Managing the birthing body: how privileged women have made childbirth a project

Project management in tag cloud

Yesterday I wrote about privilege and breastfeeding, incorporating insights from the chapter Managing the Lactating Body: The Breastfeeding Project in the Age of Anxiety by Orit Avishai.

I suspect that I am not the only one who was struck by the parallels between the breastfeeding project and birth birthing project so dear to the hearts of natural childbirth advocates. The attitude toward breastfeeding that Avishai ascribes to privileged women applies equally to childbirth.

According to Avishai:

I demonstrate that this group of women constructs the lactating body as a carefully managed site and breastfeeding as a mothering project – a task to be researched, planned, implemented and assessed, with reliance on expert knowledge, professional advice and consumption.

Here’s my conclusion about natural childbirth advocates:

Natural childbirth advocates construct the birthing body as a carefully managed site and childbirth as a mothering project – a task to be researched, planned, implemented and assessed, with reliance on expert knowledge, professional advice and consumption.

The birth project involves 4 critical tasks:

  1. Consulting books and asking experts
  2. Setting goals and assessing the product
  3. Managing the uncooperative birthing body
  4. Investing in the project

The irony is that this view of birth as a project to be managed is diametrically opposed to childbirth in nature, where childbirth, like any other bodily function, just happens. But the view of childbirth as a project serves the interests, financial and emotional, of those who promote that view.

Consider:

1. Consulting books and asking experts

If there is one thing that every natural childbirth advocate is absolutely, positively sure of it’s the idea that she has done her “research” and “educated” herself about childbirth. That’s because she has “consulted books and asked experts.” But, of course, she has done nothing of the kind. Obstetricians are the experts in childbirth and natural childbirth advocates generally ignore what they have to say. The natural childbirth advocate consults faux experts or experts in their own minds. She reads websites, books, blogs and message boards carefully curated to present an approved viewpoint and carefully monitored to delete any real scientific evidence. Natural childbirth “experts” are to birth what creationism “experts” are to evolution. They are quacks, cranks and laypeople who are so ignorant that they actually think they are knowledgeable.

The first step in the managing the birthing body, then, is not acquiring knowledge, it is indoctrination.

2. Setting goals and assessing the product

This, of course, is the real purpose of birth plans. Putting her plans in writing gives a women a way to determine if she has succeeded or failed at childbirth. The health of the baby is irrelevant; indeed the baby itself is irrelevant. The birth plan is about the project not the baby.

Years of experience, and a variety of scientific studies have demonstrated that birth plans are worse than useless.

Why?

  • Most birth plans are filled with outdated and irrelevant preferences.
  • Birth plans are gratuitously provocative.
  • Birth plans have no impact on outcomes.
  • Birth plans encourage unrealistic expectations. In fact, it appears that the birth plan may have actually set women up to be disappointed with their birth experience.

In the world of natural childbirth, the baby is not the goal, the fulfillment of the birth plan is the goal. Hence even the birth of a healthy baby after an uncomplicated labor can be a “failure” if the woman did not perform in the way that she specified in her birth plan.

3. Managing the uncooperative birthing body

In the world of obstetrics, managing childbirth complications is straightforward. The provider anticipates or diagnoses the problem, offers a treatment plan and successfully handles the complications.

It’s pretty straightforward in the world of natural childbirth, too, albeit very different. The provider denies the existence of the problem by claiming that it is a “variation of normal,” recommends wishful thinking (“trust” and birth affirmations), recommends idiotic “treatments” like chiropractic, herbs and supplements, and, when all else fails, blames the mother.

4. Investing in the project

Natural childbirth costs money. The pregnant woman must buy books, hire childbirth educators and doulas, and in the case of homebirth she must pay a midwife, buy a birth kit and rent a birth pool. Natural childbirth also costs tremendous psychic energy. She must “trust” and affirm, and be primed to argue with her caretakers if they don’t view the fulfillment of her birth plan as more important than the baby. She must also grapple with failure when, as is often the case, things do not go as planned. In the event that she is lucky enough to avoid complications, though, the payoff is that she can pretend that she is “empowered” by completing the project successfully.

Viewing childbirth as a project to be managed is only possible in a world of extraordinary privilege. It rests entirely on the notion that regardless of how absurd and unsafe the plans are, and no matter how close the mother comes to injuring or killing her baby or herself, obstetricians will successfully rescue them from her idiocy. Moreover, the idea that rejecting pain relief in labor is an achievement depends entirely on easy accessibility to pain relief. The same goes for the routine interventions of childbirth. You must have easy access to them in order to give meaning to rejecting them.

Hence natural childbirth is the province of Western, white, well off women. It has nothing to do with childbirth in nature as the millions of women forced to give birth in nature each year can tell you. Managing the birthing body is an affectation of the privileged. Everyone else merely hopes to survive.

  • sdsures

    “Natural childbirth “experts” are to birth what creationism “experts” are to evolution. They are quacks, cranks and laypeople who are so ignorant that they actually think they are knowledgeable.”

    Brilliant!

  • Deborah

    “You must have easy access to them (pain relief and interventions) in order to give meaning to rejecting them”
    Absolutely spot on.
    I have just read Veil of Tears, an on-line booklet filled with heart wrenching stories of women and girls in Afghanistan who died very preventable deaths in pregnancy and/or childbirth because they did not have access to skilled birth attendants and emergency obstetric care.
    While one in every eight Afghanistan women will die in pregnancy related complications, affluent, white women in developed countries will continue to enjoy their pregnancy/birth hobby.
    How perverse.

    • MaineJen

      This was the most important part for me, too. I can easily imagine one of those Afghani girls who was lucky enough to survive hearing that an affluent white woman “successfully had a natural birth” and saying ‘Um…congratulations? I’ll take that epidural if you’re not using it…’

      • Renee Kazmar

        I like this site. I wrote to Dr. Amy and told her I appreciate that she takes the time to run this site. I’m not against pain medications, epidurals, pitocin, or c-sections. I had two natural births because, for me, the pain never got anywhere near to what I’d consider too much too handle. If it had gotten that bad then yes, I would have taken pain relief, if it was still possible at the time. Or had a c-section for failure to progress. I had an injection in my foot one time that hurt more than both of my births. I just feel offended that you think I’m stupid or perhaps I’m in love with pain because I had two easy labors and deliveries and never needed anything for pain.

        • Amy Tuteur, MD

          Where does it say that anyone is stupid for not using pain medication when they don’t need it?

          • Renee Kazmar

            The two people who posted didn’t have to say it directly. It was the way it came across.

          • Stacy48918

            I don’t think you’re stupid for forgoing pain medication, but you’ve obviously got a complex about it if you read someone’s comments about an Afghani girl’s gratitude for pain medication and get “you’re STUPID!” out of that. You were looking to be offended.

            Congrats that your birth wasn’t all that painful. Consider yourself in the minority and realize that for most women labor and birth is excruciatingly painful and so – for most women – it is a little “crazy” that privileged white women forgo the “choice” of effective pain relief for some kind of made up moral superiority. Even if that’s not the reason YOU didn’t have pain meds.

          • fiftyfifty1

            Our society sends a steady stream of praise toward women who have an unmedicated birth. Then if the expected praise doesn’t materialize, it feels like an insult.

          • Renee Kazmar

            Yes, you’re right. I live for your praise. Or money. I’d prefer money.

          • fiftyfifty1

            So MaineJen writes a paragraph saying nothing more than that Afghani girls with the sorts of harrowing labors that Deborah described would be glad for the chance to have an epidural and wouldn’t understand all the fuss surrounding going “natural”. And you immediately decided that MaineJen had therefore called you “stupid” and “in love with pain”. So I’m trying to figure out what could possibly motivate someone who is not even an Afghani girl to feel feel that MaineJen had personally singled them out and insulted them. What’s your theory?

          • Renee Kazmar

            Look, fiftyfifty1, if they had explained it as eloquently as you just did about Afghani girls not “understanding the fuss” then I wouldn’t have said anything.

            That’s not the way the original conversation between them came across to me. As I’ve already explained, it really sounded like people who chose to and were capable of birthing without pain relief could be held responsible for the birth sufferings and tragedies of other people.

            Picture a cartoon: Girl A to Girl B, both lying in a barren landscape, “I don’t get the big fuss about natural birth. Our families have been doing it for millennia!” See how that comes across compared to things like “affluent, white women in developed countries will continue to enjoy their pregnancy/birth hobby. How perverse.”

            You don’t know this about me because you don’t really know anything about me, other than I’m white (see the pic), I like Spongebob (see the pic), and that I’ve shot a couple of babies out my twat, but the entire reason I knew I could birth naturally is because of all the women in parts of the world that do it that way. They were inspiring to me. I was 23 when I was pregnant with my first. At that age I didn’t think about the issues they must have faced. I only knew that I thought they were amazing, strong, tough, and brave, and I wanted a moment to feel that I was just as amazing and capable, and that I could set a goal for myself that was seen as insane. Does that make sense?

          • fiftyfifty1

            “Picture a cartoon: Girl A to Girl B, both lying in a barren landscape, “I don’t get the big fuss about natural birth. Our families have been doing it for millennia!”

            Yeah, that sort of cartoon is offensive. Because it sure as heck isn’t a cartoon that would ever be put out by poor Afghanis. They know that birth in nature is NOT just “no big deal”. They know it as the process that has a 1 in 8 chance of killing them in their lifetimes. Or that if they are lucky, won’t kill them but maybe will just torture them for days. Or maybe will just kill some of their babies.

            Afghani girls don’t give a crap if some white American woman uses a made-up idea of them as her inspiration touchstone when she decides to make birth into a false rite of passage where she can play the role of the amazing, strong, tough and brave heroine. She just dreads what she knows she will have to go through and prays that she will survive. Does that make sense?

          • Renee Kazmar

            Of course it makes sense. And I wasn’t trying to be offensive. I was trying to illustrate the point I was attempting to make. Obviously it didn’t come across in the political cartoon way that I had hoped. I’m finished with this conversation. You’re angry at me and at what I’ve said. I don’t know your history, so I have no way to know if I’ve said something to trigger an unpleasant memory for you. If I did, I certainly didn’t mean to. I probably could have explained myself better in my first post. I’m sorry that I didn’t. I’m human, I’m imperfect. But you’re going to keep dragging this on for God knows how long and I’m done. I’ve explained, I’ve re-explained, and I’ve come straight from the heart. That’s all I can do. If you want to reserve the right to be angry at a stranger on the internet then that is your decision to make.

          • Karen in SC

            Thank you for sharing your perspective. I didn’t read all the comments and replies but in general, it’s impossible to know any “tone of voice” in the written word and thus, easy to take a comment personally.

            I didn’t like finding out an individual mother felt bad about a comment, and hope that in the future we all can try for better language that won’t do that.

          • Renee Kazmar

            Stacy, I don’t have any complexes. I was offended by “While one in every eight Afghanistan women will die in pregnancy related complications, affluent, white women in developed countries will continue to enjoy their pregnancy/birth hobby. How perverse.” and “I can easily imagine one of those Afghani girls who was lucky enough to survive hearing that an affluent white woman “successfully had a natural birth” and saying ‘Um…congratulations? I’ll take that epidural if you’re not using it…'” because the way I interpreted those comments, they really came across as if someone like myself who was fortunate enough to have simple, uncomplicated labors is somehow to blame for people dying on the other side of the world. It’s not like I could have handed the epidural I didn’t need to a woman who really did need it, anyhow.

            I don’t care at all what you think of my birth choices, and the only reason I brought it up was to show that I am here, reading this blog because I want to learn what Dr. Amy has to say about this topic. But I am still a person, and I still have feelings, and I don’t like being made to feel that I did anything in any way to make some Afghani girls crappy life any crappier.

            I had a home birth with my daughter in 2006 because what I understood at the time was that as long as you’re a healthy mom with a healthy pregnancy a home birth is just as safe as a hospital birth. For us it was true. She’s a perfectly normal (almost) 8 year old. I was under the impression that if anything did go wrong we’d transfer to the hospital immediately but that the chance of things going wrong were extremely low. Now I’m pregnant again and was lucky enough to come across this site. What Dr. Amy explained about home birth being 4.5 times more dangerous than the equivalent hospital birth came as a complete shock. I was really pissed because I felt like I’d been lied to by the books I’d read, the websites I’d visited, and the people I had talked to about the safety of home birth. Back in 2006, I thought it was basically 50/50. I’m just glad my daughter didn’t pay the price that some of these other babies did. I loved having a home birth, for all the reasons moms usually give, but if I would have had this information back then, I wouldn’t have risked it.

          • Stacy48918

            MaineJen’s comments were about CULTURE, not blame. That you see it as such really boggles my mind. Do you tell your daughter “eat your veggies, there are starving children in Africa”? Culture, gratefulness, etc. Not cause and effect or blame.

          • Cobalt

            The comment section does frequently come across as hostile to those who have chosen to go without painkillers. What is sometimes lost is the difference between a rational choice to go without because your informed risk/benefit analysis said “skip it” and when a woman is bullied or brainwashed (or tries to force others) into not having pain relief based on a false representation of the risks.

            All of my births have been without painkillers. I have a big pelvis, smallish babies, easy labors, and major anxiety about needles (especially near the spine or where I can’t see) and narcotics. It’s the choice that made sense to me.

          • The Bofa, Being of the Sofa

            The comment section does frequently come across as hostile to those who have chosen to go without painkillers.

            And the blog also frequently comes across as hostile to those who breasteed.

            Despite the fact that it’s nowhere close.

            Lots of readers project content into the discussion that isn’t there.

          • Renee Kazmar

            Thank you! 🙂

        • theNormalDistribution

          I wonder if you’re aware that Dr. Amy herself had “natural” deliveries because she didn’t feel she needed pain relief. There’s no need to take offense where none was given.

          • Renee Kazmar

            No, I am not yet an expert on Dr. Amy’s choices. I only found this site yesterday.

        • MaineJen

          I did not in any way mean to imply that you are stupid/in love with pain, or that anyone is who feels that they didn’t *need* pain relief. Actually, I’m incredibly jealous. Believe me, if I had felt that I didn’t need it, I would have done without that 12 gauge needle in my epidural space, too. 🙂

          My point was that it’s almost cruel to pat oneself on the back for eschewing ‘interventions’ that you really need and putting yourself in harm’s way unnecessarily, when others in the world may also really need and want that intervention (including pain relief!) but be unable to get it. Does that make sense?

          I’m not saying that anyone is stupid for not using an intervention they don’t need. That would just be silly.

          • Renee Kazmar

            I knew you didn’t really mean it like that. I get tired of everything in life being judged so black and white. You either love birth by going completely natural or you hate your body by being medicated. Everyone is always at war with who they see as the other side. For a few brief, possibly insane seconds I stared at my computer screen and wondered how my unmedicated births affected Afghani girls. It just wasn’t a mental image I was comfortable hosting. I’d never hurt anyone on purpose. I hope that makes sense. I’m always worried I’ve been less than eloquent.

          • MaineJen

            This issue is so fraught, and it’s so hard to find a middle ground. I think in general, as long as someone’s choices are *safe*, they are all good. Many in the world do not even have the choice to be safe, and that sucks. So it makes me mad to hear someone say “The doctor told me I needed xyz during labor, but I knew better! I don’t need no stinkin doctor!” when someone else half a world away may be dying for lack of that very thing. Maybe an epidural is a bad example; maybe it should have been ‘I’ll take that Pitocin if you’re not using it…’ to some poor girl with obstructed labor who is far from a hospital.

          • Renee Kazmar

            Yes, I completely agree that it sucks when a laboring woman doesn’t even have the choice to be safe. That makes a lot more sense when you put it that way. 🙂

  • Danielle

    Somewhat off topic, but I was wondering how I could appropriately respond to a family member who clearly drank the kool aid. I don’t want to alienate myself (as other family members have for “not being supportive” of my sister’s less than stellar judgement in this pregnancy.) Funny how that works, the people who love you most, not supporting your self destruction…Anyway, sigh…
    How safe/effective are chiropractic techniques in turning a transverse baby? The midwife THINKS the baby is head down, smh.
    Is “we’ll just wait for labor to start to see how she presents” as terrible a plan as it sounds?
    Why would the midwife have given her two vastly different due dates (my gut tells me I know the answer to this, but don’t want to believe it.)?
    At nearly forty weeks (or later…who knows) with a baby that only recently turned head down (probably) planning on delivering in a freestanding birth center, 39 years old with a history of large babies, my sister is blissfully calm. I have become her stalker, at the ready to call an ambulance! All the while she giggles at how silly I’m being.
    I read a post here comparing natural childbirth movement to a cult, and that is exactly how it feels! Like I’m dealing with some doe eyed, hazy teenage version of my sister who is committed to selling all her possessions and living off the land.

    • Young CC Prof

      I’m sorry you have to deal with this, and I hope it all works out safely.

      Chiropractic techniques do nothing to turn babies, but most babies wind up head down on their own, allowing the chiro to take the credit. Some midwives endorse a “one-swipe” ultrasound to confirm fetal position. It only takes a moment, and then they put the wand away so they can’t ruin the experience by learning about any other potential problems.

      Let your sister giggle. If it goes well, you can greet your niece or nephew soon. And if trouble crops up, you’ll be there to protect her and the baby. Do go right ahead and call that ambulance if it seems appropriate.

      • Danielle

        Thanks for the reply. I’m sure I’m not the only one who has dealt with this type situation. It is ultimately her body and her choices. I’ve just never known my sister to be so foolish, or, well, selfish. I’m walking on egg shells here so that I can be in the loop if someone with an agenda of health and safety should be needed. Crazy thought.
        Spent twenty minutes this weekend delicately explaining to her why they don’t make jogging strollers compatible with newborn infant carriers. Smh.

        • Maya Manship

          A little OT, they do make those strollers. I own one, minus the infant carrier. But, you might not want to tell her that.

          • Maya Manship

            And yes, they sell the infant carrier that fits it separately.

          • danielle

            Wow. Just, as with all of this, just…why!? Why would a person need to jog with a newborn. It’s only their brain. I dunno, maybe wait a couple more months. Just walk. Go jogging without a newborn.
            This whole sub culture of natural birth and parenting is new to me. It’s a rare thing to have so many consecutive WTF moments.

          • Maya Manship

            Well, if they’re jogging on a paved walkway, sidewalk, or track it may be ok. Please correct me if I’m wrong, I have no professional expertise. On smooth pavement the stroller should just roll along ahead of the mother without jarring or shaking the baby. I definitely wouldn’t do it anywhere unpaved like a dirt road or pathway.

  • So much of what constitutes “feminism” seems to me to be attempting to be in control. Women, historically, haven’t usually been in control of much [at least, overtly]. So, it seems perfectly logical to want to “control” one’s birth, and one of the parameters is controlling one’s body. Except that you can’t, beyond a very limited degree. You can raise your arm; you can’t “instruct” your uterus to behave in a specific way — it is a different kind of muscle. I think many modern women feel very threatened by all this. All these “birth plans” — it is a bit like telling a cake batter that it is going to rise spontaneously without the use of heat.

    • Who?

      You could be right, but if that’s how people think about it then they are mischaracterising feminism.

      For me feminism is about responsibillity-women being responsible for their reproductive and general health, for their jobs and economic security, education, social status, family and children. In the past, some or all of those things were the province of the men in their lives, whether they be fathers, brothers, husbands or sons.

      And part of that is respecting others’ responsibilities and how they discharge them, in the same spirit. So, just say, your doctor advises you should birth by c section: you, as a responsible person, acknowledge the superior knowledge of the doctor. Maybe you seek a second opinion, but ideally not a third, fourth or fifth. Why? Because that is not respectful of yourself or your time. At some point you just have to put on the big girl pants and make a decision. And it also doesn’t respect the responsibility and professionalism of the doctors.

      I’m a nut for process, organisation and finding the easiest way to do things, but honestly parenthood isn’t about sweating the small stuff. Process is so important, but just as there is more than one way to get a toddler off to preschool in the morning, there is more than one way for a baby to come into the world. And getting hooked up on the idea that there is one right way, for everyone, on all occasions, is control-freakery gone even madder than usual.

    • fiftyfifty1

      “So much of what constitutes “feminism” seems to me to be attempting to be in control.”

      I agree that there is a lot of control-freak behavior that goes on among humans (myself included I suppose), but I don’t think it’s feminism. Take for example the Quiverfull subculture. They totally reject feminism, yet they are very much invested in the idea that birth must be a certain way and that they must perform in birth a certain way.

    • MaineJen

      Except, perversely, telling a woman that she must endure the pain by natural methods (or worse, that she’s not experiencing pain at all, that it’s all in her head) is about as anti-feminist as you can get. How about letting the woman decide how much pain is enough.

  • Anna T

    Here is my birth plan:

    1. Spurn anything that costs money, because we have none. No childbirth classes, no doula, no equipment, no books. Some reading on the internet and from borrowed books is enough.

    2. A resolution to do whatever makes me most comfortable during birth. It is impossible to know in advance. I once spent weeks making a collection of my favorite soothing music on a “birth CD”, only to end up irritated by anything that wasn’t complete silence while I was in labor.

    3. Go to hospital with onset of contractions. Have the baby. Do what it takes to come out of it healthy and whole, and with a healthy baby.

  • Belle
    • Amy M

      I thought it was pretty good, except for the part where they were talking about Csection rates and induction rates, and how many “happen for convenience.” The Childbirth Connection was cited for that one, shocker.

  • Maya Manship

    Here’s my birth plan:
    1. schedule C-section recommended by OB/GYN within a few days of estimated delivery date.
    2. VBAC will only be attempted if labor starts before scheduled C-section and will be closely monitored by hospital staff and OB/GYN. Emergency C-section will be done if deemed necessary by OBGYN.
    3. Avoid unnecessary risks, do not “trust birth”. Birth is untrustworthy. I do not need an “empowering” birth to validate myself as a mother…I need a live baby to love!

  • KarenJJ

    I know I approached birth/becoming a parent as a type of project. Trying to get my head around timelines, what options there were, what potential outcomes and what contingency plans I needed, what people I needed to hire and what facilities I might need to use and what equipment I might need. I don’t think that particular approach is harmful and indeed, many women today are trained in this type of approach to an issue. My obgyn joked that I needed a spreadsheet. What I didn’t say was that I already had one….

    The problem is when misinformation being supplied and women are choosing an image over the substance and where professional certifications are being being muddled – I would certainly never hire a Certified Professional Electrician, but one with an actual electrical license – I’ve also double checked insurances for a contractor by taking the insurance certificate number and ringing an insurer to make sure that their insurance is fully paid and up to date.

    Also it is just not possible to control everything. Projects get flooded out, cyclones prevent ships from docking, lightning strikes prevent offloading equipment, endangered species are found. Being told you can change the weather with the right type of herbs, for example, sounds ridiculous and yet women get told this about their bodies.

  • Zornorph

    Apart from the silliness of valuing process over outcome, I just find that trying to micromanage such a thing as birth is dumb. The way I usually approach things is to have a rough idea of things but with some idea about what can happen and what obstacles you might come across. Of course, with the birth, I wasn’t the one making the final decision since it wasn’t my body, but my surrogate and I did talk things over. So if something came up, I’d at least know what the doctor was talking about. Having said that, I don’t really think that you would be in a position where the doctor would be asking you if you want to do one thing or the other – it would always be them saying what they thought was the best action and you either agreeing to it or not. I would have always deferred to the doctor unless the suggestion was really outrageous – they were the experts and that’s why I hired them. Why pay somebody to do something for you if you are then only going to argue with them?

    • toni

      I’ve always been curious.. who is the biological mother of your son? Is it your surrogate or an anonymous donor? Does he have any mother figures or is that not something you are concerned about? (won’t be offended if you don’t want to answer)

      • Zornorph

        My surrogate is not the biological mother; I used an egg donor. She is anonymous, but I had lots of information about her – pictures and a whole ton of information. To be honest, there is enough information that I could probably find her without too much trying, but that seems a bit intrusive. My son can legally get that info when he’s 18 if he wishes – I do send her cards and pictures of him through the agency.
        He does have some prominent female figures in his life. Both his godmother and my sister. His godmother sublets from me, so she’s actually around in the house more often than not.

        • Karen in SC

          You and the other dads here give us an important perspective. We’re glad you are here!

        • toni

          curiosity satisifed, ty :]

    • Young CC Prof

      Oh, there are definitely situations in medicine where there’s more than one reasonable option and it comes down to the patient’s values and preferences. But for the most part, I agree. Go into it informed about what generally happens and what types of things might go wrong, then deal with whatever happens.

      • Elaine

        “Go into it informed about what generally happens and what types of things might go wrong, then deal with whatever happens.”

        I agree with this strategy. The informed/educated discussion sometimes seems like semantics. Any lay person who’s claiming they know more than an OB about birth is obviously clueless, but reading a book or two about birth *can* give you some general knowledge on what to do and expect, which is all that most of us really need. You don’t *need* to know anything about birth to do it, but I think it’s less stressful to have an idea of what is going on.

        • Cobalt

          Much less stressful if you have a general idea of what is going on. I think a big problem is how difficult it can be to get this information, or at least sort it out from all the really misleading stuff. If you don’t know anything, you don’t know what’s crap. I found a GOOD doula to be very helpful, but that was totally a chance happening.

          • sankoji

            I completely agree, particularly about finding a good doula. When I was pregnant, we interviewed exactly one doula who was highly regarded in our community. She gave us patently false medical information that followed in line with her all-natural school of thought. We were so appalled that we decided to not go with a doula at all. We know friends who have had wonderful doula-assisted births, but it just wasn’t meant to be for us.

          • Cobalt

            I totally lucked into mine. We were living in a small rural town with only one OB, low risk pregnancies were typically referred to a particular GP. The GP had a doula in the practice that any of his patients could use for free. She was fantastic: educated, realistic, and had time for the million questions you never have time for with the doctor, or don’t think of until too late.

  • guest

    I had never considered natural birth or breastfeeding as “first world problems” or issues of privilege before a few days ago, but now it seems so obvious that they are. I still say a certain degree of disappointment is warranted when things do not go as planned, especially in the postpartum period when emotions are running amok. However, this needs to be tempered with relief and gratitude that we have options when things do not go as planned, so that in our privileged culture we can pretty much be assured of healthy mom and healthy baby.

    • Stacy48918

      Disappointment – sure. Guilt and shame – no.

      In much the same way that I respond when it rains on a day we planned to go to the amusement park. Disappointed. I can’t do a thing about it. But I don’t take it personally. Neither can a woman help some of the outcomes of birth and should not take them as personal guilt or shame.

      • guest

        Yes, exactly. No guilt or shame, and no raging at the doctor if s/he recommends a C-section (or whatever).

    • PreggieLady

      I started figuring out that it was a first world problem when I read Hypnobirthing: The Mongan Method. The techniques themselves are solid, but the experience that led Marie Mongan to develop them was being sedated during the birth of her children. That was pretty funny to me because I am sure my grandmother would never have had as many children as she did if she hadn’t been sedated (she gets sedated when she has her teeth cleaned!), whereas my husband’s grandmother in Eastern Europe didn’t have the option of any pain relief and swore after her first child that she would never, ever do that ever again.

      • The Bofa, Being of the Sofa

        That was pretty funny to me because I am sure my grandmother would
        never have had as many children as she did if she hadn’t been sedated
        (she gets sedated when she has her teeth cleaned!),

        Is she, like, a Ramones fan?

        • attitude devant

          I wanna be…..

          • The Bofa, Being of the Sofa

            Twenty four hours to go….

          • attitude devant

            Nothing to do and nowhere to go-oh-oh…

  • attitude devant

    in re #3: I have been following several FB posts by women in labor at home over the last several days. One woman was supposedly arrested at 8 cm for two days (she did go to the hospital for a bit and turned out to be only five, but never mind that right now…) and the number of people who chorused that mom must have some emotional block to having the baby come was astonishing. Seriously? I have actually seen this claim in nursing handbooks. It seems outrageous to me.

    • Guesteleh

      What a terrible burden to lay on a new mother. “You didn’t really want your kid, that’s why you had problems.” Heartless.

      • Young CC Prof

        And exactly the sort of nonsense that came out of paternalistic doctors in the early 20th century. What a coincidence…

        • attitude devant

          I am old enough to remember when doctors told women who had intractable vomiting in pregnancy that it was a subconscious rejection of motherhood AND that menstrual cramps were caused by internal conflicts surrounding your feminine identity. That kind of crap attitude had no place in women’s health care then and it has no place in women’s health care now.

          • Dr Kitty

            You know when I was pregnant I filled in some questionnaires for the department of psychology who were STILL looking at hyperemesis and maternal feelings of rejection.

            Sample question (from memory)
            “Some women with hypermesis report feeling that they want to punish their baby. Tick the statement that best reflects your feelings about this.
            1. I don’t understand that reaction, I would never harm my baby
            2. I can understand how some women might feel this way, but I haven’t.
            3.I have felt like this but would never harm my baby.
            4. I have felt like this and I am not sure what I will do about those feelings.”
            At the time I thought answer 2 was more a sign of empathy than anything else…

            It is harder to bond antenatally with a baby when it is making you vomit uncontrollably.
            Vomiting uncontrollably is not a physical manifestation of rejecting the baby, and most women with hyperemesis bond just fine with their babies once they are born and/or the vomiting stops.

          • The Bofa, Being of the Sofa

            What is the cause and effect in this example? Does it mean women are vomiting because they want to punish the baby? Or they want to punish the baby because it is making them vomit?

          • attitude devant

            Very funny. I vomited 7-8 times a day with my first until about 34 weeks. The person I wanted to punish as the weeks dragged on was my husband. Luckily no one voiced the ‘baby rejection’ idea around me. I would have decked him.

          • Dr Kitty

            Psychologists honestly thought both at some point, as far as I can tell.

            The idea was that a subconscious desire not to be pregnant/anxiety about being pregnant/lack of acceptance of impending motherhood causes vomiting. there were all sorts of studies purporting to show that anxious women with unplanned or unwanted pregnancies were more likely to have hyperemesis, as a way of subconsciously refusing to nurture a foetus.

            Then, when there were various studies showing that hyperemesis was a) genetic and b) due to chemical and hormonal changes there was a sort of chicken and egg switcheroo and the psychologists decided that the women were anxious and had unwanted pregnancies or failed to bond with their babies BECAUSE they were vomiting, and that they were punishing their babies because of the vomiting.

            I don’t know what the current theory is now, but I’m pretty sure that it wasn’t dreamt up by someone who vomited constantly for weeks on end while everyone felt able to tell them to suck it up and be grateful they were even getting to be pregnant and have hyperemesis in the first place. Which is something you shouldn’t EVER say to someone with hyperemesis…because rage and punching.

          • attitude devant

            I think the current theory is that it’s all HCG level. Because THAT is what consistently correlates. I do ponder why pregnancy feels so awful. I mean, I feel like dreck (and yes I do know what that word means in German) for 36 out of forty weeks when I’m pregnant. Evolutionarily speaking, that makes no sense; why would pregnancy be awful if it is so vital to the perpetuation of the species? I suppose the appropriate answer is that the act that causes pregnancy is not awful and once you’re pregnant evolution doesn’t CARE what the state of pregnancy feels like. You’re pregnant. (since we evolved before access to reliable contraception or the option of safe pregnancy termination…)

          • fiftyfifty1

            “It is harder to bond antenatally with a baby when it is making you vomit uncontrollably.”

            Yes, for me pregnancy is like a big long sickness that I have to get through one day at a time. Baby showers? nursery decoration excitement? just luuuuuuuuving to bits my precious little baby-to-be? Um, no thanks, I’m using all my extra energy just trying to keep down my stomach contents.

          • MaineJen

            Oh what total CRAP. That makes me so mad.

          • Roadstergal

            Wow, who would have thought that a little subcutaneous implant would have done such a bang-up job resolving my internal conflicts surrounding my feminine identity!

          • attitude devant

            I know, right?

          • fiftyfifty1

            Yeah, the doctors said it was Nexplanon, but really it was like a big ol’ acupuncture to correct your femininity meridian.

    • Trixie

      That’s actually one of the least horrifying ones I’ve seen over the last few days.

    • Cobalt

      Does that mean if you have a really short labor you really really want the baby? Because if that’s true my youngest must be destined to be the favorite, he about flew out.

      • fiftyfifty1

        Bah, your youngest is nowhere near as loved as MY child then. Mine was out in 5 minutes total (scheduled c-section).

        • Allie

          Wow, with ours I pushed for 5 hours after I was fully dilated. Guess the poor dear is unwanted, although that doesn’t explain why she’s spoiled rotten because I can’t help but give her everything she wants. Dada was supposed to be the disciplinarian, but he’s worse than I am – a total softie : )

  • TsuDhoNimh

    Egads … and they say that hospitals over-manage things.

    I’ve seen some birthing plans that are only slightly less detailed than one of Intel’s projects for launching a new chip.

    • Amy M

      It HAS to be the WHALE music!!! Otherwise everything is RUINED!!

      • Jenny_from_da_Bloc

        I thought they used Enya lol

      • Mishimoo

        And just the right kind of candles!! If the hospital won’t let me have them, then I’m NOT going!

  • rox

    And what about that crap that says that birth is “an experience”, some transcendental crap, a rite of passage, a family event.
    Something is seriously deranged when family members like aunts and grandparents are offended when they’re not allowed by the dilating woman to be part of this beautiful touching family gathering. Like it’s a party!

    • Amy M

      While I basically agree with this, many cultures HAVE considered the birth of the first child as a rite of passage. I think maybe it has more to do with becoming a parent though, than the actual birth itself.

      • Trixie

        Rites of passage are generally things that are dangerous, painful, and challenging. Which, in nature, childbirth is.

        • Guesteleh

          There’s nothing wrong with treating birth as a rite of passage, what’s wrong is when you proscribe a specific set of practices that must be executed precisely or the rite is ruined! I had a spiritual experience at my fully medicated hospital birth. No doula, midwife, whale song, chants or incense required.

          • in many cultures this is exactly what is happening. Like for example in one culture (don’t remember which one), the women is left alone while the father pretends to be in labour and everyone is huffing and puffing and caring for him while the woman is alone… it’s to fend off evil spirits, you know. Or take some coming of age rites that often include self-harm (of which FGM is probably the most cknown about) or some kind of hardships. It doesn’t mean that it has to be like that though. Let’s remember that while nature is cruel, so is culture sometimes.. and when the negative sides of both come together (like in birth sometimes), the results can be catastrophic.

      • Jessica

        For me, the far more emotionally moving and important moment surrounding my son’s birth was his baptism when he was seven weeks old. Childbirth was just something to be endured and survived.

    • Ennis Demeter

      They always say it’s a marathon.

      • AmyP

        Then why does it usually take more than 5 hours?

        • Young CC Prof

          Hey, if you were 9 months pregnant, how long would it take YOU to walk 26 miles? I’d say 15 hours is pretty good time!

        • Elizabeth A

          Five hours is a totally respectable marathon time! They don’t stop the clock until six.

      • Elizabeth A

        Culturally, we are way more generous to people who attempt marathons than some of the NCB crazies are to laboring women. It would be better to deal with birth the way we deal with marathons than it is to use marathons as a metaphor, while behaving as if women in labor need no support services.

        Marathons are acknowledged to be dangerous, and communities that host them routinely pre-declare them as emergency incidents requiring medical and logistical resources. If a given course on a given day is determined to be too dangerous, the course is shut down, and runners are diverted and given transportation to safe locations. When a race results in avoidable injuries or fatalities, the running community demands analysis of the circumstances to determine what could have been done to mitigate or prevent the problems. Race organizations are required to carry liability insurance.

        In 2007, The Chicago Marathon was an actual disaster – 185 out of 36,280 (as far as I can determine, this ratio of participants to injuries is far better than the neonatal mortality rate associated with home birth) runners were transported to hospitals by ambulance. I don’t have good numbers for how many runners were treated in medical tents on the course. One runner died. A year later, Runner’s World published a report on the problems at the race, including critical analysis of water distribution on the course (insufficient paper cups), placement of cooling resources, protocol for hot weather and mid-event cancellations, and the role of the event’s leadership in the catastrophe.

        Imagine that level of accountability applied to home birth midwifery in the United States. You’ll have to imagine pretty hard, because we have nothing at all like it.

        • The Bofa, Being of the Sofa

          Awesome response!

        • Karen in SC

          This should be posted on Midwifery Today. And any blog that deals with homebirth loss. What a chilling contrast!

        • Smoochagator

          Didn’t the legendary first Marathon runner actually drop dead after he ran the 26.2 miles? Not a great precedent there.
          In my mind, I like to imagine myself training for and completing a marathon. Of course, I’d have to master training for and completing a one-mile run first.

    • Allie

      I actually had a birth plan, although it was only one page and basically said I wanted drugs, had no problem with routine IV, and valued outcome over process, since I have a friend whose baby was catastrophically injured during birth (sadly, it was one of the rare instances where that occurred in hospital, and she successfully brought a malpractice lawsuit which is funding the full-time nursing care and equipment). The hospital I gave birth at does not do routine IVs and I sorely wish they did because it took them an awfully long time to get the drugs into me after I had a PPH.

  • Belle

    Yes!

  • Amy M

    I wonder, if the NCB people, when talking (glorifying) about how “native people” give birth, they even consider that those women (in developing countries) have no choices. If so, they must see it as a good thing, since they often believe that interventions CAUSE the issues rather than resolving or preventing them. Those natives must give birth so perfectly because there aren’t enough doctors or resources around to interfere! (and we’ll just ignore the dead ones) So, for the NCB crowd, they must recreate the conditions of the developing world, otherwise, an intervention will surely be done, and ruin the birth…maybe even cause harm. It is amazing how blind they are to the plight of women in places where they have little or no access to medical care.

    • Amy Tuteur, MD

      Sure. That’s what privilege is all about.

      • Amy M

        Yeah..I’m terrible at making my point in writing. I guess it is obvious and didn’t need to be stated. I’ve got to stop thinking aloud via typing.

        • Guesteleh

          It’s not obvious to everyone. Not by a long shot. So keep on thinking and typing.

    • The Bofa, Being of the Sofa

      I wonder, if the NCB people, when talking (glorifying) about how “native people” give birth, they even consider that those women (in developing countries) have no choices.

      This is an interesting observation, because we can compare it at the same time to their assertions that NCB is “empowering.”

      “Native people”, or anyone without access to other options, are the epitome of being NOT empowered. Because they have no choice, they are completely powerless.

      And this is what the NCB crowd holds up as their ideal?

      • Amy M

        Yeah, I’m pretty sure that women in developing countries would feel a lot more empowered by getting an education, and/or gaining basic rights, than by giving birth.

        NCBers seem to WANT to be powerless, or at least denied choices in medical care, since giving birth doesn’t empower anyone to do anything other than be a parent. Also, they have terrible vocabulary skills, and don’t really know what “empowered” means. Feeling like you are strong and physically powerful in no way means that you have gained some kind of sovereignty that you didn’t have before.

    • Young CC Prof

      When accurate statistics are presented, they tend to cite sanitation and nutrition, just like antivaxxers do. Which do reduce the risks somewhat, but nowhere near as much as modern medical care.

  • JfromNYC

    I have my own rule of L&D: the likelihood of your needing any and all interventions known to modern obstetrics is directly proportional to the length and complexity of your natural birth plan.

  • Women deserve informed consent from professionals qualified to provide it – and there is a big difference between non-medical preferences and medical decisions. NCB advocates do a huge disservice to women by obstructing access to informed consent and limiting reasonable choices by constructing unreasonable moral judgements on those choices.

  • Mel

    I started a Masters in Biology program last week and have spent lots of time curled up reading papers and books on vascular epiphytes and plant histology. (Yay!)

    I feel offended that reading a book or two by Ina May Gaskin et al entitles women to be as “educated” as I will be after 2-3 years of intensive study and research.

    Plus, no human beings will be harmed as an outcome of my education.

    • Jocelyn

      I think the reading a book or two and feeling as educated as someone with a degree partly has to do with our current culture’s “DIY” fixation. You can build your own bookshelf! You can fix your own car! You can give birth by yourself!

      • Yes! That’s it! You can heal yourself. You can solve your problems yourself. You can help yourself. You know how to do this. Why is it so important that we do it ourselves? I need lots of help as a parent… and the best feeling is not when I do something difficult by myself but rather when I get the right kind of help and support. I did have a birth plan (I’m in the NL where you need a birth plan to state, “I may need pain relief”) and a doula and it all went well, luckily. But the greatest things about the birth was the wonderful team of doctors, nurses and my doula so I wouldn’t have to do it all myself!

        • Guesteleh

          My birth plan: “Give me the fucking drugs”

          • Mishimoo

            That reminds me of the awkward moment I had while explaining to an NCBer that pitocin wasn’t forced on me, I requested it. For some reason, they thought it was another name for oxycodone!

          • Young CC Prof

            Oxycodone, oxytocin, they sound the same, right?

          • Mishimoo

            That was exactly it! Oxy “means they come from the same family of drugs”

          • Dr Kitty

            Oh fun!
            Oxytetracycline
            Oxybuytnin
            Oxygen
            Oxymetolazine

            Don’t worry guys, they are all TOTALLY interchangeable on prescriptions, because they “come from the same family of drugs”, so they MUST have the same indications, MOA and dose, right.

            Snort!

          • LibrarianSarah

            So teenagers are all getting high as kites off their acne treatment pads?

          • An Actual Attorney

            That would explain a lot.

          • LibrarianSarah

            You’d think they’d be less moody if that were the case.

          • Mishimoo

            It would appear so!

          • The Bofa, Being of the Sofa

            But she’s “Educated”!!!

          • Amy M

            Omg, what an idiot. That’s an easy one to figure out, too. You don’t need to be a pharmacist to google “what is the difference between oxytocin and oxycodone.”

          • fiftyfifty1

            Wow, wouldn’t that be something else if our bodies released oxycodone instead of oxytocin during labor, breastfeeding, orgasm etc? Oh boy, we would have a lot of constipated people with little pupils walking around.

          • The Bofa, Being of the Sofa

            But this presumes that they actually have any interest in looking up the difference. They don’t. They are just blow hards.

            One of the things my wife talked about from vet school is that they instructors always hammered them on the question, “Do you think you know it? Or do you know you know it?” It taught them to always question their level of knowledge, and to force them to rely on real information, and if they aren’t absolutely sure, to verify. It actually led to a lot of hostility between classmates due to mistrust.

            This person, who doesn’t know the difference between oxytocin and oxycodone THINKS she knows it, so doesn’t need to run off and look it up. She just spouts off in her ignorance.

          • fiftyfifty1

            “It actually led to a lot of hostility between classmates due to mistrust.”

            I’m not sure what you mean. When the instructors asked them to learn the difference between “knowing” and “thinking you know” that this led students to start to be hostile and mistrust each other?

          • The Bofa, Being of the Sofa

            There were those who didn’t know the answer who wouldn’t accept the answers from their classmates who did know it (and knew they knew it).

            This was an issue in group projects, because that group member would never accept anyone else’s input and insist on having to look up the information (which everyone had to do outside of class). If they accepted the information from the person who knew, the group could advance the problem.

          • fiftyfifty1

            Wow, I can see now what you mean. That would be difficult. Imagine a group containing a Dunning Kruger know-it-all plus someone with good knowledge but OCD tendencies (I know I know it, but I better check and recheck just to be sure), plus someone who just has trouble trusting. Could be a mess.

          • Dr Kitty

            I always hated group things in medical school because of those sort of things.
            Groups of type A, highly intelligent people with big egos who
            a) can’t take criticism
            b) have to have everything perfect
            c) like to triple check everything

            Combined with very intelligent Type B people who a) don’t know how they know things, but just do

            b) seem to get by on sheer luck and intuition
            c) depend on eidetic memories or 24hr cramming sessions and just want to chill out the rest of the time
            make for possibly the least fun group projects you can imagine.

            Thankfully I went to a medical school that requires minimal group course work. I have a colleague that went to a PBL medical school, where you learn everything in small study groups, and your knowledge is only as good as the group’s weakest member.
            That would have driven me to distraction.

        • Amy M

          I had a Csection “birth plan” and a vaginal birth one. It was more a list of preferences, like who would be with me, that I was totally down with epidurals and how I planned to feed the babies.