In defense of heroism

How many times have you heard something along the lines of, “There is no medal for having a natural birth,” or “Don’t be a hero—have an epidural/scheduled c-section/other intervention of choice”?

Well, it occurred to me yesterday as I was on the return leg of my after-work run, that one reason I loved giving birth to my first child with no pain medications was that when all was said and done, I did feel like a hero. Not because giving birth unmedicated made me superior to other women: not in the slightest. This is not about relative judgments. Rather, I felt like I’d just beaten my own personal best—I did something that, going in, I wasn’t at all sure I could do, and that turned out to be much harder work than I’d ever imagined.  (They don’t call it “labour” for nothing, let me tell you.)  The feeling I had after giving birth was something like the feeling I get when I run faster or further, when I lift heavier weights or increase my endurance so I can do more reps: stronger and more powerful than I’d ever been before.

And, yes, heroic. I know that millions of women give birth unmedicated all over the world. It’s utterly common. But it’s still a big deal for each and every individual woman, just like each and every baby is a big deal for an individual family, despite the fact that there are 7 billion of us crawling around all over this little planet.

I’d argue that every birth is heroic. Every woman who gives of her body in that way, who grows and births a child, is doing something fundamentally heroic and worth honouring. At our last ICAN meeting, we talked about the idea of “cesarean courage.” Pushing your body to its limits, bringing your child into the world safely with only your own labour (in both senses) to thank is an amazing, empowering experience. And putting your body on the table—telling a doctor who you may not ever have even met before, yes, cut me open, bring my baby into this world, whatever you have to do to me in the process is collateral damage—may feel anything but empowering at the time, but is actually an incredible testament to a woman’s strength in a time of crisis, and to her willingness to do whatever it takes to save someone else’s life. I’m not sure there’s a better definition of heroism than that.

There are many different ways to feel empowered by birth. This Empowered Birth Week, I’m thinking of all the women I know who have shared their birth experiences, and shown their incredible strength as they birth naturally, as they birth after induction, as they consent to life-saving interventions, as they fight back against a system that causes needless problems during their births, as they stand up to their own fears to birth their babies safely, as they birth their babies and then watch them struggle in the NICU, as they birth their babies in the comfort of their own homes, as they give birth in custody, as they birth babies for other families, as they birth in as many different circumstances as there are different women. None of them will get medals (although my mother did get me a really beautiful engraved watch after Clea was born), but all of them, each and every one, embodies a unique kind of power that deserves both celebration and respect.

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Simple

It all really just comes down to this:

Stop pathologizing my body.

Q: Why make such a big deal about birth? A: Feminism

People often ask why I invest so much energy in birth activism, and why I care so much about how women have babies.  After all, babies are born every minute of every day, all over the world.  Why make such a big deal about it?

I started caring about pregnancy and birth when I started linking it to my identification with feminism.  I’d always known about both:  for the duration of my childhood, my mother was a family doctor with a busy obstetrical practice, and she was (is) a feminist.  I don’t recall her linking the two explicitly, at least not to me.  (Although we did have a book about Judy Chicago’s Birth Project on our coffee table, and I understood without any doubt in the 1970s that the fact my mother was a doctor at all was because of this feminism thing that she and her friends sometimes discussed.)  But I knew from the time I could be conscious of anything that supporting pregnant and birthing women was worthwhile and that feminism, defined very simply as empowering women to do whatever we wanted to do, was good.

I got that birth mattered, and that women deserved to be treated with care and respect.  I remember little things like my mother’s answer when I asked why she had short nails without nail polish:  so she wouldn’t scratch her patients when she was delivering their babies.  That made deep sense to me as a child, illustrating in an utterly comprehensible and practical way the things we can all do to make women more comfortable when they are vulnerable and in need.

Birth mattered and it also seemed absolutely mundane, and often annoying.  I was not amused as a child by having trips to the park and the pool interrupted because my mother was on call and some lady was having a baby.  I did like making pictures with all the colourful tape at the nurse’s station in the hospital where I sometimes had to wait for my mother while she worked.  But I didn’t like having to wait. And sometimes I was impatient:  I once told her to “just do a c-section” when a patient seemed to be laboring for an awfully long time, interfering with whatever it was I wanted my mother to do for me.  Yeah.

It was all very matter of fact until after my first baby was born.  I realized then that birth might be common but it’s actually never mundane, and that all the care and respect that I received as a pregnant and laboring woman—that I took for granted from a family doctor who my mother had trained—was not necessarily the norm.  I learned after the fact that I was lucky to have grown up believing the things I believed about women and to have had the kind of birth I had, and that my total, unfailing trust in my doctor and my mother’s medical angle on birth might be worth questioning, even though they believed in the medicine they were practicing and my outcome was good.

My daughter’s birth almost fifteen years ago radically altered the way I understood women’s relationship with medical approaches to childbirth.  The high I felt after giving birth, the incomparable sense of accomplishment and power, was so incongruous set alongside my unquestioning willingness to let my doctor manage my pregnancy and to accept—even anticipate—interventions simply because they were ‘normal.’  I began a long process of reframing and rethinking, asking questions, demanding justifications, searching out evidence of benefits and risks, wondering what ‘normal’ even meant and why anyone automatically believed, in the context of intervening in pregnancy and birth, that it was good.

It didn’t take long for me to recognize that the framework for my analysis was feminism.  Feminist thinking made it possible for me to de-center medicalization without demonizing individual doctors, and to explore other approaches such as midwifery without romanticizing them.  Feminist thinking encouraged me to look at pregnancy and birth first from the perspective of the women who experience it, and consider the ways in which ‘normal’ pregnancy and birth are constructed by particular social, historical, political and economic contexts.  Feminist thinking made it impossible for me to look uncritically at any action that interfered with women realizing or being supported in realizing the unhindered potential of their bodies, and allowing their bodies to take up space, and be noisy, messy and inconvenient.

It probably comes as no surprise that this has all led to some *cough* interesting conversations between me and my mother.  We agree on the fundamentals:  birth is not a medical emergency, interventions should be kept to a minimum, and women deserve respect.  We agree on many critical points, including a shared sense that today’s skyrocketing caesarean rate is a problem and the importance of supporting all women in making truly informed decisions about their own reproductive health.  But then there are other topics, such as the relative safety and advisability of homebirth, where the discussion gets a little more complicated and I have to remind her:  intentionally or not, you raised me to think this way.

Believing in women’s bodies and their capacity to grow, birth and feed babies without undue intervention, and in women’s right to control their own reproductive labour—not only whether they give birth, but how they give birth—is central to my belief in women’s capacity to be agents in their own lives and effective political actors.  I don’t reject medical intervention when a woman needs it.  I do reject the dominant medical model that says intervention is almost always necessary.  And I reject the notion that just because birth is common we shouldn’t care about it or that birth activism makes mountains out of molehills. Minimizing issues that are unique to women is a time-honored tool in the war against us.  And it’s often in the struggle for autonomy in our everyday lives—including what some consider the mundane, uninteresting work of pregnancy, birth and mothering—where we discover what power really means.

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?

After a surgical birth

I spent a lot of time today thinking about how women and babies are treated immediately following caesarean deliveries.  This topic is often in my thoughts because of my own post-op experience.  For reasons I still don’t understand, I was not allowed to touch or hold my perfectly healthy newborn daughter until we were out of the OR and in recovery, about 45 minutes after she was delivered.  In the OR, both of my arms were strapped down, and everyone present just ignored me when I asked repeatedly to touch her.  Being completely stripped of power as an individual, as a woman, and as a parent in the first hour of my daughter’s life is still one of the worst memories I have of that day.  The resulting anger and loss is almost indescribable.

Two things today made me think about this even more than usual.  First, I made the mistake of watching A Baby Story on TV at the gym this morning while working out on the elliptical machine.  (My theory is that watching shows that inevitably piss me off will raise my heart rate a little more, increasing the value of my workout.  Totally bunk science, I know, but it’s my way of justifying really bad TV choices.  Anyway.)  In the show, a woman who had hoped for a vaginal birth gets a c-section.  The hospital staff dismiss her sadness and fear prior to the surgery; afterward, they ignore her as she calls for her newborn baby, who she can hear but not see crying somewhere beyond the curtain separating her head and chest from the rest of her body.  Her baby is brought close to her face for a minute or two—already clean, dry and swaddled—but then whisked away, leaving the woman lying there with a stunned and wounded look on her face that resonated just a little more than I would have liked. 

It wasn’t easy to get the images from this morning’s A Baby Story out of my mind, and then later in the day, by coincidence, I happened upon this post at Cesarean Parent’s Blog.  The author describes a situation that should be the norm post-op in cases where a baby and mother have no health issues requiring immediate attention.  Just like after a vaginal birth, women who have had caesarean surgeries should have the opportunity to have skin-to-skin contact with their newborn babies.  Not all women will want this, and in some cases it won’t be appropriate.  Obviously women and their health care providers need to make smart decisions responding to the specific context and requirements of each birth.  But barring the need for immediate medical procedures, offering a woman the chance to hold her baby—and keeping the baby close to her/his mother— is the humane thing to do.

I write about this here because the reality of a 30-40% caesarean rate means that more women than would otherwise expect or require a c-section need to be ready for the possibility that they will have one.  For those for whom the birth process is important or who want to see and feel their babies fresh from the womb—before they have been sanitized, weighed, measured, poked and prodded by a succession of strange hands—it might be worth spending some time thinking about how an ideal post-op period would look and feel and what the hospital staff, attendants and others might be able to do to support their wishes.  None of this guarantees a positive experience, and achieving an ideal is far from the point.  The point is not to stay ‘in control’ (no such thing in birth), but simply to remain subject instead of becoming object.  For some women, preserving those post-birth skin-to-skin moments amid the challenges of a surgical procedure (especially one with such a troubling political context) can make all the difference in terms of their overall feelings about their births, their babies, and themselves.  If doing so poses no medical risk to mother or baby, and, indeed, has myriad proven benefits, why not?

ICAN of the Cowichan Valley

Forgive me, readers, for it has been many months since my last post.  I took a little professional detour (can you detour from an already diversified path? hmmm…).  It was interesting, and among other things, gave me an opportunity to reevaluate my values and priorities. 

And now that I’m back from my sojourn, I’ve re-prioritized my work around birth advocacy.  To that end, I’ve (finally!) gotten around to doing something I’ve been talking about for years:  I just started a new chapter of ICAN, the International Cesarean Awreness Network, here in the Cowichan Valley.  ICAN of the Cowichan Valley, like other ICAN groups, will offer resources and information about cesarean sections, and provide support to women who are recovering from a c-section or trying to avoid an unecessary surgery. 

After I had Annika, I attended one ICAN meeting down in Victoria.  But for a variety of reasons, including distance (it was a 2-hour drive, round-trip), I never managed to get to another one.  I’ve always regretted that, and wished I’d had a practical option beyond suffering in isolation with the aftermath of her birth.  I did have a wonderful circle of online friends who helped me through those years, but there is a lot to be said for face-to-face, local connections, especially in the postpartum phase.  And there is also a lot to be said for a specialized group like an ICAN support group.  It’s often hard for women to talk about their experiences with surgical birth, as many people still trot out the ‘but you have a healthy baby!’ dismissals, and unecessary c-sections have become normalized in our society.  ICAN groups can offer a safe place for women to connect with others who are likely to empathize, and willing to listen without judgment to their stories.

I’m still in the process of getting the group up and running–it was only officially registered yesterday, and I have yet to plan any actual events or meetings!  My hope is to find a central space where we can gather, perhaps beginning in late May or early June, and go from there.  So, local folks, please help to spread the word and encourage people to contact me at icancowichan@gmail.com.  Local and far-flung, like our Facebook page. Thanks to all of you for helping me let people know about this important new resource.

Healthy Beginnings

I had the pleasure this week of being a guest speaker at a couple of Healthy Beginnings meetings, which are drop-in groups for young children, babies and their caregivers sponsored by the local health unit.  I spoke to one group in Duncan earlier in September, and two groups on Thursday in Shawnigan Lake.  I did a little demo of core work with the women (all moms except for one nanny), and checked a few for diastasis recti (everyone was good to go!).  But aside from encouraging more people to strengthen their pelvic floors, I really wanted to get two points across:  a) let them know that I’m here as a resource for them in the community; and b) emphasize the notion that fitness is holistic, and that postpartum fitness, especially, has little to do with fitting into pre-pregnancy jeans.

Let’s talk about the second point first.  I’ve written about this before here so I won’t repeat those points now.  But I was struck at the drop-ins by how much women focus on changing their size after pregnancy.  Of course I already knew this was the case, but every time I see signs of it, the red light starts to flash in my head: teachable moment!  teachable moment!  There are practical reasons to want to get back to pre-pregnancy size–the most significant of which is probably financial, as buying an entirely new postpartum wardrobe right after buying a new maternity wardrobe is an onerous expense.  But there is nothing wrong with taking time to get there, and moreover, a healthy lifestyle + time is the best formula for healthy and lasting post-pregnancy weight loss.  Anything extreme–extreme exercising, or even not-so-extreme dieting–is dangerous, plain and simple (and most likely ineffective).  

The thing is, we all know this, and beating people over the head with such information doesn’t work.  So instead, I tried to focus on the positive:  rather than telling people what not to do, I suggested what they can do to improve their health and wellbeing after baby, and to strengthen their bodies so that they can move with freedom, and with the knowledge that they are protecting their bodies from injury. Even more importantly, I tried to emphasize that they can do that without having to be away from their babies.  (Although there is nothing wrong with working out solo either–the point is, women have lots of options and they can pick and choose what is right for them at any given time.)  And I’ll tell you–it felt very good to look around the room at women’s faces and feel like they were soaking these messages in.  I know the relief I often feel when someone in a position of some authority/expertise gives me permission to be kind to myself and to follow my instincts about what is right or wrong for me as a parent, and I hope I was able to do that for some of the women there.

On the second topic: although part of my reason for going to the drop-ins was to let women know about Fit 4 Two, I had a bigger purpose in mind, and that was to let them know that there is a place they can go if they have questions about things to do with health and fitness during pregnancy, birth, and postpartum recovery.  I got involved with Fit 4 Two because I wanted to reach out to women as someone who is not a clinician of any sort, but has other kinds of information to share, and is happy to be a source of support.  Sometimes people hesitate to call on professionals when they have questions they feel are minor, or they have questions that professionals may not be equipped to answer (even the best birthy clinicians may know little about exercise physiology, for instance).  I wanted to introduce myself to the women as a fitness professional, but more importantly as their peer:  I know a lot about pre and postnatal fitness, but I’m also someone who has struggled through the pre and postnatal phases  and can lend an empathetic ear if they too are facing challenges.  So I was so glad to have the chance to go into these groups and let the women there know that they can email or call me any time with questions; if they are within my scope of practice, I’ll answer, and if they are outside it, I can help connect them with appropriate resources.  The point is that they aren’t alone, and they don’t have to pay a penny to be supported at this time in their lives, when so many women end up feeling isolated, inadequate, and often (sadly) at war with their own bodies.  Of course I’d love for them to take my classes, but it’s not about that; it’s about creating genuine relationships, and meeting women where they are, whether they are ready for and interested in a group workout or just need some basic information about how to work with their pregnant or postpartum bodies.

Oh, and I got to cuddle a newborn.  That was probably the highlight of the whole thing for me, personally.  There is nothing better than holding someone else’s newborn baby…  😉

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