Midwifery Professor Hannah Dahlen is back, bemoaning “a toxic postnatal experience.”
Women have told us there is something worse than death – there is being alive but dead inside. There is being so traumatised by pressurised interventions in their birth plan that they can’t care for their newborn or have a relationship with their partner, and their own mental health is affected. Ms Tait’s comment that “whether a baby first glimpses the light of day via the stomach, in a pair of forceps, or via the vagina, what matters is that the baby arrives alive and the mother stays alive” is clearly naïve. We need women and babies to be more than simply alive; we need them to be well physically, emotionally and culturally.
That’s like the fashion industry bemoaning negative body image. Pious concern for women’s feelings is difficult to take seriously when it comes from the very people who make women feel bad about themselves. In the case of the fashion industry, idealized representations of the female body lead to self hatred when women’s bodies don’t meet the fashion industry norm. In the case of the natural childbirth industry, idealized representations of birth lead to self hatred when women’s birth experiences don’t meet the natural childbirth industry norm.
Dahlen may believe that she is speaking against pernicious obstetric practices, but the sad truth about the natural childbirth industry is while it promotes itself as empowering women, its insistence on a rigid, idealized view of childbirth promotes self-hatred.
As Jane Clare Jones explains in Idealized and Industrialized Labor: Anatomy of a Feminist Controversy, feminist critics of natural childbirth asserts that:
… women’s reports of “lower childbirth satisfaction” after cesarean should not be attributed to excessive and appropriative medical intervention. Rather, their negative evaluation of their birthing experience is produced by a cultural discourse of “natural” childbirth that encourages them to measure their labors against an inherently moralistic and ultimately pernicious ideal of birth.
This critique is:
… concerned with the alternative birth movement’s role in prescribing coercive norms that generate inflated expectations about the degree of control women can and should exercise over the process. Indeed, as Lobel and DeLuca note, one possible way to reduce the adverse effects of cesareans on mothers’ reports of “childbirth satisfaction” would be to encourage them to “develop realistic expectations” about labor, rather than educating them to resist obstetric practice—as has been the main strategy of the natural childbirth movement.
The leading exponent of the critique of idealized labor is Georgetown University philosophy professor Rebecca Kukla:
For Kukla, the alternative birth movement’s encouragement of such strategies as childbirth classes and birth plans, while originally laudable in intent, is responsible for establishing “completely unrealistic expectations concerning how much control one can possibly have over the laboring process.” As a consequence, the movement is implicated in “setting women up for feelings of failure, lack of confidence, disappointment, and maternal inadequacy when things do not go according to plan, even when mother and baby end up healthy”. Thus, critics like Kukla suggest, while the natural childbirth movement styles itself as concerned with empowering laboring women, its establishment of a normative ideal of birth is, ultimately, disciplinary and punitive. (my emphasis)
The normative ideal of birth includes claims like these:
Women who have pharmacologic pain relief in labor have “given in” and put their own needs above the “risk of exposing their babies to drugs.”
Women who have C-sections have “failed” at birth.
Women who follow their obstetrician’s advice and have inductions are personally responsible for the “cascade of interventions” that led to their ultimate failure.
Women who have pain relief can’t bond to their babies.
Women who have C-sections have ruined their baby’s gut microbiome AND changed the baby’s DNA in harmful ways.
Dahlen herself has repeatedly promoted many of these spurious claims.
Leave aside for the moment that none of these claims is supported by scientific evidence and most of them are lies. Such idealized representations (even if they are lies) have the power to harm fragile new mothers. Who would be so cruel as to promote these accusations to a new mother? Not anyone who cared about women’s mental health. Yet new mothers are bombarded by these accusations, either directly or as insinuations, before, during and after giving birth.
Dahlen and her colleagues CREATE the very anguish that they decry.
The solution to maternal anguish caused by anything other than an idealized, midwife-approved birth is NOT to promote ideals that lead mothers to prefer death to anything other than an unmedicated vaginal birth. The solution is to confront these arbitrary and corrosive ideals for what they are: shameless attempts by the natural childbirth industry to promote maternal guilt and then monetize it into greater employment opportunities for midwives and other members of the natural childbirth industry.
Your comment about NCBers who say that having a CS “changes the baby’s DNA” sounds like something out of the OJ Simpson playbook. To be clear: NCBers are trying to spew the same garbage that Simpson’s defense team did, regarding their “garbage in, garbage out” conspiracy theory.
Yes – it makes me cringe seeing the anti-scientists misapply the science of epigenetics.
OT: anomaly scan today.
All looking good, and such nice four chamber cardiac views that the radiographer asked if she could use them in a presentation.
Personally, I’m much happier knowing that my baby appears to have all the right parts in all the right places, with a nice high placenta, good cord flow, nice deep pools of liquor and plenty of movement.
We’re still within the margin of error, size wise, but I’m going to have some third trimester growth scans, because we’re at higher risk for IUGR (my DD was 6lbs 3oz at 39weeks and my BMI at booking was less than 20).
I’m someone who would be much less happy with a line drawing of a foetus and a SFH graph to measure growth.
Still keeping the gender a surprise though!
I am really happy you got great news!!! Congratulations!
Congratulations, having all OK in anomaly scan is a big relief! And good for you to have picture happy baby, mine plainly refused to show all heart chambers and after four attempts of standard ultrasound we were referred to fetal echocardiography (fortunately, all OK there as well).
Great news , Dr. Kitty!!
Yay for normal anomaly scans! Have a cookie. Have two, you’re small.
Cogratulations, Dr Kitty! A friend of mine has a 4-D scan next week. Not that she has any concerns. She’s very calm. But she’ll appreciate being made calmer.
So happy for you!
Unless he/she flashes you well enough! lol. Congratulations!
Re gender, it’s like the old joke:
Q: What’s the best way to determine the fetus’ gender?
A: Childbirth.
Conga-rats on such good news! May all continue to go as well as possible.
Some peopleay feel that their birth disappointment is a fate worse than death.
That doesn’t make it true.
It is hyperbolic and deeply insulting to people who have lost their babies or their partners in childbirth.
Would Dahlen really tell someone who has a live baby but lost their wife that it is better that she died rather than live with birth disappointment?
Anyway, the therapeutic solution to birth trauma from a loss of control over your NCB fantasy would be to let it go, realise that the control was never in your hands and that you need to accept the disappointment, mourn the loss of the experience you wanted and MOVE ON, looking at the positive outcome you have.
It isn’t to get stuck in the past, and try to re-do things the “right” way.
Didn’t one of Caroline Lovell’s midwives (who let her bleed to death after her home birth, ignoring her pleas for them to call an ambulance) say at the inquest or in a related press conference that she hoped one day Ms. Lovell’s husband will remember and cherish the fact that his dead wife had a lovely home birth exactly as she wanted?
That was Rose Kasary. Claire Teague’s midwife. She also shifted the blame onto Simon Teague because when Claire told him that she wanted to go to the hospital, he called the midwife and she told him she’d come back later. She said that her own husband would have heeded her and brought her to the hospital.
Claire died of a partially delivered placenta. Kacary didn’t realize that a huge chunk was missing.
Caroline’s midwives had other, Very Important Things To Do. That was their explanation to the court why they didn’t examine her when she said she was dying. Poor dears just didn’t have the time.
Thanks for the clarification. What a horrifying thing for her to say.
Kitty is right….how can birth emotional trauma be worse than a family losing their partner and mother?
Anyone who feels they would rather be dead needs serious mental health support, whatever the cause.
“Women have told us there is something worse than death, -– there is being alive but dead inside. ”
I think this is how a loss mother may feel, after her baby died a preventable death.
With all due respect for emotional and cultural wellness, I doubt that a woman in her right mind might ever claim that she would have preferred to give birth to a dead baby, or dying herself, rather than having
a disappointing birth experience.
A few years ago, I would have thought that having a dead baby was by itself a disappointing birth experience. And then I encountered Janet Fraser – an actual loss mother – and her wisdom. My sweet summer child, I told myself and accepted that I was wrong.
Oh, I’ve seen just such a sentiment on the ICAN list. Dead baby at a HBAC, but at least mom got her VBAC!
Which should be called out for the warped thinking it is.
Even Pollyanna would blanch at being glad you got your VBAC in that situation.
I went to the ICAN page, to see if I could find that (which I believe is out there, probably on facebook). I didn’t see that, but I did read several stories of homebirths after Csections, where the baby needed resuscitation and the mother hemorrhaged to the point of fainting. They all seemed to think everything went hunky-dory though, and didn’t even go to the hospital to get the blood loss checked out.
OT: Since I frequently say our healthcare system here is rotten, which it is, I now feel compelled to say something good about them. I just returned from a small staying in a sanatorium (funded by the healthcare system, from bed and food to medical treatments) to be greeted by a huge load of pressing orders (it’s astonishing how people forget that you have emailed them that you would NOT be available). But guess what? After a whole day of frantic work my hands… work. A few years ago (before I started doing the sanatorium thing on a regular basis), I would have counted my lucky stars if I could hold my fork after such a day. I always like my repaired state after such stays.
Thank god that I live in the time I live in. Even with rotten healthcare systems, it’s infinitely better than it would have been 200 years ago, and not only when we’re talking vaccines. Even if I turn out to have exostoses as was suggested to me by the girls hooking me on that lovely apparatus. (And here I was starting to hope that my frequent headaches might be because there was simply so much brain in my head!)
Hurrah for modern medicine. Hannah Dahlen can shove it. I really doubt that she’d tell me I was just meant to spend my life from age 30 to the end in constant pain because that was natural and there was only so much that nature could do for me and anyway, some 1000 years ago monks who copied texts did suffer such pains.
” We need women and babies to be more than simply alive; we need them to be well physically, emotionally and culturally.”
I would have simply settled for being well physically. Being very sick made it impossible for me to even contemplate my “cultural wellness.”
I have no patience for this level of entitlement.
And yes, there is nothing worse than death. I knew that I was *lucky* that the worst possible outcome hadn’t happened.
My culture is, my former college more or less informed me, moribund and evil, since I’m an Anglo-American with grandmothers who belonged to the Daughters of the American Revolution. Cultural wellness would be to get adopted to some worthier culture.
Actually, I’m pretty sure that “cultural wellness” here is code for “fitting in with the in-crowd”, ie, having a perfect natural birth.
I’m crap at that too. I’m doomed! lol
Why would being well “physically, emotionally and culturally” hinge on those few hours when a baby emerges?
I like the way Dahlen implies that you’re better off dying in childbirth than surviving it and recovering from whatever trauma was involved. That’s a gutsy new spin on maternal mortality.
“Women have told us there is something worse than death”
I suppose homebirth midwives (Hannah Dahlen was/is one in Australia) believe that because they don’t deal with deaths. If a death occurs and a mum expresses regret or negativity about her experiences at a homebirth she is quickly dumped from the natural childbirth circles. Hard to see death as a negative when you refuse to deal with the messy feelings, regret and heartache that such mums go through.
Would she really, while holding a live healthy newborn, look a mother who has lost her baby in the eye and say that there are things worse than death. And that one of those “things worse than death” is that her feelings are sad because she ended up needing a c-section.
Really?
People have publicly acknowledged the fact that they love one child less than the ones born vaginally. It’s rather a bottomless pit.
Everyone I have seen make such an admission has one child who is three, and one child who is not.
The favored child is always the one who is not three.
I cannot help but suspect this is not a coincidence.
As a mother to an almost three year old, an a almost 3 month old, I just had to chuckle. On another note th local PBS station (wosu). Must had a forum on the infant mortality crisis in my area. Lots of really interesting information and studies presented, about the differences between the various populations in central Ohio.
Hahaha I can see that.
Stepfather #1 went with the child who is not 14.
Wow. You are really onto something there…
-Mom to a 3 year old escape artist and losing my miiiiiiiiind
If anyone feels dead inside after a csection, I strongly encourage them to seek psychological help outside the ncb echo chamber.
Agreed, but the ncb crowd will tell them they need a ‘healing vaginal birth,’ preferably availing themselves of many expensive useless products and services along the way.
I think it’s pretty common, really, for women to come through birth feeling kind of gutted. That has less to do with process than with the fact that growing a baby is physically difficult, and plays merry hob with your hormones.
The expectation that anyone will experience pregnancy, labor, delivery, and the immediate post-partum period as non-stop bliss is insane.
You are so right. There is *such* a culture of glossing over the draining parts of pregnancy, birth, and the baby phase. It’s terribly misleading. I was gobsmacked at how hard it all was when I had my first. I also has postpartum depression and was at an absolute low in my relationship with my partner which added to the misery. Baby showers are a complete farce and sham with all of the glossing over parts. Why can’t we just be real with one another?
“Actually, Lucy, my trouble is Christmas. I just don’t understand it. Instead of feeling happy, I feel sort of let down.”
https://www.youtube.com/watch?v=-NJGRiV8jGM
And then there’s Lucy’s assessement starting at about 2:15 that is actually more apt. She gets all these things, but she never gets what she “really wants.”
I understand, I felt that way after my daughter wad born almost 9 years ago via csection, but to keep people in that grief and telling them they’re a victim is so wrong which I find the ncb community does. I completely reconciled with the fact I had a csection and moved on, then having a vbac just wasn’t important to me (though ironically I ended up having one, but that’s really besides the point, especially since my circumstances were awful).
I absolutely agree pregnancy is hard (well my second one was even before my daughter died) and I remember just being so sleep deprived with my eldest daughter.
As a recent loss mom, the attitude that some of these people have that a csection is worse than death makes me want to hit my head against the wall.
I am sorry for the loss of your infant.
I felt like I had been hit by a train, both physically and emotionally, after my first all-natural NCB-dream homebirth. Not to discount anyone’s experience—clearly, I was still very lucky and things could have been way, way worse—but I have come to believe that if you come out of birth feeling good, that’s something to be very thankful for and not the norm. Not to sound harsh, but realistically, I believe it is better to expect a hard time than anything else—I mean, it IS labor and you have to squeeze a very large being through a very tiny hole (sorry to be so graphic), or else undergo major surgery. Why would anyone expect this to be fun? Yes, taking a step back (especially in hindsight or once you’ve recovered a bit) you will hopefully appreciate the outcome, baby, health, etc, of course. But the actual process? So. Not. Fun.
“There is something worse than death”. No, there is not. Believe me, been there, seen that, no, there is nothing worse than death. If you say that it is because you have not been near death in your whole life. I am glad about it but believe me, you have no clue.
I’m pretty sure Caroline Lovell’s family would agree.
I agree with you, though I suppose it could be argued that a permanently disabled child or mother, who will have a hellish quality of life, ranks pretty high up there too.
Losing my daughter to unknown causes at fullterm was far far far worse than me having a scar from my csection almost 9 years ago (that resulted in a healthy baby who is now a healthy almost 9 year old).
I’m so sorry.
I’m so sorry. I can imagine that those things are not remotely comparable.
I’m so sorry for your loss.
I’m so sorry. I’m glad your other child is healthy.
What utter naive clap trap. Something worse than death? What women don’t want is to be haunted by the thought that if there had been intervention they would be holding their perfectly healthy live baby and not visiting the grave of their baby starved of oxygen due to a mismanaged labour.
I love this analysis. My sister in-law had 4 births and 3 c-sections. Since she had no “education” in NCB she had no shame in them at all. She was happy after having her babies and was unapologetic about bottle-feeding. She was empowered. She was not sitting around in self-doubt or self-loathing for not “trying harder”. She never tried for vbac and was relieved to schedule her c-sections instead of enduring hours of pain and stress to have it all end the same anyway.
My former self on the other hand would have felt I didn’t try hard enough if I had an epidural/c-section. I forced myself to breastfeed through PPD/PP anxiety when I should have been using medication and getting more sleep. Needless suffering is not empowering, it is degrading and enslaving. That women are the enforcers of this is even more horrendous. You can’t be a feminist and set women up to suffer more either through the pain of adhering to NCB ideal or through guilt of not meeting the standard. Keep up the fight for women Dr. Amy!
I have been thinking about the language used, when this sort of thing comes up, mostly about the word “failure.” I think it would be fair to say that a specific plan, or method can fail, but usually, the NCBers attribute failure to the woman herself. Not “”Vaginal birth failed to lead to a healthy baby, so a Csection was necessary”—its “She failed, she had a Csection.” “I’m such a failure, I can’t breastfeed my baby right.”
I see that Ms. Dahlen didn’t use the word in her essay, but she made it clear that she believes that all the women with PPD or PTSD would not feel so terrible, if only they’d had an unmedicated vaginal birth. So, even without the word “failure,” the inherent assumption is that not having that Natural Birth, is what makes women feel like failures AND the reason they didn’t have that Natural Birth is because of doctor interference and resultant loss of control over the process. Therefore, in Hannah Dahlen’s sneaky world, doctor interference = failure.
It’s quite insidious, how the NCBers convince the women that they (the women) even HAVE control over birth, so when the inevitable happens (a deviation from a birth plan), the script is already in place: blame the doctor for taking control, and/or blame yourself for giving up control.
Ms. Dahlen’s essay could have been a whole lot shorter—I agree that the best outcome of a birth is a healthy baby and a healthy mother–and that includes mental health. But, by setting reasonable expectations at the start, women wouldn’t be set up for failure when that impossible standard isn’t met.
Better mental health screening and services pre and post-partum would contribute to a mentally healthy mother as well, but its easier and cheaper to just convince everyone that an unmedicated vaginal birth is the magic cure-all for PPD/PTSD.
I agree Amy M. I had such severe PPD after my first (all natural homebirth with successful breastfeeding!) I had to be hospitalized.
Trying so hard to meet an “ideal” contributed to my decent into depression because I was so exhausted and anxious.
I had PPD too, but it had nothing to do with NCB or breastfeeding, so another story that blows Ms. Dahlen’s theory out the water. I had an epidural, which I had planned on, and got when I asked for it. I didn’t breastfeed, but I didn’t really want to, so that didn’t bother me either. So why did I get PPD? Most likely a combination of 1)sleep deprivation 2)hormones and 3)predisposition. I’m not sure my PPD could have been prevented, but due to some miscommunication with my doctor, it was missed for far longer than it should have been. Awareness of PPD symptoms, along with phone numbers for who to call should the symptoms manifest, should be standard of care for pregnant women.
As Amy has pointed out before, the strongest predictor for post-partum depression is pre-existing depression, which has a familial tendency. You are right about active surveillance of those at risk.
Women have told us there is something worse than death – there is being alive but dead inside. There is being so traumatised by pressurised interventions in their birth plan that they can’t care for their newborn or have a relationship with their partner, and their own mental health is affected.
Like the pressure to breastfeed so intense the poor mum is awake 20 hours a day, nursing, pumping and cleaning equipment?
The pressure to refuse pain meds?
The midwives that refuse to order an epidural even when the woman actually experiencing the pain wants one?
Tell me about this interference.
The pressure to say that your birth experience was great because you had a “natural” birth with no interventions or pain meds when really it hurt like hell and you’re afraid to have another baby because you don’t want to go through that again.
First baby – Bought into the woo, delivered in a freestanding birth center, went home five hours later – for reasons I won’t bore you with (above and beyond hindsight, like the lack of NICU), it was awful.
Second baby – found this site, asked for and was granted induction in the 39th week, got a FANTASTIC epidural, a baby that was 8+ lbs (thank goodness we went when we did), and even sent her to the nursery overnight while we were in the hospital. I went home well-rested and ready to sit up all night feeding – oh, and despite what the lactivists (including one on staff at the hospital) said about letting her be fed formula all night in the nursery while I slept, my milk still came in furiously the day I was released, and she still prefers it. And, because I wasn’t trying to satisfy my born-HUNGRY baby on colostrum alone, she didn’t get jaundiced. (Seriously, she was baby-birding my shoulder all the way up from from the delivery room. Colostrum alone would not have been enough.) Also, that way, I didn’t totally injure my nipples before my milk even came in.
After this second baby, I realized after I got home that my abs weren’t even sore! With the first, I pushed for nearly three hours, and couldn’t sit up on my own without much ado for weeks. After this one, I’m running around like nothing even happened.
^ THIS!!! Part of the reason that I had a hard time processing my first birth was that the women in my birth class and several other acquaintances who had recently given birth simply could not believe that I wasn’t thrilled about having a “natural” birth. They didn’t want to hear about my experience.
“Women may have told us there is something worse than death,” etc., but those women are wrong.
It’s as simple as that. They’re delusional, most likely because they’re suffering from PPD. Why create an echo chamber to reinforce their painful, self-torturing delusions? Why not… oh, I dunno… HELP THEM HEAL?!
I love this post. I wish I read it before reading Dr Sear’s birth book and falling deeply into the woo. I thought “it’s written by a doctor, so it can’t be too far out”. Wrong.
Then there’s the Canadian doc with the breastfeeding book. Fortunately, I was already skeptically inclined. It has some decent how-to info, if you don’t take stuff too seriously.
I’ve always thought it ironic that NCBers view risky situations as “variations of normal” as a means for demonizing c-sections. Meanwhile, doctors’s versions of “normal” INCLUDES c-sections!
So Doctors tell mothers, “A c-section is a perfectly normal outcome. Congratulations on your baby!” NCBers say, “You should have just tried to do the natural delivery. You failed.”
Who is empowering women again?
That is definitely my experience with docs vs MWs so far as a med student – the doctors give the information without all the moralising! In fact, I don’t recall any of our lectures (except the BF ones) having any NCB (or anti-NCB) flavour.
Death is a very common variation of normal too. But feeling sad? Nah, that means you let somebody break you. Not normal, you can be a scared straight tale but nothing else, next!
Yeah, this is the natural birth industry’s version of, “I’m sorry you got your feelings hurt.”
And what of the women who wholly reject natural childbirth to begin with, only to find themselves in systems that insist on complying with that standard? What of the women who find themselves, looking at the WHO statement on cesareans and feeling very threatened that natural childbirth will be forcd on them when they do not want it? Birth trauma is an ugly beast – a soul challenging state of being – but failing to recognize its complex nature, failing to listen to those who struggle with it and ultimately failing to commit to a core set of rights (the right to informed consent, the right to medical autonomy and the right to timely access to quality care) will perpetuate the suffering. The misinformation and propaganda of NCB causes it, but it is not the only cause.
I personally would feel incredibly traumetized if I were to request an epidural under circumstances where I should reasonably be able to expect one (not too early, not too far, appropriate personnel present and available etc) and have somebody unilaterally decide that I did not need one.
I do not do well when things do not happen according to plan and the only way I have ever been able to cope with the idea of having a child is with the knowledge that I will for sure be doing everything in my power to get that epidural as early as possible and then maybe I will be able to have a peaceful labor with music and contemplation and puzzles to distract me if there are side effects and if there are complications the doctor and I will be able to have a calm conversation about getting me into surgery post haste and everything will be safe and quiet and calm. If somebody were to take that birth plan and decide that what I really needed was hours of excruciating pain in front of strangers? I might lose my shit. I don’t want the pain. I am scared of the pain. I was born via C-Section with my mother completely knocked out and I bonded with her just fine thanks, the pain is not needed if I don’t want it. I have nothing to prove, I just want the drugs and a nap.
I agree about the possibility of feeling traumatized. Prior to my son’s L&D, I was led to believe that hospitals are epidural-happy, so to speak. My experience, however was completely the opposite – I had to _beg_ for an epidural. After the nurses asked me to confirm 3x that I wanted one, the anesthesiologist arrived and all was well with the world. I cannot imagine how powerless I would have felt had they not complied with my request.
This time around, I’ve already informed my GP that I’d like an OB who’s supportive of epidural requests. The fact that I had to beg for one last time was just so completely contradictory to what the NCB teaches about hospital births.
Should I ever have another baby, that’s my personal dream scenario, too! 🙂
Should I ever have another baby, my dream scenario is for the baby to be teleported out of my body because *none* of the options seem particularly appealing, lol! Somehow I don’t think that is a realistic expectation of technology and don’t think it will be happening any time soon…
Dalen has clearly never read (or missed the entire point) of Maslow’s hierarchy of needs.
Crash course of Maslow: Needs increase in importance from left to right. If you don’t have something in a category, you can’t move on until you get it.
Basic physical needs –> emotional needs –> self-fulfillment needs
Applied to labor and delivery
Living mom/baby –> non-injured mom/baby –> calm/happy/comfortable mom/baby –> mom’s image of how the birth went.
Blatantly obvious points:
If mom dies, her self-fulfillment needs are moot.
If baby dies, her self-fulfillment needs will have changed drastically.
Yup, I thought this (although in a less organised fashion!): priorities. The first priority is life, then the comfort and dignity and other aspects that are also important, but irrelevant if the #1 isn’t met.
Exactly.