, and who wants to have a natural birth, I am just rocking the boat gently enough that the passengers will feel comfy and slightly sleepy.

When I suggest to a woman who has not been able to obtain a registered midwife, and who doesn't want to give birth in a hospital, no matter how friendly it may be, that she look around for an unregistered, "illegal" midwife, then I am starting to make some small waves, but still not even good enough for decent boogie-boarding.

Let's try to sail together into the future, taking the waves as they come, breathing together...

Oh! my metaphor is hitting shoals - of course - who is the captain? The right answer is: the captain of the Birth Boat is the woman who is laboring and giving birth. She is the one we are attending. We are the ones with the knowledge and we can use it wisely and quietly, without scaring her as she works at bringing her baby into the world.

The root of "radical" is "root". We are trying to discover the root of the problem, we would like to root it out, to make a fresh start in the world of birth, and in the world.

Come visit me at the Radical Doula site:

Rivka