June
7th 2008
OB/GYNs, Ourselves

Posted under: book reviews, Gender, the body, women's history

eucharius-roesslin-1545.jpgEarlier this week, faithful reader, commenter, and sister blogger Knitting Clio and I got into a tussle over Cesarean Sections, and the feminist critique of the overuse of the procedure canonized in women’s health books like Our Bodies, Ourselves.  (She is a historian of medicine as well as a women’s historian, with a specific interest in women’s reproductive health issues, so this is right up her alley.)  She noted the overuse of this procedure and argued (along the lines of the traditional feminist critique of allopathic obstetrics) against the medicalization of childbirth.  Here’s KC:

Short version — the enormous rise in C-sections over the past half-century has really not improved maternal/child health and is really more a product of malpractice litigation than medical science. Also, it’s a lot easier for a doc to make his/her tee time if s/he schedules a C-section rather than a vaginal delivery.

And, she is right about that (although perhaps a little flip about the convenience for doctors–I don’t know any OB/GYNs who golf, but wev.)  For those of you who are interested in the history of the standardization of practices in obstetrics (and who isn’t?) see this article by Atul Gawande in The New Yorker from October, 2006.  He writes about how the C-section rose in popularity among a subset of physicians who needed to improve their results and teach large numbers of students a standardized procedure for childbirth, and multiple artful uses of forceps–while elegant–are difficult to teach and standardize:

But if medicine is an industry, responsible for the safest possible delivery of millions of babies each year, then the focus shifts. You seek reliability. You begin to wonder whether forty-two thousand obstetricians in the U.S. could really master all these [specialized forceps delivery] techniques. You notice the steady reports of terrible forceps injuries to babies and mothers, despite the training that clinicians have received. After [the] Apgar [test], obstetricians decided that they needed a simpler, more predictable way to intervene when a laboring mother ran into trouble. They found it in the Cesarean section.

.     .     .     .     .     .     .     .     .     .     .     .     .     .     .     .     .     .     .     .     .     .     .     .     .     . 

This procedure, once a rarity, is now commonplace. Whereas before obstetricians learned one technique for a foot dangling out, another for a breech with its arms above its head, yet another for a baby with its head jammed inside the pelvis, all tricky in their own individual ways, now the solution is the same almost regardless of the problem: the C-section. Every obstetrician today is comfortable doing a C-section. The procedure is performed with impressive consistency.

However, I argued that the traditional feminist critique goes too far in pathologizing C-sections, and that it makes the same mistake that OB/GYNs did in the bad old days of pushing one rigid model of a “good” childbirth (i.e. no anaesthetics, no cutting, “all natural,” midwives and doulas only, etc.)  Aside from the fact that many–if not most–C-sections are medically necessary, I argued that

Women are all different, and for some, it’s important to push a baby out the old-fashioned way. For others, it’s not an option unless they’re OK with mutilation and/or delivering a blue baby. For still others, “natural” is not an option they would consider in the first place. So, clearly, it’s too rigid to insist that there’s only one “correct” or “authentic” or “feminist” way to give birth.

The woman whose torturous labor supplied the plot line for Gawande’s article, Dr. Elizabeth Rourke, wanted to do it the all-natural way, without anaesthesia or serious medical or surgical intervention.  Although an allopathic physician herself, like many women who read up on childbirth and plan to take an active role in directing it, she was whipsawed by the pressure she put on herself to have the “ideal” birth, a pressure I think is exacerbated by the Our Bodies, Ourselves depiction of the wonders of so-called “natural” childbirth.  At the conclusion of the article, she said of her childbirth experience,

“I felt like a complete failure, like everything I had set out to do I failed to do,” Rourke says. “I didn’t want the epidural and then I begged for the epidural. I didn’t want a C-section, and I consented to a C-section. I wanted to breast-feed the baby, and I utterly failed to breast-feed.”

However, Historiann must admit to KC and the entire world that she was mistaken about her memory of her edition of OBOS (1984).  Its treatment of C-sections was pretty even-handed, and starts with a quotation that calls them “a sometimes useful and needed technique presently utilized in an undocumented, unclarified and uncontrolled manner,” p. 384.  (A little heavy-handed at the end there, but the editors then immediately describe the operation as “life-saving,” p. 384, so no harm, no foul.)  Where Historiann’s memory was correct was the dim view OBOS takes of anaesthetics and other pain-killing drugs taken in labor and delivery.  That section (on p. 387) starts with the sentence–italicized for urgency–that “every single drug given to the mother during labor crosses the placenta and reaches her baby,” and goes on to say that “no drug has been proven safe for mothers and babies,” p. 387.  (By the way, the two studies they cite as proof of this are dated 1966 and 1970.  I’m pretty sure that things had changed a lot in anaesthesia by 1984, let alone 2008!)  But–guess what?  No drugs have been proven unsafe either!  But they don’t tell you that–they go on to warn grimly that “some infants whose mothers received analgesia and anesthesia during labor and delivery have had retarded muscular, visual and neural development in the first four weeks of life.”  So have a lot of other kids whose mothers had the ideologically correct birth too–because some kids just turn out that way anyway.

This was the crux of my critique of the dominant feminist vision for childbirth:  why does it have to hurt?  Childbirth is the only major (or minor) medical event in the life of the human body where we shoo people (all women, natch!) away from anaesthesia and analgesia.  What’s up with that?  Shouldn’t feminists open up to the ways in which medicine has improved childbirth since Eve bore Cain and Abel?  If you wouldn’t think of getting your teeth drilled or stitches on a cut without at least a little lidocane, why would you think that attempting drug-free childbirth is a really great plan?  Why is it only this medical event, and not the routine minor surgery on men’s genitals, the vasectomy?  Why isn’t there a cult of masculinity built up around having that done “naturally,” without pain relief?  Why is it only women who are asked to prove their womanhood by suffering extreme, incredible, sometimes days-long pain?  (Let me tell you a little about something they don’t tell you about in “prepared childbirth” classes, called “latent labor.”  I call it “all of the pain, none of the progress!”  Dr. Rourke’s latent labor lasted only two days–but I know someone who was in latent labor for five days!  And man, was she pissed off that they didn’t just cut her on day one!)

So, my apologies to KC, and to the editors of my now ready-for-the-rare-books-room copy of OBOS.  The treatment of C-sections was much fairer than I remembered, although the presentation of pain relief during labor was rather one-sided.  But, I’m going to get the newest revision of OBOS–1984?  That was a long time ago.

22 Comments »

22 Responses to “OB/GYNs, Ourselves”

  1. ej on 07 Jun 2008 at 9:05 am #

    I think the issue in part is one of control. If a mother opts for a C section for whatever reason, it seems perfectly fine. If its done for the Doc’s convenience, then you have to wonder. It seems to me, however, that we grossly underestimate how complicated birth can be. My father-in-law, an ob/gyn, is often frustrated by the perception among patients that anyone can really deliver a baby-a fireman, a midwife, or a husband caught in a taxi. While childbirth seems designed for this to be true in some cases, its certainly not true for all. And as those docs often say, when something goes wrong, it goes very, very wrong, and then we’re thankful we have the doc in the room who knows how to proceed.

    It doesn’t seem like a coincidence that the one medical procedure we like to un-medicalize involves women. We don’t judge men who opt for drugs when getting open heart surgery. Why in the world do we insist on setting this absurd standard for women. As someone who had a child the “natural” way (not by choice, she just came too quickly) I can honestly say I saw absolutely nothing “natural” about that whole process. Pain is not my “natural” state of being.

  2. Amy Tuteur, MD on 07 Jun 2008 at 9:43 am #

    “This was the crux of my critique of the dominant feminist vision for childbirth: why does it have to hurt?”

    The most ironic aspect of the dominant feminist vision for childbirth is that it has accepted wholesale the sexist, racists theories of Victorian and Edwardian men. The notion that childbirth SHOULD be painful is as old as the Bible, which views childbirth pain as punishment for women’s sins. Interestingly, contemporary notions of the value of pain in childbirth also rest on the idea that pain is a punishment.

    The father of the “natural” childbirth movement, Grantly Dick-Read, was a sexist and racist, much influenced by the ideas of eugenics. His primary concern was white “race suicide”.

    In Holistic obstetrics: the origins of “natural childbirth” in Britain, O Moscucci, PMJ 2003;79:168-173, Dr. Ornella Moscucci explains:

    “[His] book, the first of many on the subject, had been prompted by eugenic concerns about the decline in middle class fertility… Dick-Read believed that the fear of childbirth was deterring the better off from having large families. …

    The argument developed in Natural Childbirth and in its more famous sequel, Revelation of Childbirth (subsequently Childbirth Without Fear), mixed Darwinian themes, neurophysiological theories, and cultural stereotypes of childbirth among “primitive” people… Whether women experienced pain or not depended on cultural attitudes to childbirth rather than on some property inherent to parturition. Dick-Read … claimed that primitives experienced easy, painless labours. This was because in primitive societies the survival value of childbirth was fully appreciated and labour was regarded as nothing more than “hard work” in the struggle for existence. In civilised societies on the other hand a number of cultural factors conspired to distort woman’s natural capacity for painless birth, producing in woman a fear of childbirth that hindered normal parturition…”

    Grantly Dick-Read’s work came out of a long tradition of sexist, racist depictions of childbirth. Patricia Jasen, in “Race, Culture, and the Colonization of Childbirth in Northern Canada”, gives a fascinating overview of the origin of racially based theories of pain in childbirth. Jasen situates claims of painless childbirth firmly within European imperialism:

    “Theories of racial difference are one of the oldest and most enduring features of European imperialism. They were inspired and perpetuated, in good part, by the desire to assess the level of European civilization and racial progress in comparison with more ‘primitive’, or less enlightened, peoples, and the history of ideas regarding aboriginal women and childbirth needs to be examined with this context in mind… [T]he notion that women in ‘savage lands’ were fundamentally different from European women gained a wide following through the myth of painless childbirth… [I]ts increasing acceptance during the nineteenth century, … makes sense only in light of the fact that this image of the aboriginal woman satisfied a growing preoccupation, in European and Euro-American cultures, with both the anatomy of race and the politics of sexual difference.”

    Jansen posits that the myth of painless childbirth did important work within European and American culture:

    “… [T]he myth of painless childbirth acquired an unprecedented following on both sides of the Atlantic around the middle of the nineteenth century and achieved a new level of abstraction from reality. The growing preoccupation with racial hierarchy and degeneracy did not preclude a belief that primitivism and health were somehow linked, and many Europeans and Euro-Americans sought to internalize the qualities of ‘wildness’… which would counter the ill effects of civilized life. Outdoor sport would help preserve the qualities of ‘natural man’, but even more urgent was the quest for the ‘natural woman’. There was a common fear that through some accident (or logic) of evolution, women of superior breeding experienced the most pain and debility in childbearing — that civilization, or over-civilization, made them less fit for reproduction. The survival of the race seemed to depend on alleviating this suffering and countering the growing reluctance, on the part of middle- and upper-class women, to undertake the maternal role.”

    Ironically, the fundamental premises of “natural” childbirth, that childbirth in nature is painless and that the pain is “valuable”, are not only fabricatio, but fabrications designed to reinforce the idea of differences between inferior indigenous races and the superior white race. Perhaps this accounts for the fact that “natural” childbirth is almost exclusively a preoccupation of white women in first world countries. Women of other races and cultures never believed in the myth of painless childbirth and never accepted the idea of superior and inferior races separated by their reactions to pain.

  3. Sisyphus on 07 Jun 2008 at 10:14 am #

    Wow, I didn’t know all that about the natural-childbirth guy. When was he active?

    And Historiann, you might be interested to know I brought the 1975 and 2008 editions of OBOS into my sections this quarter (I had never personally looked at them) and we compared them, particularly the justifications for writing them given in the prefaces. The differences were really fascinating!

    There’s not really any discussion of the genesis of the book, or consciousness-raising groups, or radical feminism in the most recent version (that I noticed), and these are all very prominent in the original version. The tone of the first one is much more angry than the conciliatory, textbook-y style of the other —- I preferred the first and my students didn’t. We were all astounded by one of the stories of a woman petting in the backseat of a car who didn’t know enough about sex to actually stop it when the guy started screwing her, though. I tried to have them talk about how much things have changed since then as a result of the women’s movement, but they all just kinda sat there with their mouths open. That was pretty much their MO for the whole quarter, actually.

  4. Indyanna on 07 Jun 2008 at 10:37 am #

    Of this very interesting thread, (and its immediate predecessor), I thought it was one that a guy should stand back from and listen and learn, and basically still do. But on the sub-theme of convenience and golf an anecdote intruded. During my mother’s third pregnancy, ages before the era of OBOS, her doctor induced delivery, supposedly with the golf course in mind according to family lore. When things still didn’t move quickly enough he made his tee-time anyway and in the process managed to miss a rather harrowing stillbirth. She never entirely got over the experience. Remarkably, there was apparently no default litigation response to negative outcomes back in those days. More amazingly, a few years ago as the family executor/historian, while dismantling the household and archiving its contents, I found the bills. They were comparable to what it would cost to have a scraped knee treated in an emergency room today (viz., $20 for “anaesthesia”; $35 for a “white embossed casket,” etc). And stamped paid in full, except for a scribbled notation: “$25 Refund allowed for going home in 4 days.”!

    So it would seem that human nature, convenience, and the eternal lure of the golf course have changed less over moderntime than other things, including technologiy, methodology, law, and underlying medical economics themselves!

  5. Historiann on 07 Jun 2008 at 10:42 am #

    Wow, Dr. Tuteur–thanks for stopping by to comment, and I really appreciate your detailed background on “natural childbirth.” And the name Grantly Dick-Read: could a novelist come up with a better name for an antifeminist supervillian? Hah!

    Your comments on the admiration for “primitive” women’s so-called painless childbirth jibe with some of the early American women’s history that’s big now, particularly on the ways in which race was interpreted on women’s bodies. Elaine Crane has written persuasively about the ways in which illness and suffering from pain was both racialized and gendered in the late eighteenth century. (Long story short: elite white women were seen as more vulnerable to suffering, and their illnesses were accepted, because of course they had servants and enslaved women to do their work for them.) Jennifer Morgan has written too about the myth of painless birth among African women, and the ways in which that myth played a central role in the developing European logic of enslavement: if Africans were insensate, “dumb” bodies, then any torture or overwork could be justified.

    ej: I think you’re exactly right. If feminism is about choices and control, then any way a woman gets a baby out of her body is OK by me. If it involves an epidural, an IV drip of morphine, and a vodka martini, then I say go for it, sister. One reason for all of these C-sections that’s overlooked is that people are having these honking huge healthy babies, since we’ve pretty much given up on drinking and smoking during pregnancy. Who the heck can push out these 8, 9, and 10-pounders WITHOUT a surgeon’s assistance?

    And Sis: great teaching tool! How funny that your students were freaked out by OBOS ca. 1975. That really was a time capsule moment for them! (And by the way, I’m sorry I haven’t blogrolled you yet–I will remedy that today!)

  6. Historiann on 07 Jun 2008 at 10:44 am #

    Indyanna–wow. I’m really sorry to hear about your mother’s ordeal. That’s something that wouldn’t happen now, in large part because of the feminist critique of medicine, thank goodness (as well as the proliferation of personal injury attorneys I suppose too.)

  7. Knitting Clio on 07 Jun 2008 at 1:21 pm #

    No apologies necessary, Historiann. I can’t remember all the details of books I read 24 years ago either.
    Amy Tuteur’s comments are very interesting and significant I think — I recall reading similar secondary sources on the United States, which stated that the resurgence of “natural” childbirth (along with breastfeeding) actually began during the 1950s and was part and parcel of the true womanhood/feminine mystique.

    Sisyphus — you’re comparison between different editions of OBOS sounds like a great exercise for students. It’s important for students to know that the changes in OBOS over the years were in response to readers’ comments — see Wendy Kline’s article in the Bulletin of the History of Medicine.

    Historically and today, the Boston Women’s Health Collective has sought to empower women by providing them with comprehensive information about the pros and cons of various medical procedures and technologies. This was pretty important in an era when doctors — nearly all (93%) of whom were male, even in ob/gyn — were extremely paternalistic and told women (and men) to follow orders for their own good.

    Scientific consensus on particular procedures changes over time as well, and OBOS reflects that as well in it periodic updates. I’m not a historian of anesthesiology but I think that warning women of the possible complications of anesthesia for a fetus, however rare, is in keeping with sound medical practice and informed consent.

    The position of OBOS on anesthesia during delivery has changed with new evidence. Now, the editors of OBOS are endorsing use of nitrous oxide during delivery — see their blog.

  8. Amy Tuteur, MD on 07 Jun 2008 at 1:49 pm #

    Historiann,

    I am fascinated by the ways that cultural constructs affect how women view childbirth. I’m not sure why feminist theorists have not picked up on the fact that “natural” childbirth ideology is just a rehash of Victorian medical treatment of women: “It’s all in your head, dear.”

    It is also an extension of the traditional idea that labor pain is “punishment” that women deserve. The Bible explained labor pain as punishment for Eve’s sin. Grantly Dick-Read explained labor pain as punishment for women wanting economic and political emancipation, and current “natural” childbirth advocates often explain labor pain as “punishment” for having the wrong attitude.

    As an obstetrician myself, I have cared for women from many different national, cultural and ethnic backgrounds. I am struck by the fact that “natural” childbirth (which has little or nothing to do with childbirth in nature, by the way) is a phenomenon almost exclusively limited to Western white women who are relatively well off and relatively well educated (some college, or a college degree). Women from other countries and cultures view “natural” childbirth ideology as crazy. I suspect that this stems from at least 3 factors:

    1. They are familiar with the death and disability associated with childbirth. They do not pretend that childbirth is inherently safe.

    2. They know that the idea that “primitive” women (read women of color) don’t suffer pain in labor is nothing more than a racist stereotype.

    3. They have been routinely deprived of adequate medical care for economic reasons or because of racist disparities in healthcare access; rejecting conventional medical care is a luxury that was never even available to them, since they were simply denied that care in the first place.

    “Natural” childbirth advocates are correct to claim that culture influences expectations about birth, but they fail to see that “natural” childbirth itself is a cultural construct, not a return to nature.

  9. Historiann on 07 Jun 2008 at 1:50 pm #

    Right you are, KC! Here are the links:

    http://www.ourbodiesourblog.org/blog-mt/mt-search.fcgi?IncludeBlogs=1&search=nitrous+oxide

    I had laughing gas for my first filling, which was done at age 7 in the 1970s, but I haven’t seen or heard of it since…what a blast from the past!

    But personally, I’m partial to morphine with a vodka martini chaser…

  10. Historiann on 07 Jun 2008 at 2:01 pm #

    And Dr. Amy–thanks for stopping by again. Women’s historians are an audience very open to your point of view, because of your emphasis on the cultural construction of women’s experiences.

    I don’t know where you are located, but at next week’s Berkshire Conference on the History of Women, we’ve got a lot of panels on maternity and motherhood globally across time. One that may lend itself to a discussion of the issues in this thread is next Saturday morning at 8:30 a.m. in Blegen Hall 145 at the University of Minnesota:

    ALTRUISM, SELF-INTEREST, AND AMERICAN MOTHERHOOD, 1943-2008

    Chair: Elizabeth Watkins, University of California, San Francisco

    In Their Best Interests: Social Science, Feminism, and the Revaluing of Working Mothers in the 1960s
    Elizabeth More, Harvard University

    Mixers and Moulders: Neo-Evangelical Models of American
    Motherhood, 1943-1960
    Eliza Young, Harvard University

    Mother’s Milk without Mother’s Body: A History of the Late 20th-Century Milk Bank
    Kara Swanson, Harvard University

    Comment: Janet Golden, Rutgers University, New Brunswick

    (See the details on the conference by clicking on the Berkshire Conference links to the left.)

  11. Susan on 07 Jun 2008 at 3:11 pm #

    This is a great discussion, and the only thing I would say that contributes to ideas about “natural” childbirth is that unlike vasectomies and open heart surgery, it can/would happen without medical intervention. Granted, the high mortality that Dr. Amy mentions. But I suspect this makes it easier to say, “oh we shouldn’t intervene.”

    I think I foolishly gave away my 1971 copy of OBOS years ago. I moved too much for a time!

  12. Historiann on 07 Jun 2008 at 7:30 pm #

    Susan–that book would be worth at least $25 now! What were you thinking? (You could have donated it to the Schlesinger Library or something, in any case!)

  13. Susie from Philly on 07 Jun 2008 at 8:45 pm #

    Wow. I was a lay midwife doing home deliveries in the 70s, and I have to say, I didn’t see this unbearable pain very often – once, if I recall. The mom (a nurse who insisted on home delivery after the horrors she saw in the hospital delivery room) had a brow presentation, refused to go to the hospital and had an excruciating tear that went up into her clitoris. (I would have screamed, too.)

    This discussion of pain as an absolute evil to be avoided at all costs sounds so strange to me. I mean, I know women who are outside training for marathons in all kinds of weather extremes, suffering shin splints, heat stroke, etc. for a sport!!! But some relatively short-term pain in order to have a healthier delivery (for mother AND child) is a huge imposition? Geeze.

    I never lied to the women in my childbirth classes. I took them the pain was like having a REALLY BAD stomach flu, but it would be over soon enough.

    A C-section is major surgery. You’re talking about a much higher risk of infection (in fact, there’s a increasing number of cases of necrotizing fasciitis after C-sections).

    I’m also surprised no one’s brought up one major factor in C-sections: fetal monitors. Given a normal pelvic opening, labor progresses more quickly if a woman can adjust her position, get up and walk around. Having to lie in bed with a fetal monitor strapped around your belly not only slows labor, it makes fetal distress more likely. (Seems to me this “passive” position makes women into mere child-bearing vessels.)

    It’s interesting that no one seems to think the sense of psychological empowerment that comes from delivering a baby as an active participant is worth much. I disagree; I had my first child in the hospital, and my second at home. A much better experience in every way! I got up and cooked breakfast for a household full of guests a few hours after I delivered; I felt fine. I mean, I’m not some kind of freak with an abnormally high pain threshold – I reach for the Advil as quickly as anyone.

    Finally, my perspective on this is only peripherally related to feminism. I used to be a journalist and a medical writer – I approach ANY healthcare procedure or treatment from a skeptical perspective. I’m a big advocate for patient empowerment.

    P.S. Oh yes, doctors DO perform C-sections to get to a golf game. I accompanied several laboring clients to the hospital we used for backup, in a wealthy suburb of Philadelphia. I’ve seen it happen.

  14. Bing McGhandi on 07 Jun 2008 at 10:15 pm #

    Great post, Historiann! Totally worth linky love!

    It’s strange. I just read the Gawande article for the first time about 3 weeks ago and was intending to write about it in my next screed. It’s like you have been reading my mind. Have you been reading my mind?

    Dr. Teuter: You rule. I would add another point. American women enjoy, historically, very low rates of infant death. Women who take safe deliveries for granted are overlooking the vast amount of work that OBs did devise the interventions and procedures that made it safe. Confident that delivery is safe, they decide to forgo modern medicine and, I don’t know, go squat in the woods or whatever. (Does this sound at all like Robert Bly for girls, or is it just me?) The logic strikes me as similar to that of the “organic” foods movement. Fact: we need to extract as many edible calories from the ground as possible as long as the population is growing. We have plenty of food if we want it, so we can be terrifically inefficient if we like and buy organic. Exporting those practices and scaring people over GM (nobody has ever been killed by GM food), is a positive disaster for countries that depend on aid and refuse to accept donated GM crops. We can do complete logical loop-the-loops. I’m going to soak my head.

    Susie: Patient empowerment is only worth so much. Whether or not a woman felt “empowered” does not contribute to positive outcomes for the baby. Once a woman has decided to see a pregnancy through, she really, in a non-bizarre world, should accept safest, most reliable health care. This includes monitoring. You have less than 10 minutes from the second that the cord gets pinched (should it happen) before you have brain-damaged babies. For life. Best I can reckon, it’s just not worth the fleeting sense of “empowerment” if you will changing the child’s diapers for the rest of your long life–talk about chaining yourself down! To put any distance between timely intervention and a distressed delivery (and NOBODY can predict which babies are going to go south), it’s just selfish and short-sighted. Re: walking around. Gravity has no discernible effect on the speed of labor, and women can get up and walk around if they like, as long as they are able. It’s like the ultimate placebo–you feel like you are doing something, but it doesn’t do anything.

    Just thought I’d put my 2 cents in.

    HJ

  15. Knitting Clio on 08 Jun 2008 at 6:00 am #

    Susie – what you say is what I was trying to convey in my original exchange with Historiann, although as a midwife with a better command of current trends, you do a much better job!

    Regarding Bing’s comments — they seem rather chilling to me. Why should women surrender their rights as adult health care consumers simply because their pregnant? Should a court be able to demand a woman have a C-section even though it will probably kill her {this happened to a cancer patient recently}. See this recent article from Our Bodies, Our Blog about how women’s rights to choose how to be pregnant and the right to choose to terminate a pregnancy, are all connected:

    http://ourbodiesourblog.org/blog/2008/06/making_the_connection_between_abortion_pregna.php

  16. Historiann on 08 Jun 2008 at 6:55 am #

    Susie–I think it’s perfectly fine for women to have their babies any way they want to, and midwifery above all has certainly helped many women get the births they wanted. I’m sure you made a valuable difference in the lives of many women in your work as a midwife. I’ve got friends who have done it the all-natural way, both in hospitals and in midwife centers, and one friend who had home births. (Although I share Bing’s fears about that–too many allopaths in my family, I guess. And who would want to clean up that mess? Not Historiann!) I just wanted to discuss the oddness of the feminist critique of allopathic obstetrics that encourages women to embrace pain in childbirth, when we all (feminists included) are perfectly fine with “unnatural” interventions into diseases, pain, and surgical procedures. And, I wanted to suggest that if feminism is about “choice,” then women who have C-sections and crank up their pain meds shouldn’t be scolded as inauthentic mothers (or feminists) because they didn’t push a baby out the old-fashioned way.

    Bing–yes, I have been reading your mind! (Although, it’s a little creepy in there sometimes.) I read the Gawande article when it first came out, although it was difficult to read about Rourke’s experiences because they were so much like mine. (Times two and a half!) The allopaths I worked with told me that gravity worked, which is why I spent 5 days walking around and jumping up and down, to no effect. From what I remember–you or Susie or KC might know better–gravity works if the child’s head is actually in contact with the cervix and helping to pound it open. If the child’s head isn’t in the right place, then you’re just a hugely pregnant woman jumping up and down and looking like an idiot. (And that was me.)

  17. Susie from Philly on 08 Jun 2008 at 8:17 am #

    I’m not scolding anyone, and I hate the “childbirth competition.” That’s not what I’m saying.

    I’m saying there are some very solid health reasons to avoid C-sections, if at all possible. The gray area is always in the stated reason for the C-section, because so much of it is intertwined with the medical establishment’s tendency to “medicalize” everything.

    You might see this trend as a positive for female consumers, while I think it’s a triumph of medical and pharmaceutical marketing.

    My point is, the choices should be made with all available information. The OB-GYN establishment is so heavily weighted on the side of intervention; the natural childbirth movement has nowhere near the clout. Just sayin’.

    HJ: I didn’t put patient empowerment at the top of the list (you did), but it’s certainly a nice bonus.

    As to cord compression: well, lay midwives consider water breaking before the second stage of labor to be a complication, and treat it as such with close monitoring. Usually there’s some other contributing factor, like a malpresentation (again, which shouldn’t be a surprise if the birth attendant is paying attention). If there’s too much amniotic fluid (again, should be picked up in prenatal care), there’s a high risk of a prolapsed cord being swept out in the sudden rush of waters. It’s a matter of hydraulics.

    The cord is more likely to prolapse and compress in a hospital because doctors so often puncture the amniotic sac to speed labor – which makes C-sections more likely, and now they get to “save” the baby. My hero!

    Look, all I’m saying is that a lot of the reasons doctors give for C-sections have more to do with the fact that they rely on machines instead of highly-experienced human beings to monitor care and labor.

    Lay midwives always had one big advantage – we didn’t have a quota to cover the overhead, so we had time to pay closer attention.

  18. Sticking up for OBOS « Knitting Clio on 08 Jun 2008 at 11:07 am #

    [...] on June 8, 2008. Fellow women’s history blogger, Historiann, has had a couple of recent posts on C-sections on her blog. Since those who read Knitting Clio may [...]

  19. hysperia on 08 Jun 2008 at 11:20 am #

    Amazing post and great discussion. Thanks.

    Adding my bit: “natural childbirth” was the talk when I had my first child in 1981 and I was committed, as a potential mother and a feminist. I think I did everything I could to make it happen. My labour was long with nothing particularly wrong and, in the end, I simply could not bear the pain. I opted for an epidural after which I slept for four hours and then gave birth, perfectly naturally, I would say, to a healthy baby and I was overwhelmed and overjoyed to see him born. And very comfortable. I know there is an issue about the quality of care one receives from people like midwives and, of course, I can’t say what the outcome may have been had I had someone “better”. I can say that I experienced shame that I hadn’t managed to soldier on and give my child “the best start possible”. I found it difficult to admit to people that I had caved.
    To add insult to injury, I was physically incapable of breast feeding. Once again, someone can and has argued that I just didn’t have the right care and support and so on.
    At the time that I was feeding my child from a bottle, it seemed a crime. I tended to hide with him and once again, was ashamed.
    I don’t think I’m a whiner and I admit that I had specific sensitivities that inclined me toward the shame response. Nevertheless, I still believe that prescriptions and proscriptions about the “best” childbirth and child care practises are ultimately harmful to women who don’t fit any mould. I do find that, nowadays, there seems to be some degree of greater openness regarding a woman’s “right to choose” what is best for her and her impending baby. I hope. My son and daughter-in-law informed me yesterday that I will be a grandmother in a few months. I was impressed that they will be visiting their doctor together in two weeks to make decisions about what kind of medical care they want, including the midwife option, and where my daughter-in-law will deliver. You can be sure that, if I offer any advice at all, it will be “Get all the information you can, try to make sure it’s accurate and then do what you feel best about. And don’t get too attached to the plan – child birth is an unpredictable process to some extent and you may have to make a decision on the fly.
    Above all, have confidence in your intelligence and your desire to do what is best for yourself and your baby. Don’t let anybody push you around, and non carborundum illegitimati.”

  20. Historiann on 08 Jun 2008 at 11:31 am #

    “Get all the information you can, try to make sure it’s accurate and then do what you feel best about. And don’t get too attached to the plan – child birth is an unpredictable process to some extent and you may have to make a decision on the fly. Above all, have confidence in your intelligence and your desire to do what is best for yourself and your baby. Don’t let anybody push you around, and non carborundum illegitimati.”

    Exactly–that’s wonderful and very humane advice. Your daughter-in-law is fortunate to have such a compassionate mother-in-law, hysperia. Thanks for stopping by and commenting.

    Your comments about breastfeeding are also revealing. Many of my friends had run-ins with the “nursing nazis” as well as “anti-nursing nazis.” The breastfeeding clinic in my town was wonderful, but like all things under discussion in this thread, whenever people get too attached to one particular model or way of doing things, it interferes with offering women and new mothers all of the options they may need to do what’s best for their families. I too felt extremely guilty about my baby having a supplementary bottle at bedtime–as if there was Drano in the bottle, rather than FOOD. And now I feel like such a jerk for having felt so guilty then. It never ends!

  21. jcl on 09 Jun 2008 at 8:56 am #

    Great post, Historiann. I’ve never understood why pain medication for childbirth would be suspect in some feminist circles. I’ve even seen some opposition to painkillers for cramps — you should just exercise and avoid caffeine, you shouldn’t complain about debilitating period pain because that’s just “medicalizing” menstruation. No thanks.

  22. Historiann on 09 Jun 2008 at 9:32 am #

    Good lord, jcl–how could anyone get any work done when suffering needlessly like that? Oh, yeah–women aren’t supposed to work for pay outside of the home. We’re supposed to be prisoners in our bodies!

    What do they tell women with endometriosis? Or ovarian cysts? I have no interest whatsoever in medical Ludditeism. (Luddism?) Wev.