Thursday, January 5, 2012

The Misogyny of Childbirth and Motherhood

There is nothing that is more in the female domain than childbirth and motherhood, and over the last few years, I have come to the conclusion that there is also nothing that is more of a hotbed of unadulterated mysogyny than the discourse on childbirth and motherhood.
And much of the hate is levelled at women, by other women - most of whom are claiming to be feminists while they seek to disenfranchise other women who don't happen to share their same views or wouldn't happen to make the same choices.

The women who trailblazed the freedoms that today we take for granted, would hang their heads in shame and disgust at the current situation. They fought so women could choose to meaningfully and fully participate in society. They fought so that women could be autonomous individuals - who are empowered with the right to free choice.

Would a real 'feminist' sink so low as to outrightly disparage another woman for freely making a decision that is different from her own? Would a real 'feminist' disparage another woman who is working to provide unbiased information that allows other women to make informed decisions? Would a real 'feminist' willfully keep information from other women, to manipulate the choices made by other women? Would a real 'feminist' hold dear to an ideology and continue to repeat its myths, long after it has been debunked? Would a real 'feminist' reduce a woman down to a bodily function and place process ahead of outcomes?

A person who would disenfranchise and disempower other women from freely making informed mothering and childbirth choices is not a feminist, never has been and never will be. That person is a misogynist in the purest sense of the word.

Its sad - that motherhood and childbirth is a bastion of mysogyny, when it should be the first frontier of true feminism.

25 comments:

  1. Love this. Love this, love this, love this.

    Posting it on my FB page. Thanks for saying what needed to be said.

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  2. This is absolutely wonderful. I can't agree more. So perfectly said!

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  3. So well said! So well said! WOW - I wish I suggest every woman read this. Well done.

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  4. When I first became a mommy, it surprised me how much judgement there was out there with how a woman chose what she felt was best for her baby. This is a must read article for any mommy to be/or mother.

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  5. I can't tell you how much this needs to be circulated among every mommy blog, support organization, and facebook page. It needs to be handed out by every midwife, doctor, nurse, and health care professional to anyone even thinking about having a child. What a breath of fresh air! Thank you so much for posting it.

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  6. Autonomy and sovereignty over one's own body should be the hallmark of genuine feminism. Having total say and total control over all the traffic in and out of your vagina, over the who and how and where of that. Free access to information, including the full and unabridged menu of birthing choices, including alternatives not sanctioned by the dominant model, must be part of that. Equal access to all models of care, and those models of care being equally funded, staffed, resourced and supported, is vital for women to have rights and autonomy in their childbearing lives. Childbirth and motherhood is a facet of life where the potential for a woman to grow in confidence and personal power is present. Yet despite this, childbearing, which can be one of the most exhilarating and positive experiences in a woman's life, has at times been twisted throughout history and across cultures, and used as a tool of oppression. Keeping her pregnant and exhausted and run-down from multiple pregnancies and births in order to keep her easy to oppress and easy to control - she's too exhausted and overwhelmed to resist. Letting childbirth be traumatic or with-holding help and loving support in order to make childbirth more stressful, painful and traumatic than it needs to be. Dis-allowing women to experience the process of labour and birth by convincing them that their bodily functions are defective, and short-changing them out of what could be one of the most significant experiences of life. Sounds sick, but this is the kind of misogyny childbearing women face, even in current times, and even in our culture.

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  7. Real empowerment means CHOICE. Even when women do face very challenging experiences during childbirth, if they are treated with patience and respect, and given access to honest information about their choices (ALL of them, not just the ones financially lucrative for the institution or those sanctioned by that particular model of care or that particular ideology), she can come through the experience feeling empowered and feeling that she was heard, listened to, respected and supported. This can be seen most clearly when a woman's birth experience crosses the models of care. My 38 yr old friend was being pressured to have an induction when she was 42 weeks pregnant. She refused. The obstetrician repeatedly rang her, trying to pressure her, and even tried to get her husband to persuade her to comply. He did not give her information on expectant management. The obstetrician terminated her care, so she hired an independent midwife and the next day, went into labour and gave birth safely at home after a 3 hour labour. Options weren't presented to this woman, but she went out and found them and accessed them anyhow. Another friend planned a homebirth. During the labour, the decision was made to transfer because they weren't seeing the progress they expected. In the hospital, she was seen by an older and wise obstetrician. He explained her options to her and was honest. He said, nothing we do is risk - free. After weighing her options, she decided not to go straight to c/s, and the epidural-pitocin route was tried. It was successful and the baby was born with the help of ventouse. It was a very challenging, difficult labour for this first time mother. But having continuity of care, emotional support and honest information about her options and the pros and cons of various course of action (such as wait longer/intervene) meant that after it was all over, this mother still felt that the experience was overall a positive one. Seamless transfer between the obstetric model of care and the midwifery model of care, with the pros and cons and strengths and weaknesses of both models, must be part of reasonable and fair care for women. To demonise either model further restricts women's choices and women's rights. It is not good enough to say, "I like hospital birth so all women should give birth in hospitals" or "I like homebirth so all women should have homebirths." Any government or community interested in the rights of women and in upholding the true tenets of feminism must make both models of care equally available and must equally fund both. Any failure to do so is a failure of feminism and a failure of women's rights.

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  8. A 60% c/s rate in Asia and an 80% c/s rate in Brazil is indicative that this is not being delivered in those places. A 100% episiotomy rate (of those who birth vaginally)in Saudi Arabia likewise is not delivering this. The experience of the vast majority of women worldwide when they are in labour is that they will walk into an institution and will lie down on a bed. Less than 1% of the female population worldwide will find any alternative to this. It is true that sadly, "motherhood and childbirth is a bastion of misogyny, when it should be the first frontier of true feminism." Feminism in childbearing means choice, and equal access to alternatives. It means not blocking, witch-hunting, reviling, marginalising and abolishing models of care in maternity that you don't approve of, or don't understand, or don't personally prefer. It means that maternity care is not based on what is most profitable or lucrative. It means thee must be no hierarchy, where one profession dictates how another profession should practice. It means options for VBAC, instead of RCS being the only easily available, or supported, or approved of, option. It means easy access to elective c/s. At the other end of the choice spectrum, it means back-up and support for those who choose unassisted childbirth (even if we don't think it's safe - all options have risks and none are risk-free). It means a woman in the obstetric model can easily change her model of care and access midwifery-style care should she choose it or need it. It means a woman who has chosen midwifery care can easily change to obstetric management should she choose or need it. It means seamless transfer, without censure, for homebirth women, and professional support for homebirth midwives. It means epidurals on demand, but also that accessing freedom to mobilise, access to deep water and declining CEFM and vaginal exams are as easy a choice to access as epidurals, IOLs and pharmaceutical pain relief (in other words the choices that do not generate profit must be just as accessible as choices that do generate profit.)Informed choice and equal access to alternatives is where it's at when it comes to true feminism in birthing, and informed choice does not mean "only the choices I approve of and believe in, because your choices are based on de-bunked myths. You are only allowed what I would choose for myself." This is true: "A person who would disenfranchise and disempower other women from freely making informed mothering and childbirth choices is not a feminist, never has been and never will be. That person is a misogynist in the purest sense of the word."

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  9. Anonymous, I agree with much of what you have said. Choice (informed choice with credible educational sources) is essential to maternity care that follows a feminist model which respects the autonomy of women. One point: A medical professional has every right to terminate care with a patient/client who is acting AMA (against medical advice). You haven't said otherwise, but I wanted to clarify that point.

    I love Mrs. W's perspective on choice specifically regarding CDMR, which should be an option to every woman unless medically contraindicated!

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  10. I was pregnant with my daughter towards the end of my medical training (I delivered two months after graduation) and I was talking about the consideration (or lack thereof) that my school had towards pregnant students (we're talking professional students in their mid to late twenties). My female friend told me that women like me (pregnant in school/working) make other women look bad because we expect special treatment. It made me so sad.

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  11. Brazil... The overall c-section rate is 45%. Not 80%.

    Around 1/4 of women in Brazil deliver in private sector hospitals, where the c-section rate can be as high as 70-90%. And about 3/4 of women deliver in public sector hospitals, where the rate is between 20-45%. Women who get c-sections in Brazil are significantly more likely to be well-educated and have higher incomes. C-section rates also vary considerably by region.

    Sources include:

    http://www.sciencedirect.com/science/article/pii/S0140673611601384 (2011)

    http://www.scielosp.org/scielo.php?pid=S0034-89102011000400001&script=sci_arttext&tlng=pt (2011)

    http://onlinelibrary.wiley.com/doi/10.3109/00016349.2010.484044/full (2010)

    http://www.scielo.br/scielo.php?pid=S0034-89102010000100009&script=sci_arttext&tlng=pt (2010)

    http://www.scielo.br/scielo.php?pid=S0102-311X2008001200020&script=sci_arttext (2008)

    http://onlinelibrary.wiley.com/doi/10.1111/j.1523-536X.2007.00209.x/full (2008)

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  12. Asia... the overall c-section rate is around 27%. Not 60%.

    Source:

    http://www.who.int/reproductivehealth/topics/best_practices/GS_in_Asia.pdf (2010)

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  13. Rebecca - thanks for the helpful info.

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  14. http://www.slate.com/articles/double_x/doublex/2012/01/cesarean_nation_why_do_nearly_half_of_chinese_women_deliver_babies_via_c_section_.single.html#pagebreak_anchor_2

    another article gave the c/s rate in Viet Nam as 60%

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  15. http://melaniezoltan.suite101.com/c-section-rate-in-brazil-36-of-births-a172360
    36% c/s rate in Brazil; 90% c/s rate in some facilities.

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  16. 40% c/s rate in Chile
    42% c/s rate in Paraguay
    5% c/s rate in Bolivia

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    1. More recent percentages:
      Bolivia was one of four countries identified by the University of Washingtone in 2010 to have made the most progress regarding the United Nations Millennium Goals of a 75% reduction in perinatal and maternal mortality. China, Equador, and Egypt were the other three. Their rates:
      China: public: 46%: private: 90%
      Ecuador: public: 40.3%
      Egypt: public: 27.6% private: 41.7%

      M Murphy
      Bolivia: public: 15.8% A huge increase from a very low base of 4.9%.

      NOTE: These four countries, with some of the highest rates (or in Bolivia's case a huge increase), were identified as the four countries where mortality rates had fallen the most percentage wise. BUT - they were still criticized for having the cesarean increase. The hypocrisy is simply breathtaking.

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  17. http://www.msnbc.msn.com/id/34826186/ns/health-pregnancy/t/c-section-rates-around-globe-epidemic-levels/
    China - 46%
    Viet Nam - 36%
    Thailand - 34%

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  18. I would like to add: Juno, having read your story, I am outraged at the way you were treated. There is no excuse for what you went through. I am appalled that the 'at least you have a healthy baby' card was trotted out to you. CS by maternal demand must surely be on the menu as any other choice. CAVB and VBAC must be EQUALLY available and accessible. I have seen the pain first hand of women hoping for a normal birth being screwed over by the system, not even being allowed to get off the bed - let along do anything, or decline anything, that could possibly support the progress of labour. I have seen the highest rates of birth trauma (physical damage as well as emotional pain) in obstetrically-managed vaginal birth. I have known women who have gone for c/s to avoid a repeat of that and women, hurt in exactly the same way, going for HBAC to avoid a repeat of that - and a few women who've tried both routes. (traumatic vaginal birth, then ECS, then HBAC). I myself was an obstetric nursing student and after seeing the patronising and humiliating treatment of women in the hospitals where I trained, I decided on homebirth as a way to dodge a system that I saw as misogynistic, and a way to keep myself and my babies safe. So I had 4 homebirths and have supported scores of other women in this particular choice. (I have also supported women who've chosen ECS, or have needed CS for clinical reasons. Unfortunately I've also been there when women hoping for a physiological vaginal birth have been coerced into CS, just as you were hoping for/expecting/planning a CS and were coerced into a VB - so wrong! I'm so sorry.) So we are coming from slightly different perspectives but we share a lot of common ground. I would not choose ECS, you perhaps would not choose HB - but I staunchly defend your right to choose ECS and CAVB and I would expect that likewise you would support my right to choose HB and other women's right to choose VBAC & HBAC. The patriarchy & misogyny that restricts these choices and paternalistically presumes to tell us what's good for us, is our common foe.

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  19. I have met too many women who've been ripped off and ripped up by the same shitty, patriarchal institutionalised system that screwed you over: a system that does not respect women's autonomy, women's bodies and women's voices. This is responsible for your birth trauma when you wanted surgery and got coerced into an unwanted VB - and the birth trauma of women who wanted natural and got obstetric. I feel your pain. I've met too many women, who just like you, are seeking ways to escape a misogynistic system that does not look after women on their own terms.
    I've noticed that lack of choice, restricted access, not being listened to, being disempowered through control and choice being taken away and being *told* what's good for you, as well as deception, half-truths, trickery, intimidation, threats, coercion & bullying of any kind - basically any dynamic where the birthing woman's voice is not HEARD, acknowledged and respected, and her ability to research and choose your course herself acknowledged, are common to many stories of birth trauma. One of my clients was calling for a c/s. She *knew* in her body that it was needed. The OB told her, "There'll be no c/s tonight." They let her suffer all night until she was exhausted, then bright and early on Mondyay morning, they changed their tune and now they couldn't section her fast enough - and by this time she was ready to push! It was never about her needs, her wants and it certainly was never her call. The epidural did not work and did not *listen* to her as she told them she could feel everything. Finally she was knocked out with a GA - which she experienced as extremely scary. The c/s was done - but only a schedule that suited the hospital. if only they had been honest with her and said, look we know you want a c/s and agree with you that it is a valid call - but the surgeon who is best at c/s will not be here until tomorrow morning. So, we'll do our best to help you be comfortable until then. Seriously, would some honesty and transparency hurt?(This mama did have the VBAC she hoped for next time.) Birth services can only do their best for women with the resources they have at their disposal - but honesty is always available. And women deserve to be treated as sentient beings who are able to do their own research, make their own informed decisions, and have the right to make decisions about their own bodies and babies. To everyone out there who has not been respected and treated fairly and considerately in this most basic and significant way, you have my sympathy - and my apologies on behalf of birthing services (of all models).

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  20. Anonymous -thank-you for your comments. It's sad women are forced to make desperate choices to accommodate real needs. There is such room for improvement in this area of care - across the spectrum.

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  21. That is so true, Mrs. W
    This just about broke my heart:
    http://www.youtube.com/watch?v=uTOffUVOlVo
    No wonder the c/s rate is so high in Latin America. If this, or a c/s is all I had to choose between, I'd UC in a heartbeat. (I have only attended a dozen or so planned UC births, and they were all truly lovely.) The thing that really grieves me is that just about everything that was done to this mother and baby (and millions like them) is supposedly "evidence-based". What passes for "evidence-based" in obstetrics is not necessarily going to be supportive of feminism & women's rights, or conducive to women's safety and well-being, babies' safety and well-being, and clinical safety. It took decades before "research" was finally produced to support women being allowed to get off the bed and mobilise during labour! Many women the world over STILL aren't "allowed" to do that. I don't think birthing women, or women in general, have a heck of a lot of say, sway or influence about which studies get approval or funding, and which get "published". And everything that does not get this approval is dismissed as being 'not scientific', or 'anectodal' or 'old wives' tales'.

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  22. When researchers reviewed 717 guidelines decreed by the American College of Obstetricians and Gynecologists, they found that only 30 percent were based on randomized controlled trials. Thirty-eight percent were based on weak observational studies, and 32 percent were pure opinion. 70 percent of standard OB/GYN treatment guidelines — guidelines for major life-changing decisions that affect millions of women — are based on little to no science at all. This is no good enough. And I question the influences behind that which does get passed and published. I don't believe there is no bias. I don't accept that the voice of the consumers - birthing women - is invalid when it comes to determining treatment protocols. Most consumers of maternity services the world over do not have a formal de-brief and feedback about their experience is not routinely sought or offered, let alone collected, collated, analyzed and used to (partly at least) determine obstetric policy. In most of capitalism, market research and feedback from customers is vital to the success of the business. The fact that this rarely occurs in maternity services, if at all, is indicative of an attitude of low regard and low value of the consumers of these services: women. If you're making money off of them, then their perspective, their voice, their feelings COUNT. The only place I know of that offers a Birth Review and hands out a feedback document that mothers can use to direct feedback to their care providers is in New Zealand (and I am not sure how uniform or wide-spread the practice is.)Perhaps part of the reason there are so many blogs and websites for women seeking to obtain and access better maternity services, and needing to de-brief after traumatic and disappointing experiences, is because there is no way for them to do this via official routes; feedback and de-briefing with one's care provider is not common practice, and the voice of the consumers is therefore not being heard, validated or valued in the setting of obstetric policy. I have known many independent midwives who do a birth de-brief session with their clients but I don't know if all do - and I don't know of a single institution that offers this service as a standard part of birth care. But I believe it is a vital aspect of appropriate birth care. (And no, I don't have evidence to back that up, so I guess my opinion is invalid.) I think that continuity of care with a self-chosen care provider (from the woman's chosen model of care), and a good rapport with that chosen cp, is conducive to a better birth experience, and conducive to better clinical safety and wholistic well-being, for mother and baby. But even though I believe that the relational aspect is preferred by many women, perhaps even most, it is still no guarantee that birth trauma won't/can't happen, because even an ideal mutual-trust rapport between woman and cp, based on mutual consulation and equality, still involves two imperfect human beings and problems can happen. However, I do believe that THE CHOICE to access continuity of care should be on offer for those women who actually DO want it, and to deprive the entire community of this option because *some* women may not want or prefer it, is not reasonable. So two things that I believe have the potential to further women's right in birthing services: the right to a de-brief and a means to give feedback to one's CP, and the choice of continuity of care with a self-chosen CP for those who which to access relationship-based maternity care.

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  23. Wonderful! I've been checking out your site today and love what I'm reading. This was so wonderfully stated.

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  24. "Seamless transfer between the obstetric model of care and the midwifery model of care, with the pros and cons and strengths and weaknesses of both models, must be part of reasonable and fair care for women."

    AWESOME POINTS

    ...and don't some places have seamless *overlap* between obstetrics and midwifery? I heard that in the UK the Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecology (RCOG) do a lot of stuff together.

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