Monday, June 6, 2011

More thoughts on The Thinking Woman's Guide to a Better Birth

There were two themes from early on The Thinking Woman's Guide to a Better Birth that really struck me. You know how sometimes you read something, and you unexpectedly feel like you just got smacked in the face with a truth you had no idea existed? It was like that.

Idea #1: Doctors act based on their beliefs, just like everyone else.

One of the criticisms that the medical side often levels against the natural birth side is that NCB (natural childbirth) advocates base their positions on belief, not on facts. They seem to believe (see what I did there?) that if anyone were properly informed of the facts, they would always be on the side of mainstream obstetrics.

And, you know, that's not a 100% unreasonable criticism. I'd like to think that most NCB advocates are people who are basing their opinions on the facts - either reading the literature themselves, or reading authors who break down the literature for laypeople, like Henci Goer and many other authors and bloggers. But I've heard some things that were at best not-helpful belief, and at the worst honestly harmful, not-fact-based beliefs. Like midwives who believe that every birth can be a vaginal birth, and a woman who gets a C-section just didn't believe enough, or relax enough, or eat properly, or whatever. That's a belief, not very common but it's out there.

But the thing is, doctors are not immune to the power of belief, either! And I think realizing that answers one of the really hard questions, namely, why do doctors do things that the literature overwhelmingly shows to be useless or harmful? Why would any doctor routinely do episiotomies when we know routine episiotomies increase the risk of a bad tear? That is something that has always baffled me. And Henci Goer has an answer: belief. If you believe that birth is inherently dangerous and women's bodies cannot be trusted to work, then you do the things that that belief system leads to, like routine episiotomies and Pitocin. Who cares what the literature says when you know in your heart of hearts that most women need episiotomies?

Idea #2. The obstetric view of women is rooted in patriarchy.

Henci Goer makes the following points about how the broader culture affects our view and treatment of birthing women.
  • We (American culture in general) views technology as superior to nature. Hey, living in a high-rise is better than living in a mud hut, and medical science is better than natural cures, right? So a natural process like birth is always improved by the addition of technology. And failed technologies are hard to get rid of, unless they're replaced by another, because going from using technology to not using technology always feels like going backward. Hence why EFM keeps taking over even though it does not improve outcomes.
  • A quote from page 4: "One tenet of gender bias is that women’s bodies are weak and defective and cannot be trusted to do what they are supposed to do." That kind of thinking goes back thousands of years: hysteria, anyone? So it's no surprise that modern doctors, too, still look at the female body and think "broken, weak, doesn't work right."
  • For more fun, the reason why women are seen as defective changes, but they're always seen as defective. Back in the day, they were just weaker. Victorian women were deformed and weakened by their corsets (this is the only one with a basis in fact). Today, I've seen obstetricians argue that modern women are too weakened by civilization to effectively push out babies, that civilization has warped womens' pelvises so that babies don't fit, that our modern diet makes babies too big to fit out of their mothers, and more. All hogwash.
  • Also from page 4: the foundation of obstetrics is that babies must be rescued from their (weak, defective) mothers' bodies. You can see a ton of this rhetoric on . It's a very common view, that the womb - designed to be the perfect home for a fetus - is a dangerous environment that the baby must be rescued from.
  • If the mother's body is the problem, then she is not a part of the solution (page 4). Hence, obstetric remedies do not involve the mother doing something; they involve doing things to the mother.
  • Finally, obstetrics "values top-down relationships" (controlling authority figure, obedient and submissive mother); obstetrics "values action over inaction" (hence, "failure to progress" that is often "failure to wait"), and values traditionally masculine qualities of "control, predictability, and efficiency." (Note that by traditionally masculine, I mean qualities that our culture tends to view as masculine.) These patriarchal values - patriarchal authority figures, privileging of aspects viewed as masculine - inform the view of birth and how it is treated. 

Now, of course, there are many female OBs, so I should note that, yes, women can be part of enforcing patriarchy, too. To break into traditionally masculine fields, women have generally had to adopt traditionally masculine traits: they had to show the men in charge that they would behave like the men did, they would keep things the same, they wouldn't mess things up with all their weird feminine feelings and giggles and stuff. Thus, female OBs often have the same negative views of women's bodies that the original male OBs did. Hopefully, this will change in the future, but for now, women who break into "male" jobs have a hard time making things better for women, because they feel they cannot rock the boat and go against the male majority without endangering their own success, and indeed endangering the success of other women in the field. (Female movie producers, for example, overwhelmingly hire male directors and produce movies for men, just like their male producer counterparts do.)

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