Just after Christmas I had my third baby at home, in a birth pool with two midwives and my partner present. For such a major event it was uneventful — painful but intensely rewarding and an experience I remember with joy.
I can say the same of my first two children. Some women I know had similar experiences of birth either in birth centres, hospital, or at home. But too many women I have met have found either one or all of their births hellish experiences, remembered with horror.
What is it about the way maternity services operate that leave some women feeling as though they have been assaulted and abused?
Maternity services are largely located within the medical setting. Pregnancy and birth come under the auspices of medicine. Pregnancy takes on the form of an “illness” and birth a (too often surgical) procedure which needs management by medical professionals. In all this women are often passive subjects and made to feel quite powerless.
Giving birth is very hard and very painful, and while it is actually happening a woman is literally powerless to advocate want she wants. She needs to be able to trust the people with her to give her strength and support.
However, there is a strong culture which assumes something will go wrong; women “try” for a natural birth, the implication being we are likely to fail. What is often missing is trust in a woman’s body to labour effectively.
If the health professionals meant to guide women do not have this faith it is very hard for women to feel confident in their ability to cope. Among women I know a large part of their negative experience stemmed from that feeling of being powerless and helpless during labour. Yet a good midwife or birth partner can help a woman to actively manage the pain of childbirth.
But by the time labour starts the role relationships have been set, establishing the woman as a lesser partner.
Discussions about birth and decisions relating to it are not discussions between two equals unless a woman is confident enough to really assert herself. More often she is just told what she should do.
In my own case, I had decided quite early on to have a home birth. When I explained my intention to doctors, they would literally bristle.
One told me I couldn’t just have a home birth. I needed to “fulfil certain criteria” i.e. I needed to get permission from him about where I would have my baby.
Doctors are often very hostile to home birth despite overwhelming evidence that home deliveries and deliveries in birthing centres are much safer and less likely to end in interventions than hospital births.
There is also extensive argument and evidence from midwives about the risks of intervention, and how a great number of medical interventions in labour are simply unnecessary. See the website of the Association of Radical Midwives (www.radmid.demon.co.uk).
While a doctor is very useful in certain circumstances, most pregnant women are not sick and do not need medical intervention. The medical profession can be amazingly ill-informed about the processes of normal healthy deliveries.
Too often poor decisions are made by medical professionals about management which can lead to subsequent problems, putting mothers and babies at risk.
In short, women’s treatment in pregnancy can mirror our treatment in society. We are demeaned, patronised, bullied, and at times physically assaulted (I refer to the practise of episiotomy, often carried out without the woman’s knowledge or consent). If we do assert ourselves we are basically accused of endangering our babies.
Of course there is more to it than this. Even progressive maternity services can fail to provide adequate woman-centred support because there are simply not enough experienced midwives. Hospital facilities can be poor and there are not enough birth centres to provide a more comfortable “home from home” environment in which women can labour and give birth.
Any campaign around maternity services must include demnds around funding and facilities. But more fundamentally, we need to tackle the sexism that has alienated so many women from their own bodies and reproductive abilities.