My attention was brought to this Article by Heather Cushman Dowdee

Essay
Industrial Childbirth

“Revisiting my son’s birth has made me angry.”

* Shonagh Strachan
* | 15 Oct 2008
* | 74 comments

* mother
* childbirth

Industrial Childbirth

My experience of childbirth was not an unusually traumatic one. In medical parlance I had an NVD: a Normal Vaginal Delivery. The midwives were pleasant. I was given an epidural. I was admitted to hospital at 2pm and delivered a healthy baby boy ( 8lb 7oz ) eleven hours later. This is the essential information, is it not? This is the only kind of information that we ever really hear about other women’s experiences with childbirth.

But there is more to it than that. It took me a while to sort out my feelings after the birth – the elation you feel at the presence of a new life combined with your physical exhaustion leave room for little else. And I never really experienced the hopeless grief of the flippantly named “baby blues” in the weeks or months that followed. What I felt – when I was finally able to identify the reasons for my confusion – was anger.

Is anger only blame and self-pity? Or can it be illuminating? For me it can – anger has traveled beyond blame, beyond the individuals involved and my personal experience, and shocked me into changing my whole outlook on life.

I wasn’t angry during my pregnancy at the lack of options for childbirth. I never knew what else I could expect. I wasn’t angry during any stage of my labor. As soon as I was admitted, I was told that I was two centimeters dilated and my waters were to be broken with something resembling a crochet hook. “Okay.” After that I wandered the halls and breathed through contractions for a few hours. When I was re-examined, I hadn’t “progressed” enough. I was told this was dangerous for the baby, and I needed an Oxytocin drip to speed up and strengthen the contractions. “Okay.” Now, these heightened contractions would be very painful so I’d probably be requiring pain-relief. “Okay.” The epidural is probably the most effective “Okay.”

I gritted my teeth but I wasn’t angry as the drip was repeatedly and painfully inserted incorrectly into my hand, or as the epidural took 20 minutes to stick into my spine. I wasn’t angry that I wasn’t allowed to eat anything even though I was very hungry. And I wasn’t angry that my parents weren’t allowed to see me in the delivery ward after driving for hours to be there.

As I watched the clock pass midnight into Halloween, fireworks cracked and flared outside the hospital. I smiled knowing that my baby would have great birthday parties to come. And for this next hour, I shivered in freezing shock, immobilized on the delivery table, uncaring and unangered as the drugs wore off so I could finally push. I wasn’t angry because the hospital staff was just doing their jobs and it seemed so normal for them. I was moving towards having my baby and this is what every mother went through.

The point at which I started to feel a twinge of anger was when, after the delivery, I wasn’t allowed to feed my baby. It was only then that my instinct was strong enough to say, “No. This is really wrong.” There is a period of about an hour after the birth where the newborn is alert and breastfeeding can be established. However, after a brief hold, he was taken away as I was given a Syntometrine injection and his placenta was delivered (by tugging on the cord). He remained away as I was stitched and examined and had to wait for a doctor to examine me.

By the time I was given the all clear (in tears at this point asking, “Can I feed him now?”), I had to be moved from the delivery ward and down to the post-natal ward. It was now 2 am, so friends and family in the waiting room were told to go home without ever having seen the baby or me. The baby’s dad had been present at the birth but was also sent home. Yet again I asked, “Please, can I try to feed my baby?” but he had to be taken away again – this time for a Vitamin K injection and for the nurse to bathe him and put his first vest and Baby Gro on.

When she brought him back he was tired and wanted to sleep. The nurse asked if I still wanted to feed and gave a little perfunctory hold of him up to one breast and then the other and said, incredibly, “No. He’s not a boob man is he?” She then put him down to sleep in the cot beside me, told me to sleep too and that I could try again when he woke up. I spent that first night wide awake, watching every twitch my new son made, desperate to hold him, horrified that I hadn’t managed to take him to my breast after he was born.

When he finally did wake up, I remember ringing for the nurse – looking for her permission to pick him up! This same nurse was the one who would throw back the curtains from around the beds at night if anyone dared to wish for some privacy.

Thankfully, my baby started to feed hungrily the next day. The rest of my stay in hospital was a blur of no sleep, noise, crying babies, feeding times, masses of visitors for two hours and then being left completely on my own. On the second day I remember being allowed to meet my teary mom at the end of the corridor as she passed me some supplies. Later that day I finally managed to have the baby fed and sleepy at a time when there was a lull in hospital activity. I was just dropping off – for the first time in about 70 hours – when I was woken up to bring the baby in for a BCG injection. I did so in floods of exhausted tears.

I gave birth to my son at the Holles Street National Maternity Hospital, in Dublin. Obstetricians at Holles Street have pioneered a policy of “active management” – an obstetrician-led intervention process that speeds up hospital labor. It begins with ARM – artificial rupture of the membrane of the amniotic sac or “breaking the waters” – though this may leave the fetus unprotected and vulnerable to pressure and infection. It continues with monitoring the birthing women and administering to them if they aren’t progressing “correctly.” In Holles Street, for example, the decided-upon correct rate of cervical dilation is 1cm/hour. If the mother “fails to progress” at this rate, she is hooked up to an Oxytocin drip which causes the onset of sudden intense contractions. In 2004 (the year I gave birth), 55 percent of first-time mothers at Holles Street were told they had “failed to progress” and needed to be sped up in this way (unsurprisingly, a slightly larger percentage opted for an epidural to ease the pain). Active management is currently used widely throughout the world.

The most oft-stated defense for the prevalence of today’s medicalized births is that in pre-hospital years gone by, childbirth could be a death sentence. The reality, though, is that most complications during pregnancy and childbirth occurred due to poor maternal nutrition and infections that are now easily treatable or preventable with better hygiene. The high-tech medical interventions available today certainly save some lives but in many cases – especially where active management is practiced – these interventions are often used unnecessarily.

There is also an often noted “cascade of intervention” where once one medical procedure has been carried out, another follows, and then another – leading to more invasive and traumatic interventions and often culminating in a caesarean section. In Ireland, the average rate of C-section is one of the highest in Europe at 25 percent. The midwife-endorsed alternative to this policy of aggressive intervention is “wait and see.” Strangely enough, this usually works out just fine.

In theory, a woman has the right to refuse any of the interventions offered to her. In practice, the normality of intervention and the culture of risk minimization (read: liability minimization) mean that women do not feel empowered to say “no.” I certainly never thought about saying “no” or asking what the alternatives were. I blame myself for this – that I was not more informed and proactive. But I am also angry at the bullying system in place. It is hurried and overwhelming so there is never time or space to question the “professional” medical opinion as to what is really right for you and your baby. So we become numbers, subject to routine interventions.

At Holles Street membrane rupture is carried out routinely. A “managed” third stage of labor is also routinely administered – with hormone injections and cord tugging to deliver the placenta. This is justified by saying that it reduces the risk of postpartum hemorrhage – a fact disputed by many midwives who argue that the early cord clamping involved is potentially injurious for the newborn and that the third stage of a normal birth should never be managed.

Until recently, episiotomy (cutting the perineum to allow more room for the baby) was routine. It is now being shown to be usually unnecessary and at worst a mutilation. Until recently, if a woman had one caesarean section, she could not expect to be allowed to try for a vaginal delivery in subsequent births (this is now slowly changing). At Our Lady of Lourdes hospital in Drogheda, Dr. Michael Neary carried out unnecessary routine hysterectomies, post-caesarean-section, over the course of 25 years before it was brought to light in 1998. At the same hospital (and at Holles Street, the Coombe and others around the country) between the 1950s and the 1980s, hundreds of women underwent a procedure known as a symphysiotomy. Here, a woman’s pelvis was literally sawn apart during childbirth, as an alternative to a cesarean-section. The justification seemed to be a good catholic one – the pelvis would heal widened and the woman would be able to bear more children – even though most were never even told what procedure had been carried out on them and many suffered life-long pain, incontinence, problems walking and arthritis. This is the history of routine interventions by those who know what’s best for us.

Our collective idea of childbirth is pretty nasty – blood and fluid, panting and screaming, stretched anatomy, the emergent gooey greyish-purple alien… horrible! Remember when you first heard about sex? Remember how horrible that seemed? But sex isn’t horrible, is it? What’s missing – and indescribable to a virgin child – is the emotional element. Sex is a natural and beautiful process, all entangled with love and passion. So too, and a million times more, is birth. In essence, our modern patriarchal institutionalized world has a childish view of childbirth. It can’t imagine that something that looks so gruesome could be anything but a horrendous experience and one that should be shortened and medicated. But childbirth is not a medical procedure any more than sex is.

Now, I’m not saying that every woman should have a pain-free, blissful, complication-free birth. I am saying that fear has no place in the process. Fear causes adrenaline production. This initiates the “flight or fight” response where blood drains from the uterus to the limbs, slowing the process of labor until the primeval woman escapes to a safe place to give birth. Meditation and relaxation techniques during childbirth – which are often described to women as methods for coping with pain – can in fact be methods of preventing pain by preventing fear. As with sexual intercourse, if a woman does not feel safe, relaxed and preferably loved, she will experience tension and pain during childbirth.

Without ever taking a single deep breath or doing a second’s meditation, what woman wouldn’t feel more relaxed anywhere but on a table in a hospital delivery “suite”? Looking back on it, it seems like the most ridiculous place to try to give birth. As with sex, your body wants a darkened, intimate, safe and private place to give itself over to its natural urges and processes. Instead, we retain bizarre postures under the bright lights and the ready interference and stares of strangers. Could you orgasm under the same conditions? Are you surprised then that our labors “fail to progress,” with fear and adrenaline coursing through every vein in our bodies? Overcome it with drugs. Pull, drag and cut those children out of us. Then tell us to be thankful. Mothers, partners, sisters and doctors tell us we are endangering lives, we are taking risks. Fill us with fear. No woman wants to endanger her child’s life so almost every woman does what she’s told and gets hospitalized.

Is it shocking to hear that many women liken the experience of “normal” hospital childbirth to being sexually assaulted? Aside from the obvious – the exposure of your most intimate areas to complete strangers – there is an utter lack of control over what is being done to your body. Your consent may never be sought for certain procedures – or it may be sought in the coercive manner of institutions that count on your fear for your cooperation. The feelings that may be experienced afterwards are those of shame and guilt that you weren’t able to give birth naturally, that you didn’t ask the right questions, that you gave up control and weren’t strong enough to resist certain things being done. These feelings can be particularly strong if the mother is separated from her newborn – for example, after an emergency C-section or if a baby is incubated. In some of these cases, mothers can experience bonding problems with the infant. Even once bonding is achieved, the guilt that accompanies this can be life-long.

But surely many mothers experience hospital births without mental trauma? Surely the fact that there is a healthy infant in your arms makes up for anything you went through? Aren’t you safe? Shouldn’t you be grateful to the hospital for delivering your baby? (Do women ever get to feel grateful to themselves, to feel the power and ability of their own bodies?) Won’t questioning the event just cause unnecessary pain and distress for women – shouldn’t they just forget about it and move on with their lives? Like survivors of sexual assault, survivors may live years, or their whole lives, unconscious of feeling anguish or anger about their experiences. But this doesn’t mean they are unaffected by them.

It is my belief that at some deep level, we all feel that we have been robbed. We pass through our childbirth initiation to become disempowered, disconnected, long-suffering, patriarchal mothers. We tell our horror stories as just that, or we say nothing at all. But it doesn’t have to be this way. If I ever have another child, it will not be in the same way. And it doesn’t stop there. I will never again blindly place my trust in authoritarian professionals and institutions. I will recognize all capitalist patriarchy for what it is and I will do my best to speak out against it.

Every day, in every way, my son is a wonderful gift. I would go through ten more hospital births just to keep him. I am sorry for his shabby entrance into this world but I am thankful to this little person for helping me to see something: the bald, blatant, oppressive, damaging, misogynistic forces at play in the most vital aspects of women’s lives. Revisiting his birth has made me angry, but that has made so much else clear: how blinded we can be by the guise of protection, how crippled we can be made by fear.

I wish that we talked about it. That we could stop reveling in horror stories and better place our fingers on the reason for our traumatic births – not the curse of Eve medicated to by our benevolent system – but the systematic violence that delivers our babies for fear that we might give birth to them ourselves. For in the process we might begin to understand our own strength and find words for our anger. We might begin to disobey.
Read more articles from Issue #80 - The Freedom From Want