Having a Baby in America
By Peggy O'Mara
For over twenty years, I have listened to women talk about their intentions before birth and have been fascinated to compare this to what they report afterwards. Often, as new mothers, we are disappointed when things do not turn out as we had hoped and planned. We are confused and blame ourselves. We wonder what might have been different about our baby's birth and what simply must be accepted. What does a woman require to birth normally? What are the qualities and experiences that allow a woman to have the confidence necessary to believe in her capacity to birth normally?
We now know many things that contribute to this confidence, but most women in the US do not yet receive them. For those who do-who birth with a midwife or have a supporting doula-pregnancy is an opportunity for empowerment and maturation. Pregnancy and birth, in fact, are by nature transformative. Despite our best efforts to rid ourselves of our conditioning in the US, we are still subject, unfortunately, to the beliefs of our culture about the limited capacity of women. We must expand our sense of ourselves in order to birth normally. We must radicalize ourselves.
The beauty industry, fashion industry, and drug industry all tell us the same thing. We are not good enough as we are. We need something more. The birth industry suggests, by its very existence, that we are not equal to birth and implies that we will need drugs or interventions. These doubts about our capacity to birth normally are deep and pervasive, rooted in our fear of death, our lack of comfort with the intimate, and our suspicion of the feminine. Bringing consciousness to these things as pregnant women makes our birth choices much more than lifestyle choices. In this light, birth becomes, in fact, a political act.
Having a baby in America is a political act because to birth normally you must keep your vision of your own inherent capacity strongly in focus to resist the competing special interests that vie for dominance of your birth experience. American insurance companies define pregnancy as a disability; obstetrical medicine practices defensively to ward off malpractice suits; pharmaceutical companies and manufacturers of birth technology offer incentives to practitioners to try their products; in short, birth has become a business. While we hope as pregnant women that our needs will be put first, we are often overpowered by the culture of medicalized birth.
As pregnant and birthing women, we are naturally vulnerable and might rightly assume that our vulnerability would be appreciated by society and that we would feel protected. Unfortunately, this is not always the case in the US, where so many families live in poverty and many women simply cannot afford prenatal care. This is so in 2002 despite the fact that the National Commission to Prevent Infant Mortality called for access to prenatal care for all women as long ago as 1988. Even when a woman can afford health insurance, her policy may not give her any real choice regarding birth.
We have a lending library for the local community in Santa Fe, and a woman came into our office recently to check out some books. She recounted how she had been refused an appointment at the local medical practice she had been previously using because she had gone up to Taos to see the birth center there. She was told by the local practice that she had fired them by consulting another practice. This dumbfounded her as she was newly pregnant and had just moved back to the area. She had legitimate concerns about her previous births that made her want to explore various options. However, she was severely censured for simply getting more information and for doing so openly.
We wrote in issue 109 about a couple who were also censured, but in a different way, for bringing a birth plan to the hospital. The medical profession carries a difficult burden, to be sure. We expect physicians to do everything right to save our lives, and yet we are often too eager to blame them when things go wrong. It is difficult as new parents, however, to break away from the contemporary adversarial quality of health care. This is what makes it imperative that you find a compatible birth attendant regardless of the cost. If this is simply impossible, it is essential that you at least have a birth advocate, labor coach, or doula with you at all times during labor. These things are not simply good ideas. They can make the difference between whether you feel victimized or powerful after birth. They may even affect whether you begin life as a new family traumatized or ecstatic.
Why is it necessary to have someone with you at all times? Why am I making such a big deal of this? I'm alarmed. I have been working to advocate natural childbirth for nearly 30 years, and things are getting worse. Women are at risk, regardless of their inclination toward natural birth. Pregnancy and birth interventions, surgical birth, and maternal death are all on the increase in US hospitals. Tragically, as women birthing in these hospitals, we are at risk of being subjected to machines, procedures, and surgeries that are used routinely and yet are simply not supported by evidence.
And, what is worse, we have accepted this situation as normal. Women in the US actually believe that we need these things. Over one-third of us give birth surgically. Over 40 percent use drugs during birth, even though we spend our pregnancies avoiding them. We are at the mercy of an insatiable medical technology, one that will offer us more and more technology until we simply refuse. Mothers, where do you stand on this? How can we regain our power as birthing women? How can we believe again in our capacity to birth normally?
In the 1970s when birth practices changed dramatically in the US and more options began to be available to families, there were powerful groups of parents who worked with midwives for legislation and social acceptance. These were often people who had been inspired by their baby's birth experience to believe in their own inherent integrity. It is a time now for such people and such groups to rise up again. We must organize together in our communities to encourage natural birth and to build a supportive subculture of normal birth, a "village" within each of our towns.
The cesarean rate in 1960 in the US was 7 percent. Today, despite the World Health Organization's recommendation of a 10 to 12 percent cesarean rate, the US rate is over 20 percent and on the rise. Now, you tell me, were women's bodies different in 1960? Are women's bodies different in other countries? Of course not! The increased rate is related to a recent decline in the number of vaginal births after cesareans (vbac) due to lack of medical encouragement. Remember that your birth will be impacted by its cultural and social milieu, as well as by your own personal psychology. So you must make your birth a political act if you are to ensure that it is evidence-based rather than driven by special interests.
As if the high rate of forceps, vacuum extraction, and cesarean section were not enough, you can also count on the use of experimental drugs in US hospitals and among some US midwives. In issue 107, we published an article on the dangers of Cytotec, a peptic ulcer drug that is used off-label for labor induction and that is so powerful it can cause uterine rupture and even death. It is the use of this drug for induction in women with previous cesareans that has recently given vaginal births after cesareans a bad name. It's not the VBAC. They're perfectly safe. It's the drug that is unsafe.
If you are offered drugs during birth, don't be naïve. Ask questions. You asked about everything you put into your body while you were pregnant. Don't stop while you're giving birth. Ask about the drugs, or tell your doula to do so.
But why do we take drugs anyway? Usually we do not have the support we need to explore nondrug soothers or our natural chemistry for relief. We seldom have the opportunity to consider the effects of the drugs on the baby beforehand. We may mistakenly think of birth pain as a nuisance, something that shouldbe eliminated because it can be. The experience of normal birth, however, is intangible.
In 1982, psychiatrist Ronald Laing wrote, "We do not see childbirth in many obstetric units now. What we see resembles childbirth as much as artificial insemination resembles sexual intercourse. And, birth, as a home and family event, has virtually been cultured out. Women are allowed or not to have their babies at home. In hospitals, they are allowed or not to move, scream or sing, stand, walk, sit or squat. Women are allowed or not to have their babies after birth. Š To allow is to exercise as much, if not more power, than to forbid." Laing pleaded for genuine choice, asking, "Why should any one way have to be imposed on all? Why cannot two or more ways coexist in the same society? Why should there be any monopoly on what is available?"
As members of the animal kingdom, we have a beautiful, inherently elegant, and precise physiological blueprint for birth that is often undermined and seldom acknowledged by the habits and common practices of US hospitals. Such institutions change slowly, and their policies are often based on economies of efficiency rather than emotional well-being.
Emotional well-being, however, is precisely what we must ensure. It is our responsibility to protect our unborn baby and ourselves from unhealthy environments. To do so, we need to become radicalized. We must put aside the limited view that others have of our potential and our capacity, rely on the generations who have successfully birthed before us, and generate a new and broader vision of ourselves as birthing women. We must be like my friend, Elizabeth, who replied when her mother called her a "poor thing" during her labor, "I'm not a poor thing. I'm a warrior."
Where is your warrior? Where is your wild side? Where does the animal live in you? For it is the animal in you who will give birth. In the 1970s, we felt liberated because women had increased opportunities in the workplace, yet we were still washing all of the dishes. We are not yet liberated in our lives today if we are not in charge of our own birth experiences. Today, we must see that liberation in the workplace is only the beginning. We must reject the passivity that allows us to accept without question health care that is often experimental.
The president of the American College of Obstetricians and Gynecologists publicly recommends elective cesareans rather than vaginal births. To suggest to US women that surgery is equal to vaginal birth is the ultimate deception. How gullible are we? A cesarean is surgery. Sarah Buckley's article in this issue dramatically illustrates how nature has elegantly provided us with an ecstatic hormonal chemistry designed to comfort us during birth, keep our baby alert after birth, and prepare us for bonding and breastfeeding. It is this delicate and essential chemistry that we miss when our births are orchestrated by medical technology.
We holler about choice as though all choices were created equal. What choices are truly important? Perhaps the most important is first to decide where you want to give birth. Then choose a practitioner with whom you are compatible, one who sees birth as normal and who does not interfere with nature.
Real choice is not about accepting the limited options offered you by insurance companies and conservative medicine in one country at one time in the history of the world. Real choice requires thinking out of the box. It means recognizing the fact that you are a parent as soon as you become pregnant and that it is never too soon to begin to take responsibility for your baby and your future life together. It is also never too late to find a new birth attendant. Nature has provided you and your baby with instinctual aids intrinsic to the pregnancy and birth experience. Rely on them. They make things much easier, and not surprisingly they also facilitate your future life together.
On the other hand, when you choose the medical model for birth, things are more difficult. Interventions lead to other interventions. You are continually questioning yourself. Does starting out life as a new mother with birth interventions make us more likely to need intervention at future parental transitions? Does this make us more likely to trust experts and less likely to trust ourselves?
As parents, our expertise is inherent. We must step back from the limited view ascribed to women and mothers by modern-day US culture and uncover a deeper, more primitive confidence in ourselves. Let the animal in you out. Listen to her. Let her lead. Once you get to know her, you'll recognize her. She is the part of you that is always on your side.
Peggy O’Mara is the mother of four grown children. She has gained international celebrity as publisher, editor and owner of Mothering Magazine. She is also the author of four books: Having a Baby Naturally: The Mothering Magazine Guide to Pregnancy and Childbirth, Natural Family Living: The Mothering Magazine Guide to Parenting, The Way Back Home: Essays on Life and Family, and A Quiet Place: Essays on Life and Family, all of which can be purchased in the Mothering Shop. A dynamic speaker, she has lectured and conducted workshops in conjunction with organizations such as the Omega Institute, Esalen, La Leche International, and Bioneers. She has appeared on numerous television and radio programs and has been featured in national publications including The Wall Street Journal, USA Today, The Washington Post, Chicago Tribune, Mother Earth News, and Utne Reader.
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