Pregnancy, Parturition, and the Patriarchy: how do we best serve women?

[GeorgeFayne]

(Parturition is the medical term for childbirth. Yeah, I wanted it to be catchy. Maybe it wasn't. LOL.)

Pregnancy and childbirth is a charged and emotional issue for so many of us. And looking at it through the lens of feminism should give, perhaps, a unique perspective from the mainstream narrative.

We've had an interesting discussion going on another thread, and it brings so many questions to light that I would love to hear discussed by the brilliant mind trust of FWR.

Topics like: should women have the right to insist on female-only attendants at birth? What about the greater field of OB/GYN--should men even be in the profession? What can we do for women who have been victims of sexual assault when it comes to birthing? What are the boundaries related to a woman's consent and bodily autonomy when there may be a question about the well-being of the baby?

More personal: was birth an uplifting and empowering event for you? Or did it leave you traumatized or ashamed and lacking confidence in yourself as a mother? And how do you think the role of your midwives or physicians or nurses (or the system) contributed to those feelings? What are some hidden misogynistic practices that we rarely discuss?

Most importantly: what can we, as feminists, do to improve our modern gyn and birth practices?

Have just read the other thread... had absolutely no intention of posting my experience to be dismissed and sneered at on there!

The thing that was lacking in my birth experience was very simple but fundamental - it was kindness. The nurse (midwife? Her role was never clarified to me) and the midwife who took over my care after DS was born both displayed a distinct lack of kindness and empathy. I was left labouring alone all night (I was induced, although that was the only intervention I had) and then mocked for ‘walking funny’ (I’d suffered from PGP and was still hobbling a bit directly after the birth).

What I needed was someone to call DH in for me before - I was in a side room so no one else would have been affected - and a bit of reassurance that the PGP would clear up afterwards. But I didn’t get it. On the plus side, the midwife who handled my actual delivery was great, so that is at least something. However, I won’t be having any more children - not totally because of that experience because there are lots of reasons. But it’s a factor.

It is distressing that some medical professionals appear to lose their empathy for pregnant and labouring women. Or perhaps never have it? I would like to see much more emphasis on this. I understand that midwives and doctors see labour all the time, and that a reasonably straightforward labour like mine is no big deal to them, but it was my first time and although I’d tried to prepare for it, I really had no idea what I was going into and I did get upset, and I did get scared. It was a very, very long night in the dark - I couldn’t lie down in any position at all due to my PGP and couldn’t even work out the tv so I just knelt on the bed in the dark, all night. I feel ashamed of how I felt now - so stupid to be upset by it.

What this would take, I suspect, is money. Money for better staff to patient ratios so staff aren’t racing from woman to woman. Investment in facilities that are comfortable and relaxing. More training, perhaps even paid sabbaticals so that staff don’t burn out. And placing the woman’s experience at the centre of the whole process - actually centring it, rather than paying lip service to it as at present (which is cheaper, but not terribly effective).

Those are my thoughts, based on my experience, anyway.

I think women should have the right to only be looked after by female staff during birth if that is what they feel they need.

Having said that, I had two emergency cs and the first one was particularly traumatic. The male consultant who made the decision that it was necessary, then carried out the surgery, was incredibly kind and reassuring unlike the female midwife who had been with me for around twelve hours of labour and didn't introduce herself or talk to me. In fact, if she'd shown any interest in actually delivering a baby rather than sitting with her back to me writing notes and staring at monitor, maybe no cs would have been needed. I found midwives to be incredibly lacking in humanity, compared with doctors who were without exception very understanding. And the post natal period was even worse. Doctors were very willing to write prescriptions for pain relief then the midwives cheerily dismissed me with 'oh, you don't need it, everyone here has had a baby you know, you need to just get on with it'. I'm terrified of midwives to be honest.

Spudlet
I'm so sorry for your experience. It is clear how frightened and alone you felt, and that never should have been the case. You're totally correct that kindness would have gone a long way, (and that is actually free!). But also, it raises the important point that, whether it's a physician or a midwife, male or female, treating women with respect and dignity is the least we should expect.

How do you think your birth experience affected you as an early mother?

My thoughts are similar. It needs more money pouring in so women are supported.

My first was a c-section and I was very scared at the second. It was a fantastic vbac - mainly because I had a doula and so was supported throughout.

My local hospital doesn't have a good name, I was scared and I could afford it.
But what about all those women who can't afford or don't even think they may need additional support?

I felt the misogyny was primarily located in the availability of pain relief.

It is frankly bonkers that induced women who ask for an epidural find themselves at the mercy of whether an anaesthetist is available or not.

The idea that "people have been giving birth since the beginning of time" negates this predicament is bizarre. People have been dying in acute pain for thousands of years; you don't hear that as an excuse not to give a dying person pain relief today.

And there's no other reason for it apart from the old legacy of the sins of Eve.

Isabelle
Another sad, sad story here. I can't believe your midwife didn't introduce herself! Well, actually I can believe it. It happens here in the US, too.

After my first baby, I had some unexpected post-partum hemorrhaging. My midwife had left for the morning and they were waiting for the new one to come on, but she was delayed on account of breaking her ankle. Instead, one of the OB residents (physician, but in training) was sent in. Didn't introduce himself, say what service he was on. Just said, "You've got some bleeding. You need medicine." Next thing I know, he's sticking a gloved hand up my butt to place a suppository! No warning, no mention of what he needed to do. Completely violating!

I was a faculty attending at that hospital, and I was livid. I spoke with his program director. She said there had been many complaints before and they had tried to "excuse" him from the training program multiple times, but per federal guidelines, he'd been given another chance. (Shortly after my experience, I came to learn he voluntarily left to pursue psychiatry.) I'm still horrified, many years later, about his behavior and wonder how many other women he wronged.

But...the OB who delivered my third child was truly an angel. Kind, nurturing, caring. Skilled and knowledgeable! He put my "advanced maternal age" worries to rest and gave me so much confidence and peace. I can honestly say he made a tremendous impact in my life experiences and will be forever grateful.

I have been very fortunate to have two straight forward labours. They were very fast (2hrs, and 40 minutes start to finish) and I am very fortunate there were no complications, particularly with DD1.

The midwife for my first labour kept trying to send me home as my contractions weren't regular (and nor would they ever be). Despite the ward being very quiet, she didn't want to examine me, so I asked if I could stay and labour regardless. With my OH backing me up, she reluctantly agreed.

I insisted that I wanted the pool for pain relief, but she wouldn't examine me to check I was far enough along. DD was back to back so she said I would feel more pain, but that I wouldn't be 4cm yet. Eventually, she gave in and let me get in the pool. She spent the entire time doing paperwork in the corner and didn't acknowledge me.

About 15minutes after getting in, I told OH that my body was starting to push, which he relayed to her. She didn't act until he told her he could see DD's head. Suddenly, I found myself being man-handled and pulled by 2 midwives into a "more optimal position" (leaning back, rather than on all fours). It was MUCH more painful, but I was mid contraction and I couldn't fight them off or verbalise that they needed to stop. In this new position, it took another 3 pushes to get her out. I was panicking as I knew she should already have been born, and was getting no reassurance. I'm convinced it was the change in my position which delayed her. There was no shoulder dystocia.

In some ways, I am grateful this midwife was so useless, as it gave me a lot of confidence in my body, and I had DD2 at home with a lovely supportive hands-off midwife who made the birth so so much better. She was very switched on and was quick to notice when things had ramped up, despite irregular contractions, a fast labour, and no vocalising from me.

However, I am now expecting twins and I'm incredibly anxious about the birth. I realise I have developed a distrust of medical intervention during birth - something which will be much more difficult to avoid with a twin labour. There are all sorts of interventions seen as standard and it is making me VERY worried to consent to any of them. I think this is as a result of the intervention I had in my first labour, which made things more difficult for me. I have talked it through with my twins midwife, but I still feel (irrationally) completely distrustful of anything other than being left to my own devices.

I know many women have suffered far more than me. Some of the stories on here are just awful. But I feel it's important to share that even easy straight forward labours can have a lasting affect on your mental state for future births, if care is poor.

Crap, the formatting didn't work. So sorry for that essay with no line breaks!

Birthing rights are human rights. And women's rights.

We all have a right to bodily autonomy. To to informed consent.

That means that each woman chooses where and with whom she births. It means we trust women to analyse risk. It means we support women to feel safe to make decisions. It means we don't allow anyone to say that at a certain point in pregnancy/childbirth the woman ceases to be important.

Women are not always the best birth attendants, but any woman who chooses to be surrounded only by women should have that right guaranteed, unless there is an emergency situation. And even there, where possible prior permission should be sought so that the birthing woman knows who will be called in and what might happen if something goes not as planned.

Women need information. We need to be empowering everyone to understand what their bodies are doing, what is normal, when they should be concerned. Education matters.

And respect matters. Nothing makes it clearer that women are not considered human than the fact that during pregnancy/childbirth/postpartum we are so often treated like meat, spoken to disrespectfully, ignored. That so many who interact with women at this time can't be bothered introducing themselves or asking permission to do something, or explain what is going on is telling. It's woman hatred on a grand scale.

The fact that withholding care or painkillers is common should raise alarms for all feminists. The fact that so many tell the same stories and yet nothing changes should raise eyebrows.

And yet, talk with many women and they will either downplay the problem or start trying to justify which moment in the pregnancy they personally believe her to lose her autonomy because 'there are two patients/people'. This is a slippery slope and I believe we need to stop allowing this derail. Either we are human adults and have the right to make decisions about our bodies or we are not.

Listening to woman's hour right now; sorting it out for black women is definitely a priority.

Just horrendous to hear outcomes for UK black women are much worse than for white women.

Black women are 5 times more likely to die in childbirth in the uk.

www.bbc.co.uk/programmes/m0006sg5

And how do you think the role of your midwives or physicians or nurses (or the system) contributed to those feelings?

The attitude and approach of any birth attendant is absolutely central to the birthing experience. A shift change, and/or new personnel can instantly alter the dynamic and the atmosphere entirely. For better or worse.

It used to be the case, not sure if still true - that you could have a named mid-wife, who would stay with you throughout the entire labour and delivery ( certainly in home birth situations).

The interesting question I saw raised on the other thread was - it is one thing to insist all mws are female (or easily available if requested) or even all obgyns (or easily available if requested). But how does that work when extended to any other staff who may care for you during pregnancy and birth? Anaesthesiologists, sonographers, porters, HCAs - just for a straightforward case. All neonatal staff too?

The idea that "people have been giving birth since the beginning of time" negates this predicament is bizarre. People have been dying in acute pain for thousands of years; you don't hear that as an excuse not to give a dying person pain relief today

Yes, I dont understand it either. It always seems to be womens pain that is disregarded as 'natural' and to be endured. Be it period pain, endo or childbirth and so on.

I had an EMCS at 35 wks to save my baby's life.

I had a student midwife who stayed with me for the first part of the evening when my baby's heartbeat was being monitored for induction the following morning. She was lovely.

When it was decided around midnight that an emcs was necessary for the baby to survive, i felt very much surplus to requirements. Things were happening around me and no one really explained anything or even acknowledged that I was a person. The female surgeon mocked me for getting upset and asked "what on earth" I was crying for. The midwife replied, "I imagine she's scared for her baby". I was was really grateful for her response given I couldn't say anything. I'd already had an injection at that point and was feeling very out of it.

The kindest person was the male anaesthetist who stood at my head, stroking my hair and telling me how brave and strong I was being and that everything was going to be ok.

The overwhelming lack of empathy generally was astounding.

Can someone link to the other thread?

When I had my first baby 20 years ago, I was in a side room waiting to be induced and a man came in with a load of other men. The main man asked the others if they knew what was "happening here".

There were a few guesses.

The man if they knew what the machine I was hooked up to was and what it was used for (foetal heart monitor).

The men stayed in the room for about 5 mins or so. No one even looked at me let alone spoke to me or introduced themselves.

I don’t know how it effected me as a mother. I did develop PND, I think - I never had a firm diagnosis as I didn’t want to let anyone know. I concealed how desperate I was feeling from everyone, and quietly planned how I would end my life if it got worse, rationalising that it would be for the best as DH would be able to find another, better woman to be with and DS would not remember me and would think of this other woman as his mother. Thankfully it went away fairly quickly but it was a dark old time. I do remember being terrified that my stitches weren’t healing and that I’d have to be stitched again - the thought of going through that in cold blood was horrific. Happily my lovely (female, if it makes any difference) GP sorted things out and put my mind at rest, and I was ok. I could hardly speak down the phone to the receptionist to make the appointment, I was so terrified. But that might have happened anyway, there’s no way to know for sure.

In general it’s left me with a faint distrust of medical professionals. I know there are many good ones - my mum is a nurse! - but I don’t automatically assume they’re going to do what’s best for me, or listen to me. I would have done once. But I don’t have that level of trust any more.

Affected, not effected! The shame

I did develop PND, I think - I never had a firm diagnosis as I didn’t want to let anyone know. I concealed how desperate I was feeling from everyone, and quietly planned how I would end my life if it got worse, rationalising that it would be for the best as DH would be able to find another, better woman to be with and DS would not remember me and would think of this other woman as his mother.

Really sorry to read this Spud, and it's exactly how I felt after my birth (which resulted in PTSD), probably for about 2 years. I was trying to think of "quiet" ways to "go" where nobody would notice, before my DC got old enough to become too attached to me and someone else could just be "slotted in", who would be a much better wife and mother, rather than this wreck of a person who was constantly going round and round in the same loop of trying to talk through every little detail of what happened in order to try to understand why.

I ended up with an emergency birth and full emergency team in the space of a few minutes and, tbh, that team were all great with the delivery, haemorrage, and resusitation. Everyone introduced themselves when they rushed in too, (although I was being pinned down and all dignity was gone).

But it was the hours of care from a midwife leading up to the birth which got me I think, where she dismissively told me to go away, several times, because I wasn't in labour (despite very frequent contractions and me losing a lot of blood, and vomiting from the pain). She had also sent my husband home. Of course it turned out I was fully dilated, baby was stuck and heart had almost stopped.

Thankfully, another midwife overheard me, checked me, and hit the emergency alarm and then everyone swung into action from there, but I had a lot of guilt about my inability to make myself be listened when it was so serious and life threatening for me and DC, and that it was a chance intervention by someone else which was the reason why everything turned out OK, whereas I was just going to sit there quietly, like a good little girl not making a fuss, until the worst happened . Why did I do that? I was really angry at myself about that, and also at the midwife.

My labor and delivery was nearly textbook, though painful as I did natural childbirth, and then there was, at the end, a rushed episiotomy that had me screaming blue murder. Still, I thought all in all, I was treated well, and this was in the US, with a hospital that had "birthing rooms" where my DH was with me the entire time and then through the first night sleeping.

The issue I had began the next day when I and my baby were moved to Pediatrics because she was jaundiced. The nurses made it clear I was not their patient, and I accepted that. I was able to sleep in the same room with my newborn-under-glass, and I was glad of that -- but it was only an armchair I was given to sleep in; I was clotting badly; I might not have been the patient on the pediatric ward, but I felt that I was, still, someone's patient, or should have been.

But there was/is a complete absence of after-care. I don't know if that's changed. But the notion that a woman can give birth and be up and running less than 24 hours later is absurd. I was exhausted, unable to sleep well in a chair, and that exhaustion followed me home when my baby was discharged and took a very long time to lift -- at home, too, I was no one's patient, and with lack of paid leave what it was in the US, I was pretty much alone with my baby, DH at work, family far away.

My exhaustion and utter depletion meant I was never able to get a good start on breastfeeding and from the second week had to supplement with formula, by three months was unable to continue.

There simply isn't enough physical support for new mothers both inside a hospital and outside of it. Because childbirth is seen as "natural," unless there's a C-section, it's not seen enough as a medical event from which a woman must heal and recover.

Yes, I think if there was one thing I’d like to make expectant women understand, it’s that you’re going into a situation where the only person who will truly advocate for you and your baby is you

Other people’s laziness, sexism, burn out, tiredness, pre conceived ideas etc will get in the way. Don’t fully trust anyone

It sounds bonkers but I really believe it.

For various reasons I basically insisted that DS2 was born by cesarean. He unexpectedly turned out to weigh 12lbs as I had undiagnosed gestational diabetes. DS1 was a section too, so it would have been my first vaginal delivery. Fuck knows what would have happened if the medics had had their way. I feel very lucky in retrospect

Spud and Sonic

I too developed what I think, in retrospect, may have been PND. It went on for 10 years before I finally summoned the courage to reveal that something was wrong and ask my doctor about medication. I have no doubt those 10 years of depression adversely affected my daughter, though I tried very hard not to let that happen; they nearly destroyed my marriage, though we recovered with counseling; and they contributed to my giving up or losing, depending on how you look at it my first career.

Angelo
Here you go: www.mumsnet.com/Talk/womens_rights/3635754-birthing-mother-abused-for-refusing-male-nurse?pg=1
Good luck on that one!

Spud, Sonic, and Bickerin
I'm so sorry that you have all experienced such pain and trauma from birth. It's heartbreaking, really. The reality is clear that you are not alone--so many women are suffering silently, putting on a brave face of motherhood and numb or dying inside. The role of birth in post-natal depression is just not discussed enough. (The issue of isolation and feeling alone after having a baby is something else that I feel is quite common in our modern culture, and also gets brushed under the rug.)

Bernard I absolutely agree.

Neurotrash
I read this last year and thought it was an excellent article:
www.nytimes.com/2018/04/11/magazine/black-mothers-babies-death-maternal-mortality.html

Emerence
Your comments are so right on and mirror my thoughts and feelings exactly. (I posted something very similar on the other thread.) Women are capable of making these decisions that directly relate to their bodies and their children; informed consent is paramount to improving women's experiences with childbirth.

Education of women is critical, and yet, we are so far removed from the whole act of birth, (and death, too). So many first-time mothers have never seen a woman give birth; the act is completely foreign and unfamiliar. It's taboo to show a birth video to students, (at least here in the US it is, despite the fact that porn is actively being viewed on smartphones in the classroom). How do we effectively change this?

And yes, respect and dignity is the foundation on which a positive system should be based. Understanding that a woman's body is still HER body, that she still defines the boundaries and limits, and that ultimately, she will be the one who must deal with the consequences and outcomes of what transpires during birth.

I'm struck by the lack of kindness so many of us have experienced--and just how important it is. Clearly, there are women who have had very frightening birth experiences and barely avoided significant complications, but because they were treated with compassion and respect, are not traumatized.