Tuesday, 19 April 2011

Raising birthing consciousness: moving beyond cruelty to women and babies

I met a friend for breakfast this morning at a lovely little cafe on the shores of a local lake.  My friend is a Calmbirth practitioner and I have had 30 years in private midwifery practice. We are both passionate about sharing information and exploring ideas about birth and parenting with couples.  Our conversation involved a lot of animated discussion on the subjects dear to our hearts, including why women chose the care they do.

How women and their partners think about the birth of their babies and choose their care provider and their birth place is intriguing.  Women who sought out my midwifery care wanted to know who was going to be with them during their labour and birth, so building trust and understanding during pregnancy was an integral part of their plan. They wanted to ensure privacy and be in control of what happened to them and their baby.  They wanted continuity of care into the postnatal period for support. How their baby was born was something they considered deeply; they wanted their babies to be born gently, into a loving environment and for themselves to be as involved as possible.  These parents desired to be the first to touch their babies; they sought minimal intervention and to discover the sex of their children themselves.  They were fully aware that their baby was a conscious being who participated fully in the labour and birth experience.

According to my friend,  women who access her services don't realise there is any other choice but private or public medical care. They didn't consider public maternity care and didn't generally know about midwifery models of care. As they are generally privately insured, they want to "get their monies worth" by employing an obstetrician and having a private room in the hospital.  We discussed the way that employing a surgeon usually means you will end up with interventions and surgery.

I told my friend about a video on birth trauma that Gloria Lemay had shared on Facebook (see below) and a post Birth Abuse by Navel Gazing midwife.  Routine obstetric management of birth is shown in the video. The video is a compilation of clips are from women's own birth videos collected by a chiropractor and made into this short film. For those not habituated to medical care at birth, these scenes may be distressing, so please take care of yourself when watching this information.
Warning: If you are pregnant, it may be best to give this video a miss as you are better off watching beautiful birth films that inspire and support your birth vision.

Birth Trauma from Centre Quiropràctic Molins on Vimeo.

Both those items and the accompanying comments have really troubled me. That women still emerge from their birthing experiences feeling like they have been abused is a dreadful and indefensible underbelly of maternity care. I left the public system thirty years ago to go into private midwifery practice because of the abuse I'd observed. I've written about that in my master's dissertation.
My friend told me she had been very roughly examined vaginally during the birth of her first baby and how devasted she had felt after that experience.  She told me that she felt it was the beginning of her slide into severe postnatal depression with that child and the source of the tremendous fear that she felt with her second pregnancy.  My friend said that she didn't stand up for herself at the time and as she was a midwife she 'should have'.  Then she said something that really illuminated the whole issue of birth trauma and abuse for me. She said "I should have stood up for myself, but I didn't have the words to do it..."
I thought about the way that women trust their health care practitioner to do the right thing by them and believe their practitioner has their best interests at heart.  Obviously, when the practitioner is rough, or behaves differently to what the woman expects, the woman goes into a shock-like biobehavioural state and has a cognitive dissonance experience. Cognitive dissonance experiences are usually difficult to put into words at the time.

A comment on Navel Gazing midwife's blog explored the Roots of birth abuse. The comment sheds some light on the reasons why birth abuse occurs.  The big question is how do people (partners, family members, midwives, obstetric nurses, doulas, registrars, paediatricians etc) accept these atrocities committed in the name of obstetric 'care'? Mind you, there is conversation in the various tea rooms across the land that revolves around these issues and I know many doulas lament what they observe in labour wards.

Perhaps in the main, the focus of wanting the baby 'out' and 'alive' means the 'how' and the 'why' pales into insignificance until we 'wake up' to the actual brutality of what is accepted as routine obstetrical management. Until we wake up, we are blind to that reality. Blindness to anything other than that which the person is focused on is called 'inattentional blindness'.  An explanation for inattentional blindness can be found in the latest research on how certain neurons actively suppress visual data streaming into the brain. This research informs us that we are only aware of approximately 1% of what's going on around us.

My friend and I discussed ways to provide information to women and men about birth options and ways to raise consciousness about birth choices and effects. How do we help this generation of parents to understand that abdominal birth and vaginal birth are not equal; that the choices they make for their care will have profound effects on the outcomes and their experiences?  How do we create a culture where violence against women and babies, even that form of violence couched in terms of 'obstetric care' is unacceptable? How do we lay the foundation of kind, respectful woman centred care in maternity services? How women are treated in their most vulnerable state during childbearing provides a template for how society treats women generally. How do we help parents recognise and engage with the spirit and consciousness of the child that is embodying and being born?


MidwifeThinking said...

I wish I had the answer to this one...
I think it needs to come from mothers/parents demanding better. Care providers in the system often can't see the water they are swimming in, or choose to ignore it to survive. The fact that most midwives choose to birth in hospital tell us what they really believe about birth and women.
The information is out there. If women did the amount of research for birth as they do for their wedding they would be more informed.
I also think if more 'mainstream' women homebirth and talk about it that will help. The stereotype of the 'hippie homebirther' puts many off (although of course we love those hippie homebirthers!)
I think there is a change occurring. In the last 2 years I've looked after lots of women who would not previously have chosen homebirth and would be considered 'mainstream'. However, with the changes in midwifery regulation there may not be the midwives to support this change.

Carolyn Hastie said...

You are right that the demand has to come from women and their partners Rachel. The problem is that people don't know what they don't know. How do we increase the cultural understanding and encourage deep thinking about what birth means. A telling comment was made by a woman who used a midwifery service close to her home just because it was close. This woman was someone from a lower socio-economic group, left school young, long term unemployed family. There is no way she would have actively pursued that service or gone out of her way to use it the first time. When I asked her what the service had meant for her, she said, after thinking carefully, "You know ... I felt like a real person". She told me she would never have known if she hadn't experienced it herself. That's our big challenge. People don't know what they don't know.

lisa said...

I think many women would like the answer but I wonder if the result would be similar to the question about the 'meaning of life'?

Today I sat in the antenatal clinic of my local hospital, not as a patient but to help raise awareness about C section.

Many women that were approached were simply apathetic and so accepting of their situations. One women even said, "Well I don't have any other option as I have already had a C section". She smiled sadly and turned away.

These women need further support immediately after their experiences. Not at 14 weeks pregnant in an antenatal clinic where carers are pushed for time.

Change needs to happen from within the system that is obviously broken. All women need to be offered opportunity of continuity of care whether it be obstetric or midwifery.

I don't work within the Public healthcare system so I don't have a great understanding of how things work...maybe there is too little funding, maybe funding could be put to better use, maybe education for the workers and co workers, or perhaps even a National and very public campaign would help.

But sadly I think most women feel beaten by the system.

I can only wonder what that women who I met today will do with the brochure that was given to her, and send my blessings to her.

Carolyn Hastie said...

Interesting you say that women are 'beaten by the system' Lisa. Do you mean that they just accept what's said or done and don't feel able to challenge anything or do you think they think the system representatives know best so just accept what they say? We are taught not to 'buck the system' aren't we? We are taught to conform. Good on you for being there and seeking to make a difference to the women who were at the clinics today. You just never know what influence you have have had and in what way. Sometimes a word or a smile is enough to start an avalanche of change in someone's life.

MidwifeThinking said...

Lisa - I think you are right. Most women just accept the system. To opt out requires effort, trust and to take responsibility. We live in a world where everyone is looking for that external expert and someone else to take responsibility. Fall down in the street = council's fault for not maintaining the path...

I just got an email from a young primip whose homebirth I attended. Out of her 4 friends ALL of them had an 'emergency c-section'. She is shocked by this and wanted to know if c-section really is this common. These are healthy young women who went along with the hospital system because that's what you do - it's safer isn't it. They will all leave the system believing their body doesn't work and the hospital saved them. This will be the story they tell to themselves and others. Perpetuating the message that women's bodies can't be trusted so make sure you birth with the experts.
The mother who had the homebirth is considered 'brave' and 'lucky nothing went wrong'. If anything had gone wrong it would have been her responsibility for stepping outside the system.
I don't know how we can turn it around. Good on you Lisa for reaching out to women. As Carolyn says - you may just nudge a change in someone's life.

lisa said...

Thank you both for your support. I often feel out of my depth in regard to birth as my own experiences were mostly'picture' perfect and I was supported in my choices. Mostly because of my wonderful husband who advocated my wishes. And I don't have a any other background in birth. Sadly I see choices taken from some many women hence I would like to find a way they can find their voice. By the term 'beaten' I mean it in every sense, unable to challenge because the experts know best and yes we are told to conform and behave. But I think if we all found a little time to voice how we feel and reach out to just one or two people change can happen, and that change will be for the better.

You are more than right when you say people are not willing to take responsibility. When I was practicing as a naturopath, this was often the case, the simple commitment of making a change was all too challenging for many and the considerations of the long term benefits were over ruled by the convenience of pharmaceutical preparations.

I will continue to try, I am not afraid of having doors closed, as they are many more that are left ajar. In fact a closed door has just opened a little for me today, as I am on my way to visit a local OB.

Carolyn Hastie said...

Lisa, I wish you all the best for your visit with the obstetrician. May ears and hearts be open to receive the message. People like you are the ones who are going to change things for the better as we midwives are seen as having a vested interest when we speak and yes, I admit I do. My interest is in safe and supported birth so both woman and baby's health, wellbeing and attachment are optimised (in a mind, body and spirit way). Heck Rachel, that email's content is a sad indictment of our cultural meme around birth and women's power. We really have to wake up as a species in more than one way!!