Are women stupid?

It strikes me how often choices around birth—especially women’s choices (as opposed to choices made by doctors, midwives and other professionals)—are reduced and simplified, boiled down to the overall message that women are stupid and can’t be trusted.   

I remember distinctly during my second pregnancy when I’d tell people I was planning a homebirth being met with horrified gasps, and comments along the lines of, “Aren’t you scared?  What if something goes wrong?!”  Aside from the obvious responses (anything unknown is always a little bit scary, and something could go wrong at any moment of any day—it’s more likely I’ll get hit by a car crossing the street than have a catastrophic homebirth), I often found myself wondering if the people asking the questions actually thought I was stupid.  I got to the point where I would just retort, facetiously, “Oh, wow, I hadn’t thought of that because I don’t care at all about my health or my baby’s safety.  I’m just having a homebirth because I don’t know any better.  Plus, all the cool the kids are doing it.”  I’m not very nice when I’m pregnant.

There isn’t a lot of room in conversations about birth for the women who are actually having the babies and the reasons why we do what we do.  Our voices get drowned out amidst so much politics and ideology, and we’re left looking like idiots who really can’t manage our own lives.   For example, I read a comment in an article earlier this week about women being birth copycats:  a celebrity gives birth in this or that way, stupid sheep women follow suit.  So easy.

Spare me.

Yes, celebrities are influential.  To wit:  I became a vegetarian when I was 12 because of Howard Jones, and I joined Amnesty International in grade 8 because there was a membership table at the U2 concert I went to that year.  I bought white jazz shoes because Duran Duran wore them in several of their videos, and I still favour black clothing because of The Smiths.

But I did not plan a homebirth when I was 34 because of Ricki Lake or Cindy Crawford.  Nor did I have a c-section because of Britney Spears or Gwen Stefani (even though I do like the latter’s music, and appreciate how easy she has made it for me to teach my children to spell “bananas”). 

Celebrities can do a lot to normalize certain birth choices, and sometimes they launch advocacy campaigns of their own.  Widely publicized elective inductions and c-sections can make those procedures look like no big deal and help to strengthen a culture that encourages non-medically-indicated intervention in birth.  Similarly, Ricki Lake’s The Business of Being Born has encouraged critical thought about the birth industry to come into the mainstream, instigating conversations about things like homebirth that might otherwise never have taken place. But none of this automatically translates into women deciding to do x or y with their bodies during birth.  Taking such a reductionist approach really misses the mark. 

It seems to me, and some research appears to support this, that the notion that women make birth choices based simply on celebrity behaviour—or because it’s ‘what’s cool’ on MDC or Babycenter or among their circle of friends—is patently absurd.  It’s an assumption that allows a convenient side-stepping of the problems with the whole notion of choice in childbirth. 

There are multiple reasons why women make particular birth choices, and—libertarians be warned—those choices are rarely autonomous. More often than not, they (we) are ‘choosing’ the least problematic of the limited options available, with partial or flawed evidence plus heaps of personal constraints informing/directing the decision.  Reducing decision-making to one variable is the surest way to silence birthing women and to cut off any meaningful discussion about how to support women—how to change what is currently in North America a very, very flawed system—so that all of us can give birth in the scenario that is most comfortable, most safe, and leads to the best possible outcomes.

The painful point is:  none of us can make really good choices in a system that condescends to women as a group, and holds our integrity in contempt.

Rather than judge women for their choices, it might be more fruitful to question the professionals who control access to the bulk of the information (most women don’t have privileges at academic libraries and wouldn’t be able to read the professional journals, even if they had the time or inclination to do so), who interpret the scientific data for non-scientific audiences, and who market various forms of birth with motives that have little to do with women’s best interests.  It might be useful to bust open the false doctor-v.-midwife/vaginal-v.-surgical/home-v.-hospital dichotomies, and remember that real women’s bodies are the battlegrounds for what often come down to professional, ideological, and corporate wars.

It’s hard to make confident choices when you are doing so in the midst of a firefight.  I had a doctor literally throw my chart at me when I told her I was choosing midwifery rather than physician care for my second pregnancy.  I have been castigated for accepting interventions that supposedly led to my c-section, and accused of false consciousness for having felt empowered by my first birth because it was induced and thus not natural.  I’ve seen the same things and more happen to dozens of other women, often by professionals, but also by other mothers, many of whom react from a place of anger  or frustration with a system that may have mistreated them and/or betrayed their trust.  All of this is unacceptable.

Each one of us makes the best choices we can with the information we have available.  Information is rarely perfect or complete and knowledge is always partial, and sometimes choices made with the best of intentions turn out to be the wrong ones.  Rather than assuming that pregnant women are idiots, why not assume that they—more than anyone else—want to have their babies safely, in a setting that is appropriate for them and their families?  Why not admit that the system in which we give birth is adversarial?  What would happen if we didn’t blame women for being stupid or vapid, and instead looked at the reasons why they’re putting their trust in Ricki Lake instead of their midwife or OB?

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6 Comments (+add yours?)

  1. Nicole SistaMidwife Deggins
    May 22, 2011 @ 19:38:27

    Well said!!

    Reply

  2. Kimberley
    May 23, 2011 @ 01:22:07

    Indeed! Very well said. What influenced me? My observations of my sister having babies (she shared very little with me about what actually happened, etc) and my own intuition about what felt right. I don’t regret the choices I made but realize that I was very poorly informed, even though I had a very confident, positive experience leading up to my first baby being born. For my second, it was very stressful making decisions based on medical opinion and if I could have had a midwife (none in my area would see me with a planned section) with a home birth I would have. I went from feeling that a hospital was the safest, most comfortable place to have a baby (pre #1) to feeling that it is the worst place to have a baby. And that’s saying a lot from a germaphobe. The back of a cab would have been more fun for me.
    Has there been much research on the impact on mothers, families and our society when women recover from childbirth? For me, 2 sections has profoundly affected me and my family. I still believe that it was the only way but could more have been done to help me recover and prepare for #2- definitely.

    Reply

  3. Carolyn Hastie
    May 24, 2011 @ 02:09:19

    Thank you so much for this post. You have summed up the complexity around what is happening for women during their birthing experiences extremely well.

    This comment

    “The painful point is: none of us can make really good choices in a system that condescends to women as a group, and holds our integrity in contempt”

    is sadly, the reality of much of which passes for maternity ‘care’.

    Your final comments included these foundational truths:

    “Rather than assuming that pregnant women are idiots, why not assume that they—more than anyone else—want to have their babies safely, in a setting that is appropriate for them and their families? Why not admit that the system in which we give birth is adversarial?”

    Once we as health care providers can see the sense of and agree to both those points, then we can come to a place where the woman is seen as the expert on herself. We can ensure we commit to a system that puts the woman’s thoughts, feelings and situation at the helm and invite her full participation in any decision making process that occurs about her maternity care. To take such an emotionally and socially intelligent and competent perspective means getting over ourselves as health care practitioners, removing professional silos and working from the proposition that we are there for the woman (radical thinking, I know!).

    My dissertation was about how doctors and midwives interact in the delivery suite about the care of birthing women, so this topic is very close to my heart.

    If anyone is interested in reading my dissertation “Putting women first: Interprofessional Integrative Power (Chapter 1 and the Conclusion are most relevant to this discussion and easy to read too!) the work is available online here http://hdl.handle.net/1959.13/29305

    Thanks again for this great post. Everyone involved in any way in maternity services (the whole population, as we were all born somehow) needs to read it. Passing it on xx

    Reply

  4. danielle
    May 24, 2011 @ 10:15:46

    I would love a homebirth of i had a second child. I clearly remember the doctor making a cameo appearance after twenty hours labour…stating
    ” SO …you finally got what you wanted !”..
    I had no idea what he was talking about as i was so exhausted, panicked, angry, scared, alone…

    Apparantly he was going to use forceps… i had begged for chainsaw…a bullet… ten hours ago at LEAST ! You would think i had deliberatley WITHELD my son’s birth to ” get what i wanted” ??? Forceps?
    The nurses however had been lovely…
    His comments and his presence were the very height of arrogance.

    Reply

  5. Pregnancy Journals
    May 30, 2011 @ 08:58:49

    Good congratulations finally you got the baby!

    Reply

  6. Nathalie Boulanger
    Jun 02, 2011 @ 05:47:57

    I had to be transferred to the hospital after my homebirth because of a retained placenta and hemorrhage. The OB who took care of me at the hospital told be after the birth with a frown: «No more homebirth for you, this is too risky». But I loved, my homebirth and even if I could go back, I would still choose it. Now that I am pregnant again and I am still considering a home birth, I know I have the support of my midwifes to make the choice that will be right for me, but I know that my parents, who are both doctors, will… think that I am stupid!

    Reply

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