Industrialised childbirth - for those of you who are pregnant, taking control

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http://www.adbusters.org/magazine/80/industrial_childbirth.html

Essay

Industrial Childbirth

" Revisiting my son's birth has made me angry. "

Shonagh Strachan | 15 Oct 2008 | -------------------------------------

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My experience of childbirth was not an unusually traumatic one. In

medical parlance I had an NVD: a Normal Vaginal Delivery. The

midwives were pleasant. I was given an epidural. I was admitted to

hospital at 2pm and delivered a healthy baby boy ( 8lb 7oz ) eleven

hours later. This is the essential information, is it not? This is

the only kind of information that we ever really hear about other

women's experiences with childbirth.

But there is more to it than that. It took me a while to sort out my

feelings after the birth – the elation you feel at the presence of a

new life combined with your physical exhaustion leave room for little

else. And I never really experienced the hopeless grief of the

flippantly named " baby blues " in the weeks or months that followed.

What I felt – when I was finally able to identify the reasons for my

confusion – was anger.

Is anger only blame and self-pity? Or can it be illuminating? For me

it can – anger has traveled beyond blame, beyond the individuals

involved and my personal experience, and shocked me into changing my

whole outlook on life.

I wasn't angry during my pregnancy at the lack of options for

childbirth. I never knew what else I could expect. I wasn't angry

during any stage of my labor. As soon as I was admitted, I was told

that I was two centimeters dilated and my waters were to be broken

with something resembling a crochet hook. " Okay. " After that I

wandered the halls and breathed through contractions for a few hours.

When I was re-examined, I hadn't " progressed " enough. I was told this

was dangerous for the baby, and I needed an Oxytocin drip to speed up

and strengthen the contractions. " Okay. " Now, these heightened

contractions would be very painful so I'd probably be requiring pain-

relief. " Okay. " The epidural is probably the most effective " Okay. "

I gritted my teeth but I wasn't angry as the drip was repeatedly and

painfully inserted incorrectly into my hand, or as the epidural took

20 minutes to stick into my spine. I wasn't angry that I wasn't

allowed to eat anything even though I was very hungry. And I wasn't

angry that my parents weren't allowed to see me in the delivery ward

after driving for hours to be there.

As I watched the clock pass midnight into Halloween, fireworks

cracked and flared outside the hospital. I smiled knowing that my

baby would have great birthday parties to come. And for this next

hour, I shivered in freezing shock, immobilized on the delivery

table, uncaring and unangered as the drugs wore off so I could

finally push. I wasn't angry because the hospital staff was just

doing their jobs and it seemed so normal for them. I was moving

towards having my baby and this is what every mother went through.

The point at which I started to feel a twinge of anger was when,

after the delivery, I wasn't allowed to feed my baby. It was only

then that my instinct was strong enough to say, " No. This is really

wrong. " There is a period of about an hour after the birth where the

newborn is alert and breastfeeding can be established. However, after

a brief hold, he was taken away as I was given a Syntometrine

injection and his placenta was delivered (by tugging on the cord). He

remained away as I was stitched and examined and had to wait for a

doctor to examine me.

By the time I was given the all clear (in tears at this point

asking, " Can I feed him now? " ), I had to be moved from the delivery

ward and down to the post-natal ward. It was now 2 am, so friends and

family in the waiting room were told to go home without ever having

seen the baby or me. The baby's dad had been present at the birth but

was also sent home. Yet again I asked, " Please, can I try to feed my

baby? " but he had to be taken away again – this time for a Vitamin K

injection and for the nurse to bathe him and put his first vest and

Baby Gro on.

When she brought him back he was tired and wanted to sleep. The nurse

asked if I still wanted to feed and gave a little perfunctory hold of

him up to one breast and then the other and said, incredibly, " No.

He's not a boob man is he? " She then put him down to sleep in the cot

beside me, told me to sleep too and that I could try again when he

woke up. I spent that first night wide awake, watching every twitch

my new son made, desperate to hold him, horrified that I hadn't

managed to take him to my breast after he was born.

When he finally did wake up, I remember ringing for the nurse –

looking for her permission to pick him up! This same nurse was the

one who would throw back the curtains from around the beds at night

if anyone dared to wish for some privacy.

Thankfully, my baby started to feed hungrily the next day. The rest

of my stay in hospital was a blur of no sleep, noise, crying babies,

feeding times, masses of visitors for two hours and then being left

completely on my own. On the second day I remember being allowed to

meet my teary mom at the end of the corridor as she passed me some

supplies. Later that day I finally managed to have the baby fed and

sleepy at a time when there was a lull in hospital activity. I was

just dropping off – for the first time in about 70 hours – when I was

woken up to bring the baby in for a BCG injection. I did so in floods

of exhausted tears.

I gave birth to my son at the Holles Street National Maternity

Hospital, in Dublin. Obstetricians at Holles Street have pioneered a

policy of " active management " – an obstetrician-led intervention

process that speeds up hospital labor. It begins with ARM –

artificial rupture of the membrane of the amniotic sac or " breaking

the waters " – though this may leave the fetus unprotected and

vulnerable to pressure and infection. It continues with monitoring

the birthing women and administering to them if they aren't

progressing " correctly. " In Holles Street, for example, the decided-

upon correct rate of cervical dilation is 1cm/hour. If the

mother " fails to progress " at this rate, she is hooked up to an

Oxytocin drip which causes the onset of sudden intense contractions.

In 2004 (the year I gave birth), 55 percent of first-time mothers at

Holles Street were told they had " failed to progress " and needed to

be sped up in this way (unsurprisingly, a slightly larger percentage

opted for an epidural to ease the pain). Active management is

currently used widely throughout the world.

The most oft-stated defense for the prevalence of today's medicalized

births is that in pre-hospital years gone by, childbirth could be a

death sentence. The reality, though, is that most complications

during pregnancy and childbirth occurred due to poor maternal

nutrition and infections that are now easily treatable or preventable

with better hygiene. The high-tech medical interventions available

today certainly save some lives but in many cases – especially where

active management is practiced – these interventions are often used

unnecessarily.

There is also an often noted " cascade of intervention " where once one

medical procedure has been carried out, another follows, and then

another – leading to more invasive and traumatic interventions and

often culminating in a caesarean section. In Ireland, the average

rate of C-section is one of the highest in Europe at 25 percent. The

midwife-endorsed alternative to this policy of aggressive

intervention is " wait and see. " Strangely enough, this usually works

out just fine.

In theory, a woman has the right to refuse any of the interventions

offered to her. In practice, the normality of intervention and the

culture of risk minimization (read: liability minimization) mean that

women do not feel empowered to say " no. " I certainly never thought

about saying " no " or asking what the alternatives were. I blame

myself for this – that I was not more informed and proactive. But I

am also angry at the bullying system in place. It is hurried and

overwhelming so there is never time or space to question

the " professional " medical opinion as to what is really right for you

and your baby. So we become numbers, subject to routine

interventions.

At Holles Street membrane rupture is carried out routinely.

A " managed " third stage of labor is also routinely administered –

with hormone injections and cord tugging to deliver the placenta.

This is justified by saying that it reduces the risk of postpartum

hemorrhage – a fact disputed by many midwives who argue that the

early cord clamping involved is potentially injurious for the newborn

and that the third stage of a normal birth should never be managed.

Until recently, episiotomy (cutting the perineum to allow more room

for the baby) was routine. It is now being shown to be usually

unnecessary and at worst a mutilation. Until recently, if a woman had

one caesarean section, she could not expect to be allowed to try for

a vaginal delivery in subsequent births (this is now slowly

changing). At Our Lady of Lourdes hospital in Drogheda, Dr.

Neary carried out unnecessary routine hysterectomies, post-caesarean-

section, over the course of 25 years before it was brought to light

in 1998. At the same hospital (and at Holles Street, the Coombe and

others around the country) between the 1950s and the 1980s, hundreds

of women underwent a procedure known as a symphysiotomy. Here, a

woman's pelvis was literally sawn apart during childbirth, as an

alternative to a cesarean-section. The justification seemed to be a

good catholic one – the pelvis would heal widened and the woman would

be able to bear more children – even though most were never even told

what procedure had been carried out on them and many suffered life-

long pain, incontinence, problems walking and arthritis. This is the

history of routine interventions by those who know what's best for

us.

Our collective idea of childbirth is pretty nasty – blood and fluid,

panting and screaming, stretched anatomy, the emergent gooey greyish-

purple alien… horrible! Remember when you first heard about sex?

Remember how horrible that seemed? But sex isn't horrible, is it?

What's missing – and indescribable to a virgin child – is the

emotional element. Sex is a natural and beautiful process, all

entangled with love and passion. So too, and a million times more, is

birth. In essence, our modern patriarchal institutionalized world has

a childish view of childbirth. It can't imagine that something that

looks so gruesome could be anything but a horrendous experience and

one that should be shortened and medicated. But childbirth is not a

medical procedure any more than sex is.

Now, I'm not saying that every woman should have a pain-free,

blissful, complication-free birth. I am saying that fear has no place

in the process. Fear causes adrenaline production. This initiates

the " flight or fight " response where blood drains from the uterus to

the limbs, slowing the process of labor until the primeval woman

escapes to a safe place to give birth. Meditation and relaxation

techniques during childbirth – which are often described to women as

methods for coping with pain – can in fact be methods of preventing

pain by preventing fear. As with sexual intercourse, if a woman does

not feel safe, relaxed and preferably loved, she will experience

tension and pain during childbirth.

Without ever taking a single deep breath or doing a second's

meditation, what woman wouldn't feel more relaxed anywhere but on a

table in a hospital delivery " suite " ? Looking back on it, it seems

like the most ridiculous place to try to give birth. As with sex,

your body wants a darkened, intimate, safe and private place to give

itself over to its natural urges and processes. Instead, we retain

bizarre postures under the bright lights and the ready interference

and stares of strangers. Could you orgasm under the same conditions?

Are you surprised then that our labors " fail to progress, " with fear

and adrenaline coursing through every vein in our bodies? Overcome it

with drugs. Pull, drag and cut those children out of us. Then tell us

to be thankful. Mothers, partners, sisters and doctors tell us we are

endangering lives, we are taking risks. Fill us with fear. No woman

wants to endanger her child's life so almost every woman does what

she's told and gets hospitalized.

Is it shocking to hear that many women liken the experience

of " normal " hospital childbirth to being sexually assaulted? Aside

from the obvious – the exposure of your most intimate areas to

complete strangers – there is an utter lack of control over what is

being done to your body. Your consent may never be sought for certain

procedures – or it may be sought in the coercive manner of

institutions that count on your fear for your cooperation. The

feelings that may be experienced afterwards are those of shame and

guilt that you weren't able to give birth naturally, that you didn't

ask the right questions, that you gave up control and weren't strong

enough to resist certain things being done. These feelings can be

particularly strong if the mother is separated from her newborn – for

example, after an emergency C-section or if a baby is incubated. In

some of these cases, mothers can experience bonding problems with the

infant. Even once bonding is achieved, the guilt that accompanies

this can be life-long.

But surely many mothers experience hospital births without mental

trauma? Surely the fact that there is a healthy infant in your arms

makes up for anything you went through? Aren't you safe? Shouldn't

you be grateful to the hospital for delivering your baby? (Do women

ever get to feel grateful to themselves, to feel the power and

ability of their own bodies?) Won't questioning the event just cause

unnecessary pain and distress for women – shouldn't they just forget

about it and move on with their lives? Like survivors of sexual

assault, survivors may live years, or their whole lives, unconscious

of feeling anguish or anger about their experiences. But this doesn't

mean they are unaffected by them.

It is my belief that at some deep level, we all feel that we have

been robbed. We pass through our childbirth initiation to become

disempowered, disconnected, long-suffering, patriarchal mothers. We

tell our horror stories as just that, or we say nothing at all. But

it doesn't have to be this way. If I ever have another child, it will

not be in the same way. And it doesn't stop there. I will never again

blindly place my trust in authoritarian professionals and

institutions. I will recognize all capitalist patriarchy for what it

is and I will do my best to speak out against it.

Every day, in every way, my son is a wonderful gift. I would go

through ten more hospital births just to keep him. I am sorry for his

shabby entrance into this world but I am thankful to this little

person for helping me to see something: the bald, blatant,

oppressive, damaging, misogynistic forces at play in the most vital

aspects of women's lives. Revisiting his birth has made me angry, but

that has made so much else clear: how blinded we can be by the guise

of protection, how crippled we can be made by fear.

I wish that we talked about it. That we could stop reveling in horror

stories and better place our fingers on the reason for our traumatic

births – not the curse of Eve medicated to by our benevolent system –

but the systematic violence that delivers our babies for fear that we

might give birth to them ourselves. For in the process we might begin

to understand our own strength and find words for our anger. We might

begin to disobey.