on business, emotion, and the sacred

Back before Christmas, I wrote about a meeting that was held wherein consumers, birth advocates and birth workers met to discuss the state of the birthing and midwifery community of Ottawa.  Arguably, we didn't get as much done in that meeting as we had intended.  We didn't do a lot of troubleshooting or brainstorming of ideas as to how to right this situation, or what sort of actions might need to be taken to effect change.  But we did generate a healthy and lengthy discussion of the issues, one which was at times emotional, at times heated (not argumentative, just very passionate) and at times very objective.

That previous post was linked to by a number of people interested in this issue, people who feel strongly about or are connected to birth work in Ottawa.  That post got more hits in the space of three days than the rest of this blog put together.  But apparently it struck a wrong chord with at least one party.  I have since heard that one person felt that it was too "emotionally and personally written" and she refused to forward on the link to other interested people.

I heard about this last night, and I have been bothered ever since.  There are two reasons why, one silly and unimportant and the other far more significant and with wider reaching implications.

The first reason I am bothered is totally personal.  I never intended that post to be an objective news source.  It was merely my reflection on the meeting and my own thoughts inspired by that discussion.  I am by no means an expert in birth work or midwifery care: I am simply a woman, a feminist, and a mother, one who feels strongly about the sanctity of birth, the sanctity of choice, the sanctity of bodily autonomy and individual rights, and who advocates for these things as best I can.  That other people found the post interesting or edifying is flattering and encouraging, but I think also speaks highly of the subject matter and not just the author or the copy itself.

The second and far more significant reason I am bothered is this: birth is emotional.  It is an emotional subject.  I - and many other people like me - feel strongly that birth is supposed to be an emotional topic.  It must be if it is to be the experience we so fiercely believe it ought to be.  But I've been hearing a lot of arguments for an increasingly 'business-like' approach to effecting change within the state of birth.

Consider that term: business-like.  Business.  

Birth should never be a business.  It is an intimate, personal experience.  It is a rite of passage, in so many ways, and it is sacred.  We cannot - must not! - must fight against making the sacred into merely a business. 

We can argue that we must find a way to work within the existing framework, the existing model of care, to effect the change we desire.  Midwifery in Ontario has achieved just that and has become fairly mainstream, and is now entirely covered by Ontario Health Insurance, allowing every mother, regardless of income, to have a midwife-attended birth either in hospital or in a home.  Well done, we can say, and pat ourselves on the back for such an achievement.

But we must also be honest with ourselves.  We must admit that there are some serious flaws with this model, that the midwives and mothers are suffering from this overly business-like model of care, that by fitting that round peg of holistic care into the square hole of allopathic obstetric care, we had to make concessions.  And those concessions, those necessary compromises, are starting to cause problems.

At our last meeting, we who were concerned about the current state of birth in Ottawa were told by someone who has been an advocate for midwifery care for decades that we have "a very fortunate problem".  That we are lucky to be in a position where we can complain about some of the actions taken by some midwives, because 15 years ago, the fight was simply to have midwifery licensed and made legal.  We are lucky, we were told.  At least there are midwives for us to complain about.

And I said, "For now.  But if our midwives are leaving the region, leaving the province, leaving the profession entirely because they are so disheartened, so unhappy, so fed up or just so scared that they cannot practice, then we are still back where you [the midwifery advocates] started; there won't be any midwives for us, or there won't be enough for the number of birthing women who want midwifery care."

I think perhaps the time for compromising is past.  Perhaps it's time to stop playing the obstetric game, and force the establishment to play ours.  After all, these are our bodies, our babies, our births.  Ours, and ours alone.

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.

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.

the power of a four-legged creature

Hello, my blog, how I've missed you!

I wish I could give you a detailed rundown on the sessions at the 2nd International Breech Birth Conference as Rixa did on her blog.  Unfortunately, I wasn't able to attend any of the daytime sessions (one of the drawbacks to a toddler who exclusively breastfeeds is that leaving her for more than a couple of hours ata a time is pretty impossible) so I'll instead direct you here and here to read about the events at the conference.  From what I've read and in speaking to those who attended, it was just awesome and the arguments and evidence in favour of vaginal breech really gave the obstetricians and care providers pause.  One obstetrician, quoted by Rixa, expressed delight and excitement to begin attending hands-and-knees breech births.

While I didn't attend the conference itself, I did have the opportunity to attend the two evening events: Birth, Karen Brody's play, on Thursday evening, and a storytelling session with Ina May Gaskin on Friday evening.  I enjoyed the play, though I think the cast was tighter and more polished when I saw the play at its debut performance back during the original run in August.  It was particularly encouraging to see a greater male presence in the audience.  In August, there had been only a very few men present, whereas the audience at the remount in October was at least a quarter to a third men.

On Friday evening, Ina May spent the majority of her time somewhat focused on breastfeeding as her latest book, Ina May's Guide to Breastfeeding has just been released.  Her thoughts on breastfeeding and breastfeeding culture were very interesting.  There was a lot of laughter, particularly as she related the story of an Amish woman with extremely inverted nipples, and some of the suggestions Ina May made to her for dealing with the issue.  She related that she wasn't sure what limitations Amish principles had on the practices of the bedroom, so she wasn't sure how her suggestion that the expectant mother's husband suck on her nipples would be received.  She mentioned two ideas suggested in an old French textbook on breastfeeding: that an "intelligent" maid be found to suck on the woman's nipples to draw them out, or to find a large puppy (I kid you not) and put the puppy to the breast.  Ina May supposed that, by comparison, having one's husband suck on one's nipples would likely seem pretty tame and acceptable.  She noted in her talk about breastfeeding that four-legged mammals very rarely have difficulty nursing.  Baby creatures, more often than not, are able to nurse immediately after birth and without trouble, and mothers generally fare best when allowed to follow their natural inclinations to nurse.

During the second half of the storytelling session, questions were submitted by the audience. Some were very specific and related to particular issues in birth, such as CPD and VBAC.  One though, was quite thought-provoking.  Ina May was asked, "Of all your accomplishments, which one makes you most proud?"  She considered for a moment, then responded that learning from Guatemalan midwives the practice of rolling a mother onto hands-and-knees to resolve a shoulder dystocia and publicizing this maneuver (it's refered to, officially, as the Gaskin maneuver) makes her extremely proud.  I can only wonder how many infants have been safely birthed because of the judicious use of this maneuver, how many lives saved and how many mothers saved from unnecessary and risky surgery.

In talking about the Gaskin maneuver, Ina May said something which really struck me.  She paused for a moment, looked a little wistful, and said "we just need to make the mother a four-legged creature."  She had mentioned earlier that it took decades of working with mothers and infants before she noticed that newborns can crawl.  They can - even at only 5.5lb, Glynis was able to crawl up my chest for weeks after her birth - but, Ina May noted, only when they are placed face-down.  When we lay a newborn on her back, as is so commonly done immediately after birth, the infant is incapable of crawling or moving.  In laying the baby on her back, we steal her power and her autonomy, however limited it may be in the first moments out of the womb.

It is the same with birthing mothers.  When we lay a mother on her back, we take away her power, her means of autonomy, her control.  The Gaskin maneuver has been studied and found to be extremely effective in relieving shoulder dystocia and allowing the birth to proceed normally.  I read recently a supposition that it may be the act of rolling the mother over her side which helps dislodge the infant's shoulder, and that the final birthing position on hands-and-knees may be immaterial to the ultimate success in the birth.  If there is one thing that birth practitioners simply must appreciate, though, it is that we cannot separate the physiological events in a birth from the psychological ones.

A successful birth requires not only adequate positioning of the infant in utero (adequate, rather than ideal, because babies can and frequently are born in a posterior presentation, though it is far from ideal, just as babies can and are also born breech) but also the confidence and courage of the mother to effect the birth.  We cannot expect women to birth if we tell them they are incapable of doing so.  When we lay a mother on her back and immobilise her legs, even as we tell her "this is the way to birth" we are telling her body and her mind that she is powerless, she is impotent.  But roll her on her hands and knees so that she can sway, she can tilt, she can move, even if only a little, and we give her back her power, her autonomy, her self.  We put HER back in control of her birth.  We allow her the same dignity afforded an elephant, a dog, a horse, a gorilla, and the opportunity for her to find within herself the same strength, the same wisdom each animal mothers possesses.  How, then, can it be any wonder that such a maneuver is so frequently successful?

meta-post: responses to The Today Show's "Perils of Midwifery"

As I wrote last night, Friday's Today Show segment is bad , bad journalism, not only because it shamelessly attacks people, but because it lacks the journalistic integrity of unbiased and balanced reporting and fails to bolster its argument with substantive research (clue: the plural of  "anecdote" is not "data").  NBC will receive hundreds, if not thousands of angry letters, including one from me.  But (to quote Levar Burton) don't just take my word on it:
 

Iridescent tile makes all the difference -  A very impassioned post relating the claptrap so many hospital administrators think we birthing mothers "need" to the name-calling in The Today Show segment.  (Also, having just discovered this woman's blog, I am already a huge fan. She's made of awesome.)

Grassroots Network: Today Show in bed with ACOG - Susan's post is quick and to the point (*cough* unlike my own *cough*) and includes helpful links like this one so that we can email our thoughts on the segment to the people at The Today Show.  I'm sure they'd love to hear from all of us.  Multiple times. :)

Reality Rounds Calls a "Code Bullshit" on The Today Show - a great post from another one of my new favourite blogs (I've got to hand it to The Today Show: thanks to their shoddy, smarmy segment, I have discovered some fabulous blogs!  So, thank you, I guess.)  The comments to this post are particularly awesome, including one from a woman who has spoken with Catherine, the mother featured in the segment.

Physicians Take Anti-Midwife Smear Campaign to the Airwaves: Home Birth Mothers, Celebrities, Insulted on National TV - a pdf of The Big Push for Midwives press release in response to The Today Show's segment.
And last but most definitely not least:
Code Mec! Code Mec! - Rixa of Stand and Deliver calls a Code Mec (because it's icky and leaves a stain) on The Today Show, and delivers an extensive and superb meta-post of her own wherein you will find commentary on the segment and links to other responses.

Found another response to the segment that you think I'd like to read: post a link in the comments!  Written one yourself (perhaps you, too, have a blog?): post a link in the comments!  I am perpetually expanding my blogroll.  There's always room for more, so get in on the fun.

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.

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.

It's not all bad news all the time

Sometimes, we just need to see that good things are happening. That was how I felt today, anyway. Reading about babies in NICUs being given formula, sugar water and pacifiers and kept in little plastic boxes rather than held at their mother's breast and nursed totally ruined my mood. Then I stumbled across a link to Earth Birth. Women in developing countries making a difference, not through drugs and knives and "westernization" but through empowering women, encouraging women and girls and through viewing birth as a means, not only to a baby, but to social change. From their site:

We view childbirth as an act of social change. Safe and peaceful birth experiences are necessary for generations that are to live without war.

We are a community of health care professionals, activists and academics. We stand in solidarity with women who have been victims of war, who have been silenced, abused, or shunned. We move with and support those who have dedicated their lives to peace and justice, to creation in the face of destruction, to fearless resilience.

Powerful stuff, isn't it?

Film: "Birth of a Surgeon"

Just today, I watched this film produced by PBS's Wide Angle. "Birth of a Surgeon" tells the story of one woman, a midwife, in Maputo, Mozambique, and her training to become one of the world's first midwife surgeons. The film is good. It showcases a part of the world many of us in North America fail to consider. Personally, I had little knowledge of the state of affairs in Mozambique or Sub-Saharan Africa at all. The film does well in demonstrating the state of maternal health care in Mozambique, both urban and rural, while also humanizing it. These are not just sad faces in dusty lands: these are people, these are women and children, whose lives are critically affected by the lack of health care. The initiative on which the film focuses is interesting as well. Midwives with little more than very basic education - the woman featured completed only grade 10 - many of whom are illiterate, are training to not only catch babies and deal with simple maternal and infant complications, but to perform ceasarean sections and hysterectomies. Given the lack of education and the minimal resources, this is huge. The initiative was begun in an effort to quell the staggering maternal and infant mortality rate in Mozambique. More than a million women will die every year from complications in childbirth. Ten percent of all infants will die within their first year of life. Hemorrhages due to placenta problems are a very real concern, as surgery is the most certain way to stem the bleeding and save both mother and child, and there simply are not enough doctors to save those lives. But here is my concern with this initiative. Several of the mother's whose deliveries are featured in the film have had multiple ceasareans before the deliveries filmed. The doctors and nurses and midwives express concern for these mothers, stating that they are concerned that their uterus may rupture. The only safe option is to forgo a natural labour and deliver surgically. When these surgeries are filmed, the cause for their concern becomes obvious: the scars from previous sections, and the new incision filmed are all classical, vertical incisions. Rather than using the newer, safer, low transverse incision which does not render the uterus far weaker after it is healed, they have been trained to use a technique which greatly increases the risk of rupture for every future pregnancy. I think what Mozambique is trying to do - save women and children by elevating midwives to a position of greater power and ability - is admirable. I do, however, think it could be done better. The fact is, surgery is risky in even the most developed country, in even the most sterile environment. In the developing world, in an environment where surgical gloves must be washed and reused, and where electricity is unreliable (both are issues presented in the film) surgery is far, far riskier. The fact is, better healthcare pre-pregnancy, better education and better nutrition would likely go farther to save more women's lives, and more women's fertility. Hopefully, Mozambique is making that a concern as well.

Something interesting is happening in birth: Part I

Yesterday evening, I attended a performance of the play “Birth” by Karen Brody. The play was staged by Three Sisters, a company of professional actresses in Ottawa, and was staged in order to raise funds and awareness for the Coalition for Breech Birth. The Coalition was founded by consumers, women who had had their births stolen from them by a system which refuses to admit the reality of breech birth, a system which fails to instruct its physicians in catching breech babies, and allows those physicians to coerce mothers into unwanted, unconsented and unnecessary caesarian sections.

The play is beautiful. It tells the story of 10 women's births with their first (and in one case, second, third and fourth) children. There are stories of joy: a woman chanting a mantra as she births squating, supported by her husband and her doula, believing and trusting her body; a woman kneeling in a pool in her home, her three children beside her, cheering her through her labour. But there are many, many stories of sorrow. Women coerced into deviating from their birth plan, into denying the needs of their own body. Women treated with disregard and disrespect while pregnant and while labouring. Women assaulted while birthing: cut, without need or consent, while bringing her child into the world.

It's extremely difficult to watch, even when staged in a minimalist, Vagina Monologues-style format. An actress, mimicking birth, telling the true story of a true woman's birth, screaming, not only in pain but in terror, in sorrow, in rage, at the realization that, just as she reached between her legs to feel her daughter's head being born, her doctor, her practitioner, was slicing through her perineum. Watching it, it was not just unethical, and not just assault: it was rape.
 
This is happening. This happens far more often than we'd like – and than any physician would ever dare – to admit. This is one of the realities of birth in North America. Women experiencing the trauma of rape during their births.

What do we do? Me: I'm getting mad. I'm getting really, really mad. I'm getting vocal. I'm pissing people off. I'm happily making an obnoxious ass out of myself. But here's one of the problems: too often, when we start talking about birth choices, and making options truly available to women, those who've chosen non-traditional births (I'm using the word traditional in the, well, traditional sense, to mean the sort of births that women have been having since the dawn of Creation) and gone a more medical route, become defensive. Arguments start being made about the importance of medical intervention, the value of pain-managing medications, the reassuring availability of caesarian sections.

I struggle to express to people that my issue is not with their personal choices – after all, those choices should be theirs and theirs alone – but with the fact that for many, many women, their choices are not their own: they belong to a nurse, a doctor, a midwife. But not to the labouring parents.

I'm not fighting other mothers to make decisions the way I would make them: I am fighting a system that is telling mothers, all mothers, what decisions to make about their bodies, their babies, their births. I am not in the practice of fighting mothers. I am fighting the medical establishment. I am fighting social norms. But I am not fighting the mother in front of me.

For far, far too many people, birth continues to be viewed as a black and white issue. You're either all-natural, crunchy-granola, kum-ba-ya and western medicine is the work of Satan, or you're not. And so many of the people – men and women – seem to assume that we who are natural-birthers, who are birth activists or working with birthing women, see things that way, too.

I don't. Western medicine has saved countless women and children from certain death. This is a fact. Surgery has literally saved the lives of mothers and babies I've known. And thank God for it. Thank God that J, our prenatal instructor, and her son were saved when she suffered a placental abruption with her first birth. But thank God, as well, that she was able to go on to have two midwife-attended homebirths after that. I

t isn't so simple as saying “old is bad: new is good”. It's equally not so simple as saying the reverse. There is a place for life-saving medicine in birth. But let it be life-saving. Let's not let it be time-saving or pride-saving. Let's not let it be about the doctors. Let's let the reasons for intervening in a birth be good ones, important ones, lives-hanging-in-the-balance ones. Let's not let it be about dates or estimated weights or breech presentation. Let's let it be about need.

So I will continue to tell people about birth. I will continue to cull statistics and research results and store them away in my mind for those conversations with sceptics and the uninformed where there is the possibility of educating one. More. Person.

And maybe, someday we won't have to. Maybe, just maybe, someday...everyone will already know. Originally posted on knit me a new one