Over the past 100 years, the nature of birth in the western world has mirrored the dominant cultural story of industrialisation, and as a person who is exploring life beyond the parameters of this civilised story, and also as a woman expecting her first child, I have found myself on a journey of questioning – what is it to carry a child, and to give birth in the 21st Century?
“Industrialised farming and industrialised childbirth have many points in common. One can even claim that they are two aspects of the same phenomenon. In one case it is about non-human living creatures. In the second case, it is about human beings. Both are typical ways to deviate from the laws of nature.” Michel Odent
Allow me to give a little bit of history to What Michel Odent refers to as the “industrialisation” of birth: Since the beginning of the 20th Century, there has been a transference of power away from women (midwives and mothers) to obstetricians and bureaucratic institutions, as it was then that the medical profession began to make official links with midwifery: “it institutionalised a subservient role of the midwife to the physician.” Not only was the power being usurped from the traditional female support roles, but also from the mothers themselves. As Michel Odent points out in his book The Farmer and the Obstetrician: “In the age of industrialised childbirth the mother has nothing to do. She is a ‘patient’”. In a famous article and speech, Prominent professor of obstetrics, Joseph DeLee, declared labour a “pathological process.” He recommended the routine use of forceps and episiotomy (cutting of the skin between vagina and anus) at every birth. Suddenly the Obstetrician was a person (usually male), who could ‘save’ a woman from the affliction of childbirth, with his arsenal of tools and pharmaceutical drugs.
A perfect example of this was a technique pioneered in Germany was known as “Twilight Sleep”, which involved injections of morphine, followed by a dose of the amnesiac drug Scopolamine, which caused the woman to forget what was happening, followed by a further administration of ether or chloroform in the Second (and most primal stage) of birth. “Twilight Sleep” was literally designed to override all of the natural processes of birth – not only was this experience to be painless, but the woman wouldn’t even be able to recall what happened. When we consider that giving birth is arguably one of the most important Rites of Passage in a woman’s life, and also one of the wildest, most primal of all human experiences, we can also see that birth has the potential to be one of the most empowering experiences of a woman’s life. What are the implications of this in a patriarchal narrative? Well, it just doesn’t fit the story, does it?
Techniques like Twilight Sleep, and De Lee’s ‘Prophylactic Obstetrics’ were just the beginning. Whilst farmers sought to control their crops for industry, so too was the ‘Birth industry’ growing. From here, the advent of caesareans, (which went from being an emergency procedure to a matter of convenience and “comfort” for the mother), electrical foetal monitoring (which has been shown to hinder, not help the birthing process in many cases), epidurals (which numb the mothers sensations from the waist down and greatly impact her ability to work with her body during labour), not to mention drips with synthetic hormones (to replace those that have been inhibited, often by environmental factors that have affected the mothers ability to produce the hormones her body needs), catheters, forceps (a metal instrument used to ‘extract’ the baby), and episiotamies. These industrial tools set to aid the birthing process where taking women further and further away from the natural, organic nature of birth.
I want to stress here, that it is not my intention to dismiss the number of lives (both mother and child) that have been saved by some of these technologies. To the contrary, I acknowledge and value the amazing work that has been done and is being done for women and babies who have needed intervention. Indeed, there is a place for this technology. I, myself have witnessed the wonders of caesarean recently when a friend had to have an emergency intervention to ensure the well-being of both herself and her baby. I am not referring to medical emergencies, rather the standardisation of medical births for what are referred to as “low risk” (note, it’s not “high ability”) mothers. The implication of this medical framework is that a woman is not actually capable of giving birth without the help of modern medicine, despite the fact that every one of us has descended from a line of women who have laboured either alone, or with the help of midwives and womenfolk for some 200, 000 years. It has become normal to give birth in a hospital, it has become normal to take drugs for ‘pain management’, it has even become normal for a woman to book an elective caesarean to suit her busy schedule. My question is how does this ‘industrialisation’ of birth impact us as human beings? How does this intervention and fear-based prophylactic approach dis-empower woman in one of her wildest and purest life experiences? What is the effect of this on our children, and our relationship with the world?
The word that keeps coming back to me is ‘choice’. I believe that every woman should feel empowered and enabled to make informed choices about her pregnancy and the birth of her child. Throughout the pregnancy, I have certainly felt that there are certain expectations and assumptions from me as an expectant mother – scans, blood tests, urine tests -all of which are diagnostic tools, once again, playing into the narrative of pregnancy as a pathology rather than a natural, healthy process. I have found that has been very difficult not to get drawn into a fear state – every midwife visit seems like another list of ‘risks’ that I need to be tested for…
This is my first pregnancy, and I have found it especially hard to trust my instincts, to have confidence in my health and well-being, and to believe that I can grow and birth a happy healthy baby without medical intervention. For example, Pete and I had a long debate about scans (which come with their own set of risks)*. In the end, following a much inner dialogue, self doubt and indecision, we decided that it would be of greater benefit to me and my stress levels to have the (faersomely titled) “Anomoly Scan”, rather than to not have it. We had the scan, but not the needle tests or find out the sex of the child. It was more about seeing the baby in there, like some kind of confirmation of what is happening inside, rather than as a way of identifying abnormalities (besides, Ultrasound is only approximately 60% accurate for detecting abnormalities). I have to admit, was a great relief to see the little life was actually there, to see it’s heart beating, alive. Not only that, but it was rather magical, to see the little being there, wriggling and moving…
In fact, I feel that the opportunity to witness our child growing inside me, actually enabled me to feel more confident about having a home birth, and it seems to have facilitated a deeper sense of trust in the process. But, I wonder if I would have had the same anxieties, had all the risks not been pointed out to me, and the ‘standard’ scan not been offered, had I been encouraged and supported to trust what was happening inside me… Pregnancy is a quagmire of decisions – for the informed woman, there is a choice to be made with every test – tests which are not always accurate. This pathalogical approach can often become a gateway for the ‘cascade of intervention’, resulting in further tests and lists of risks, causing huge amounts of stress for the mother, often with little benefit in moving toward a healthy birth*.
One of the key issues in empowering women for birth and pregnancy is learning to trust the intelligence of the body, and to ensure that the people and environment are conducive to this process. For example, one of the main hormones that facilitates birth is oxytocin (also the hormone released by a woman when she is sexually aroused, and during breastfeeding). This hormone helps the cervix to dilate, and aids the contraction of the uterus. It also aids maternal bonding. Oxytocin is inhibited by adrenaline, which can be triggered by fear, panic, unfamiliar people or surroundings, bright light, electronic machines and so on. Basically, anything that makes a woman feel unsafe has the potential to stall labour by inhibiting the natural release of key hormones, and result in medical intervention. On the contrary, anything that makes the woman feel safe, comfortable, held will have the opposite effect, allowing the body to do what it needs to do. For some women, being in hospital, surrounded by doctors is the safest, and most comforting environments, for others, it is their home environment. Similarly, some women find that regular testing and midwife visits are re-assuring. For others, it is an unnecessary stress, drawing them further away from the ability to trust their body and the process of pregnancy and birth. Again we see the importance of choice – the ability to ask: what will empower me in this process? What will be best for me and my baby? Here is where information and support of the mother is key, to give her the confidence to ask for what she needs, rather than being subjected to medical protocols, much of which are more about bureaucracy than the well-being of the mother.
To the credit of the NHS, there is a movement towards choice for pregnant women. Home births are possible in certain areas, depending on availability of staff, birthing centres are available in some areas, alternatives to pain relief such as hypnobirthing and water birth, and the benefits of natural birth are discussed by some midwives. But, it is still left to the few renegade midwives to promote these ‘alternatives’, it is not ‘standard practice’, and ultimately, midwives still have to operate within the medical framework, otherwise they risk loosing their right to practice. In addition to this story of bureaucratic control, private midwives have recently been prevented from practising due to a ridiculous new prohibitive insurance law that means insurance will cost more than most private midwives could earn in a year.
Doula’s are also an option, for those who can afford to pay for extra support. The Doula is a birth partner and advocate for the mother. Her role is based on our ancient traditions of birth, where a woman was accompanied through the birth by another woman, who had experience of birth (often a mother, grandmother or medicine woman). Tragically, this role is no-longer a given part of our community support network, but rather a privilege for those who are able to pay for it. I believe that the Doula has an incredibly important role to play in the empowerment of a woman through pregnancy, and in helping her to navigate her way through the endless choices, and often frightening journey of birth. It is just a shame that this role is not prioritised, and that midwives themselves are often so busy with ticking boxes for their ‘superiors’ that they just don’t have the time to fulfil this nurturing, supportive, present role, which is really the essence of midwifery (the middle english origin for midwife translates as “with woman”). The birthing ‘industry’ has taken the midwife away from the woman.
At this time, we, in the Industrialised world are suffering from an of epidemic of separation. Often with best intentions we have intervened with natures intelligence, which is also our intelligence. Whether through our attempts to save the world through mass agricultural industrialisation, or through the industrialisation and medicalisation of birth, we have severed our connection to the innate intelligence of our being. Whether this means that we are so disconnected from what we eat that we believe it’s acceptable to poison and pollute ourselves and our habitat in order to produce food, or that we are so disconnected from our bodies that we believe we need tools and drugs and “professionals” to enable ourselves to give birth. Not only is birth the most natural process in human cellular memory; birth is a political act. The way we chose to bring our babies into the world is fundamental to the ecology of planet earth. As Odent’s research for the Primal Health Reaseearch Data bank suggests “the way we are born has long-term consequences, particularly in the fields of sociability, aggressiveness, or, otherwise speaking, capacity to love”. Beyond the deeply personal journey of choices, trust and self-empowerment, there is a greater responsibility that we all have in advocating healthy, natural birth. Birth is not an industry, it is the way we are brought into the world. It is a sacred act, a human right to be respected and upheld as such. What are the socio-political implications of industrialised birth? Leboyer articulates a response in his seminal book, Birth Without Violence:
“Such is birth. The torture of an innocent. One should have to be naïve indeed to believe that so great a cataclysm would not leave it’s mark. Its traces are everywhere; on the skin, in the bones, in the stomach, in the back, in all our human folly, in our madness, in our tortures, our prisons, in legends, epics and myths. The signatures themselves are surely none other than this abominable tale of woe”.
Just as Industry is resulting in a desecration of our land, so it is desecrating our people… we are in a state of emergency. In order to heal, we must start by informing and supporting the women who carry the next generation. Only then can women reclaim and re-member the deep knowing that is rightfully theirs, and give birth from a place of trust and safety.
* For more information on scans, other maternity choices, and statistics check out:
Sheila Kitzinger http://www.sheilakitzinger.com/
Michel Odent http://www.primalhealthresearch.com/
‘Golden Birth’ by Clive Hedger http://www.clivehedgerart.co.uk/