It will be no surprise to people who know me, that I am a champion of woman-centred* birth. Extensive reading throughout my five childbearing years, backed up by observation of my own experiences and hearing about others have given me plenty of evidence to support my gut instinct – that women and babies are suffering in enormous numbers under an unfit, patriarchal model of care.
This week, the articles that have been pressing buttons throughout the world of birth, are the ones citing the PNAS (Proceedings of the National Academy of the USA) study that suggests women are evolving out of being able to give birth vaginally, due to babies with bigger heads, and no corresponding increase in maternal pelvis size – a result of increased births by caesarean section.
I am keen to read the study, to get a better understanding of how it was conducted, but unfortunately the PNAS website seems to be down for the time being, so I can’t!
I have read several articles based on the study, though, and they all have one thing in common – not one of them mentions how the birthing women were treated.
There is absolutely zero information in the articles on whether the women included in the study were subject to interventions in the natural birthing process, such as:
- Planning to birth in a hospital: known to increase the c-section rate, instrumental delivery and episiotomy. (Birthplace 2014)
- Continuous fetal monitoring: known to increase the c-section rate with no associated improvement in outcomes. (cfah.org 2012)
- Epidural anaesthesia: known to increase the c-section rate when administered in early labour, as well as increasing perineal trauma and operative vaginal delivery. (Klein 2006)
- Induction of labour: known to increase the c-section rate in low risk women. (Jacquemyn, Michiels, Martens 2012)
- Not having a doula: known to increase the c-section rate and the use of pitocin (Syntocinon in the UK) to accelerate labour. (Trueba, Contreras, Velazco, García Lara, Martínez 2000)
- Not being upright during labour: known to increase the c-section rate, increase use of epidurals (see above) and increase the risk of neonatal unit admission, as well as instrumental deliveries and perineal trauma in second stage mothers without epidurals. (Cochrane 2013 & Cochrane 2012)
I’m sure I could go on; there are studies upon studies out there, proving time and time again that our medicalised, patriarchal model of maternity care is causing harm to mothers and babies. I know from my own personal experience how the mainstream care model can derail an otherwise healthy experience of pregnancy, and birth; and perhaps more importantly I know at first hand how very different it can be, when mothers receive woman centred care, and are provided with the conditions they physiologically and emotionally require to be able to give birth safely.
What I need to know before I can form an opinion of the PNAS study is whether or not the basic needs of birthing women, were met for each and every study participant. Because if they weren’t, then this is just another invalid piece of research that treats our inadequate, unfit and often dangerous mainstream model of maternity care as a biological norm that it could barely be further from.
What does this all have to do with feminism, though?
Birth is a massive feminist issue. Name me another fundamental function of the human body, that has been undermined to the point where many of us believe it’s not even possible in nearly a third of cases, without surgical intervention – even in the face of the stacks and stacks of evidence (again, see above for a not-in-the-least-bit-exhaustive list) proving that generally speaking medical intervention makes it more dangerous.
Is it any surprise that it’s a basic function of the *female* body that’s been undermined so completely?
Women buy into it as well; I certainly did. The first time I was pregnant, I was absolutely fucking terrified of giving birth. I just wanted somebody to knock me out, give me a nice quick, clean c-section and to have nothing to do with the whole painful, dangerous, messy business. I lost that baby in a miscarriage, which although terribly sad turned out to be an enormous blessing, as the experience of going through miscarriage actually taught me a lot about how well-equipped my body was to handle exactly that sort of involuntary physical process.
That was the event that set me on the path to what was probably my first radically feminist act, planning a home birth; choosing to trust in my body and in the skills of a good midwife, over the patriarchal and misogynist messages that had been fed to me from girlhood, that women giving birth are an accident waiting to happen, and unless you happen to get lucky, you will need rescued.
My two home births were transformative, I can think of no better word to describe them. I have never met a woman who experienced undisturbed birth, who doesn’t say much the same thing. Throw yourself down the rabbit hole for a moment, and have a read of positive birth forums on the internet – so many more women using words like “amazing”, “empowering”, “beautiful”, “ecstatic” – now imagine if *most* women were experiencing this, rather than the relatively small number who have the support, knowledge, experience and (yes) the luck they need to successfully birth against the system.
Anecdotally speaking, most of my Scottish home birthing buddies identify as feminist and were also Yes voters in the 2014 independence referendum – it’s not a scientific study, no, and it’s very possible that I’m simply living in a pro-indy, pro-birth bubble; but if that trend is actually valid, then I feel it says a lot about how women who have chosen evidence based birth against the weight of mainstream opinion, may also be likely to embrace other radical, non-mainstream options to secure the future they want for their children. Can you imagine a norm of such women? I can sense a great deal of appalled establishment and patriarchal boot-quaking at the very thought…
Like I said, birth is a massive feminist issue. If enough women continue missing out on the transformative and empowering experience that giving birth autonomously can be, well that’s all very much in the interests of those who would keep us in our place, isn’t it?
This is why I have such a problem with the reporting of the PNAS study so far, and why I am so anxious to read it in full. Currently, all we see is a report undermining the female body’s innate ability to cope with birth; how many of us will simply take this as read, without thinking about how far the study conditions may have been from the conditions that women require to give birth in, safely? Will this just be another addition to the heap of internalised misogyny that prevents so many women from believing that birth can and *should* be very different from the modern experience?
Show me the research paper where every participating woman had a dedicated and skilled midwife, who looked after her one-to-one throughout her pregnancy, building trust and friendship; where every woman was allowed to go into labour in her own time, in her own environment, and given the peace, quiet and (sometimes) darkness her body needs to feel safe and give herself over to the birthing process. Show me the research paper where every woman was completely free to move, eat, and sleep as she felt she needed to, where there were no ticking clocks marking “too long” and no invasive vaginal examinations marking “too narrow”, where every woman was protected from negative imagery and messaging about birth, and instead heard stories of empowerment and euphoria as the norm.
Show me the research paper where all these basic needs have been met, for every single woman involved. If that one says we are evolving out of being able to give birth vaginally, then I’ll hold up my hands and say “fair enough”.
* I hope you note I refer to myself as a proponent of “woman-centred” and “autonomous” birth rather than simply natural or vaginal. In emergencies, surgical birth is obviously life saving; my argument is that such emergencies can often be avoided with the correct care.
In the meantime, let’s remember that the concepts of correct care and empowerment also apply to c-section mums – like this amazing woman, birthing her baby. How fucking awesome is this?
Love this Elaine!
Exactly. I read this article on BBC website and thought ‘oh another thing for women to feel bad about when giving birth’. The fear put out to women is ridiculous. I read Ina Mays Guide to Childbirth before my first of three births and it changed everything I ever thought about childbirth and it fired me up for doing what my body was telling me to do. And I am determined my daughter (and sons) will grow up understanding that birth is not a weird thing to do but something womens bodies are designed to do bloudy well if you have the right support. Great writing mum of boys!!