Feminism is for everybody

An article in the Lancet earlier this month explained how Feminism is for everybody

The article quoted bell hooks, who said “to be ‘feminist’ in any authentic sense of the term is to want for all people, female and male, liberation from sexist role patterns, domination, and oppression.”

Women and men are held in a negative pattern of behaviour by the dominant paradigm of patriarchy. That pattern of behaviour is so normal, people can't perceive it until they become more mindful and aware. Even then, it is easy to slip back into unconsciousness and the same pattern of behaviour. There is a concept that 'fish can't see water' and that applies to us humans too and the dominant patriarchal paradigm. Not only is it hard to perceive without education and questionning, some people will argue for their limitations and to maintain their inability to perceive the socially transmitted invisible structures that contain and shape us.  Neither women nor men can truly be all they are capable of being until they throw off the shackles of sexist role patterns and become aware of the subliminal messages that support and cultivate the behaviours that enable dominantion and suppression.

This video, shared on Twitter this morning, has been watched by 4.48 million people across the world and demonstrates all too clearly how 'normal' violence against women is. The comments are enlightening. I encourage you to read them and think about why bell hooks wrote about feminism in the way she did and how it essential for everybody.

Childbirth is an area where women are even more vulnerable than usual. In pregnancy, women need to be cared for and supported as their mind/bodies are fully engaged in growing the next generation. Women need a safe environment for their bodies to work well.  However, pregnancy is a time when domestic violence can erupt for the first time or worsen. Not only are women damaged and murdered by violence in the home, living with violence irreparably damages children. The immediate and long-term consequences on children of living  with violence is becoming more understood and increasingly talked about in the media.

There is also recognition that too many women's wants, needs and desires for birthing their babies are ignored and dismissed by the people working in the system.  More and more women are emerging from childbirth shattered, their belief in themselves torn to shreds. A term used to describe this phenomenon is 'obstetric violence'.  Many health care professionals are horrified by that term, claiming that they care about women and their babies and their work is designed to keep the woman and her baby safe. The fact that so many women feel damaged by the very system that has been created to keep them safe means we have a problem - the question is, has the disrespect and invisible negative pattern of behaviour that signals the patriarchal paradigm caused a blindspot in the health sytem's perspective?  Women want to birth normally and need to have the support to do it.  WHO is recommending that labour,if everyone is well  and healthy, to be enabled to progress at it's own pace. Despite this call for change, intervention rates are increasing. A new book by a gastroenterologist from Cork provides a scathing attack on modern medicine, calling it “an industrialised culture of excess” and a threat to health". Certainly, along with the way women feel following childbirth, the distress and rate of death by suicide in the medical profession indicates that things need to change. Some are calling for a Royal Commission into Obsetric Care in Australia - perhaps the time has come to look deeply, with fresh eyes, at what we are doing to women and babies during childbearing.

After 68 women were murdered last year in Australia, the majority murdered by someone they loved, a northern rivers' musician, Ilona Harker, herself a survior of domestic violence experienced as a child, gathered other musicians from around the area to create a moving tribute to the women who had been murdered and to end violence against women, using Valentine's Day as the framework.

Ilona called to all of us to make a difference:

 "I would also like people to feel compelled to speak up when they see micro-aggression acts or anyone who has any hate speech towards women or children.

"And I'd really like men to stand up because without men we're not going to change this."

It's time for a new normal. As bell hooks wrote so compellingly, if we "want for all people, female and male, liberation from sexist role patterns, domination, and oppression.”  then feminism is for everybody.


https://twitter.com/JIMINSPROMlSE/status/1096449763111854080

Thirty years of the World Health Organization’s target caesarean section rate. It’s time to take it seriously.

Australia, like much of the western world faces burgeoning numbers of women having caesarean sections along with increasing rates of postpartum haemorrhage, postnatal depression and other morbidities. There are many who argue for surgical birth, saying childbearing women are older, fatter and sicker and therefore require the life-saving operation. Others are critical of the increase. Then there are those who examine the literature and seek the truth of the matter.

Today's blog post is by Dr Kirsten Small, an Obstetrician and Gynaecologist who teaches in the School of Nursing and Midwifery at Griffith University in Queensland, Australia. 

Kirsten has a research interest in examining the mismatch between the evidence base and what happens in clinical practice in maternity care.

In line with her research interest, Kirsten provides the following thought provoking lens on a recently published review of the World Health Organisation's target caesarean section rate. Read on, I think you'll find what she has to say fascinating.

The Medical Journal of Australia recently published a narrative review, titled “Thirty years of the World Health Organization’s target caesarean section rate: It’s time to move on.” (link: https://www.mja.com.au/journal/2017/206/4/thirty-years-world-health-organization-s-target-caesarean-section-rate-time-move).

Authors Stephen Robson and Caroline DeCosta argue that the “ideal” caesarean section (CS) rate proposed by the World Health Organization in 1985 is “too low” (Robson & DeCosta, 2017, p 184).

By selective use of published literature, they generate a narrative to support this argument, and somewhat obtusely recommend that “in Australia, we should be aiming to provide CS to all women in need” (Robson & DeCosta, 2017, p 184). It is difficult to disagree with this point, but the high Australian CS rate would suggest that we are also providing CS to women who have no need for it, and who may not desire it.

The key points of their paper are presented in a summary as Figure 1 below. 

 Figure 1: Summary Robson & DeCosta, 2017, p 181

It is possible however, to use the published literature to create a different narrative, one that supports the contention that Australia’s CS rate is not appropriate.

An alternative summary of the evidence is:

• It has been two years since the WHO reaffirmed its longstanding position that the ideal CS rate is under 20% (Betran, et al., 2015).
• CS rates, particularly in wealthy industrialised countries continue to rise, with no evidence of associated improvement in perinatal outcome (Betran, et al., 2015)
• The strongest predictor of CS birth for the first infant is birth in a private hospital (Dahlen et al., 2012).
• Women whose first baby is born by CS find it difficult to access a care provider who will support them to achieve a vaginal birth in subsequent pregnancies (Toohill, Gamble, & Creedy, 2013).
• Outcomes that interest the patriarchal medical model typically exclude those that reflect women's experience of their care (Parry, 2008).
• Longer term outcomes for the neonate are better following vaginal birth rather than CS (Hyde, Mostyn, Modi, & Kemp, 2011).
• Pelvic organ prolapse and incontinence are not strongly correlated with mode of birth (Bozkurt, Yumru, & Şahin, 2014). Surgical procedures for these conditions are increasingly safe and carry low risks of complications (Ogah, Cody, & Rogerson, 2011).
• Serious complications of CS such as placenta accreta, while rare, are of increasing concern to health care systems, given the large number of operations performed annually (Cheng, Pelecanos, & Sekar, 2016).
• We should aim to provide all women with evidence based care that achieves high rates of vaginal birth (Caughey, Cahill, Guise, & Rouse, 2014). All women should be involved in decision making regarding their birth options, to the extent that they wish to be.

Conclusion: There are ingrained systemic reasons why the medical model presents CS as the safe, easy option for women (Bryant, Porter, Tracy, & Sullivan, 2007). The evidence is clear – there is no population benefit for a CS rate of over 15%. Clinicians should focus on applying evidence to the care of individual women in order to achieve the best outcomes for them and for their infants.

References

Betran, A.P., Torloni, M.R., Zhang, J., Ye, J., Mikolajczyk, R., Deneux-Tharaux, C.,Gülmezoglu, A.M. (2015). What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reproductive Health, 12(1), 57–57. http://doi.org/10.1186/s12978-015-0043-6

Bozkurt, M., Yumru, A. E., & Şahin, L. (2014). Pelvic floor dysfunction, and effects of pregnancy and mode of delivery on pelvic floor. Taiwanese Journal of Obstetrics and Gynecology, 53(4), 452–458. http://doi.org/10.1016/j.tjog.2014.08.001

Bryant, J., Porter, M., Tracy, S., & Sullivan, E. (2007). Caesarean birth: Consumption, safety, order, and good mothering. Social Science & Medicine, 65(6), 1192–1201.

Caughey, A. B., Cahill, A. G., Guise, J.-M., & Rouse, D. J. (2014). Safe prevention of the primary cesarean delivery. American Journal of Obstetrics and Gynecology, 210(3), 179–193. http://doi.org/10.1016/j.ajog.2014.01.026

Cheng, H. C., Pelecanos, A., & Sekar, R. (2016). Review of peripartum hysterectomy rates at a tertiary Australian hospital. Australian and New Zealand Journal of Obstetrics and Gynaecology, 56(6), 614–618. http://doi.org/10.1111/ajo.12519

Dahlen, H. G., Tracy, S., Tracy, M., Bisits, A., Brown, C., & Thornton, C. (2012). Rates of obstetric intervention among low-risk women giving birth in private and public hospitals in NSW: a population-based descriptive study. BMJ Open, 2(5), e001723–e001723. http://doi.org/10.1136/bmjopen-2012-001723

Hyde, M. J., Mostyn, A., Modi, N., & Kemp, P. R. (2011). The health implications of birth by Caesarean section. Biological Reviews, 87(1), 229–243. http://doi.org/10.1111/j.1469-185X.2011.00195.x

Ogah, J., Cody, D.J. & Rogerson, L. (2011). Minimally invasive synthetic suburethral sling operations for stress urinary incontinence in women: A short version Cochrane review. Neurourology and Urodynamics, 30, 284–291. doi:10.1002/nau.20980.

Parry, D. C. (2008). “We wanted a birth experience, not a medical experience”: exploring Canadian women's use of midwifery. Health Care for Women International, 29(8), 784–806. http://doi.org/10.1080/07399330802269451

Robson, J., & de Costa, M. (2017). Thirty years of the World Health Organization's target caesarean section rate: time to move on. The Medical Journal of Australia, 206(4), 181–185. http://doi.org/10.5694/mja16.00832

Toohill, J., Gamble, J., & Creedy, D. K. (2013). A critical review of vaginal birth rates after a primary Caesarean in Queensland hospitals. Australian Health Review, 37(5), 642–7. http://doi.org/10.1071/AH13044