HELLO LOVELY LADIES!
It's been quite awhile since I've written a blog post. I needed some time off to attend some births, process them, help some mamas, and make some major changes to my business. The most significant of which is to begin "Empowered Mama Coaching", which you can see and read about here. Very briefly, my goal with coaching mamas is to offer a sisterhood and guidance above and beyond what a doula is able to provide during the prenatal and postpartum time period. I now offer coaching online, to reach mamas at a distance who feel connected with me, mamas who may not be close to a doula, or may have very limited birthing options. I want to reach those mamas who have had a traumatic experience, or deep fears about birth and want to find their sense of safety and well being again to bravely enter motherhood this time. I want to reach those mamas who want to prepare for birth in a more holistic way than is available to them with just their midwifery or medical care, to do emotional, informational, herbal, nutritional, nurturing and empowering work. Please read more and contact me with any questions. You can listen to my FREE teleseminar by signing up on this page.
Anyhooo! I was reading this article today and found it to be a truly compelling topic: the idea of Autonomy in Birth. I encourage you to read the article and the research it's based on- a study in Scotland in 2005.
Autonomy has another essential aspect. Edwards (2005) explains weaving safety from autonomy and describes “women's embodied knowledge as an unacknowledged source of safety”.
women negotiate safety for themselves, their babies and their families through ethical decision-making that unfolds best in the context of trusting relationships with those who can engage with them and focus on what really matters to them. Enabling autonomy through the facelessness and technocratization of our maternity services is impossible. (p. 255)
They discovered that "devaluing women's knowledge was a major obstacle to safe birth." This particular sentence rings huge bells of truth for me. I've seen this done repeatedly. Many women feel that the safest place for them to birth is in a hospital setting, because they feel the medical knowledge of the care providers there is superior to their own. And they would be right. But I would argue, and stay with me here, that the fact that the care providers see birth as a medical event causes it to become a medical event. And this happens, primarily, by making Mom a patient, instead of the expert on her own body and child.
Now, there are obvious cases where Mom's autonomy has been completely removed. I have, sadly, and undoubtedly, witnessed doctors, sworn to "first, do no harm", force things upon mamas in the midst of trying to bring a baby into the world, that they blatantly didn't want. Ranging from the small (an IV) to the large (hands being shoved into mama, or surgery being demanded as the only option.) But that's not what I'm talking about here, those cases are obvious, and we can clearly call them traumatic or worse, birth rape. I'm talking about the grey area of the medical model of maternity care.
There are times when I have seen doctors call mama "the captain of the ship", and I think, genuinely mean it. Times when I have seen doctors, watching a baby's heart rate drop dramatically, use a gentle tone to say "You're doing a perfect job, but I'm feeling a sense of urgency that I might need to help baby." Could there be a better standard of medical care for mamas than a doctor patiently, silently sitting and waiting for a delivery? I don't think so.
But I believe that there is a fundamental problem with healthy mothers delivering in a hospital setting: from the beginning they begin to distrust their "embodied knowledge" in favor of the "medical knowledge" and this sets mamas up for obstacles to safety.
Please don't misunderstand me to be saying that all mothers should deliver in free standing birth centers or at home. I am of course aware that there are rare extenuating circumstances, I'm talking here about a general principle.
Here's what I mean. Let's take an example of a perfectly healthy mama. She's a first time mom, going into pregnancy and birth thinking she likes her doctor, he's really cool, and he makes her laugh. He must know something more about this process than I do, and my friend liked him, so that's that. As the process begins, there's a few appointments, lots of blood work and lab work and questions about prenatal tests for a million things- mostly things she can't do much about regardless of the outcome, but will worry her sick. Birth has already become a medical event that requires testing and measuring.
As birth gets closer, she starts to worry if she can do it, though she wouldn't admit that, because that's silly, everyone can "do it". So to assuage her very normal fears, she doesn't read much birth information and she leans into her doctor for more and more help. He, seeing birth as a procedure, fraught with potentially scary things, monitors her very closely to make sure none of those scary things happen. If they do, he is confirmed in his training and belief that birth is precarious and uncertain and comforts this mama by telling her how great it was that he saved her. If it doesn't need saving, he tells her how lucky she was.
Even small subtle inferences can mean a lot to a woman embarking on motherhood and birth for the first time (or 2nd, or 3rd...). When I see well-meaning respectful doctors ask if Mom wants her water broken, for example, they are already implying that something needs to be done. The message she receives is "You thought you were doing fine, but you were wrong, something needs to be done." The good doctors out there are merely trying to say "I could help! I could do something! I like to DO things!" But that's not what mom hears.
If we keep telling Mamas that they are in control, but subtly imply that if they're smart they'll agree with us, this may be informed consent, but it's certainly not true support. The thing is, many women don't realize the difference between the medical model and the midwifery model of care. They don't know that your doctor has been taught to assume that everything will go wrong until proven otherwise.
Though I am a proponent of writing birth plans for hospital births (and at least as a personal exercise), the system is such that mamas feel that have to submit their plan for approval. Already implying that doctor knows better than their inherent wisdom.
Giving mothers autonomy in birth does not just mean hanging up signs that say you support the magic hour after birth, and telling mamas you respect their decisions. It comes from stepping back, asking her how she's feeling instead of reading her chart, watching her movements and breaths instead of checking her cervix (a virtually useless measure of labor) and asking her IF there's anything you can do for her, to start.
I have seen mothers believe so strongly that they needed their doctors that they literally created a need for them at the end of delivery. Everything was going so smoothly, which didn't line up with her belief that her doctor was necessary, so at the very end, much to the surprise of everyone (including her doctor I might add), she created a brief emergency that required intervention.
What would birth look like if instead of telling mamas what to do, and running them through test after test, searching for something to be wrong, obstetricians asked mamas what they needed? What they could do to serve them instead of the other way around.
Do you think there's autonomy in birth? Why or why not?