blogging for choice...all choices

I missed the annual Blogging for Choice Day yet again this year (because that's what I do: I realize that a date is coming up after it has already passed.  It's a pattern of mine) but I'm posting some thoughts today anyway because, really, they need to be voiced.

I recently read the personal story of one family's painful experience with Trisomy 18.  Rates of Trisomy 21 - better known as Down Syndrome - amongst infants are far higher than T18, largely because it is suspected that the majority of T18 babies are naturally miscarried very early in pregnancy, and also because most T18 babies do not survive pregnancy. In truth, an extremely large number - not sure of the rate, actually - of T18 babies are therapeutically terminated during pregnancy shortly following diagnosis.

I can understand why a family might make such a choice.  Knowing that you are carrying a baby who is extremely unlikely to survive birth, and will assuredly not survive beyond one very challenging, entirely-in-hospital year of life would be unfathomably painful.  I cannot even begin to imagine carrying that burden while carrying that child.  I support a family's, a mother's, a woman's, choice.  But the essential thing to remember when we are talking about choices is that if there is, in fact, a choice, it means that there is an alternative action.  What is the alternative in this situation?

The alternative is to embrace the pregnancy, to embrace the possibility of meeting that child with a broken body, to embrace that tiny person as a part of the family and strive toward sharing some time, maybe a moment, maybe an hour, maybe - just maybe - a few days of life with that tiny person, that tiny spirit.  I support that choice, as well.  To do so would take a kind of strength - not more strength than the choice to end the pregnancy, but perhaps a rarer kind - that I suspect many of us do not have, and for that I applaud those families.

But what is the medical establishment's position on choice in this circumstance?  From the story that I read, from a fellow Canadian (and I'll link to it if I get the ok from the woman who writes the blog) our doctors are not supportive of the choice to continue the pregnancy.  This couple was repeatedly encouraged to terminate their son, as well as discouraged from pursuing every avenue to best enable their son to survive beyond birth and share some time earthside with his loving parents, aunts, uncles, grandparents, and brother.

This is not what supporting choice and honouring informed choice is supposed to be about.  If we support choice, it means we support it whether it is the choice we would make for ourselves or not.

politics and birth

There is an increasing trend that really, really bothers me. I'm not sure if it indicates a problem within the birthing sphere or if it is evidence of a general misunderstanding of the political "spectrum" as we in the West conceive it (id est left wing = big government, right wing = small government), but it's there and it concerns me: repeated references to natural birthing, pro-midwifery, pro-informed choice advocates as obviously being "left-wing".

There are two main reasons why. First, good, informed, positive, empowered birth experiences do not belong to the left wing: they belong to everyone. They belong to every woman, every family, regardless of ideology, regardless of religion, regardless of the family structure. Everyone. And those of us who advocate for precisely these birth possibilities may belong to any ideology, any religion and any family structure. They are not inherently linked, nor are any of them necessarily mutually exclusive. Making blanket statements about how empowered women are automatically left-wing, or automatically not people of faith is not only patently untrue, but unfair.

The second reason is fairly simple. As an advocate for informed choice, I advocate for every woman, every family to make decisions for themselves. Give people the necessary information they need regarding prenatal care, birth choices, and infant and child care and then let them decide for themselves. What has shocked me - as someone who used to fairly happily proclaim herself to be stolidly left-wing - is that much of the left-wing as I have encountered it doesn't seem entirely in keeping with this personal ideology. There is a certain degree of "don't worry: we've done the research and we know what's best for you". And that doesn't fly with me, even if what is being prescribed is precisely what I would have chosen for myself and what I believe to be best. Because what I might choose may differ greatly from what others may choose, whether I like it or not.

With this post, I'm pretty obviously coming out of the closet as non-left-wing. I couldn't say what I am, precisely, or where I fall on the entirely inadequate left-right political spectrum, but I do know these two things with certainty: I am always in favour of choice, and I refuse to tie up birth advocacy with any political identity. To do so is exclusionary, and if we are advocating for all women we simply cannot start excluding people.

something new

I've been remiss in blogging for, well, quite a while now. Turns out moving house (yet again!) with a two year-old while also trying to fulfill a part-time job, particularly one which involves committee meetings like mine does, while still struggling to maintain one's sanity is a bit of a challenge, and one that leaves little time for composing posts. But I have something to tell you! Something new and exciting.

As I blogged about before, there is some concern amongst a number of people in this city - consumers and midwives alike - about how the informed choice of birthing women is being respected, or not, as the case may be. It isn't about attacking practitioners, or going on the offensive: it's simply a matter of wanting to uphold informed choice, and support those who strive to uphold birthing women. Out of this, the Informed Choice Coalition has been born. We're a group of people, women and men, lay people, doulas, midwives, and even other organizations who feel strongly about the importance of informed choice, and want to create a support system to better enable birthing women and men to execute their choice, as well as to assist practitioners in honouring those choices.

It's extremely exciting, and I am so privileged to be a part of this community of concerned citizens, and to have the opportunity to be a part of this from the beginning. Watching it grow is - and will be - very rewarding. Already the ICC has generated interest in other cities and other provinces across Canada. We are not the only ones concerned about the state of choice in birth and during the birthing years.

We are part of something bigger than just we are. I can't wait to see where this leads us!

lest ye be judged

Monday, I wrote about the current crisis in midwifery in the National Capital Region.  While I did - and will continue to - obfuscate over many of the details, there was quite a bit of discussion about judgment.  As those who had gathered shared birth experiences, particularly those which were negative, unpleasant or which deviated from our desired approach to our births, there were many expressions of dissatisfaction, of anger, of judgment toward the midwives who had been involved and had committed these "wrongs".

The issue of judging the actions of others comes up a lot when talking about...well, anything even remotely controversial.  Childbirth, parenting, codes of practice, medical practices: it is nigh impossible to engage in a discussion of these topics without the dialogue leading to some level of judgment in the course of things.

My darling husband likes to make the point that we should judge, that we must judge, that judgment and discernment are important elements of being an intelligent and considerate human being.  It is what we choose to do with that judgment that determines whether we are just and fair...or not.  To judge for one's self does not necessitate being judgmental.

There are practices which we midwifery/natural birth/informed choice advocates generally oppose.  There are practices and trends and attitudes which I personally abhor. How do we reconcile supporting and caring for our midwives - as well as each other - while also advocating against the practices we oppose, even while these same midwives engage in these practices?

I do not want, and refuse, to be an apologist.  Unacceptable practices are just that: unacceptable.  It is unacceptable that there are fear-mongering midwives threatening mothers with the spectres of dead babies and hemorrhaging mothers.  It is unacceptable that women in the throes of labour are being let down by their midwives, too afraid of litigation to act in the best interest of the mother.  It is unacceptable that antiquated procedures - which evidence shows to be ineffective or harmful - continue to be used because they make some midwives comfortable.  Moreover, it is unacceptable that there are midwives who play the "uncomfortable" card with mothers and families with regard to informed choices which midwives had previously supported.  If the playing field remains the same (that is, if there is no change to the mother's or unborn child's condition) why are the rules being changed?

The answer is fear.  More on that later.

something is rotten in the state of birth

Several weeks ago, 18 people - women, men, mothers, fathers, and children as well - met at the home of a local supporter of midwifery and birth choice.  We met because we are concerned about the current state of the birth climate in this region.  We met because we want our rights, our choices, our bodies and our births honoured and respected.

I can't get into all of the specifics of what motivated us to meet with little warning, what events precipitated this meeting, nor all of the details that were discussed, because there are some...issues of legality.  Suffice it to say that we, a group of consumers and birth workers and advocates are not only concerned about some of the trends in midwifery in this province and this region, but are also prepared to stand up and take action.

Over the several hours of discussion that ran late into the night (it was pushing midnight by the time my ride - and new friend - left) there were several recurring themes.  What constitutes informed choice?  How do we define it?  Are we consumers, and if so, what are we consuming?  Do we consume a product or a service?  And if it is a product, what is it?

Many medically-minded advocates have penned articles or scripted news segments arguing that birthing women and men have unreasonable and unrealistic expectations of birth, that we have delusions of entitlement and have hedonistic visions of candle-lit, "perfect" birth experiences, and that these expectations have led to a culture of litigation among dissatisfied consumers post-birth, and a culture of fear and defensive medicine amongst obstetricians.  One of our concerns discussed at our meeting was that such a climate is no longer exclusive to obstetrics, but is disturbingly present within the current practice of midwifery as well.

The point was also made that the modern face of midwifery in Ontario is obstetrically-born.  We have virtually no (I know of only one) direct-entry midwife in this region, which is to say that only one of our local midwives learned and trained purely through apprenticeship.  All newly-licensed and registered midwives in Ontario must be university-educated, through three-year programmes at only a few schools in the province, schools with limited spaces for students.  The academic curriculae are based on a medical-model, and while a thorough understanding of human physiology and biology are - obviously - helpful in attending and assisting births, the resident fear in the medical model appears to be seeping into the culture of our midwives.  How can this be?  What can we do?

It isn't enough for women and men to simply say "We want a change."  We need to find a way to not only effect that change but to support it as well.  Anyone with eyes open to the climate of birth in North America and the Western world in general knows that we are socially trained to fear birth, to see it as inherently dangerous and risky.  We can not simply demand that our midwives - women (and men) who have been largely been born and raised in this same climate of fear - ignore that fear, withstand the pull of that fear on their spirits and act entirely differently.  We must acknowledge the great task that stands before our midwives, the great challenge they face in not only assisting families to have safe, positive birth experiences but also be brave and courageous amidst the majority of the birth-working community (id est doctors and nurses) who have been taught so effectively to fear birth and all the natural outcomes thereof.

But what can we do?  How can we as consumers, as clients, as mothers and fathers, as men and women, as families and citizens, support our midwives?  How can we help them be brave and courageous?  How can we assist them in feeling the passion and zeal they had when first they decided to pursue the path to attending and assisting births?  How can we nurture their livelihoods and nurture their souls?

We didn't come to any specific conclusions during our meeting.  What we did acknowledge is that this will be an ongoing process: there is no quick fix, and supporting and upholding not only today's midwives but the entire art of midwifery is something which will continue to be of great value and importance.  What we begin today must continue for generations.

it's bad advice to starve a child

As I type this - one-handed - I am defying my daughter's pediatrician's orders.

He told me to stop breastfeeding.

At least during the day.  Her iron count, hemoglobin and B12 counts are quite low because she won't eat solid food, she'll only breastfeed.  His solution is for me to refuse to nurse her during the day so that "she'll learn to eat".  He also suggested that we put her in a private daycare because seeing other children eat is all she needs to help her start eating.

We won't be returning to that pediatrician's office.  Because while I am in utter agreement that she needs more than she is currently getting, I absolutely refuse to starve her, refuse to deny her her primary comfort, refuse to hand her over to strangers for the majority of her day.  Refuse.

Fortunately, I have a friend who's an Occupational Therapist, and she's given us some sound advice for troubleshooting this, and is going to find some names of other OTs in the area who specialise in peds.  Here's hoping.

Parents, remember: just because the 'advice' you're given comes from a man in a white lab coat doesn't mean it's good advice.  Remember, always remember: be vigilant, and think for yourself.  Otherwise you might end up agreeing to starve your child.

more lowdown on Australia's anti-midwifery, anti-woman, anti-liberty legislation

The lying bastards of the Australian Ministry of Health have released an amendment to the proposed legislation which will affect midwifery care in Australia.  In short, there will be no true midwifery care.

There will be people who will argue that a midwife under the auspices of an obstetrician is better than no midwife at all.  Maybe.  But we know for a fact - BC's recent study proves it - that outcomes are better for midwife-attended homebirths than for midwife-attended hospital births, so why deny women that choice?  We also know that midwives and doctors who refuse to play by regressive, interventionist, choice-limiting or -eliminating rules routinely have their privileges revoked.  So I call a big ol' bull$hit on anyone who claims that this is better than nothing.

"Better than nothing" is a stupid, idiotic argument.  It is NOT GOOD ENOUGH (and yes, I am yelling.  Hell, I'm screaming!).

My DH weighs in on this issue from a political perspective here.

how high do we set the bar?

A woman gave birth in Minnesota last night.  I'm sure she wasn't the only one, in fact, but I imagine she was the only one to do so live-streaming a video feed to the internet.  A massive number of viewers tuned in to watch her birth.  What began as a natural birth ended with an epidural, pitocin, and purple pushing in the lithotomy position.  There has been much discussion on facebook, and on a number of blogs, much of it analyzing, and some have said criticizing, the progress of the birth. I've weighed in on The Unnecessarean Facebook fan page and on Navelgazing Midwife's blog, but the discussion has compelled me to consider how we balance the expectations of birth with the reality of birth when that reality falls short of the bar we have set.

Very often we hear people say "As long as mother and baby are alive and healthy, that's all that matters" but such a phrase seems disingenuous and not terribly optimistic.  Shouldn't we expect more than mere survival and the avoidance of catastrophic events or wounds?  Why have we set the bar so low for birth in an era of relatively good health, good hygiene, access to nutritious food, and frequent medical miracles?  Isn't it reasonable to expect a great deal more than women are typically getting?  How can survival be enough?  And yet, how do we show the necessary care and compassion to those mothers whose births fall short of their own pre-birth expectations?  What do we say to our friends, our peers, our clients, when they are swept along in the tide of intervention despite a previous desire to avoid it?

How do we find the necessary balance?  What do we do?  What can we say?  I'd really welcome your thoughts, so please do comment.

resources and reaching out

I don't think I mentioned the lovely message I got over Facebook from a friend of mine.  It was several weeks ago, now.  My friend is young, only 21, and one of my opera compatriots.  She has said on several occasions, and repeated in her message, that she doesn't intend to have children.  More power to her for knowing what she wants to do with her life and her body: parenthood isn't necessarily for everyone, and that's just fine.

Despite her plan not to have children, she thanked me for writing this blog and posting links to articles and blog posts on birth to my Facebook page.  In part, she wrote, "Thank you for putting it out there. Even if people are slow to see the truth, it needs to be out there - that way, when people ARE ready for the information, it's there. And thank you for making it accessible, and educating me in the process."

Isn't that lovely? Isn't it reassuring that there are young women who understand the magnitude of these issues, who appreciate that birth and bodily autonomy and chauvinism are a universal concern?  I wrote her a long and grateful response, including,

I can't tell you how much I admire you for informing yourself on issues that may not now, or may never, directly concern you (the really birth-specific issues, like cord-clamping for instance). Every person who informs him or herself becomes a resource, a source of knowledge for every other person. So even if you never have children, some woman or baby may benefit from you having taken the time to learn and then share that information. And that is an encouraging thought.

This young friend of mine enthusiastically replied that she wants to be a resource, to share knowledge and information.  How delightful!  For generations we have separated birth from regular life, making it of concern only to those who are actively having children or working in the birth 'industry'.  It should not be this way.  There are many wonderful, gifted midwives and doulas who have never had and may never have children.  That doesn't prevent them from listening to women or acting based on centuries of knowledge as well as modern research.  Information and education are for everyone.

It's one of the messages of Debby Takikawa's film (nota bene: didja see her comment on my post about her film?  How cool is that?!): birth is a further reaching concern than we currently think.  It affects us all.  How we approach birth and babies and women's bodies and personal choice is very, very indicative of the state of our society.  What does our current approach say about us?  That we are fearful?  That we are disrespectful?  That we are paternalistic and patriarchal?  That we are dismissive?

And what do we want to say?  That we are courageous.  That we are faithful.  That we are respectful.  That we are dignified.  That we are caring.  That we show concern.  That we are open to new possibilities.  That we welcome miracles.

ACOG has sunk to a new low

As if scare-mongering and fact-twisting weren't enough, they have now sunk to exploiting a heart-broken couple's pain.  This Today Show segment is rapidly making the rounds on the internet (I've had about four or five friends post it to their Facebook pages so far, and it's popped up in at least four blog feeds, as well) and for good reason.  The segment is so obviously intended to further the position of the ACOG, so obviously meant to attack the midwifery and homebirth movements, and so obviously lacking in any effort to provide unbiased or well-balanced journalism that it is almost laughable.  Almost.

Exploiting a family tragedy in a veiled effort to shore up their own image by undercutting the alternative is utterly ludicrous.  Sadly, though, it's extremely common in this sensationalist-style "journalism" (though to call it that insults all of my journalist friends who do actual, you know, research before airing their stories).  No, what I find even worse is the blatant and slanderous insult.  Andrew Goldman of New York Magazine, and author of the article "Extreme Birth" is briefly on screen and delivers this soundbite:

 One of the doctors I spoke to said that he thought that homebirth had become almost the equivalent of a spa treatment, that it was this sort of hedonistic concept of birthing.

 As if insulting every woman who has ever considered or had a homebirth wasn't bad enough: they felt the need to slander, shame and blame the woman whose story they were exploiting for the very basis of the segment!  Obviously, if only she hadn't been so selfish, so self-involved and self-important, if only she had really considered her baby, she would have happily bought into the load of lies and half-truths and evidence-less practices so often sold by members of the ACOG.  If only...  

What's even more spurious about this segment is the date of its airing.  The very day the ACOG released the results of their 2009 Survey on Professional Liability, in which the ACOG admits that current practices are known to harm women and babies.

"This latest survey shows that the medical liability situation for ob-gyns remains a chronic crisis and continues to deprive women of all ages—especially pregnant women—of experienced ob-gyns," said Albert L. Strunk, JD, MD, ACOG deputy executive vice president. "Women's health care suffers as ob-gyns further decrease obstetric services, reduce gynecologic procedures, and are forced to practice defensive medicine."

 Forced to practice defensive medicine.   Let's all just ruminate on that phrase and consider it's meaning.  Continuous Electronic Fetal Monitoring.  Mandatory IV's.  Mandatory antibiotics for GBS mothers.  Mandatory induction after rupture of waters.  A national caesarean rate of 31.8% in the USA.

It has been stated to me recently that ob-gyns do not begin their practices in an effort to victimize women.  I would tend to agree with this statement.  I would like to think that, at their core, or at least in their genesis, doctors have a desire to help or to heal.  But that does not excuse engaging in practices and procedures which hurt women and children!  It does not excuse ignoring study after study after study which shows that common procedures routinely harm the very women and babies they are supposedly to help!  And it certainly does not excuse denying women bodily autonomy or informed consent.  For this there is simply. no. excuse.

It has been suggested that the current expectations for birth are unrealistic, that parents expect "perfection" from their doctor and that when their experience falls short they choose to litigate to make up for it.  Perhaps that is so.  Perhaps a 91% claim rate against respondents to the 2009 liability survey is indicative of parents having ludicrous expectations.  But should the doctors not shoulder some of that blame as well?  Should we, instead, address and acknowledge the fact that if the doctors are the "experts" they should be imparting a little of that wisdom to their "patients" (I'm utilizing sarcastic quotation marks again: a pregnant woman isn't sick) and having frank and earnest conversations about the realities and limitations of practitioners and birthing environments?  Perhaps if doctors were honest with women, were honest with parents, and actually divulged some of the information they so often try to keep hidden, there would be a greater understanding on the part of those parents after the birth for any perceived shortcomings.  Marsden Wagner writes in his recent paper "Fish Can't See Water":

One reason for the epidemic of epidural in many countries is that women are not told the scientific facts about all of the risks to them and their babies when epidural block is used for normal labour pain. Indeed, at one meeting of obstetric anesthesiologists in the US, discussions were held on how to prevent any information on risks of epidural from reaching the public. The excuse used was the typical patronizing approach of some doctors: "We don't want to scare the ladies." It is absolutely essential that any women offered epidural must be told all the scientific facts about the risks before she gives informed consent to the procedure. 

 Instead of respecting women - and also men; we must not exclude male partners from the equation - and dealing with them honestly, there is an overwhelming air of paternalism which often just smacks of chauvenism and downright misogyny.  And what's so totally ridiculous about it is that it only serves to shoot these same, paternalist, controlling doctors in the foot when claims are launched against them by dissatisfied and even injured women and parents (I say parents because if it is the child who is injured, the infant will obviously not be launching the claim).  Holly Barhamand, a doula and childbirth educator, contributed a comment to a recent post on Reality Rounds about whether patients can ever have any say in their own healthcare.  Her comment sums up my point better than I ever could.  With her permission:

I’m sure it’s a prevalent attitude, but I think it’s dangerous. When a patient has the decision making taken away from them, they are no longer responsible for the outcome. So when the outcome is adverse (and it will be sometimes, inevitably), then the doctor is at fault. Even if it was always out of the doctor’s hands. And this is a setup for distrust and fear for both sides and probably litigation. If a patient has a true voice in his healthcare, the responsibility for the outcome falls on his shoulders as well. I think this would solve a lot of problems, even if it means more time and investment for both sides.

How does this all come back to the Today Show segment?  The ACOG - through the guise of Peter Alexander - is trying to tell us that self-determination and personal responsibility are bad things.  They are trying to convince us that we want no part of the decision making process.  And they are, unequivocably and entirely, WRONG.

Believe it

I am an opera singer.  I've been singing amateur opera for just over four years now, and began my training back in 2004.  Before I began training, I had been singing folk and contemporary Christian music for years.  I have been told that my voice is lovely, easy to listen to, very enjoyable, and have been asked by professionals if I have perfect pitch.  But every time I open my mouth to sing, I doubt myself.  Every.  single.  time.

Why? Because when I was 21, a 'friend' (note the sarcastic quotation marks) told me that my pitch was usually flat.  At that time, I was singing with a band at a monthly church service for young people.  The thought that my pitch was consistently off and being mic'd, subjecting the entire congregation to bad singing, was totally mortifying.  I was entirely riddled with self-doubt after that day.

It was since then that I began my classical voice training, and and since then that I've had greater and greater successes with my singing.  It was since then that it was suggested that I may have perfect pitch, or at least perfect relative pitch.  But still my 'friend's' words echo in my ears. Your pitch is usually flat.

When I had my first lesson with my vocal coach, I asked her at the end: how do I sound?  She said I sounded nice, and that I should definitely continue pursuing singing.  Then I asked her: So, I'm not flat?  "No", she responded, looking perplexed.  "Why would you think that?"  I told her, "A friend told me I was, once".

"No," she said again, looking horrified. "No.  That's not true.  Don't believe that.  Anyone who tells you that is no friend.  No.  You have a lovely voice.  Just forget you ever heard that.  That's a terrible thing to think.  No."

Why am I telling you about this?  What bearing does it have on, well, anything to do with birth or pregnancy or birth choices or even breastfeeding?  One sentence, spoken by someone whose opinion is of very little weight or value to me, spoken nearly a decade ago, which has since been repeatedly and consistently refuted, continues to haunt and shake me.  I continue to doubt myself.  I continue to doubt my abilities.  If such a small matter can weigh so heavily for so long, how can we then withstand all the noise which tells us that we cannot birth?  How do we arm ourselves against the onslaught of anxiety and pessimism which is so common and so debilitating in our society today?  How do we protect ourselves, our babies, our births, against the voices which would have us believe that we are incapable, that we are reckless, that we are somehow dysfunctional?

I can't honestly say that I know.  I don't know precisely how I was able to withstand those voices, that noise, that fear.  I do know that I believed, without a shadow of a doubt, that I could - and would - birth my baby without intervention or 'help' (again with the sarcastic quotation marks).  Perhaps a belief in one's ability to birth goes deeper than an appreciation for our talents.  Perhaps our ability to birth is so much more primal, so much more fundamental to who we are, not as individuals, but as human beings, as mammals, as creatures, that our belief has more substance than were it merely a personal talent.

My optimism, however, is not universal.  Too often I speak to expectant mothers who say they are going to try for a natural birth, who express doubt, not only in their ability to withstand pain, but in their very ability to actually birth their child.  Too often I hear of women who have been told - and have been convinced - that their pelvis is too small, their uterus too weak, their body too fat, their constitution too fragile.  And how terribly often do I speak to women who have likewise been told and believed that their breasts are too small, too large, their nipples too flat, too inverted, too large, too small, their breasts incapable of producing milk, and that they are unable to breastfeed and should simply not try.

How can we imbue other women with this confidence?  How can we eliminate generations of our undoing?  I try by speaking truth and confidence to the women I meet.  And I write this blog.  All in the hope that it will help.

BirthLove - a truly phenomenal online resource

I was linked to a website, BirthLove, through a Facebook friend. It is an absolutely amazing resource. I haven't yet read everything on there because there is, quite simply, WAY too much on this site to be read in one day while also playing with a toddler, feeding a toddler, dealing with meals... It is a very prolific site.  Amongst their contributors are Gloria Lemay - one of Canada's best known and respected birth attendants - and Marsden Wagner - former director of Women's and Children's Health with the WHO - as well as Gretchen Humphries - I've linked to her site in the 'Resources' sidebar - and Sarah Buckley - a mother and writer from New Zealand.

One article recently really jumped out at me from the site.  It's entitled  Rape of the Twentieth Century.   It is a shockingly honest and brutal portrayal of the sadly-common tragedy of unpleasant hospital births.  The author begins with a description of her five hospital births, each one a broken birth, a birth in which her choices and her body were treated with disregard and disrespect.  She describes how her body and her births were used as teaching tools, rather than treated with honour and sanctity, how unnecessary and unwarranted procedures were performed on her and her unborn children "in the name of science".  It is a harrowing tale.

She goes on to discuss the interventions used in medicalized births and many of their untold risks: the use of episiotomy motivates heavy suctioning to clear the infant's lungs, and poses the possibility of cutting the baby, forceps can disfigure women's genitals, caesarean section increases the likelihood of maternal death by a factor of sixteen.  And as the author writes:

In a cesarean section, a private, secret, and sensual event becomes a sterile crucifixion in a room full of slicing, staring strangers. And the ultimate rape is that we are told we need to be cut. The sanctity and power of birth becomes a meek "yes, doctor" and we become spectators to our own violation; we even thank the doctors as they scurry on their way out of the operating room.

Her description of medicalized birth is unforgiving and cuts deeply, but she writes as one who has had more experience with hospital births than is average.  Five hospital births.  Five births which left her alone and weeping.  Five births in which she felt her body a failure, defective and incapable.

She argues strongly in favour of homebirth and midwifery, not purely because it is so pleasant, it is so simple, but because hospital births truly do pose such a grave risk.  It is a risk not only of undesired intervention or surgery, not only of dissatisfaction, but one of deep and abiding sadness at what has been lost, and of avoidable death.

We are living in strange and savage times. This century will be remembered as one of war and genocide; and violent, coercive childbirth. Birth is weeping, and bleeding. We are made to believe we must give birth in sometimes hostile and mostly indifferent hospitals, where interference with a woman's natural birthing rhythms is the norm. Our vaginas can be stared at and cut by strangers, and abnormal emotional and physical behaviors- such as excessive fear, crying, and stress-induced stoppage of labor- have become normal and expected. Babies are routinely harmed; and the perpetrators are exalted as life savers, instead of reviled as child abusers. A birth without unnecessary intervention is now unusual, even though we all have the potential to birth beautifully- if only left alone.

The numbers support planned homebirthing

If this doesn't bolster the push for a wider acceptance of homebirthing, I'm not sure what will.

The results of a study conducted in BC were recently released (about a week ago; I'm a little late to the plate on this one).  The cases of three groups of women who were considered low-risk were compared: those who had planned hospital births with an obstetrician, those who had planned hospital births with midwives, and those who had planned homebirths with midwives.  The numbers don't lie: perinatal mortality results were the same for homebirths as for hospital births, and homebirths had "reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician."  

What's particularly great about this study is that midwife-assisted hospital births were included in the study, thus eliminating the attendant from the equation.  It cannot be argued that a hospital birth with a midwife is "just as good" as a homebirth.  The fact is: they aren't.  Outcomes are, by and large, better for homebirths.  

Hopefully, the results of this study will help encourage professionals and legislators to support homebirth, and will provide women with some additional ammunition to assist them in convincing reticent spouses that homebirth is a safe and encouraging choice for birth.

The hollow echo of the cave (a post in which my Humanities degree exerts itself)

See human beings as though they were in an underground cave-like dwelling with its entrance, a long one, open to the light across the whole width of the cave.  They are in it from childhood with their legs and necks in bonds so that they are fixed, seeing only in front of them, unable because of the bond to turn their heads all the way around. Their light is from a fire burning far above and behind them...
...Do you suppose such men would have seen anything of themselves and one another other than the shadows cast by the fire on the side of the cave facing them?..
...Then most certainly...such men would hold that the truth is nothing other than the shadows of artificial things.  The Republic of Plato, 514-515c

I recently had a revelation, an epiphany of sorts.  For months, almost years now, I have attempted to explain natural parenting (natural birth including homebirth and midwifery care, breastfeeding, co-sleeping, babywearing, etc.) to more "establishment" parents, and never feeling like any communication was really successful.  It isn't just that we weren't agreeing - this wasn't some argument that was to be won or lost, but just discourse - it was that those who were firmly entrenched in the more established way of doing things seemed to truly not understand what I was saying at all.  It was like we were speaking totally different, unrelated languages.

The other day, it occurred to me: it's Plato's Myth of the Cave.  What I have seen of birth, of parenting, is so entirely different, so entirely foreign, it must be unbelievable.  "How can birth possibly be enjoyable?" I am asked.  How can I not resent my child for still nursing more than a dozen times a day?  How can we not find her continued presence in our bed not intrusive?

And if he once more had to compete with those perpetual prisoners in forming judgments about those shadows while his vision was still dim, before his eyes had recovered, and if the time needed for getting accustomed were not at all short, wouldn't he be the source of laughter, and wouldn't it be said of him that he went up and came back with his eyes corrupted, and that it's not even worth trying to go up?  And if they were somehow able to get their hands on and kill the man who attempts to release and lead up, wouldn't they kill him?  The Republic of Plato, 517a

Sadly, the response is not exclusively one of disbelief, but sometimes violent dislike and offense.  Rather than listening to one another, to hearing the truth behind each other's words, there is attack and defensiveness, on both sides of the debate as, unfortunately, the discourse and discussion has now become.

The truth behind the defense of unnecessarily medicalized birth is often fear.  Fear of the unknown, fear of loss of control.  Fear of our own bodies, our own humanity, even.  The truth behind the attack of the natural birther, the natural parent, may well also be fear: fear of constant criticism, fear of losing our resolve in the face of that criticism, fear of legal action as a result of our choices.

We must - we must - keep yelling into the cave, despite this fear.  Even if what we hear echoing back to us is distorted or unpleasant, we must: after all, there may be people in there looking to escape.

Something interesting is happening in birth: Part II

As I said, something interesting is happening in birth.  That interesting thing is that birth has now, seemingly suddenly, become interesting.

I spend a lot of time on the internet.  A shocking amount of time, actually.  One of the few benefits of having a child who still nurses, oh, at least 15 times a day, is that I certainly have an excuse to sit on my couch and do some surfing (though it does make typing difficult sometimes, hence the several days it's been since my last post).  I read a lot of blogs, and spend a great deal of my time on Facebook looking at birth-related groups and following links posted by other women (thank you, Emma!).  I think it's fair to say that about 75 percent of my time on the internet is in some way birth, pregnancy and parenting related.  Because so much of my time is spent on topic-specific sites, though, I wasn't sure that the trend I was perceiving was actually real, and not just the result of the lens through which I view the media.  That trend is toward a general interest in birth-related topics.

Birth blogs are many.  I just Googled "birth blog" and got 60.5 MILLION hits.  Yes, MILLION.  Well past the first 50 pages of hits, the links are still largely to blogs about birthing, birth stories, or pregnancy and birth blogs.  For women and couples who are pregnant, it's to be expected that the topic might cross their minds.  For those of us who have birthed, who have experienced what birth is like in North America and who didn't like it, it's equally understandable that we'd find such a subject engaging. Likewise, those who are employed in the distressingly-termed "birth industry" would be expected to be interested in the subject of birth (one would hope, at least).  But the topic has always seemed somewhat sidelined to these demographics who are directly affected by the state of birth.  There have been books about birth, classes about birth and cheesily-produced movies about birth, but they were very much separated from the other books (Chapters shelves the pregnancy and birth books in the children's section) the other classes and the other movies (I dare you to go to Blockbuster and ask where their birthing dvds are located.  Go on: it'll be funny!).

Recently, though, there's been a shift.  Major media, news media, have started highlighting stories on birth topics.  Just this week, Fox's Detroit station aired a news feature on Marie Mongan's HypnoBirthing method of birthing.  It's a surprisingly pro-natural-birth story; rather than finding obstetricians to discuss the validity of such a technique, they instead interviewed an instructor as well as two women who have benefited from self-hypnosis.  Last week, Artvoice, a publication out of Buffalo, featured Getting Off Our Backs, an article about the midwifery model of care, homebirth, and how women are changing how they see and experience birth, as a cover story.  Late last month, The Huffington Post featured an article posted by sociologist Louise Marie Roth about the status of women in labour in which she referenced specific instances of births 'gone bad' so-to-speak, where birth choices by women resulted in legal action and the suspension of parental rights.  This wasn't her first post on the state of birth in America.  The New York Times' Home and Garden section online featured a slideshow of images and anecdotes on homebirth back in November 2008.  It's beautiful, it's inspiring, and it's very positive.

At the recent staging of Karen Brody's Birth in Ottawa, I was delighted to see that not every audience member was a woman, and that not all the women were mother's or birth practitioners.  There were single women present who had never given birth, and young couples who were not yet even expecting their first child.  But they were there, and they were interested.  During the Red Tent before the Saturday evening performance, many of us told our birth stories.  I was one of the very last mothers to recount her story, and I was inexpressibly excited to see such interest on the faces of those who had yet no personal encounter with birth.

We could discard this trend.  Who cares?  we could say.  It's a fad. Interests come and go: what difference does it make?  The difference is that with interest comes information.  The more people inform themselves, the more likely they are to demand change, to demand respect, to demand their rights and the rights of their babies.  The more women and men, mothers and fathers, stand up against a system that would have them lay down and lay still, the more likely that change will come, and sooner, too.  No mother or father should ever need to weep while acknowledging that their rights and the dignity of the mother's and baby's body were violated, and not just by one doctor or one hospital, but by an entire system.

I think it's interesting.  I think it's exciting.  It gives me hope.  Just as the world in which I grew up was a far, far different one from that in which my mother grew up - I never had to stage a protest in order to be allowed to wear trousers to school, but she did - I have great hope that my daughter will not have to fight so hard to have positive birth experiences should she choose to have children.  I have hope that her choices, her rights, and the sanctity of her body will be automatically respected and upheld.  I have hope that any births she may have in her future will be positive ones, as empowering and uplifting as any can be.

It can only come with change.  That change has already started.  And that is very, very interesting, indeed.

Who's driving this thing, anyway?

It occurs to me that I haven't introduced myself.  There is some personal history that motivates me to write this blog and advocate to anyone who'll listen - and speak loudly enough that those who choose to disregard me cannot help but overhear - about birth choice.

In May of 2008, I gave birth, vaginally and without pain management or medical intervention, to our daughter, Glynis, after 35 weeks 5 days gestation (or exactly 36 weeks, depending on how you choose to do the math).  We were attended by a midwife and a midwifery student who acted as our doula.  Ours was a hospital birth, and a pediatrician was present because of the pre-term nature of our daughter's birth.  Despite the research, and her APGAR of 9 at birth, Glynis was clamped and cut immediately, and handed to the pediatrician to be taken across the room to where I could barely see her to be poked and examined.  My midwife administered a shot of pitocin to chemically manage the third stage of labour.  I didn't get to hold my baby, my first child, for about an hour after her birth.

My labour was fantastic.  It really was.  I can't say enough good things about how it felt to be swept along on the power of physiological labour.  It was awesome to see how my body could be so strong, so amazing, so powerful.  But the circumstances surrounding the immediately ante-natal period are just not good.  Our choices were ignored, our birth plan disregarded, our consent not obtained, and evidence-based care not administered.

It was months, truly, before I became angry about the circumstances of our daughter's birth.  For 8 weeks following her birth, we fought like hell to establish a successful breastfeeding relationship - and we did succeed, thanks to Dr. Jack Newman's help and support via email and one 7-hour long drive to see him - so I was just happy that my baby was healthy.  But as time and distance allowed me a more objective perspective, I began to realise that what had transpired was not acceptable.  It was not necessary for things to have occurred as they did, and events as they played out may have even exacerbated our trouble with nursing.*

By many perspectives, I had a good birth.  I am "lucky".  I "should be happy".  And, comparatively, I am.  I could have had an ob who tried to pressure me into an unnecessary epidural.  I could have had my child whisked off to the NICU and fed formula and sugar water just because of her dates and birth weight (5.5 lb: pretty good for a 36 weeker, actually) regardless of her actual health.  I didn't, and for that I am, most definitely, glad.  But her birth could have been handled better.  It should have been handled better.

So now I advocate.  I try to educate.  I speak loudly and passionately about birth choice and informed consent and refusal and evidence-based care.  I encourage women to ask questions, to listen to their gut, and to really think about what they want and think is best.

*half-way down the page: “It seemed to me that the babies in which we had delayed cord-clamping were just stronger. They nursed better, they were calmer babies.”

The Trust Birth Initiative

I came across the Trust Birth Initiative in the links sidebar of the Fearless Birth blog. Their manifesto is really something to read. I like everything she says in describing the outlook and ideals of Trust Birth. Is it extreme? Yes. Do I agree, totally and completely? Yes, I do. There is another post to come about the paradox of childbirth in the 21st century, and it relates back to the statements on the Trust Birth site. In short, though, I am extremely enthusiastic about the initiative, and wish there were a meeting nearby (only one in Canada?! Come on people!).

Getting more than you bargained for

If this story doesn't anger and terrify you on multiple levels, I'll be surprised. A woman in Illinois wanted a c-section. She got one, and a sterilization as well. A tubal ligation was never discussed with her ob, never requested, and she certainly never consented to one, but the surgeon sterilized her anyway. I mentioned this story to my husband, and as horrified as he was by it (and he was: as a proponent of personal agency and informed choice, I definitely married the right man!) he suggested that perhaps it was just an error on the surgeon's part. "If he had several sections with tubals scheduled earlier in the day, maybe he just made a mistake." And I agree: it seems entirely possible that this was simply an error on the surgeon's part, possibly the result of becoming so accustomed to all this reproductive surgery that he stopped really thinking about what he was doing. But wouldn't that indicate a more basic problem? Say it with me now: too many unnecessary scheduled ceasareans!! **If you aren't already a fan of The Unnecesarean on Facebook, or have her on your blogroll, I highly suggest you do so: it's just one awesome post after another over there. Shared via AddThis