What does it mean to promote normal birth?

Promoting normal birth is always and only about promoting midwives.

When I first read the phrase “promoting normal birth” I was confused. Why would a healthcare professional be promoting any set of procedures or any particular approach to a health issue? I thought it was the job of health professionals to promote safety.

You won’t find any real medical professional who insists that he or she “promotes” laparoscopy over laparotomy. An ethical medical professional recommends whatever is safest for the patient, not whatever is most lucrative. There are no real medical publications claiming to promote one form of treatment or even one philosophy over another. Real medical publications promote health and promote safety, not the opportunity to line one’s pockets.

I’ve come to understand, as I wrote yesterday, that normal birth has nothing to do with normal and nothing to do with birth. The definition of normal birth is simple and straightforward: If a midwife can do it, she calls it normal. If she lacks the skill to provide the needed care, she insists that the birth is not normal even if it results in a healthy mother and a healthy baby. “Normal birth” and “midwives” are interchangeable. In other words, “normal birth” is nothing more than a marketing term.

Once you realize that, it is a lot easier to understand the books and websites that promote normal birth. For example:

An article by childbirth educator Judith Lothian entitled Promoting, Protecting, and Supporting Normal Birth should be read as Promoting, Protecting, and Supporting Midwifery Employment.

The tag line of Lamaze International, Lamaze International envisions a world of confident women choosing normal birth, really means Lamaze International envisions a world of confident women choosing midwives.

The Royal College of Midwives maintains a Campaign for Normal Birth (A Campaign for Midwives) declaring that “promoting normal birth key to cost savings” (Promoting midwives a key to cost savings.)

Birth International advocates “Reclaiming Midwifery Care as a Foundation for Promoting ‘Normal’ Birth.” Of course they do. “Normal birth” really means midwifery full employment.

You can look high and you can look low, but wherever you look, midwives or their advocates are behind every attempt to promote “normal birth” (i.e. market midwifery). Indeed, the leading textbook of the radical midwifery theorists is Promoting Normal Birth – Research, Reflections and Guidelines best understood as Promoting Midwives – Research, Reflections and Guidelines.

The editor Sylvie Donna has the grace to be abashed at the use of the word “promoting.” She starts the introduction with the following:

You may have wondered, on first seeing this book, why the title includes the word ‘promoting.’ Why should normal birth be promoted particularly? The answer is simple. Other forms of birth — those involving plenty of interventions, especially cesareans — get plenty of promotion, simply because they may appear to be the easiest option for caregivers or the least frightening ones for pregnant women…

Even on its face, it’s a pretty inane explanation, but it is far worse when you substitute what is really meant:

You may have wondered, on first seeing this book, why the title includes the word ‘promoting.’ Why should midwives be promoted particularly? The answer is simple. Other forms of birth — those involving plenty of interventions (most of which midwives cannot do), especially cesareans (which midwives definitely cannot do) — get plenty of promotion, simply because they may appear to be the easiest option for caregivers or the least frightening ones for pregnant women…

So midwives need to market themselves or they risk being eclipsed by obstetricians who know more and can do more. And the fact that what obstetricians know and do can calm the fears of pregnant women? Irrelevant. It is more important to promote midwives then to meet the needs of women.

“Normal birth” is a way to sanitize what is really nothing more than midwifery marketing. Insisting that women hire midwives because midwives want employment isn’t particularly persuasive. Insisting that women hire midwives because only they can provide them with a “normal” birth (who wants an abnormal birth?) sounds a lot better. The key, of course, is to invest “normal” birth with a cachet beyond the word normal. That’s where all the stuff about birth warriors, empowerment and experience comes in.

After all, what’s so special about a midwife attended birth? Nothing. That’s why women must be jollied into believing that they have done something worthy of praise by hiring a midwife. Ooh, you’re strong. You can do it mama. You can kick birth’s butt. And you are giving your baby the safest most loving choice. Less pain, less joy.

Uh-huh. Midwives certainly don’t think pregnant women are particularly intelligent if they believe that most women will fall for such an obvious means of self promotion. And, indeed, most women don’ fall for it. British women resent the fact that access to obstetricians is severely curtailed. Dutch women go to other countries to give birth rather than settle for the midwife led care (and higher perinatal mortality rate) that is a feature of the Netherlands. And the majority of American women, regardless of the availability of midwives, choose obstetricians. Indeed, there are not enough practicing obstetricians to accommodate all the patients who want them.

Promoting normal birth is about one thing, and one thing only: promoting midwives. It has nothing to do with what is safest. The words safe or safety don’t even appear in the entire introduction to the book, which is fitting since safety is entirely irrelevant to the project of promoting midwives. As far as I can tell, using Google to search inside the book, the word safety doesn’t even appear until page 177 and then only to be used pejoratively (“An obsession with safety is characteristic of our age …”).

What does this mean for pregnant women? They should understand that there is no such thing as “normal birth.” It is nothing more than a marketing term used to dress up the self-serving promotion of midwifery by midwives. There’s no reason to feel bad about not having a “normal birth” since the only harm is to a midwife’s pocketbook, not to the health and safety of their babies or themselves.

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