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?

But I feel compelled to point out that, as ugly as some of our hospital birth stories are, there is shame and misogyny that exists in the world of natural childbirth as well. Fear of the "cascade of interventions" that gets peddled, the narrative that there is a "right" way to give birth, and the falsehood that transfer to a hospital for medical care or the need to have a C/S is "failure."

How does this better serve women? Just more guilt and condemnation that gets thrown at women.

My birth experiences were varied, none were great. My first was a c-section, mainly because they managed it shallowly, IMO. I didn't know what I was doing really. Second I tried VBAC but had a section with baby in distress. It was ok, my doctor had to leave in the middle because her father unexpectedly died but I liked the women who delivered me.

I also tried for a VBAC with my third, and it was horrible. I was very much abused by the doctors there - two women and a man as it happens. It was a different hospital with a bad attitude, not up on best practices at all.
My fourth baby I had a planned section - the policy here is no VBAC after three sections and I was happy with that. It was all pretty low key.

So like anyone, this has affected my views in various ways. I am pretty pro-midwife and home-birth where appropriate (which is not usual here we have only a few midwives and home-births are difficult to get) and I think interventions need to be thought out carefully.

I am big on non-paternalistic care and working with the health goals of the patient. I think under normal circumstances people should be able to choose a caregiver of the same sex.

On the other hand, I've been involved in health enough to know that not all patients are reasonable, and some do things which make it impossible for their medical staff to help them. Circumstances can make what you want impossible (My dad for example lives in a town with two doctors who staff a tiny ER. Chances are you have no choice about the sex of your doctor, or even nurse, when you arrive in an emergency.) And there is a line where any doctor of person in a position of responsibility will say no, I can't do that, even if it's what you want, I don't think that would be an ethical medical practice. I don't think you can train people and give them a lot of responsibility, and not allow them to have boundaries like that.

About maternity care in general - so much of it is not science based. But part of the problem is so much of it involves things that are not really amenable to medical trials.

One thing about the powerful experience of birth thing - I think that is true. But it also causes a problem in that sometimes people put so much weight on that, it creates its own baggage. Whenever people build up a vision of the way something is going to be, it causes problems. I remember when I was doing doula training, and older doula I worked with told me that really, she found that women who put too much time and effort into birth plans and things tended to sabotage themselves.

But the notion that a woman can give birth and be up and running less than 24 hours later is absurd.

I wonder if this isn't something that has been affected by the "women are as capable as men" idea. At a certain point, certain customs that had accepted that women had different needs seemed to disapear. Like expecting them to opt out of swimming when they had their periods.

Of course its good that it isn't expected, but now it seems like you can't really. I know some girls that go on birth control because they can't take any time out of sports teams to deal with their period. It's like we think we have to say "oh, I had a baby, but that doesn't make me less useful than a man employee..."

Being more likely to live apart from extended family makes a difference as well.

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?

Wow, you're right, that is insane. Why on earth should it taboo to show childbirth.

I don't know if it is still the case but my UK ante- natal classes showed videos of births. I didn't think it was particularly helpful and tbh I felt I was invading another woman's privacy. Possibly the fact I grew up on a farm and had seen cows, horses, pigs, sheep, cats and dogs give birth contributed to the not being particularly useful feeling.

As I had a very calm, very smooth, elective caesarean at 10.30 a.m it was ultimately irrelevant.

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

I'm not 100 % convinced by all of this- certainly the statement that " we trust women to analyse risk" in the middle of a birth going badly wrong. However if you're merely advocating for a woman's right to refuse advice , assistance or medical intervention no matter how dangerous that might be for her or her child and no matter what the consequences, then that is her right but medical staff should not be blamed if it ends badly- although of course they will be.

My own experience is exactly what I wanted. A nice , calm highly medicalised experience with a shift of theatre staff who knew in advance that is what they would be doing that morning.

I had very little contact with midwives beyond a few routine ante- natal checks.

GeorgeFayne thank you for being one of the voices of reason on that other thread. I don't have much more to say on this one but I think this will be a far more useful thread.

when I was pregnant I kept on asking the docs I saw questions about the evidence of risks for both mother and child when various practices and they brushed me off.

Most OBs have a way they want to do things and to hell with science, to be honest they seem completely ignorant of pros and cons of various practices (I have literally gotten condescending sighs and eye rolls when requesting this information - I shouldn’t even have to request it - it should be given to all women).

If These medical professionals don’t know the risk/benefit stats well enough to tell me how on earth am I supposed to make an informed decision or meaningfully consent?

I’m a difficult patient I suppose, since I’m unwilling to be treated like an inanimate object incapable of reason/thought. I think it suits docs purposes to keep women ignorant and compliant (less “hassle” for them if everyone’s a c section scheduled between 9 and 5 pm - note obviously no dispersions meant to be case on women who choose this mode of birth btw).

Note that I had a fine birth experience (in US hospital).

Main issues I had: nurse seemed skeptical that I was in active labor / was really surprised to find I was 9 cm upon arrival. Maybe listen to me when I give you my meticulously recorded contraction intervals?

They asked me multiple Times if I wanted an epidural despite me not asking for pain relief once and saying I was fine the first time. I got the distinct feeling they thought it was “cute” that I felt I didn’t need one.

I hate the idea of empowerment through birth ect

If men gave birth c sections would prob be the norm by now

WH today was sobering and distressing. The stats for UK maternal deaths in BAME women are dreadful. White patriarchy needs dissembling (easy said, I know).

I'm glad someone started this thread, the other thread was like repeatedly smashing oneself over the head with a frying pan.

I had 3 very different births in 4 years -

Dd1 was a 3 day affair in a midwife led birthcentre, no drugs, wrestling a fucking enormous bean bag and ending in a mad rush to a Labour ward as dd2s heartbeat became erratic. There followed an episiotomy, ventouse, 3rd degree tear and repairs by a surgeon.

Dd2 was a year later, discovery that baby was in distress whilst waiting for water birth in Birth centre induction, epidural, reaction to epidural, quick birth ...whilst passing out. 2nd degree tear, stitches by midwife, restitching by surgeon.

Ds was 3 years later, elective caesarean which was awful, I reacted to drugs, lost a lot of blood, ds was whisked to NICU grunting, before I could hold him. Post natally I developed chest pains and an infection in my veins and in the wound and ds was very ill. My gp diagnosed PTSD and I was a bit of a wreck. I went for 'birth trauma counselling', which, in reality was a massive arse covering exercise by the hospital (I went in expecting a counsellor and was met by consultant and surgeon from birth) as by the time it happened it was obvious that ds had disabilties (it eventually transpired this was not related to the birth)

This all came after 7 years of ttc, miscarriages and a 2 1/2 year hiatus due to a molar pregnancy developing into a cancerous gestational trophoblastic disease, which in turn led to a year of chemotherapy and a year of being unable to ttc.

As a result my experiences of fertility doctors, hcps, gynaecologists, oncologists, midwives etc is pretty varied! There were good and bad regardless of their sex. I made official complaints about the aftercare in the hospital I had dd1, the attitude towards women giving birth and breastfeeding support in that hospital was appalling, even a year later, it seemed to have improved.

On the other hand I sent a photo of our 3 children and a Thankyou, to the amazingly kind doctor who took so much time and kindness when discussing getting pregnant after chemotherapy. I was lucky enough to have Europe's leading authority on GTD when I was ill, and a funny, warm and sarcastic cancer nurse to guide me through it all.

The big negatives for me in the actual care throughout all this were
-Being ignored and infantilised
-Not having concerns taken seriously
-Being used as a medical 'example' (I see similar things now with ds having a rare disorder)
-A lack of correct procedure
-A culture of 'good birth' and 'bad birth'.

I think the UK still has a long way to go with care during pregnancy/birth.

Unfortunately I think there is a bit of a culture of infantilising/patronising women and I feel the language that surrounds maternity care is cleverly constructed to create unbalanced power dynamics.

Even from the earliest midwife appointments nothing is ‘offered’, it is all ‘you need to give a urine sample/you have to be booked in for a scan’ and so on, the tone is very much set that the medical professionals are now an authority who can exercise power over your body and you must be compliant. I remember the midwife stating that if I went over 42 weeks then I would ‘have to’ be induced before literally taking out a calendar to work out when to pencil an induction in. The language during labour and birth is the same, even on OBEM, where staff are on their best behaviour and being filmed by cameras, it’s commonplace to hear women told and not asked things like ‘we are just going to/need to examine you’

I ended up with a horrible forceps delivery and realised I didn’t have enough knowledge prior to birth about the different situations that could arise during labour and what the actual choices I could make were. So the medical team made all of those decisions for me, as they do for the vast majority of women. The second time I researched properly and as a result had much more control during labour. Yet birth plans are routinely mocked and dismissed and misunderstood as being a rigid set of planned circumstances, not about women knowing their rights and choices for different possible scenarios. Consent is often seen as optional by many medical professionals. The fact that consent can be difficult to obtain in certain life-threatening situations is used as a reason to not bother with it in all circumstances by some.

Respectful care and an emphasis on dignity/privacy is also an issue in childbirth imo. Women routinely told to ‘leave their dignity at the door’ so no little extra measures are taken to preserve it.

I know the healthcare system in the UK is incredibly different from the US. One of my greatest frustrations here in the US is the move to make it an "industry." People get forgotten and relationships don't matter.

There is something to be said for getting to know your birth attendant during the months of pregnancy. Trust gets established. And in the event shit hits the fan during delivery, a woman will know that she can rely on what her doctor or midwife is saying to be valid and necessary. The value of relationships is being lost and eroded here, and it's really tragic.

The trust thing is an issue throughout the medical system IMO.

It's what the idea of individuals having a GP who knows them and sees them through specialist care and so on is meant to address. I had that growing up - the doctor who delivered me into the world was the Gp for my sisters, my mom, and all four of my grandparents. He gave me my first pap smear years later. He knew my family medical history better than I did, and I knew he always had my best interests at heart.

Now many people here don't have a GP, or they barely know the person. It's one thing I've worried about with the collaborative care model that is now being pushed here. I see the advantages from an efficiency POV. But it means that you see your own doctor even less.

I hate the idea of empowerment through birth etc
Yes , I'm a bit dubious about that too.

And I definitely go against the grain that a healthy baby is all that matters. I had no birth plan beyond I will go to the maternity hospital when the time comes and I will do what the midwives and doctors think best. I had no ambition not to have pain relief if I needed it. I had no ambition that I had to have a natural birth.

As it happened a complication at the end meant I was offered the option of a caesarean, if I wanted it. Thank you very much said I.

@LassOfFyvie I agree that I should have been clearer. I am advocating for women to have the right to refuse or request medical treatment at any stage during pregnancy and childbirth. This doesn't take away the responsibility of medical people to ensure that this is as informed as possible. And I think I also said that emergency situations should be as far as possible handled in a way that respects the individual woman's known preferences.

I 'think' that @GeorgeFayne is saying that at schools they cannot show birth videos - not that they cannot be shown in prenatal classes. Part of breaking down the barriers and empowering women is providing education about how bodies work well before they might be pregnant. The number of women who don't know the names of all their own body parts and don't know what they look like and how they work is scary. Especially where education is officially provided up until late teens and porn is widely accessible.

I had two hospital births and two home births. Birth 2 was traumatic for me, despite the fact that on the surface it was 'normal' 'easy' and generally uncomplicated. There were many factors, but the feeling of being superfluous to proceedings is a part of what makes the memory of that birth uncomfortable/unhappy.

I don't think that the home birth/natural birth world is free of misogyny and patronising behaviour. It's an industry itself, and the dynamics can be just as toxic as those experienced in a hospital.

To the PP who was expected to sleep on a chair next to an unwell newborn less than 24 hours after giving birth. I'm so sorry. I wish we lived in a world that recognised the 6 week postpartum period as being just as important as the pregnancy. Women need care and support and monitoring just as much after the birth as before. Again, if women were human rather than human making machines then our systems would recognise this.

Maybe a simple summary would be that relationships matter.

I can see this from both sides, as I’m a mother of 2 DDs and also spent 36 years as a hospital doctor, during which I inserted hundreds of epidurals for women in labour, and also anaesthetised for C sections, retained placentas, trials of forceps, etc.
Most of the PPs on here are well informed intelligent women, who understandably want to be consulted and have input when discussing management of emergency complications in labour.
I think you forget that the majority of patients we deal with are not.
Many are ignorant of the most basic facts of pregnancy and delivery, are distressed and out of control with pain, and there certainly isn’t time to discuss detailed obstetric management with them when the fetal heart rate has nose dived or they’re bleeding to death!
Our focus, as I’m sure you will appreciate, is on saving the mother and baby’s life. Social niceties such as introductions and chat may have to take a back seat.
I remember one emergency section under spinal, where the consultant obstetrician didn’t have time to even meet the patient- we’d got her draped and ready on the table, the surgeon rushed in from the scrub sink and made the incision, pulled out the baby, (thankfully alive), and then he leaned over the drape, held up the infant to the mother and said “Um - Hello. i’m Dr X and this is your baby!”
That same chap saved DD2’s life as we waited for the paediatric crash team to arrive. He was dry and laconic, an old Scot of few words, and many of you might regard him unfavourably- but he was bloody good at his job. Which I rate much higher than conversational skills in an obstetrician.
I’m sorry a lot of you seem to have had uncaring midwives who lacked compassion. There are plenty of excellent ones, but sadly too many are either rigid control freaks, or have been hardened by years of listening to women screaming in pain, to the point that they have detached emotionally to shield themselves.
There are also some, unfortunately, who have a feud with doctors, and they try to deter women from having epidurals or medical intervention in order to retain complete control of the labour themselves.
I don’t think there are easy answers, other than to complain about bad practice wherever you find it, and to make plain from the start that you want to be consulted about your management in labour.
But in all fairness, unless you have a medical degree and an MRCOG qualification, your attending obstetrician is much better placed than you are to call the shots if labour is not going to plan!

Continuity of care would help hugely. I liked and trusted the midwife I saw in the community during my pregnancy. I wish she’d been there for the birth bit too. The hospital midwives were strangers to me and I really disliked that. If I’d had a home birth I’d have had my own midwife there, I believe.

Babdoc It is all very well you talking about the worst case scenarios, but the lack of consent and, as a pp said, infantilising language is an issue during normal, non-emergency situations during birth. Paternalistic attitudes are a big problem, IMO.

But in all fairness, unless you have a medical degree and an MRCOG qualification, your attending obstetrician is much better placed than you are to call the shots if labour is not going to plan!

I agree. (I'm not a doctor) I'm never wholly convinced by the "I know best because I'm a woman/ I'm a parent" stance.

Fear of the "cascade of interventions" that gets peddled, the narrative that there is a "right" way to give birth, and the falsehood that transfer to a hospital for medical care or the need to have a C/S is "failure." How does this better serve women? Just more guilt and condemnation that gets thrown at women

But the cascade of interventions is true in many circumstances. it is not something that is being "peddled". Using such emotive language clearly highlights your own stance, most likely based on your own experiences; however, It is very tiresome when other women are not 'permitted' to talk about their own view, based on their own more positive experiences- without being told they are blaming or "condemning" other women.

I do think woman’s healthcare is an absolute disgrace and massively behind the times.

My first birth experience was shambles, they didn’t believe a word I said which resulted in me ending up in intensive care. It was the ‘you’re in Labor not dying’ mantra like a first time mum wouldn’t know anything. DP didnt have a clue either as put all trust in the drs.

I agree drs know best in most situations but woman need to be listened too.

My second experience was much better, they put on my c section notes that I previously had PTSD from birth and I had 2 lovely Midwife’s either side ready to calm me down if I needed it. They listened to everything I said, had blood on standby and planned the section on a day experienced consultants could be present.

The second time round, I knew my rights, I knew the immense risk that birth was and I knew that unless I laid down exactly what I wanted and needed, I would be left again. We need to stop treating pregnant woman like infants and tell them (and their partners) exactly what could go wrong and that they can say no, they can demand a second opinion and that drs do make mistakes, and we need to ensure the NHS gets up to standard.

Me and my eldest child nearly lost our lives because of absolute incompetence, and what did they do? Sent someone to see me the day I got out of ICU to talk through my ‘experience’ and let me know how tough it is for them.

I hate the idea of empowerment through birth ect

Nobody is requesting anyone love anything.

However, birthing is, and can be a very empowering experience for many women.

There is censure on saying this, though.

Justhadathought
Let me clarify about the "cascade of interventions" and acknowledge that maybe "peddled" wasn't the best word--it suggests the theory is false or there is no merit to it. Yes, I do think there is evidence to show that sometimes, one intervention leads to another. But it's not an absolute and my frustration with many (not all) in the natural childbirth movement is that they do tend to portray this as a CERTAINTY. (I know at the point in my life when I was heavily influenced by the natural childbirth literature, I was convinced that epidurals lead to more c-sections, even though the literature doesn't actually support this.)

The answer to this is, in my opinion, more research and evidence. For example, continuous fetal heart monitoring (an intervention) may actually result in more c-sections, but intermittent hands-on monitoring (variation of an intervention) does not and has positive outcomes.

Also, there are times when an intervention IS medically necessary. I can't tell you how many mothers (of my patients) who ended up with a c-section express feelings of guilt or shame that somehow they caused the escalation of care by consenting to X intervention. I'm not sure this helps new mothers, and the post-partum period (especially for a section!) is already difficult enough.

And I totally agree about the need for women to feel free to talk about their experiences, positive or negative. (That's kind of why I started this thread - - open dialogue). I'm just tired of woman shaming in ALL of its forms.

Lass and JustHad

Regarding empowerment with birth: would it be fair to say that this is something that may be as highly varied as women themselves are?

I'm an idealogue (sp?) and tend to assign a lot of significance to certain life events. It's not surprising that I went into my first birth with the idea that it was going to be LIFE CHANGING. And you know what? It was. I felt incredibly powerful, amazing, like I could do anything. Truly a goddess moment! And it cured me of my body shame and hatred. For the first time in my life, I loved my physical self.

My best friend is very much a pragmatist. She only viewed birth as a means to get her baby from the inside of her body to the outside. Nothing mystical, just physics and physiology. She didn't really care how it happened, but that it would happen safely. Her birth experiences absolutely fit who she is as a woman.

Maybe the feminist answer is that some women look to birth to be an affirming and transformative event...and others do not. Both might just be ok and normal. Perhaps there isn't one right way to woman.

I believe, however, this is important for providers to assess during pregnancy--again, the critical need for relationships in medicine! Women, such as myself, might really benefit from conversations about how they will feel if things don't go according to plan. Discussing and establishing an alternative plan in advance (should it be necessary) can still preserve her feeling of accomplishment and purpose in the birth.

My best friend is very much a pragmatist. She only viewed birth as a means to get her baby from the inside of her body to the outside. Nothing mystical, just physics and physiology. She didn't really care how it happened, but that it would happen safely. Her birth experiences absolutely fit who she is as a woman

Yes that describes me. Also I've never had body issues.

I see I missed out a word in an earlier post . I meant to say I And I definitely go against the grain that a healthy baby is not all that matters.

I don't find pregnancy and birth awesome in the way many posters on FWR do. I'm referring to statements I frequently see such as "growing a whole new person" as if this was some sort of magical, mystical thing. Humans are mammals- it's what all female mammals are built do. It's basic biology.