Giving Birth to Judgement

As I've been reading various blogs about birth and women's health, I'm finding myself face to face (or face to computer screen) with people who have very passionate views on birth, epidurals, c-sections, and so on. Sometimes it feels like every chatroom or blog with birth as a subject has at one time or another become one of those vitriolic town hall meetings on I've seen CNN. Birth and the circumstances surrounding it can be a sensitive issue for many people regardless of their experience with it. Women who are proponents of natural childbirth are called selfish birth Nazis. Women who have had planned, elective c-sections are being verbally attacked for their choices. And who is attacking these women, you might ask. OTHER WOMEN!!! Women belittling, degrading, and passing judgement on other women. What has that ever solved? Ummm, let me think... Oh, yeah. NOTHING!!! *Deep breaths* Sorry, I just get so steamed when I see this stuff. I'm calm now. I promise. Back to what I was saying.

Birth is a very personal event and there is no one right way of giving birth. And I don't believe every woman on the planet can or should give birth vaginally or without intervention. Anyone who knows me knows that I am a staunch supporter of natural birth and *true* informed consent. I have no problem with a woman choosing to have an epidural or a c-section as long as she knows the risks and those risks aren't down-played to influence her decision. What I do have a problem with is a system which perpetuates the idea that women's bodies are flawed, that at least half of us don't have the capacity to birth our babies the way our foremothers have done for ages, that we are emotionally and physically unable to cope with the rigors of childbirth, that we need to be rescued. I don't feel that a woman who undergoes a c-section or has an epidural has failed. If anything, it may be she who has been failed. Perhaps if more women were supported within their communities, by their health care providers, and, dare I say it, by other women, our (non-medically indicated) c-section rates might not be as high as they are. That being said, it is time we stopped hurling insults at each other and started turing our passionate feelings and our energy toward fixing the system.

Last week, I discovered ACOG's disturbing survey, "Complications Related to Home Birth". Apparently, ACOG is concerned that the rising rate of elective home births will somehow lead to an increased rate of maternal and fetal complications. The list of complications that they provide for selection on the survey range from multiple gestation to shoulder dystocia to postpartum hemorrhage. My question was this: What does home birth have to do with these complications? Common sense tells me that the location of a birth does not dictate whether or not a complication arises. More relevant would be the awareness, knowledge, and preparedness of the birth attendant(s), perhaps. But even with the most skilled and perceptive attendant, hairy complications can happen, right? What ACOG seems to be suggesting, however, is that hospital births are free from complications until midwives or "untrained" birth attendants bring their so-called "train wrecks" from home to be rescued by doctors and hospital staff. It is precisely this type of thinking, perpetuated by many in the medical community, that leads people to expect perfect results every single time from doctors. And when perfect results are not achieved, lawsuits arise because folks need to blame someone. Who better to blame than the person or persons who assured you that if you followed all their often uncomfortable and counter-intuitive rules you'd have a perfect outcome? Anyway, that's my two cents.

I also found a great response to ACOG's survey. It's created by a doula, Tabare Depaep, J.D., and re-posted on the EnjoyBirth blog. Very cleverly written. Here's the link:

http://enjoybirth.wordpress.com/2009/08/28/response-to-acog-homebirth-survey/

Lately, I've had boobies on the brain. That's right. I've been pondering breastfeeding. A lot. More specifically, I've been annoyed and outraged by those who claim that breastfeeding is obscene or disgusting and should only be done behind the closed doors of a public bathroom stall. And I've been vocal about it. One friend commented, "Wow, you sure are passionate about your breasts!" Well, I am. They're great. And someday, they'll hopefully nourish the next generation of the Milk Chocolate Midwife family. I'll be damned if I'm doing that important task behind closed doors unless it's strictly by choice!
So, in honor of International Breasfeeding Week, here's Blacktating's August Carnival of Breastfeeding. Love it, live it.

August Carnival of Breastfeeding: Prepared for Life

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Playing Doctor

Sometimes, I get the feeling that many, if not most, of us in the health care field went into our lines of work because we simply don't like being the patient in a health care situation. We'd rather be the people who are in charge, the ones who know what's going on. Maybe I'm projecting, but as kids how many of us wanted to be the patient when we played doctor? I sure didn't. I wanted to be the doctor because being the patient held little appeal. The doctor got to use equipment and DO stuff. The patient just got to lay there and be sick. At no time during these play sessions did the patient question the doctor or get to participate in deducing what was wrong or deciding what to do about it. How did I (and so many others, I'm betting) learn these classic and faulty elements in the roles of doctor and patient at such a young age?

It must start when we are babies or very young children, for most of us. I remember my terrified little brother thrashing around on the table and eventually having to be restrained by four adults (he was 2 or 3 at the time) while the doctor looked into his infected ear with an otoscope. No one spoke to him or asked him what was wrong or why he was so afraid. Poor kid hasn't been to the doctor willingly since then. He's now 21. My own personal experiences with doctors as a child were often less than pleasant. One of my earliest memories is peeing in a doctor's lap as he gave me a shot in the buttocks. Hey, I told him to wait and he refused to listen to me! Note to pediatricians, when a 2 year old says, "Wait, I've gotta pee.", she may be stalling but maybe you shouldn't lay her across your lap in your newly carpeted office (instead of an exam room) and proceed to give her a shot! My dad was standing there unable to keep a straight face while I watched my urine soak the doc's pant leg. Even the doc laughed. I was mortified. Daddy apologized and dried my tears.

As an adult, the experiences don't get much better but by this time I made it a point to visit the doctor only if I was practically at death's door. When you have no insurance, that's an easy resolution to stick to. In 2007, I did have insurance. I also had a UTI that was morphing into some lovely kidney pain. After visiting the ER, I made an appointment with a nephrologist in my area. I was sitting in the exam room when the doctor came in to greet me. He glanced at my chart and said, "History of UTI, eh?". I nodded and he asked me to stand up. At this point, the doctor grabbed my crotch. Let me repeat. HE GRABBED MY CROTCH!!!!!! To add insult to injury, he said, with his hand still at my crotch, "Well, that's your problem right there. It's too hot in there." What the fucking hell??? I was stunned. My mouth simply hung open and no words came out. I did not punch him, though I should have. Nor did I push his hand away or yell any of the million things flying through my brain at that moment. I did nothing. I said nothing. Because he was the doctor. He was the DO-er and KNOW-er. He had the power. I was the patient. All I got to do was be sick. And after that, I was sick.

I don't hate doctors. Far from it. My dislike is for the unequal and counter-productive power dynamic that exists between many doctors and their patients. The existance of this dynamic isn't soley the fault of doctors or the medical community. I think that patients shoulder an equal share of responsibility here. But here's the problem. Most of us were patients before we were ever health care professionals and we've been socialized to be "good patients". A "good patient" doesn't ask too many questions, is compliant, and understands the patients' place in the medical hierarchy is below the doctor/nurse/midwife, etc. Today, we need less "good patients" and more people actively involved in their own health care. We need patient education and respect. We need to stop asking doctors to shoulder the burden of making health care choices for us because when things go wrong (as they sometimes do), whoever made the decision also carries the blame. We need doctors to stop practicing health care that's based on fear of litigation. We need to be the kind of patients who don't just lay there and be sick.

Religious Right? Or Wrong? Are We to Judge?

One night not that long ago, I happened to find myself involved in a familiar and uncomfortable conversation about religion and spirituality. Now, I don't usually delve into these conversations with perfect strangers due to the sensitive nature of the subjects. However, that night proved to be an exception. Funny, enough, the conversation did not begin in this vein. It was actually about childbirth, at first. See, I love to talk about birth and women's bodies and the political dynamics of both. I don't know how this conversation which was initially centered on the anatomy and physiology of the birth process ended up "in God's hands" literally and figuratively (mostly figuratively).

Before I continue, I feel I should clarify a few things about myself for anyone who is reading this. 1. I do believe in a power that is above and beyond my intellectual reach and physical understanding. 2. I do not generally identify with any particular religion even though I try to live my life according to values that some might argue are inherently Christian (though I've also been called a heathen and I'm totally fine with that). 3. I try my best to respect the views and beliefs of others, even when it's so much easier to write someone off as a fanatic.

So, back to the strange and uncomfortable conversation. The woman with whom I was talking had very stong opinions and wasn't afraid to share them with me. Several times during the course of the evening, she made references to "healings", "revivals", and "casting out evil spirits". This didn't bother me. I understood that she was Christian as were the 6 or 7 other women in the room. I continued my lecture on the stages of labor and birth. After my lecture had ended, she sought me out to talk and I was open at that point to discussion. I thought the discussion would remain in the realm of birth. Silly me. I should have anticipated otherwise. The conversation was fine until I was told that Catholicism, Traditional Chinese Medicine, Buddhism, etc. all contained elements of paganism and satan in their workings. This is when I started to get that sinking feeling in the pit of my stomach.

Seeing as how I'm neither Catholic, Buddhist, or a follower of Traditional Chinese Medicine, I fought to understand why I was feeling offended by her comments. Then it hit me. I don't like hypocrisy. I don't like when people stand behind the shield of Christianity (or any other religion that espouses love as a beacon to live by) and hurl rocks of judgement and condemnation at anyone who doesn't share their brand of faith. While I admire those who posses an unflappable faith in whatever it is that they believe, I admire humility and honesty more. I'd much rather discuss religion and spirituality with someone who says "This is what I believe with all my heart and I pray that it pleases God.", as opposed to someone who says, "This is what I believe with all my heart and I know that I'm absolutely right and anyone who doesn't believe as I do is wrong." Now, don't get me wrong. This woman seemed quite nice and I'm sure she never meant to offend me. She was simply stating her beliefs as she has a right to do and I didn't argue with her. After all, I was there in a purely professional capacity. However, I got the distinct feeling that even if I had chosen to share my view, at best, she would not have been open to hearing them. At worst, I might have been marked as a harbinger of evil, possibly satan's concubine, and condemned to the depths of hell. Oh, well. Maybe next time.

Wise Latina Woman

I've been watching the confirmation hearings of Judge Sonia Sotomayor and I'm frustrated and disgusted by the display of White, male privilege and fear that I'm seeing. It blows my mind that we've made such strides in this country with regard to overt racism, but at the same time, those gains seem to mean nothing when the reality of racism pervades our government so thouroughly. Much of the controversy surrounds a statement that she made in 2001 saying "I would hope that a wise, Latina woman with the richness of her experiences would more often than not reach a better conclusion than a White male who hasn't lived that life." Due to this statement, there is much talk of "reverse discrimination" and "reverse racism". Every time I hear these phrases coming out of the mouths of supposedly intelligent people, I want to scream. What the hell is reverse discrimination/racism???? As far as I know, racism is racism and discrimination is discrimination regardless of who is being discriminated against. No one race, gender, religion, etc. owns racism or discrimination. The belief that racism can only be perpetrated against people of color, for example, only serves to make racism okay (as long as its not publicly, and blatantly exhibited) because its something that only hurts "those people". The reality is that racism and discrimination hurts society as a whole.

What I don't understand is why this woman is being taken to task for asserting that her ethnic background and gender have an influence on the way she views the world and (gasp!) the way she may rule on cases. Is the same not true for the hundreds of White male law-makers? Am I to believe that White males' policies and judgements are not influenced by their upbringings, their race, and their gender? It's as if they would have the world believe that only people who are not White and male are suceptible to influences such as race, ethnicity, gender, and social class. Seriously????

I certainly understand Senator Lindsey Graham's assertion that if he had made a similar comment being that he is a Whilte male that he would have been condemned as a racist. However, I would argue that in the country in which we currently live, a White, male law-maker doesn't have to discuss or defend the influences that his gender or race have on his ability to make wise choices. He may discuss being a farmer or coming from "common" roots, but he doesn't dare publicly reflect on how White privilege has shaped his view of the world.
In American politics, White and male is the yard stick that is accepted as the norm. Everyone else is, well, everyone else. It's hard for me to hear law-makers claim that it's important to have diversity on the bench, but only as an effort to prove that racism, classism, and sexism have been eradicated from American politics. Not that we need diversity because different people bring different viewpoints that may add to the richness of dialogue and communication. Come on, folks. I think the American public is tired of the posturing, eloquent language, and "code words" (such as empathy) that serve to promote the kind of fear that only propagates racism, sexism, classism, and all the other -isms that we desparately need to overcome.

A Midwife's Transition

During labor, transition is often the most challenging period of time for many women. This is a time when a woman generally has to dig deep to find strength for herself physically and emotionally. I've seen many women begin to doubt themselves during transition. That's when they start to cry out things like, "Come on, baby. Mommy can't do this for much longer." or "Time out. I wanna stop now and try again tomorrow." The urge to quit can be strong, but women usually come through it and birth their babies (often within minutes of calling for a time-out). It's a beautiful journey to watch and I always feel blessed to be a witness to it. Although I've never physically birthed a baby, I feel like I can relate to this type of struggle on an emotional level. Actually, I feel like I've been in transition for months now.

My transition has been manifesting on many levels and in various aspects of my life. It began when I graduated from midwifery school last year. A dear friend and midwifery classmate was battling cancer. My determination to get through my schooling was fuelled by the fact that she had become so ill that she couldn't continue her midwifery education. What right did I have to complain of being tired when she was dying? Watching my friend, the woman who was supposed to be my future business partner, gracefully slip out of this life...that was a tough and valuable lesson. Every time I look at her picture where she's smiling at a mother and her newborn, my heart aches to talk to her again.

The next phase of my transition came a few weeks after my friend's passing when I got married. I love my partner and I love being married. Like many couples transitioning from being single to being committed and living together, there have been challenges for us. It's been hard for me. Especially since I moved to another state a thousand miles away (literally) from my family and childhood home the day after the wedding to be with my partner while he finishes his education. If someone had told me a few years ago that I'd be living in a state where it's warm only 3 - 4 months of the year I would have laughed them out of the room. Leaving my home just wasn't part of my grand plan. But here I sit.

The latest part of my transition actually has to do with this move. Unfortunately, I have found myself in a place that is not very mother-friendly, baby-friendly, or midwifery-friendly. After talking to several midwives here, I'm beginning to realize that I may never be able to practice midwifery the way my heart and mind see fit if I stay here. The midwives here are too often bound to hospital policies and medical practices that are not evidence-based or even common-sense based. And this is, in part, due to their hospital-based training. However, there is the issue of the midwifery laws in this state. In short, they leave much to be desired. I'm becoming discouraged. A part of me is ready to call a time out. All I want to do is serve women and families. Why does that have to be so hard?