Childbirth--Feminist Choice Issue

If you are thinking of getting pregnant, trying to get pregnant, or already pregnant, buy or borrow two excellent new books--Pushed by Jennifer Block and Born in the USA by Mardsen Wagner. Read them before your next OB appointment; they might substantially reduce your likelihood of having a C-section. As a long-time childbirth activist, I am appalled that so many American women face returning to work six weeks after major surgery.

Marsen Wagner is formerly the director of Women’s and Children’s Health at the World Health Organization (WHO). A whistleblower, he offers a scathing attack on obstetrical standards of care, suggesting they are abusive at worst, and based on nonscience that mainly serves doctors’ interests at best. Jennifer Block was an editor at Ms. magazine and a writer and editor of Our Bodies, Ourselves. Her book, extremely readable, covers much of the same ground Wagner’s does. Read the excellent, lengthy review in the Women's Review of Books:

Here are two central facts about American birth: first, the US spends more per capita than any other developed nation on maternity care. Second, the World Health Organization ranks the US thirtieth out of 33 developed countries in preventing maternal mortality, and 32nd in preventing neonatal mortality. Our country is not doing well by mothers and babies.

Both these books describe, in splendid detail, the myriad interventions of “active management”—the practices perpetrated upon even a healthy woman planning the most unremarkable of births. Although these practices may help in critical situations, they are more likely to cause harm than good in a normal birth. For example, active management includes the induction of labor in as many as forty percent of all American births, even though this leads to longer and more painful labors and “ups a woman’s chance of a [cesarean] section by two to three times,” according to Block. ...Active management also includes speeding up a woman’s labor with the use of Pitocin in perhaps a majority of American hospital births today. According to Block, “a recent American College of Obstetricians and Gynecologists (ACOG )survey found that in 43 percent of malpractice suits involving neurologically impaired babies, Pitocin was to blame.” And it includes routine electronic fetal monitoring, used in 93 percent of hospital births even though studies show that its only effect is to increase the c-section rate.

The quintessential intervention is the cesarean section, which is how nearly thirty percent of American women delivered their babies last year. WHO says that when a population has a c-section rate of higher than fifteen percent, the risks to the mother and baby outweigh the benefits—and a WHO study found that “the main cause of maternal deaths in industrialized countries is complications from anesthesia and cesarean section,” Block reports. She cites another study published last year, of 100,000 births, which found that “the rate of ‘severe maternal morbidity and mortality’—infection requiring rehospitalization, hemorrhage, blood transfusion, hysterectomy, admission to intensive care, and death—rose in proportion to the rate of cesarean section.” As for the baby, other research has found that “preterm birth and infant death rose significantly when cesarean rates exceeded between 10 and 20 percent,” and that “low-risk babies born by cesarean were nearly three times more likely to die within the first month of life than those born vaginally.” Nonetheless, ACOG not only rejects the fifteen percent target, but even continues to support the idea of elective c-section.

What are your alternatives to an interventionist and/or C section birth?

As evidence is increasingly showing, the people who best enable normal births are midwives. Obstetricians, after all, are surgeons, and many never witness a natural, normal birth in their training. Midwives, in contrast, are women who know that one of the best answers to pain is sitting in a warm tub, who know how to manually palpate a woman’s belly to find the baby’s weight and position, and who know how to help a woman handle labor in ways that facilitate birth.But midwifery in the US is up against some powerful forces—mainly, again, obstetricians and American College of Obstetrics and Gynecology. Doctors throughout American history have worked to discredit midwives—labeling them dirty, uneducated, and unskilled—and to drive them out of business. Today certified nurse-midwives who practice in hospitals report having their hands tied by doctors and hospital protocol.

Is it possible for change to come from women themselves?

Block ends with a challenge to today’s organized feminists to bring birthing under the umbrella of “choice,” quoting childbirth educator Erica Lyon, who says, “I think this is the last leap for the feminist movement. This is the last issue for women in terms of actual ownership of our bodies. It will take a revolution."

These books deal only peripherally with one of the most problematic issues: what do you do when women freely choose, or think they freely choose, medical procedures that increase their risk and that of their children? If women believe their obstetricians are their best advocates, how do you convince them to think skeptically? Until women take birth into their own hands, until they realize that doctors are not necessarily women’s advocates, until they seek out the evidence, which is in these books but not in doctor’s offices, about the normalcy of birth and the dangers of interventions, they are going to continue to believe that birth is a crisis about which only one person – the obstetrician – knows best.

We fought this battle in the 1970s and early 1980s and thought we were winning. I had four children between 1973 to 1982; two were hospital births, two were home births. I employed one obstetrician, one family practioner, and two nurse-midwives. I was given pitocin against my will for my only OB-assisted birth; I received no other medications.

Do We Remember the Event or the Photo?

1939, 1946, 1950

The first picture of my uncles and their friends was taken at Thansgiving. Showing them these pictures elicited many stories about how they did not go trick or treating at Halloween. Instead, they dressed up as hobos at Thanksgiving. Several had forgotten about it until I showed them the picture. The second photo shows me holding court with my young uncles and their friends; I was treated as their little sister. I don't remember living with my grandma and my 5 uncles and 1 aunt for the first two years of my life. But that picture has shaped my view of my early life and helped me understand my fascination with family history. The third picture shows my dad, me, and my brother Joe in the garden. I did not remember how very involved we used to be in dad's lifelong gardening.But the picture evoked many memories, such as of plucking Japanese bettles off roses and putting them in the small can of oil.

I have more than 50 boxes of family slides as well as about 30 photo albums, going back to the 1920s. During the four years I cared for my mother 24/7, I scanned thousands of family photos and created family picture sites. Immersing myself in the family history, I certainly remembered much I had forgotten. But do I remember the actual event or do I remember the slides of the event? Do I remember clearly what was never photographed? Discussing the picture websites with the whole family did elicit everyone's memories, which then became incorporated into individual memories.

I fondly remember countless slide shows with everyone in my immediate and extended family.There was always screams of laughter and frequent admonitions to the kids to to stop standing between the projector and the screen and making shadow puppets. I recall Mom's telling me Joe was showing his first girlfriend the family slides. I suspected correctly that she would call back a few hours later to announce their engagement. I encouraged my future husband to watch the family slides on his second visit to New York in 1996:) I gauge the seriousness of potential family mates by how immersed they were in the family photos. When we first met my nephew's future wife in 2001 and observed her photo fascination, we patiently waited for the announcement of their engagement in 2007.

Yet the pictures distort the reality of our everyday life. My parents could not avoid to take many pictures. Most pictures were taken at Baptisms, Holy Communions, graduations, Christmas, vacation. We got a few toys at Christmas, but we never played with them. We went away on vacation the entire summer. In the summer we lived in the water, either in the pool or at the beach; in the winter there was always abundant snow. We were always outside, never inside. We never played ping pong or knock hockey. We never played board games that ended with some poor sport upsetting the board once his loss became inevitable. (I was always a good sport because I was usually winning.)

Much of our outside play is neglected. We never played badminton; we never played baseball; we never went ice skating; we never had sleds; we never rode bicycles. We did play basketball in the driveway unless the next door neighbor started complaining to the cops about evening play. My oldest brother Joe never ran cross country. Several brothers were photographed in football regalia, but there was no proof they actually played on a l team. One broken leg is honored, but not a broken arm. We were very religious; we spent an inordinate amount of time receiving our communion and being confirmed. However, we never went to church at other times. I never wore glasses; that is an outstanding accomplishment given that I got my glasses at 10 and my contact lenses at 19.

We only graduated from school; we never attended it. There are no pictures of our schools or our teachers. You would never realize we attended three different high schools and three different grammar schools. According to the pictures, we never studied, never read a book, never went to the library, never participated in any after school activity. Joe was a drummer; I was a baton twirler. Bob started playing the accordion at his second wedding in 1989, not in 1961. Our family pets are very neglected. I gave up trying to figure out how many cats we had and what they looked like. Families who call their cats "cat" don't waste film on them.

Relationships are neglected. Mom and Dad never kissed one another after their wedding or hugged us after babyhood. During our childhood we always wore pajamas for photographs. Dad was rarely there because he was always behind the camera. Mom was never pregnant or nursing her 6 children, an accomplishment even more amazing than my never wearing glasses. No one was ever filthy, battered, bloody. The siblings related to each other by lining up in size order. We must have photographed every single occasion when my brothers wore jackets and ties. Only certain children got birthday parties. The last three brothers barely existed.

Photo therapy is neglected in the treatment of elders suffering from dementia. My mom was never the same cognitively after a terrible fall down the stairs, landing on her head. I made her a photo website, with 400 pictures captioned and arranged in chronological order. We watched the slideshow countless times, and consequently she was always able to remember the important people she loved and the significant milestones in her life.

I wonder what impact the digital camera will have on memories. We now take pictures of everyday life, not just state occasions. We already have over 1500 pictures of my 15-month-old grandson, more than twice as many as our parents took of all of us from 1945 to 1985.My grandchildren won't have to rely on memory; their whole lives will have been photographed.