December 2004 in The Feminist Psychologist
Feminism and Childbirth: Part 2 of 2
by Jill Kuhn
In my last column I discussed the patriarchal control of women as they labor and deliver their babies. Women’s pregnant bodies are under siege, and their options are being severely limited. Below is a partial list of questions and ideas to help pregnant women plan and prepare for a feminist birthing experience.
1. How have you been socialized to think about pregnancy and birth? What messages has popular culture given you about what it means to labor and deliver a baby in our society? What role are women typically expected to play (e.g. active or passive)? Who are your models of birth? Who do you imagine being present at your child’s birth? What hopes and fears do you bring to this experience? Who might be upset or disappointed if you deviate from the social norms? How can your feminist beliefs be applied to this journey? Most of us are socialized to believe that physicians have the answers and will put our needs first. Yet, most are practicing defensive medicine, wish to save time, and are thinking about their bottom line.
2. Who benefits from a particular birth intervention? For example, a common birthing standard is for women to give birth while lying flat on their backs. The lithotomy position very clearly benefits the physician. He or she can sit comfortably on a stool with their “work area” arranged at just the right level. However, women who can utilize gravity and positions that widen the pelvic outlet have faster deliveries and less need for forceps or an episiotomy. Furthermore, women are often convinced that they need to be induced by their “due date.” The very act of induction starts a woman on a slippery slope of interventions that increases the possibility of a C-section. For example, research on the fetal monitor shows that the only thing its use reliably predicts is the incidence of Cesarean delivery. Most of the technologies that obstetricians utilize are more for their convenience or liability than for your safety.
3. Read voraciously. Arming yourself with as much information as possible will help you make the most informed and most empowered decision for you and your baby. Read the mainstream books so you know what information most women are getting and then read alternative sources (e.g. Mothering magazine, Midwifery Today). Read research studies (many are readily available through online searches) on induction, length of labor, ceseareans, episiotomies, electronic fetal monitoring and epidurals. One good place to start is www.maternitywise.org (you can order or download a 2004, research based booklet entitled, “What Every Pregnant Woman Needs to Know About Cesarean Section”).
4. Consider seeing a healthcare provider other than an obstetrician. Physicians are trained to treat disease, yet pregnancy is not an illness in need of a cure. Most midwives see birth as a healthy process and are trained to support a woman and view each individual woman’s birthing process as normal. If you deliver with an obstetrician, there is a good chance you will be coerced into a number of interventions. Interventions, in most cases, will increase the length of your labor and/or increase the likelihood of a Cesearean. If you have a C-section, your recovery will be more difficult, and your future birthing options will be severely limited (e.g. no VBAC). Also be aware that just by delivering in a hospital the likelihood of interventions goes markedly up. Hiring a doula who will lovingly support you, advocate for you, and help you manage pain will significantly reduce the probability of a C-section or of an assisted birth (i.e. forceps or vacuum extraction).
5. Trust your body. With extremely rare exception women can deliver their babies without induction, without an episiotomy, without constant fetal monitoring, and without placing a woman’s labor on a time clock. Babies come out when they are ready. They do not need to be coaxed, cajoled or forced out on an artificial timetable or in an invasive way.
6. Know your rights. You do NOT have to consent to interventions or to a C-section. Hospital staff and physicians will often tell you what to do, but if you know your rights then you can discuss and create a birth plan with your caregiver that best meets your needs. If your caregiver does not wish to answer your questions or is evasive, then it may be time to find someone new.
7. Ask about C-section rates. The World Health Organization recommends a C-section rate of less than 10-15% while the national average in the U.S. is 26.1% and is steadily rising. If you deliver at a facility with a high C-section rate, then there is a good possibility that you will have an unnecessary C-section. Also ask about other rates of intervention and when your healthcare provider chooses to utilize them.
Some of these ideas may seem scary or controversial. Yet, the research consistently supports their validity. Ultimately, you cannot control your labor, but the people you surround yourself with, the place you choose to birth and the information you arm yourself with can help you be prepared for the unknowns. As feminist psychologists, we are in a very unique position to evaluate the research and to empower others and ourselves.
As always, feel free to e-mail me at kuhngale@earthlink.net