Saturday, 10 March 2012

Giving birth is not a competition

International Women's Day has been a powerful reminder of how far we've come as a species.

IWD has also shown how far we still have to go to create a social world where the vast majority of women and many men enjoy the human rights of sovereignty and social safety to live as they desire and deserve.

From delusions of being able to create the master race to the idea that you can reduce or even eliminate risk in life, medicine and science have sought to control and dominate nature.

Nowhere is this more apparent than in the area of reproduction and in particular, for western women. Western women have come under increasing surveillance, control and criticism from medical 'experts' and the population at large during childbearing and parenting.  Conflicting advice abounds creating confusion and distress for women, all of whom want the best for their babies and want to do 'the right thing'. Women are told on the one hand that the rate of stillbirth doubles after age 40 and so induction around 37 weeks is recommended. On the other hand, other experts say that babies born early around 37 - 38 weeks with induction of labour are at risk of health problems.

What's hard to reconcile with the constant negativity with what is a very normal, human activity is that evidence shows that medical error causes more death and disability to people in hospital than motor vehicle accidents, breast cancer or AIDS. You may note that childbirth doesn't get it a look in with the comparison because the real problems with childbirth, even those caused by intervention, are so low in the western world. The other disturbing fact about hospital culture is that people are afraid to report errors because they fear recrimination. So really, we don't know what actually goes on in hospitals. Our only clue in NSW for example, is the Mothers and Babies report and that is a broad brush view.

We do not know exactly what the rate of intervention in the birthing process is doing to developing brains and human relations, but there are some signals that there are detriments.

Various individuals and groups challenge medical domination of birth and the medical profession's dismissiveness of the social aspects. There are thankfully, some enlightened doctors championing "patient" centred care and calling on clinicians to "relinquish the role as the single, paternalistic authority."

Films such as the Face of Birth, which aim to defuse the hysteria and show the social view of humanity's most primal act, have a tough gig. The media's delight in traumatic tales, coupled with 'reality TV's' depiction of birth all flavour enhanced by the medical profession's staunch opposition to birth at home and midwifery care, especially in Australia, has led to public opinion becoming increasingly hostile and disapproving of those who choose other than the 'doctor in charge' status quo. As a result, western women are becoming increasingly fearful of birth.  They are increasingly feeling under 'siege', a state of perpetual fearfulness. What is not so well known is how 'fear' affects a person's physiology.  The biochemical correlate of fear is cortisol. There is a lot of work being done on the effect of cortisol on physiological functioning and brain development for the fetus. Prenatal programming is a burgeoning field of inquiry investigating how a person's lifetime risk of disease or health is actually 'set' in the womb and dependant upon the mother's social world. We need to really wake up to what that means.

Western women are also becoming increasingly insecure about their parenting, which for heaven's sake is hard enough without the avalanche of 'advice' and disapproval from all and sundry.  I have been reading the comments under the mass media's articles on birth at home and the different perspectives are fascinating and show how we all see life through our own lenses of beliefs and experiences.  What, however is alarming, is the punitive and nasty way that some people respond to people's choices.

The scorn and criticism heaped on women who choose to do things differently, no matter what 'norm' is being touted by whichever interest group, is horrendous and needs to stop.

Where a woman gives birth and who she gives birth with is her business. For anyone to think they care more about a woman's life and baby than she does is the height of ignorance and arrogance. Our job as a society is to support women's choices because the evidence is clear that when a women feels supported and has choices her cortisol level is lower and her physiology and therefore her baby's physiology is more likely to be 'normal'.

Birth is NOT a competition.

It is about feeling safe, supported and respected.  Interestingly, the outcomes, including those of maternal satisfaction, are very very good when that is the situation. On another note, so many people downplay the need for the woman to feel good after birth - the health and wellbeing of the family are enhanced when a woman feels loved, respected and cared for, so that should be the focus of society.  We need to ask ourselves where does she feel safe and how can we, as a society support her in that?

Meanwhile, in too many countries, women are dying in childbirth.  The current estimate is that around 1000 women die every day giving birth.  That statistic is shocking and, with the right conditions, preventable.  These statistics illustrate clearly the social determinants of health and disease. Women are dying because in their cultures, they are "nothing" - they are worthless in the eyes of their culture  - they are the possessions of their partners or parents; they have no access to contraception and often have (too) many children, their nutrition is very poor, they are dreadfully anaemic, in some areas have malaria, HIV/AIDS and live with domestic violence and the threat of more of it hanging over their heads. Their living conditions are harsh. If we use Maslow's Hierarchy of Needs to think about the social determinants of health, you can readily see that these women exist without even their basic human needs being met. No wonder the challenges of reproduction are sometimes too great for them.  These women do not have the best conditions at home to give birth there - even the hospitals are poorly equipped and lacking in staff, but at least there may be someone there, with some education and training, who can support them and help them give birth safely. We know that when there is a strong and capable midwifery profession,  childbearing women and their babies do well.  Capacity building midwifery education is one of AusAid's projects to improve maternal and neonatal wellbeing and decrease mortality and morbidity rates in PNG.

People in the western world who are so concerned with what childbearing women do and where they give birth need to turn their attention to the developing world and work on making it safer for all women and their children.  We are, after all, living in a global village. What affects one, affects us all.

Instead of making birth a "who's right or wrong' competition, let's make it about cooperation, compassion and support.

If we want a peaceful society and happy mothers and babies, we would do well to ensure women felt loved and cared for, respected and nurtured, fed good food, rested, kept away from bad news and surrounded by loving family and friends and able to give birth the way they want to, with people they know and trust around them.


Anonymous said...

Thankyou Carolyn, once again a thought provoking blog post. Every women would be able to birth as nature intended if birth was trusted, left alone and every women had continuity of care, from pre pregnancy to 6 weeks postnatally :)

Carolyn Hastie said...

Thank you for your comment anonymous. Yes, the chances of giving birth normally and emerging healthy with a healthy baby and happy attachment are much higher with good midwifery care. I read a story once about an old NZ midwife who worked the turn of the 1900's who had a great philosophy and 'delivered' thousands of babies in her community as she travelled around on horse back. She'd 'never lost a mother or baby' - a truly lovely story. Says everything I think. I just got a photo from a friend working in PNG of a triplets placenta - all babies good and breastfeeding. So lovely to see things go well when the care is right and the women are happy.

Selena said...

Thanks so much for this wonderful post Carolyn! I am a Mum of 2 beautifully born babes (had to fight the system for the second as it was a planned vaginal breech), & I'm currently 40wks +3 with my third bub, looking forward to a carefully planned homebirth any day now with a wonderful midwife, whose birth photo you have used in this post! :-) I am sorry to say that I have had to stop reading all mass media articles & comments on anything to do with homebirth, because they are generally just too upsetting. I completely agree with you that birth is not a competition, and I certainly don't proclaim myself to be any more superior because of the choices I make for me and my family. I have done LOTS of research on the subject and I sleep very well at night knowing that they are the right choices for us. Whatever anyone else thinks or chooses is entirely up to them and it's not my place to judge them because everyone is entitled to their own opinion... but why can't the media and all those vitriolic commenters out there share this similar respect for this basic human right?? How dare anyone accuse me of choosing to homebirth because I am selfish or have little regard for the safely of my own child! The bullying in (Western) birth culture certainly has to stop. I also believe that women need to inform themselves & invest more in their own birth experiences, because too many are quite happily handing them over to science/medicine without a second thought or realisation of the consequences. It's ironic that science/medicine is so focused on 'risk' management but fails to disclose many of the risks inherent in many of their own standard practices. It's people like you (& maybe even me if I ever gather enough courage to speak out against the bullies!) who will make a difference... so on behalf of my girls who will give birth in the future (hopefully in a much improved birth culture), thank you thank you thank you xx

Carolyn Hastie said...

Thanks for your comment and your insights Selena. Your words are powerful and women need to hear them. I'm so glad you took the time to say what you think and what you've experienced. You write well. Your voice as a woman and mother is vital to share, Perhaps you may like to write a guest post on negotiating the birth you wanted for your breech baby? Would be wonderful for women and their partners to know how you did that. :)

jasz_altaz (Taz) said...

Always love your posts Caroline. Insightful, informative & supportive.

In my experience attacks come from a place of fear.A need for control/power. Whilst at times they are narrowminded & infuriating I always have a twinge of sadness for the attacker & the pain they are experiencing. What must have occurred that has them so frightened of pregnancy, birth & the female body. Shocking.

As I follow the path to my first homebirth mid Year, I embrace the journey that has allowed for soul searching, fear embracing & finally love of my body, my babe & my beautiful support network. This is how pregnancy should be. I AM EMPOWERED.

I am honest about my choice to homebirth, often to the shock of others, with my favorite comment being "I would never birth without drugs". My reply is always the same - "Thats the point. How you birth IS entirely up to you. The important thing is your decision was an educated choice based on unbiased opinion, rather than made from a place of fear". I am generally answered with silence but several have come back to me lately to enquire further about my choices & experience this time round. "You look so happy".

Sadly as women we are bombarded with fear & self doubt over every choice we are manipulated into. My theory is the human race is so frightened of the combined power of female they prefer to keep us at each others jugular using these very means.
I embrace the day all women feel her strength & come together as a collective to reclaim what is ours. OUR BODIES. OUR MINDS

Carolyn Hastie said...

What a beautiful perspective you provide Taz, I love your reply to those who challenge you - very respectful and honouring - truly the path of least resistance which gives others an opportunity to open their minds and change. Thank you for sharing that. Congratulations on the birth of your baby.

You are so right about the fear of the power and strength of women - it is confronting and wonderful.

Kathleen Fahy said...

Great post Carolyn, so holistic and evidence-informed. I love the way you share your knowledge and wisdom so broadly and not just with SCU students.

Carolyn Hastie said...

Thanks for your kind comment Kathleen, I really appreciate your support. I read a comment by Charlie Tremendous Jones who said something along the lines of "your life changes for the better by the books you read and the people you meet" - we are fortunate in these days as we have access to amazing people and ideas from around the world thanks to the power of the internet and digital devices. The more we can interact and share what we know, the more life can change for the better for everyone - don't you think?

Glenda Gleeson said...

Wow so much in this post what to say? Great you're sharing your thinking and writing it is so important for others to be informed and constantly challenged because of the power of the media. Really value the way you have related first world issues to the developing world issues. Its so necessary that we continually remember we are an international community and we need to truly care for each other. Continue to share your wise thoughts and opinions. Glenda

Carolyn Hastie said...

We are a global village aren't we Glenda - we, as health care practitioners and educators need to care for people across and throughout the world, while making a difference in our own immediate community.

We are in a time of accelerated change, I've read estimates that within ten years there will be 3 billion more people connected to the internet and communicating via social media - that's 3 billion more voices, creativity and solution generating opportunities. Things are looking very good for humanity to me - just imagine what hasn't even been invented yet - very exciting. We have to lift our eyes out of the sandbox enough to realise there are big changes ahead. Cooperation, compassion, kindness and creativity are the future. Thanks for contributing to the conversation :)

Joy Johnston said...

Thanks again Carolyn for working through complex and challenging issues. Yes, giving birth is not a competition - it's sooo much more!
Giving birth is the beginning of a whole new life, and a whole new defining of the mother, the father, and the family.
I have appreciated the comments to this post as well as the post itself. No-one knows what lies ahead in terms of health and wellbeing, especially in the childbearing continuum, but we do know for sure that Plan A - working in harmony with our bodies - is the way that is designed to protect both mother and baby.

Carolyn Hastie said...

Yes Joy, Plan A is the one! What is wonderful is the way that science is completely backing what midwifery has always known. Instead of 'nice' to do, we are becoming more and more aware of how fundamentally essential it is for society to take care of, nurture, support and be kind to childbearing women.

The health and well-being of society depends upon the woman's physiology working in an optimal way and it can only do that when she feels loved, cared for and in control of her mind, spirit and body and her destiny.

alison said...

I've just found my way to Think Birth and I'm so blown away by the deep truth of what you have written. Women need to be nourished and supported and respected and then their bodies will likely do what they are made to do - simple as that! If only the WHO Codes and other MANifestos were worded more like this! Thank you!

Carolyn Hastie said...

You have summed it up far more succinctly and eloquently than I have Alison! Thank you for your comment. I'm glad you've found your way here and I look forward to more conversation with you.