Thursday, May 9, 2013

Reclaiming Maternity

Mother's Day is upon us. As a doula, I've been blessed to bear witness to many women as they became mothers, as they harnessed all their inner strength, as they fought for the births they wanted, as they held their children for the first time.

This is a topic near and dear to my heart, and it has been since I was a college student reading book after book after book about how much things have changed in health care. It wasn't until I was a laboring mother in that system that I really saw it though, and it wasn't until I became a doula that I knew there was something I could do about it. With my hands and my heart, I have the power to help other women reclaim maternity.

If you talked to 100 women and asked them to describe their experiences with pregnancy and childbirth, there's a good chance that you would hear 100 very different stories. Some of them would be triumphant and inspiring. Some of them would be anything but. Too many of them.

The truth is, pregnancy and childbirth don't belong to us women the way they should. They haven't for a very long time. For any discussion of why maternity is as messed up as it is today to make sense, we have to talk how and why we got where we are.


Since the dawn of time, for as long as women had babies, they have had help.

That help came from other women, most of which had birthed children of their own. Midwives. Without formal training, they learned the craft by hands on experience. They were skilled in breech deliveries, they were skilled in the use of herbs to assist with labor, with bleeding, with nursing. They understood that pregnancy and childbirth were and are a very normal, natural part of the human condition - a requirement of it, in fact, in order for society to perpetuate itself.

All that began to change in the early 1800's with the development of hospitals and the invention of forceps. Men began to push their way into birthing rooms, claiming they had new tools and procedures that would make labor better. By mid-century, more and more women were giving birth in hospital settings with male doctors and fewer with midwives, particularly in urban settings. Hospital births were more expensive, a privilege of those with money, and the perception quickly arose that they were therefor better.

Though the thought at the time was that the hospitals were safer and more advanced, the truth is that they weren't. Obstetricians began demanding women employ the lithomy (laying on the back) position for pushing, primarily because it made their job easier - even if it's not the one most women would naturally gravitate towards. It decreases the size of the pelvic outlet and makes the delivery process longer and harder for the mother. In addition to changing the mechanics of labor, the use of forceps and episiotomies skyrocketed, again for the ease of the doctor. All this must have come with some benefit of better outcomes, right?  Wrong.

Maternal deaths went up as disease spread far easier in hospitals, doctors moving from one patient to the next without realizing that unwashed hands were a perfect vector for illness.  Puerperal fever, also known as childbed fever started killing mothers at alarming rates. Women were also increasingly likely to suffer from sepsis because of the surgical interventions.

Even still, the profession pressed on, declaring their superiority over midwifery. Male doctors pushed for a monopoly on childbirth, and gradually the practice of midwifery was outlawed, even though there was no actual evidence that medicine was better. In fact, the evidence was to the contrary.

By the turn of the century, women just came to accept that births occurred in hospitals. Twilight sleep was frequently employed, leaving the women with little or no conscious memory of the birth. They arrived at the hospital in labor, were drugged, and eventually woke up having given birth, usually with large episiotomies.

Families weren't present, women weren't even conscious. Birth had become an automated process that all happened behind closed doors.

Those women, the ones who were drugged and had their children ripped (sometimes literally) from their wombs?

They are our mothers and grandmothers.

In the matter of a few generations, women lost any real connection to what labor is supposed to be like. It went from a normal part of the human condition, attended to by knowledgeable women, to a medicalized process where mothers were at the mercy of the industry.

Add in the more recent additions of elective inductions and pitocin (the devil's contractor is what I call it) and you end up with countless women who were told that their bodies couldn't labor right, that they failed to progress, that their uteruses were overstimulated, that they needed c-sections. Tethered to machines, kept on their backs and drugged, it's no wonder their bodies didn't cooperate.

This is not what labor is supposed to be like.

And yet, it is. More than that, it's what we've come to believe is normal.

I cannot even tell you how many women I have talked to as they tried to work through what happened. Who break down when I tell them that what they've experienced is real and legitimate and it's called birth trauma. Who didn't realize that they didn't have to go along with every intervention. Who feel like their bodies have failed them. Who are hesitant to ever go through it again out of fear. Who didn't feel empowered to ask questions, to ask for time, to say no.

It breaks my heart.

One of my favorite clients and dearest friends was one of them. Her first delivery had been traumatic. Induced, it took forever for the induction to work. Starving and exhausted, she got an epidural because she couldn't handle the artificial contractions anymore. Then one thing after another happened and she eventually delivered her son in a drama filled urgency of interventions. One of those if we can't suction him out with this push right now, we're rolling you to the OR for a section kind of endings.

She felt defeated by it all, and I remember how scared she was that it would go that way again. She called me in tears when she found out she was pregnant with the next baby. I told her that it might happen again, but that it didn't have to. That things could be different. That I could help her.

Her second pregnancy, with more complications than the first, ended in a dark hospital room one night. Music playing in the background, calm surrounding us. She had to be induced, there was no avoiding that, but I was there to help her work through the pain. She ate. She drank. She breathed. She went into the deepest recesses of her mind when she needed to gain clarity and peace. She pushed for only a few minutes. No vacuum, no forceps, no episiotomy, no c-section, no drama. The baby was healthy, she was healthy. It was beautiful.

I'm pretty sure she felt like she could conquer the world that day.

~~~~~~~~

As women, we need to help each other feel that way.

Women need to be taught that their bodies almost always know what to do. They need to learn to trust their instincts.

We don't have generations of women before us to teach us these things like we used to, so we need to relearn it all. Then we need to share it with other women. We need to support each other.

Pregnancy is normal. Birth is normal.

It is not a medical emergency unless it is.  It is a necessary condition of humanity.

Complications happen, yes, but not all the time and not to everyone. For those women and their children, often the only safe route to birth is surgical, and for that option we will be forever grateful.

Birth is not something we should be afraid of.

Knowledge is power. Experience is important. Having someone there to support you is vital.

Women should be there, helping each other, whether the births happen at home or in hospitals, whether with midwives or obstetricians, whether for the first time or the fifth time.

We need women who've done this before. Who can tell how dilated you are just by watching your body language. Who can find the place where you keep your tension and release it. Who won't rush you. Who can whisper the words of encouragement in your ear when the doubt sets in. Who will remind you to focus. Who will tell you that you are strong and beautiful and capable. Who will tell you that you can do this. Who will get you through each contraction by promising that it's one step closer to meeting your baby. Who will sit in the hushed silence with you as you wait for the first cry. Who will shed tears of happiness with you. Who know what a miracle birth is, no matter how many times they see it.

Pregnancy is beautiful. Birth is beautiful.

Let's take it back.

Let's take it all back.

One pregnancy at a time.

6 comments:

  1. I have to get through today but I WILL be sharing this tomorrow. Excellent post.

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  2. Tears. Beautifully written, Lovely.

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  3. This is wonderful. When my daughter was born 23 years ago I had to continually stop the doctor from giving me drugs for pain. I had to fight to sit up after 30 hours of labor, after vacuum didn't work and I didn't want forceps. I have a huge episiotomy scar when we'd talked about perineal massage. It was me arguing with the doctor to have the things we'd agreed to do before her birth and not the calm, natural event I'd planned.

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  4. I heard about only the scary c-section stories of birth before I had my boy. I was two weeks late, induced, blah, blah, blah, c-section, guts dropped into my body all willy-nilly...I would probably have had more kids if it were not for that god awful delivery. I mean it was the WORST! Good to know great people like you are doulas. Wish I was more educated about this when I was pregnant! ~Amanda

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  5. I am so glad you wrote this. I have strong feelings on this subject. Jehryn was born at home, with two amazing midwives standing by. My labor was intense and lengthy (40 hours) but I learned that my body is perfectly capable without intervention. I have been recently considering becoming a doula, but have much research and soul-searching to do first.

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