More on why I'm down on the medical-industrial complex

[theatokos]

I'm currently reading Pushed: The Painful Truth About Chilbirth and Modern Maternity Care by Jennifer Block. I'm only a few chapters in, but it is already confirming both my limited experiences in the pregnant world and the reading I've been doing. Before getting pregnant I was already wary of the medical world and leaning more toward the side of natural childbirth. Now 6 months into this pregnancy I am more than ever convinced that natural - and by that I mean as little medical intervention as possible, even outside of a hospital - birth is the best way to go. Each medical intervention isn't a bad thing on its own. I'm glad we have many tools to help women birth healthy babies. However, it's the attitude of the hospitals and the messages sent to women that bother me the most.

Women are increasingly "choosing" (there is some debate over this word - are they actually choosing? being strongly suggested to choose it by their doctor? choosing it when all of the other interventions aren't "progressing"?) elective cesareans. Some are choosing it because they fear the damages caused by vaginal birth. Birth is treated as this problem waiting to happen, rather than a bodily function that we are evolutionary designed for. Of course birth is hard and scary, but when left to progress in its own time, births do not have to cause damage to the vagina and other parts of the female body.

And that's the problem. Left to progress in its own time, monitored by patient and knowledgeable staff. There is no patience in the hospital. OB/GYNs have to get a lot of stuff done before their shift is over and make enough money to cover their incredibly high malpractice insurance costs. Hospitals don't have the time or the staff to let a woman labor for 24 hrs - or more. And one intervention inevitably leads to another. Once women are hooked up to IVs, monitors, catheters, etc she has to labor on her back - which is the WORST position for a laboring woman. This position is for the convenience of the doctor, not the mother. No woman left to her own devices labors this way.

The more I learn about the history of childbirth the more I see how it's developed out a deep misogyny and disrespect for the female form. Modern obstetrics does not come from the centuries old practice of midwifery, but from the developing field of medicine in the 19th century. In the Victorian era middle and upper class women wore corsets, were encouraged to be inactive and undernourished (being small and helpless was a woman's natural form), basically causing all kinds of problems for pregnancy and delivery. Women needed to deliver on their backs, as it was unladylike for a woman to be on all fours, ass naked, in front of a man/doctor. The bodily restrictions of the Victorian age led to the development of ways to speed along awkward deliveries - induction. The mentality that womens' bodies were ill adapted to vaginal birth underpins our modern medicalization of the birth process.

I read a quote in Pushed explaining why one sex therapist had elected a cesarean. "Why ruin a perfectly good vagina?" she said. This to me reveals the deep anti-woman mindset of our birth culture that women are absorbing. What does this woman mean by "ruin"? I'm guessing she fears tearing (so do I, but when birth progresses at it's own speed this is less likely to happen), incontinence (occurs after 2% of births, most female incontinence is old-age related), and the ol' saggy vagina. Complications to the vaginal area occur in c-sections too, but these get less press. This woman probably doesn't want to "ruin" her vagina FOR HER MAN. I may be putting words in her mouth, but this attitude that vaginas just won't be as good after vaginal birth is nonsense and is driven by patriarchal ideals of women - all vaginas should feel like 15 yr old virgin vaginas, all 40 year old women should be as tight and firm and fit as 25 year olds. Puh-leeze.

I also think this anti-woman attitude toward birth is fear of the female form. Pregnancy and birth are the two things the male body cannot do. While I do feel quite vulnerable in a new and profound way being pregnant (I find that I do not jaywalk anymore, that I cover my belly in unfamiliar busy places, that I move more slowly, etc), I am also amazed at the capacity my body has to carry this life, to grow it and sustain it and me. I may be moving more slowly, be not quite as sharp mentally, but I am in no way compromised. The female form is powerful. We'll see how I feel once I've birthed this little guy, but knowing that I will be medically and emotionally supported makes me EXCITED to see what this body can do. Women's bodies are completely capable of delivering babies into this world. I think men and the patriarchal medical establishment fear this. Births are messy and all parties are out of control. To help get doctors home to dinner and to control the unknown factors, and perhaps even to keep women in their place, birth has been put on a time table and contained by tubes and meters and drugs. Women expect this to be part of birth. Without realizing it they are being told that they can't handle it; they are told that they should be scared.

The more I read the more I am deeply relieved that I will not be birthing in a hospital. My baby is not an "outcome," another statistic for hospitals and doctors to put into one column or another. I don't want my physical integrity compromised for the efficiency of the hospital staff. I am not a problem waiting to happen. And I don't desire my care to be mandated by statistics and litigious ass-covering. I don't want my care based on a fear of their being sued. I want my care based on my actual health. I'm scared enough as it is about the whole birthing process and I don't need doctors I don't know to tell me what my body "should" be doing, to infer that my body and my baby don't know what to do.

Comments

[msmidge.livejournal.com]

I guess being in the Bay Area you actually have birth centers, eh? We don't have any around here.

In the end I was glad that we were in the hospital--turned out the L&D nurses didn't know how to recognize a baby w/breathing problems, but the NICU did--but I was not glad that said hospital was 25 miles away from our house.

If we have another baby, I will probably have another hospital birth, but I don't think I would use an OB/GYN. I had a midwife last time, and while there were some things I didn't like about her approach, there was definitely no pressure like all the stuff your book is describing.

[ewigweibliche.livejournal.com]

I don't think all hospitals are bad. Statistics show strong regional variance. And I don't think all doctors are caught up in the ass-covering, nor are all midwives awesome. My midwife bugs the fuck out of me. She's brilliant, but WEIRD. Thankfully, I really like her midwife student that attends me as well.

As for the Bay Area, there are only two birth centers! As progressive as this area is, health care is not as progressive as one would expect. I mean, there are a million yoga studios, chiropractors, alternative medicine people, etc - but when it comes to birth, oh no. One birth center is actually super high class (ie, $$$) and connected with a private hospital. Photos on the web make it look like a spa. The other is in SF (the one I'm going to) and is run by one midwife, with three midwife students near the end of their training. She has a relationship with area hospitals in the event that the mother needs or wants to transfer.

I feel VERY lucky to have a choice in my birthing process. Adam and I, thanks to a work project he got over the winter, allows us to pay for the birth center out of pocket. However, the total cost for the birth center (all prenatal care, classes and the birth) is still not much more than the total costs of using Kaiser - even with insurance! The realities of location, option, insurance, income, familial support, etc will influence what kind of choice a woman has.

[miss-december.livejournal.com]

I heart you for this post. I'm researching the hell out of birthing centers in CT, and so far I can only find one. At least I'm having better luck with doulas and hospitals that do waterbirths.

I can't stand the idea of giving birth so artificially - on my back, pain meds, induced, any of that. Glad to know that even though a lot of people think I'm nuts, there are other women who completely get it.

[msmidge.livejournal.com]

I did my labor in a birthing tub and highly recommend it. I didn't get to actually deliver in it because my child was preterm, but the tub labor seemed much more tolerable than what I saw other people going through in the hospital.

[ewigweibliche.livejournal.com]

My sister had her first child in a birth center and wanted a water birth, but she found that once she was in labor the water didn't feel good to her. I wonder what I'll prefer in the moment? One woman told me that while in active labor she wanted to be left entirely alone and didn't want anyone to talk to her! I do a lot if visualization around the birth to try and prep my subconscious, but I'm also trying to leave myself open to lots of different reactions.

Good luck with finding a place that will support your birth!

[queen-of-wands.livejournal.com]

Sing it, sister!

[ewigweibliche.livejournal.com]

I feel very blessed to be so supported in this process. I have so few friends that have babies - many of my friends don't ever plan to have babies! But still, being supported by awesome women and men is strengthening my confidence!

[said-by-me.livejournal.com]

I am really glad you are reading that. Medical intervention was a huge downside for me. I am not sure I could have delivered without it but, I wish I had taken the option of trying.

[ewigweibliche.livejournal.com]

I am glad that we have medical interventions, I'm just alarmed at how they're pushed and expected.

I worry a little bit about posting such strong feelings about this subject because there is already SO MUCH judgement around women's bodily choices in general, and women themselves can become very self-righteous about their birth choices. Instead of supporting one another in a society that hinders positive bodily and birth choices, we can often tear each other down and disempower one another. Sadly, lots of women don't ever get past being told what is best for them - but I am quicker to blame the patriarchal medical complex than I am to blame the women.

[said-by-me.livejournal.com]

I agree... Alex turned during labor. Could I have delivered breech? Was a c/s needed? I don't know. In hindsight, I wish that I was more informed and had someone like minded and educated championing for me.

[(Anonymous)]

I find that most good hospitals these days are getting away from the "intervention" and on your back labor,and they no longer whisk your baby away. Most hospitals have geared their L&D units to a more woman freindly atmosphere. They incorporate your birthing plans, and don't require you to have an IV or stay on your back hooked up to a monitor. If you find that this is so at your hospital then it is about 10yrs behind in thinking. I had one baby at a birthing center and one in a hospital and I have to say the only difference was the surroundings. Walking is and should be encourage through out labor. The most important thing is just making sure your communicate with your health care team. Although with my second one I was glad to be in a hospital becuase I hemorraghed afterwards. Most babies can be born outside a hospital if the mother is healthy, however when things go wrong, they go wrong very fast.

[ewigweibliche.livejournal.com]

Statistically, hospitals are NOT getting away from intervention (from the reading I've been doing). I think it's very regional - some encourage what you describe, others not at all. From what I've heard, had I stayed with Kaiser, I could have had a low intervention birth. But it bothers me that I have to put that stuff in writing and make sure that some one is advocating on my behalf for it the entire time. It's sad that the first instinct is to make it easier for hospitals rather than for women.

Plus, the more I read and experience the more I realize that the medical world hates women.

A question, were you induced at all with #2? I've read that Pitocin can sometimes cause hemorraghing (how the hell do you spell that?). Was it related to your placenta? Just wondering.

[(Anonymous)]

No I wasn't induced. And yes pitocin is not a good idea, if it can be avoided. I just have a real hard time imaganing your scenario. I guess were blessed here in Alaska with good hospitals. However, I do see with larger hospitals that they push getting epidural, and women agree becuase of fear of the pain. And with epidural comes a foley catheter (to drain pee, which have a high rate of a UTI), and the decreased ablility to move around freely. Also with people opting c/s, i have cared for a number of post c/s women with infected incisions. Also it takes twice as long to recover, and you've just had surgery so you may need vicodin or pecocet, and plus its SURGERY for goodness sakes. And I've seen one done and it aint pretty!!!OUCH!!

[ctiee.livejournal.com]

How terrifying.

[howilearned.livejournal.com]

in short, hear hear. Having some knowledge of what you're talking about (I worked for a non-profit that dealt with birthing and was militantly pro-natural birth, for good and bad reasons)its clear that this is an issue that shouldn't be. Or at least not as much of a problem as it is. The thing that boggles my mind is the evolutionary piece, as you mentioned. Really people? We've evolved for this long and nature didn't work out the whole birthing process? We didn't seem to have a problem populating the planet before hospitals.

I am able to believe that the medical profession has helped many babies and mothers; I can imagine that we are, with our analytical, scientific minds able to augment the birthing experience or, at least, address problems that naturally arise. But its not about augmenting, its about replacing birth with something better, more efficient, louder, fizz bang wow IT'S BIRTH v2.0, now deliver your baby online!

This is to say that hospitals still seem to be bass-ackwards about so much that seems so basic, so willfully ignorant or filled with professional hubris that cannot acknowledge the primacy of a woman's body. Hospitals in general evokes many of the conflicting feelings I have about Western civilization in general. So much good, so much bad; all in the name of progress.

[ewigweibliche.livejournal.com]

Yes, thanks for this! I don't want to sound like I think all medical interventions are misguided inventions, because, as my sister says (the anonymous poster) when things go wrong, they go wrong quickly. And Western medicine is fantastic for solving those kinds of problems. But the hospital is pathology based - it's there to diagnose and problem solve. Birth in and of itself is not a problem in need of solving.

On another topic entirely: DUDE! LONDON!!

[(Anonymous)]

This is why I am not getting pregnant. :-) Actually, it's not, but it's a nice side effect.

I can offer my thoughts on the details of this later (like maybe after you give birth!) but for now I'll just say that I think the key is what you mentioned, Nik, regarding supporting women in the choices they make, as this is an extremely personal decision. I'm not sure what choices I would make were I preparing to give birth, but my friends who have given birth have given this much thought and discussion and have made the decision they were comfortable with. I don't think this is a "live and let live" issue. I think it's critical that we give each other the freedom and support to make the right decisions for us, recognizing that not only should each woman make her own choice, but the same choice is not going to be the right one for each person.

I've talked about this a lot with Unc.Doug over the last few years, but right now I'm too lazy to type all my thoughts based on those conversations (I can tell you sometime when I see you), but for the moment I'll say that his opinion is that it's most important for the two partners to agree about this, whatever it takes. Sometimes that's hard, but if they don't see this the same way it can cause major problems later.

In general, I couldn't agree more that women need to support each other's decisions, rather than criticize them or be in competition. It's very refreshing that this is not happening in this hoot chain!

Seriously, I think women of our generation (this is a massive generalization) are too often competitive and comparing and judgemental on everything ranging from: career or not and what kind of career? get married or no? have children or no? how to give birth to them? what to eat while pregnant with them? infertility treatment or no? adoption or no? religion or no and how it plays out? and on and on and on. I find it irritating and I've decided to check out of that rat race.

I feel so fortunate to have some amazing women in my life who resist this as well (like you!).
It's awesome to have good friends who are really care about each other and are really interested in the life decisions others make, for the sole purpose of understanding them and knowing them better and being supportive.

Hooray for you for being strong about what's best for you.

I'm switching the tv back and forth between Hockey Night in Canada on CBC and "Jesus, the Complete Story" on the discovery channel. :-)

[lillitu-shahar.livejournal.com]

i am reading with great interest your posts on this subject. i would love a required reading list once you are through- i especially was interested in the one of the last books you mentioned- on sexual stimulation during labor, i think?

and i would love to hear about your midwife and birthing center. what is your "birth plan"?

[ewigweibliche.livejournal.com]

Oh! The sexual stimulation comes from Ina May Gaskin. Her first book, SPiritual Midwifery, was written early in her career and definitely has that 1970 hippies vibe about it. But her second one, Ina May's Guide to Childbirth, comes at a more mature point in her career and I recommend it unreservedly! She talks a lot about how the energy that got the baby in is the same energy that gets the baby out! Not that a woman has to be sexual in childbirth to have a successful birth, but so many of the hormones that are present in orgasm and sexual stimulation are present in birth - I mean, we engorge and expand! I truly felt inspired after reading her book.

I think I will write some more about my midwives (I get two!!) and the birthing center. For now, I don't have a plan. All the things I'd want are part n' parcel of the birth center: the freedom to move as I am comfortable, no drugs, all the support necessary to have no interventions (but some are available if needed, which is good), and the permission to have whomever I want in the birthing room with me. I plan on taking my favorite icon of the Theotokos and the Peacock wreath you got us to have in the birthing room with us. You know, to welcome the right people in!

Also, I am so sorry to hear about the sad changes in your life. But I also give you mad props for allowing yourself the freedom to grow and change. You may feel topsy turvy, but your writing has been incredibly clear and full of love, for yourself and J. Good luck with it all.