Is natural birth more beautiful than any other birth?

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The obstetrician wrote:

Occasionally I’m asked why we so often congratulate women on “beautifully natural births?” Some have commented, “all births are beautiful, why do you specifically call out natural births as though medicated births are somehow less beautiful?” …

I realize that this is a marketing message. This physician is trolling for more business and he believes he knows where he can get it.

Nonetheless the message Dr. Christopher Stroud is promoting is what is carefully crafted to be a dog-whistle for its intended recipients.

Congratulating a woman for having a vaginal birth rather than a C-section is like congratulating a woman for being fertile rather than infertile.

A dog-whistle is:

… messaging employing coded language that appears to mean one thing to the general population but has an additional, different, or more specific resonance for a targeted subgroup. The analogy is to a dog whistle, whose ultrasonic whistling sound is heard by dogs but inaudible to humans.

Stroud’s marketing means one thing to the general public, but another to natural childbirth advocates:

When we congratulate a mother on a “beautifully natural birth,” we are actually congratulating her on achieving her goal; we’re calling out her success in her unique, personal journey; the achievement that she, for a variety of reasons, may have thought unachievable. We’re not in any way valuing a non-medicated birth over a birth aided by epidural anesthesia, or a successful VBAC over a scheduled repeat cesarean section, for example. Rather, we’re saying, often shouting, “you did it; you made it; you are strong, brave and wonderful.” The cheers are about victory; victory over doubt; victory over adversity; victory over what is too often bad advice from previous providers…

As an important aside, it is undeniable, however, that many women who desire an non-medicated birth experience feel as though they have to fight against the hospital staff and their providers to achieve what they want. We see many women for their second pregnancy after they’ve had a bad experience in pursuing natural birth in their first pregnancy. So when these women finally achieve what they have so desperately wanted there is a great sense of accomplishment; of overcoming what may have seemed insurmountable, and that leads to great celebration and elation. This experience is not better or more worthy of celebration than an uneventful labor with the use of an epidural, for instance, but the celebration is often just “louder.”

Silly me! I thought birth was about having a healthy baby! But in 630 words, “baby” is only mentioned once.

Dr. Stroud would like his marketing targets to think that he believes that unmedicated vaginal birth without interventions is more beautiful than any other birth.

The message was received loud and clear.

As one commentor noted:

This post was amazing! I switched to Strouds practice after having a pretty traumatic birth experience that ended in a c section with my first baby. From there, I specifically sought out Strouds practice which has allowed me to attempt 2 VBACs and has fully supported them. By having a supportive provider, it made me felt so empowered and made things so positive the next 2 times around. thank you for ALL you do for women and their families.

Let’s leave aside for the moment the question of why privileged white women deserve praise for something poor women and women of color are forced to do every single day in developing countries. Let’s examine instead the two most disturbing aspects of this marketing message, an obstetrician’s belief that any form of birth is better than any other and the ugly ableism that it implies.

Physicians are people. Obviously they are going to have private views that some patient choices are better than others, but in my judgment those private views are just that: private. A doctor may feel that waiting for marriage is “better” than pre-marital sex, but that view has no place in counseling a patient about contraception. He may feel that a biological child is “better” than an adopted child, but that view has no place in counseling an infertile patient, nor should it be broadcast to promote his infertility practice. Similarly, he may feel that an unmedicated vaginal birth without interventions is “better” than any other birth, but that view, like views on pre-marital sex and adoption, has no place in counseling patients nor should it be broadcast to promote his obstetric practice.

What personally bothers me more, however, is the ugly ableism behind the sentiment. The ability to have a vaginal birth without interventions rests on biological factors beyond a patient’s control. Women have no control over the size and shape of their pelvis, the size and position of their babies and whether or not they develop complications like gestational diabetes or pre-eclampsia, yet all these factors can be limiting factors when attempting vaginal birth. To praise a woman for having a vaginal birth rather than a C-section is to praise her for being lucky. Indeed, it’s similar to praising a woman for being fertile rather than infertile.

Dr. Stroud’s claim that women who have a vaginal birth without interventions have had to fight harder is patently absurd. There’s simply no question that it is more difficult to obtain a maternal C-section on request than an unmedicated vaginal birth. So why isn’t that more beautiful than a vaginal birth?

The most pernicious notion in all of this, a notion that Dr. Stroud does not question, is that one type of birth is more praiseworthy than any other. That notion was promulgated and has been promoted by the natural childbirth industry and is fundamentally misogynist. It is a form of biological essentialism that imagines that all women are alike, that one size birth ought to fit everyone and that those for whom it does not fit (or those who simply don’t want a one-size-fits-all birth) are lesser women.

That view is not beautiful; it’s astoundingly ugly.

  • Tallo MD

    I live and practice pediatrics in the same community with Dr Stroud. His practice is very popular. His message is very seductive. Those who choose him are very devoted to his point of view. I agree with your review of his message. Our medical community remains strangely silent. Encouaging women to suffer more during childbirth for no appreciable benefit to mother or baby is shameful. It seems to be popular to engage in shameful acts of stupidity.

  • Cynthia

    Personally, after having a 2nd trimester miscarriage with my first pregnancy, I thought it was pretty damn beautiful to be holding a healthy baby girl a year later – while I was still on the operating table being sewn up from my c-section.

    I was there when my sister had a vaginal birth with no epidural with my niece. It was amazing to witness the miracle of birth, but the no epidural part didn’t make it any more amazing. My sister was actually pissed off – she had been planning on having the epidural but was told at the least minute that her platelets were too low.

  • Sarah

    Wonder if he’s got anything to say about women who desire a more medicalised experience but have to fight for it and are often denied it?

  • Marie

    Ah yes, my own natural birth was a truly glorious scene, me on my hands and knees screaming hard enough to break blood vessels in my face, pooping in the student nurse’s face, the sudden sensation of being unable to tolerate anything touching my skin which led to me to rip off all my clothes in front of about a dozen people. Too bad no camera could capture the beauty of actually feeling the second degree anterior tear travelling up my urethra as it happened.
    The student nurse was about 19 and it was the first birth she had ever seen. I still remember the haunted look on her face that lingered after the stitches were in and the blood was mopped up. As a nurse myself I felt a tiny bit guilty for traumatizing her like that. But I still chuckle about it in hindsight.

  • Hannah83

    My first birth was unmedicated, no significant tearing and a little less than three hours from start to finish. Sounds good but there was absolutely nothing beautiful about this birth (apart from the lovely baby I got from it). It left me traumatized and I suffered from temporal amnesia for the time between pushing and my baby’s first minutes.

    The only person who can decide if a birth was beautiful or not is the person giving birth.

  • Ozlsn

    OT: my husband walked out into a demonstration near his work today and googled it. Turned out to be in support of a midwife who is attended an “unexpected twin homebirth” and who was reported to AHPRA by hospital staff either after “mum brought her happy and healthy babies in for a check-up” (via the change.org petition) or after “an ambulance was called after the birth when one twin was in respiratory distress” (via the midwife’s facebook account). Either way the midwife has given an undertaking not to practice while the investigation is underway. The twins were 35 weeks, which probably is part of what is driving the investigation.

    Facebook account is here: https://m.facebook.com/530240987090240/posts/1852165078231151/
    Petition is here: https://www.change.org/p/australian-mothers-have-the-right-to-a-safe-natural-birth-of-their-choice-save-martina-midwife

    The difference in the versions is… interesting.

    • Mel

      The following twin is really blue in that first picture. In the NICU, I got pretty good at estimating my son’s blood oxygen saturation based on the color of his lips, fingers, face and torso. When my son looked like that, he was at a 50% oxygen sat or lower. That kid needs some stimulation, warming and supplemental oxygen pronto.

      He’s doing a bit better in the second picture, but his hands are still quite blue and he’s pretty mottled.

      I though Australia had rules that a licenced midwife needed to transfer a client to a hospital if they were delivering prior to 36 weeks; is that what you mean when you say the gestational age is driving the investigation?

      • lsn

        I’ve been going through the new guidelines and I’m not sure that gestational age is explicitly mentioned but certainly the combination of twins and pre-term is not exactly recommended for a homebirth – all the programs through public hospitals that I am aware of specifically exclude multiple births, and pre-term would likely be transferred as well. So the complaint is likely to be that she should have transferred earlier, especially once she realised it was twins.

        Agree that the twin was in need of oxygen in that picture – but apparently the magical bonding hour comes first or something.

      • Anna

        Gotta get photos first!!! Definitely prior to 37weeks is a contraindication for midwife attended homebirth in Australia. Twins are a no-no, so is breech, but the new way around it is to claim a “surprise”. There are lots of “accidental” freebirths happening too. Mothers want to cover their bums so they attend antenatal care at hospital and book in, with no intention of ever going. Then oopsie, baby came too quickly at home!

    • Hannah83

      The midwife published her “stats” for 2018 on Facebook. It’s really horrible.

      https://m.facebook.com/TenMoonsPersonalMidwiferyCareMelbourne/photos/a.639413882839616/1833110783469914/?type=3&source=48

      • Anna

        Holy FUCK! Just screenshotted that. It needs to go to AHPRA and if they don’t suspend her then they are useless and we might as well just have open slather. 85% refused Vit K?? Gee I wonder why, because the midwives are telling them its not necesary. 19% refused all ultrasound. 1 “surprise” breech (against guidelines, ambulance should have been called). Several post 42weeks (against guidlines), one with broken waters 8 days???? and shes bragging about this??? it beggars belief.

        • Merrie

          And look at the numbers that declined GBS swab and anti-D shot.

          Might as well say “We convinced everyone that all those swabs and tests are useless and forget whether they might have an actual purpose”.

    • Anna

      Hannah Dahlen and the acting head of the ACM have shared the petition as well as the Professional Supervisor something something of the ACM. Apparently they all think labouring at home at 35weeks is good practice. They are all LYING through their teeth that these twins were undiagnosed. Thats utter crap. I don’t know what the midwife is smoking to be honest because her update that they did call an ambulance (eventually – should have been as soon as labour started, and then again as soon as she realised there was another baby coming) incriminates her further really. This is flagrant negligence, well below professional standards and yet they are all defending her. I shouldn’t be surprised by now, but I still am surprised every time I see how much lower they will sink to protect “the cause”.

  • Mel

    Well, I can only speak for myself – but I didn’t hire an OB/GYN under the assumption that I’d have a straightforward unmedicated vaginal birth where my offspring easily started their own life support systems independent of mine without any extra help. You really don’t need much help outside of someone to catch the baby when everything goes that well.

    Managing a patient who shows up at the hospital because of nagging umbilical-area pains that ended up being severe pre-e with class 1 HELLP that developed in the 10 days since her last low-risk OB appointment – that’s a job for an OB/GYN. I’m so grateful for the entire medical staff who kept me and my kiddo safe.

    Can Dr. Stroud explain why an uncomplicated vaginal birth is worth more “loud” celebrations that the miracle of saving my life along with the life of my extremely premature son? I’m so grateful to that entire staff every day of the last 650-odd days that I’ve had alive with my little boy that I can’t imagine regretting the fact he was born by a C-section rather than an unmedicated vaginal birth.

  • demodocus

    Ableism is damned annoying, be it someone acting like a woman who cannot give birth a certain way is lesser or that psychologist my husband was seeing who spent the whole hour last month questioning the wisdom of letting a blind person be a parent.* It’s truly hard for me to understand the mentality of childbirth being something to romantacize. It was always a means to the snuggly ends that are my kids. If my biology means this or that method of childbirth gives my kids the best odds, I’ll go for it.

    *I am -still- pissed off at that one. She’s the only one who’s questioned it, but she’s also the one in charge of helping my husband deal with anxiety and depression and she’s been flipping adding to it.

    • namaste

      I myself am a psychotherapist, and one who has pretty significant mid-range hearing loss. The way your husband was treated is fucking disgusting. That should NOT have happened. Find a new therapist.

      • demodocus

        We are. Actually, he’s going to see his old one. She’d had tons of scheduling problems, which is why he switched, but hopefully Dr. F’s settled into a routine again. No way is he going back to Dr. M.

      • Petticoat Philosopher

        I question my decisions plenty and torture myself over whether or not I handled that situation with a client exactly the right way. And then I hear a story like that one and I’m like “You know what, I am doing fine.” (Though I do think that questioning yourself within reason is part of being a conscientious therapist, wow…some things really give you perspective.)

        • demodocus

          I know she meant well and that she really was just concerned about my kids’ safety, but egad, she’s seriously blind on this topic. Pun intended.

          • FormerPhysicist

            The road to hell is paved with good intentions. People can be caring and sincere and all that, and goddamned STUPID and dangerous. (Oldest daughter’s health teacher is claiming the placebo effect cures cancer. I need to report her. And why are they talking about safe sex if the placebo effect cures everything, anyhow?)

    • Petticoat Philosopher

      Another therapist (clinical social worker in this case) here just speaking up to offer support and back up that that therapist’s behavior was completely horrifying. I hope you have luck finding someone new. Just…wow. Ugh.

  • attitude devant

    Some are easy, some are hard. If everything goes just great without my having to get out my bag of tricks, that’s fine, but there’s nothing ugly about births where we all have to work hard to get there.

  • fiftyfifty1

    I must admit that I can get impressed by biological factors. Like the rare nullips who have start-to-finish 3 hour labors and deliver without a hitch. Like the self-described “old maid” patient of mine who surprised herself by marrying for the first time at 40 and then delivering 3 babies at age 42,44 and 47 without any fertility help. Like whenever I get a patient who presents with a raging textbook case of something that you learn about in medical school but rarely see. I do find it sort of exciting and “impressive.”
    But are these things better or more beautiful? No. And do they reflect anything about the character or worth of the person? No.

    • BeatriceC

      Personally I was impressed and awed at the medical community’s ability to save my life and the lives of my children. This is beautiful to me. Sure, the little one looked more like a drowned rat than a human baby, and it was months before there were fewer tubes and wires than actual human infant, but to my eyes, this is beautiful. It sucks to have a body that doesn’t do pregnancy well at all, but thanks to the wonderful people who have dedicated their lives to learning how to care for these tiniest of humans, they had a chance they wouldn’t have had even just a couple generations ago. Is there really anything else more awe-inspiring?

      • fiftyfifty1

        Agreed. I think about that with my sister and nephew who surely would have died from eclampsia/HELLP in times past. But instead of being dead, they are alive. Beautiful.

        • demodocus

          My sister and nephew probably would be too without a c-section. Her uterus wasn’t exactly up to full strength, being riddled with metastasized ovarian cancer and all.

        • Ravens Starr

          My hospital birth with preeclampsia was beautiful. The NICU team swooped in like champs to make sure my son was okay the second he was born because there were signs he might be in distress, they they wrapped him up and put him in an incubator because he was cold. It was mildly disappointing I couldn’t hold him right away or unwrap him from the blankets when I did get to hold him, but I was an adult and understood his well being was more important than “skin to skin bonding” or whatever. Then they took him off to take care of him and put me on an IV filled with drugs that would keep me from having seizures and dying and brought me to a quiet room to sleep. I had an epidural in so I didn’t have to feel agonizing pain the entire second half of my labor. I didn’t bleed to death because the Pitocin helped the bleeding stop and I didn’t get an infection because everything was sterile. Billions of women in the past and today could only dream of having such a beautiful childbirth experience, and nutjobs are choosing to sit in a plastic pool of bloody poop water with a kook chanting rhymes at her about the moon goddess and refusing her any pain meds – other than weed, of course, because it’s “natural”.

    • Petticoat Philosopher

      Well, I’d imagine that your propensity to be fascinated by interesting or unusual cases is part of why you became a physician in the first place. Not a thing wrong with that.

  • Christine O’Hare

    What is really beautiful is a mom and a baby that are alive and healthy and able to go on with the rest of their lives.
    I’ve begun to think of birth as I do weddings. They are not the end all be all, but rather the start of something much longer and more important. A good wedding is great, but a good marriage is what’s most important. A good birth is great, but a good life is what’s most important. And in both cases while the former is required for the latter to occur, the quality of the former generally has no impact on the latter.

    • Desiree Scorcia

      And in both cases, “good” is entirely subjective!

  • Anna Lee

    You know, I don’t even know how to respond to Dr Stoud’s statements. That’s how ridiculous they are. Birth is just a process to bring a baby into the world. That’s it. That is the only purpose of birth. All births are beautiful because of the brand new human being who being born, not because any mother or father “achieved” something through it.

    Birth is not an empowering, wonderful, amazing, orgasmic experience for most women. For those whom it is a great experience, good for you. Now please stop bothering the rest of us about it.