Are midwives and doulas sadists?

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It’s the best piece I ever read about natural childbirth. Published on the website Feminist Current, Eve’s punishment rebooted: The ideology of natural birth by C.K. Egbert is a powerful, thought provoking essay.

There’s something pornographic about the way we depict childbirth. A woman’s agony becomes either the brunt of a joke, or else it is discussed as an awesome spiritual experience… [W]e talk about the pain of childbirth — with few exceptions, the most excruciating, exhausting, and dangerous ordeal within human experience — as valuable in and of itself. Hurting women is sexy.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]”Hurting women is sexy.”[/pullquote]

The euphemistically termed “natural childbirth” is often justified on the basis that it is a woman’s choice, that pregnancy and birth is a “natural process,” and that it is best for the woman and baby (both for medical reasons, and because a woman won’t feel attached to her child otherwise). Put into context, these arguments ultimately boil down to “women’s suffering is good.” …

When people tout “natural birth” as an “empowering choice” (sound familiar?), they conveniently ignore all the women who have been harmed by these practices and for whom giving birth was (completely understandably and legitimately) one of the worst experiences of their lives. Natural birth advocates, just like many in the pro-sex movement, don’t seem to be concerned about the harm that women suffer through this practice or finding ways of preventing this harm from occurring. Women can choose, as long as they choose to suffer and see themselves as liberated through suffering.

Egbert is brutally honest about the philosophy of natural childbirth. Responding to the claim that natural childbirth is “better,” she notes:

What about the argument for women’s health? We probably wouldn’t give much credit to an argument that we should strap patients to the operating table and refuse them anesthetic during surgery, even though general anesthetic is usually the most dangerous part of surgery. Rather than eliminating palliative care, we seek safer and more effective means of performing surgeries and administering anesthetic. Natural birth advocates are not concerned with women’s welfare, because they are not advocating for safer and more effective forms of pain management; they argue they should be eliminated, because women’s suffering is itself a good. And while feminists applaud efforts to give women support and comfort during the birth process (e.g., emotional support, more home-like birthing environments, etc.), this is compatible with providing women pain medication. Once again, the danger of anesthetic only becomes an issue — rather than a normalized part of medical treatment — only when and because it can be used to hurt women. (my emphasis)

Not surprisingly, there was tremendous denial from natural childbirth advocates, but Egbert skillfully defended her thesis in the comments section.

But this isn’t about the best way to give birth. It’s about what significance we give to women’s suffering and pain, and how that relates to women’s subordination in general.

Exactly, and in the world of natural childbirth advocacy, women’s pain and suffering is “sexy” and “empowering.”

That’s not surprising when you consider that the philosophy of natural childbirth was created by old, white men who tried to convince women that the pain of childbirth was in their heads, not their bodies. And the philosophy of natural childbirth has been perpetuated by white women (midwives, doulas and childbirth educators) who enjoy wielding power over other women and glory in humiliating them for failing to mirror their own choices back to them. The tragedy is that many women are complicit in their own subjugation and claim to be “empowered” by it, because they are so used to being judged and bullied that they believe it is for their own good.

Simply put, the philosophy of natural childbirth is deeply retrograde and profoundly anti-feminist.

I’ll even go a step further. The philosophy of natural childbirth is sadistic in that its promoters derive pleasure from convincing others to needlessly endure pain.

The originators of the philosophy of natural childbirth were sadists when it came to women’s pain. They felt that it was irrelevant, unworthy of treatment, and annoying to doctors. The philosophy of natural childbirth could best be encapsulated as, “Shut up and give birth without bothering us.”

The contemporary avatars of the philosophy of natural childbirth are often sadists when it comes to women’s pain. They consider it irrelevant, unworthy of treatment, and demonize effective pain relief as “weakness” and “unhealthy,” when it is neither.

The midwives and doulas who chivvy women into refusing pain relief, who delay calling the anesthesiologist when a woman requests an epidural, who promote inadequate forms of pain relief and praise women as warrior mamas (i.e. “good girls”) for enduring labor without pain relief are sadists. They believe that women’s pain and suffering aren’t worthy of their compassion and concern. They believe that women are improved by agonizing pain and diminished by relief.

The philosophy of natural childbirth is not based on science; it is based on fundamental beliefs about the unimportance of women’s suffering. It is based on beliefs about the ways that women “should” use their bodies. And not coincidentally, it is based on the value that midwives and doulas place on their own autonomy, in addition to the satisfaction they gain from having their personal choices mirrored back to them.

The philosophy of natural childbirth is about embracing and enjoying women’s agony and that, of course, is sadism.

  • Zizi

    That particular article may or may not be good, I don’t know. Just be aware that Feminist Current as a whole tends to sneer at the kind of “choice feminism” promoted on this site, and that FC as a whole is often an Andrea Dworkin fan club. Caveat emptor.

  • RudyTooty

    Thought of this post today while I was watching a publicly-posted video of a woman giving birth on the floor in her hallway.

    After the baby comes out, the mother says: “God, that was awful.”

    Her midwife shares on the comments: “That was my favorite part.”

    Midwives are sadists. In case there was any doubt.

    https://uploads.disquscdn.com/images/ca63aeca2f0b0e6777e1871a5c8def5682ef88a464b3a41f560c24d7ae94e229.png

  • Flamelily

    After not having visited this site in over two years now I am quite shocked to see how the level of vitriol towards the home birth movement here has increased dramatically. I just don’t believe this topic is anywhere close to being this contentious anywhere else on the planet, where the attitude is closer to “to each her own”.

    What is very clear to me is that those of you in the anti-home birth camp just do not get it. Not.at.all. You assign zero responsibility to the medical community for practices that drive, yes, *drive* women to the home birth movement. I have lived in numerous countries in my life and if had given birth anywhere else but here I would have had a hospital birth. And I was seriously contemplating having a hospital birth for my second child in the U.S. as a matter of fact, which I did end up doing due to preterm labor, and am very grateful that I was able to do so under these circumstances.

    The original piece turns the argument inside out and accuses the home birth movement of what the medical community is guilty of. It’s as if anti-home birthers are blinded by their own grandiose delusions and projecting their twisted attitudes towards women onto the home birther movement the same way that personality disordered individuals do. It’s quite alarming really and makes me very concerned about the direction we are heading as society.

    • RudyTooty

      Hi Flamelily, what’s your question or concern here?

      I have worked in both home birth and hospital birth settings. I’ve also worked in freestanding birth centers.

      There is room for improvement in all birth venues. But the birth sites with the highest complication rate – in terms of needless deaths and injuries with a population of low-risk, healthy patients – are the home birth settings and freestanding birth center settings – AKA ‘community birth’ settings.

      Others who post here have similar experiences with unscrupulous midwives practicing in out-of-hospital settings. I do think I, and others, get it. So I’m taking issue with your nonsense that says that we don’t.

    • rosewater1

      Part of being an adult means doing things that you may not want to do…but you do them because they are the right thing to do.

      The top priority for a pregnant woman? Healthy mom and healthy baby. Period.

      So where do you go if you want the best-not 100%, but the best-chance of this happening? You go to a hospital. Period.

      Hospitals aren’t utopias. There are many areas for improvement. No one with an ounce of sense will deny this.

      Are hospitals THAT awful? Is it worth it to gamble with your life? Your child’s? For what?

      There is so much more to being a mom than a beautiful birth experience. It starts with protecting your child and doing whatever it takes to keep them safe.

      If you don’t see that, then perhaps childbirth and parenting aren’t for you.

      Harsh? Too bad. I’ve spent way too much time with loved ones in hospitals this year. I owe the medical profession too much. I’m not wanting to see it slandered again.

  • no longer drinking the koolaid

    Multiple discussions during the 80s regarding why feminists did not take up natural childbirth as a feminist cause.
    I think we now know the answer why.

  • Queen Khentkawes

    Here’s an interesting historical note: Both Queen Victoria and Prince Albert were interested in the possibility of chloroform being used in labor. Victoria gave birth to her last two children, Prince Leopold and Princess Beatrice (great-great-grandmother of the present King of Spain) with its help. Victoria always referred to it as “that blessed chloroform.” Maybe these health professionals need to read Victoria’s diary.

    • It was subsequently known as “the queen’s anesthesia”. But even then, male physicians decried it as ruining the mother-child bond

  • andrea

    The other part of the sadism picture is advance worrying. I am not even pregnant yet, and I found myself drafting a letter to an activist CNM about how I can “not annoy” my future OB nurses “just in case they had a worse experience” or “have a more complicated case down the hall.”

    • mabelcruet

      That’s another issue that I think is unethical-comparing patients. Denying your experience of pain by saying ‘the woman in the next room is having twins and she’s not crying like you are,’ is unfair. Your pain or your sensations experienced during pregnancy and labour are unique to you-only you know the impact they are having on you and what you need to deal with it, and you shouldn’t have to ‘compete’ with other patients to try and prove that you’re worthy of getting pain relief in the way you want it.

      • andrea

        Briefly, I thought “hmm, with the opiate tsunami, my insurance may pick for me about whether or not I get an epidural,” then I thought “GRRR other people’s behavior, see why we can’t have nice things?” ::angry face::

        • mabelcruet

          I got diamorphine after having emergency abdominal surgery (for a torted ovarian cyst)-it was lovely, quick acting and got me pain free and reasonably comfortable very quickly. Technically it’s medical grade heroin. I had one large dose post-operatively and guess what-I didn’t become an addict, despite all the scare mongering!

          • I’ve had 3 C/Ss, salpingectomy and tubal ligation for an ectopic pregnancy, two hip replacements. I have always demanded the maximum allowable pain medication for the first 24 hours post-op —- and afterward regular Tylenol was sufficient, and not a lot of that. Indeed, with my first baby I flew to the US from Israel when he was ten days old, to let my dying mother see her first grandchild, and I felt fine. More than once, however, I had nurses threaten me with the “addiction” card when told them it was time for the next dose during that first 24 hours.

        • AnnaPDE

          What exactly would an epidural have to do with the opiate tsunami, anyway? The addiction-type opiate drug abuse rarely happens in a stick-a-needle-into-your-spine way.

          • andrea

            The insurance company might think “she’s going to come in high anyway, so let’s not take the risk of any meds.”

          • AnnaPDE

            By that logic no one would get an epidural, or really any other drugs, in the first X hours of a hospital stay — we could all be high after all. Yet people don’t have to come half a day or more early for surgical procedures.

          • andrea

            I’m an ultra-high risk group specifically for “hillbilly heroin,” though, white 30-something who hangs around rural Appalachia. I wouldn’t give me a bottle of Vicodin if I was an oral surgeon. I wouldn’t be surprised by a yay or nay from my goofy insurance company, really.

          • Heidi

            I think you’ll get the epidural. I think those are seen differently, even in the height of the opioid epidemic in TN. It has affected my medical care twice unfortunately in the ER, being dismissed as a drug seeker because “everyone is a drug seeker” attitude.
            Both times I didn’t want pain meds anyway, just for my actual ailments to be treated in case they were life threatening. Opioids are not effective pain relievers for me anyway and I don’t get high from them – just severely depressed.

          • mabelcruet

            My sister is the same, she doesn’t metabolise opioids. I think that’s a fairly common metabolic variant, but you never find out until you’re prescribed them and they don’t work (and if you’re lucky, your doctor doesn’t think you’re pretending they don’t work because you’re angling for larger doses of stronger stuff!)

          • Heidi

            Yes, both my father and both of his parents couldn’t do opioids..I know both my dad and I can’t even really take antihistamines like Zyrtec and Benadryl. We just feel miserable.

          • mabelcruet

            Anti-histamines absolutely knock me off my feet! I get travel sickness whilst flying, and tried Kwells (travel sickness meds-antihistamine called hyoscine). I felt utterly stoned-woozy, dizzy, really out of it. I haven’t a clue how I managed to navigate the airport and find my gate-no recollection whatsoever! I could probably use them as recreational drugs given the response I had….

          • Allison

            I had several doctors and ALL the OB nurses convinced I was nuts for refusing percocet after a c section. But… I have no analgesic response to oral or IV narcotics. (Codeine works as a cough suppressant, and morphine worked in the epidural. I have no response at all to oral oxycodone or hydrocodone, or to IV morphine or fentanyl.) They’ll have me loopy on the couch in short order, but as painkillers, they do absolutely nothing. They tried slamming me with fentanyl and morphine before emergency surgery for an ovarian cyst – it did NOTHING. I BEGGED ‘just skip to the part where I lose consciousness’, because nothing else was gonna fix that hot mess. There’s no POINT in giving them to me, so ibuprofen, people, and for God’s sake, keep it coming!

          • PeggySue

            If they deny, it might not be due to opioid issue. I have heard of policies which simply do not cover maternity care well, including not covering epidurals.

          • andrea

            That, too.

          • Zizi

            Shhh. Logic doesn’t belong in the promotion of a puritanical and disastrously counterproductive drug war. Go away.

        • MaineJen

          The epidural does not make you high…..

  • alongpursuit

    It started when I arrived at the hospital to deliver and continues to be my experience as a mother: casual cruelty from many other women. There is a sadism there that surprised me at first, but I understand it now as a function of the patriarchy, a crabs-in-a-bucket continuation of oppression, a “SAVE-THE-BABIEEEEES” (but damn the mother) kind of thing.

  • mabelcruet

    With regard to some of the practices in the blog post, like delaying calling for the anesthetist until its too late to site an epidural, midwives who do that should be disciplined. That is grossly unethical-its denying a woman’s autonomy, and it doesn’t matter a damn if you (as a midwife) think she should be able to manage without. People have the right to know about, consider and request any treatments that they believe will help manage their pain. They are at liberty to refuse these, but you can’t refuse them on their behalf simply because you think they don’t need it. You cannot impose your own choice on her, which is precisely what you are doing when you delay calling for the epidural. You should be ashamed of yourself if you’ve ever done this.

    Go right back to basic medical ethics-autonomy, beneficence, non-maleficence, justice. Denial of pain relief is breaking every one of those rules. You deny the person’s autonomy, you are actively harming the patient, both physically and mentally, you are not alleviating her distress so you’re doing no good, and you’re not treating her fairly because you are making a value judgement on her pain by overriding her decision.

  • mabelcruet

    I don’t think they derive pleasure from seeing women in pain, I think that at least a significant proportion of them think that the pain is beneficial and therefore good for them (remember ‘Dr’ Denis Walsh, midwife, who said women had to suffer the pain in order to prepare them for the responsibilities of parenthood, conveniently forgetting that there is usually another parent around who doesn’t suffer any pain and yet is still a parent:

    https://www.theguardian.com/lifeandstyle/2009/jul/12/pregnancy-pain-natural-birth-yoga

    and there is another subset who genuinely don’t believe that it is painful as its claimed to be-either they’ve never had a baby (see ‘Dr’ Walsh again), or they had a relatively easy birth themselves and think women who claim to suffer pain are making it up.

    I think the move to change the language of child birth is patronising and undermining-remember the paper championed by the Royal College of Midwives:
    https://www.rcm.org.uk/news-views/rcm-opinion/the-language-of-labour/

    suggesting that pain or contractions should be relabelled as surges, or power waves, or something else equally facetious? I think that if a woman in labour uses the term pain, then to deny her experience of it and say ‘its not painful, its a power rush’ is demeaning, undermining and patronising, even if you genuinely think you are doing the right thing by trying to get her to see her pain differently. We’ve all talked about this before-male pain experiences aren’t dismissed in this way. Male chest pain is diagnosed as ‘rule out a heart attack first’ and female chest pain is more usually ‘probably indigestion, drama queen’.

    I have never had kids, so I have no idea what the pain is like. I can empathise with it, having had pain from other abdominal causes, but I can’t comment on the severity of childbirth pain. But as a medical student, I was taught the old fashioned McCaffery standard, that pain was “whatever the experiencing person says it is, existing whenever the experiencing person says it does”. We were taught to believe the patient/person, and taught to be guided by them in what they thought they needed to help with the pain. I genuinely fail to understand why pain caused by childbirth is considered different from all other types of pain-it affects the body, it uses the same neural pathways, it triggers the same hormonal responses. I also fail to see why childbirth pain isn’t considered worthy of appropriate pain relief-if someone is hypertensive and needs a higher dosage of medication, they get the higher dosage. If pain relief is inadequate, and the person needs a higher dose or a different formulation, then the response is too often that they must be a drug seeker, or ‘faking it’, or a drama queen, or being a baby. Why do we make what is a simple request for analgesia into a value judgement on their character?

    • EmbraceYourInnerCrone

      Because women’s pain is not taken as seriously as men’s pain ( I know I am repeating comments made here before but reading this will make you rage all over again:

      https://www.theatlantic.com/health/archive/2015/10/emergency-room-wait-times-sexism/410515/

      “Women are “more likely to be treated less aggressively in their initial encounters with the health-care system until they ‘prove that they are as sick as male patients,’” the study concludes—a phenomenon referred to in the medical community as “Yentl Syndrome.”

      Pain during delivery is treated even more callously by many because since it is expected people think it’s no big deal. I had agonizing menstrual pain and have had migraines since I was 6, but delivering my daughter was a whole new level of pain. It has taken me years to not just go along with doctors downplaying my pain.

      • mabelcruet

        It’s not just being female, being old and female is even more awful.

        I’m the only doctor in my family, and I’m usually asked tabout all my relatives ailments, despite having not laid hands on a living patient for 30 years. Many of my relatives are now aging, and I see a similar dismissal of their symptoms as ‘it’s your age, dear’. My elderly aunt, who is fitter than me, who has never spent a day in hospital and who was walking a couple of miles a day with the dogs, was suddenly struck by severe shoulder girdle and hip pain so severe that she was unable to get up from a sitting position on the sofa one evening-she ended up being incontinent and eventually managed to phone her next door neighbour in the morning to help her up. Simply from her symptoms, I diagnosed polymyalgia rheumatica-she went to her GP, he didn’t even bother examining her (exactly as in that article), and she was told it was arthritis and what did she expect. He prescribed nothing, did no tests-I’d emailed her a list of what she should ask for, including basic bloods like ESR and CRP. He refused everything out of hand-told her she was old and that was all there was to it. She went back 3 times in one week, and he still did absolutely nothing and told her to try over the counter paracetamol.

        So, I paid for her to see a rheumatologist privately (her GP is obviously NHS). His immediate diagnosis-polymyalgia rheumatica, confirmed within hours by simple blood tests and she started on high dose steroids with almost overnight improvement. I encouraged her to complain about her GPs treatment-she was lucky that she had me to ask, and that we could afford for her to see someone privately, another elderly lady in that GP practice may not have been quite so lucky-PMR can leave you blind-and he was so utterly dismissive of her pain because of her sex and and her age, that when he was challenged he doubled down hard and still refused to do anything at all. But she was too scared to do that-she thought if she complained he would throw her off his list and she would have to find another GP. I think it was a combination of misogyny and ageism, both very ugly in a health care professional.

        • StephanieJR

          What happened with your aunt is so horrible! I hope she’s doing better now.

          My gran’s in her mid eighties, with a variety of health ailments, and it took us too many years and too many doctors to get her arthritis diagnosed. It wasn’t until they got a specialist in, who took one look at her and knew what it was, that anyone realised it. All the time the poor woman was in pain.

          • mabelcruet

            Her GP is an idiot. I usually am very careful not to step outside my area of expertise (I’m a perinatal/paediatric pathologist so all of adult medicine is generally a mystery to me, I haven’t done clinical adult medicine for 30 years), but her symptoms were absolutely classical textbook PMR-a first year medical student could have diagnosed it. She’s now on long term steroids-it usually takes at least 6-12 months, often longer. She had a brilliant response very quickly, but she’s still got a quite a bit of residual pain and weakness and she’s quite frail, certainly she’s lost a lot of her oomph and she was always so active and independent. I just wish her GP was more supportive-he is prescribing the necessary steroids but whenever she goes to see him for check up blood tests, he’s horribly dismissive towards her-comments about ‘I hope you don’t think I’m going to prescribe anything stronger, paracetamol should be enough’. I think he’s pissed off at her for not accepting his original diagnosis and going over his head.

          • Sue

            That is both cruel and dismissive. The moral outrage over narcotic use could be part of this. Tools like Fentanyl patches are ideal for the elderly.

          • mabelcruet

            Personally, I think he’s a misogynistic fuckwit.

          • rational thinker

            I was on fentanyl for a few years. The patches were a little annoying to deal with but they gave me my life and mobility back.

          • PeggySue

            Holy crap! That’s just horrific, and thank heaven she has you. I wish she didn’t have this doctor to deal with.

        • fiftyfifty1

          I remember 2 patients I diagnosed with polymyalgia rheumatica. The first was in so much pain that her husband carried her into clinic in both arms like a baby. The second was a man who cried tears when he had to stand up from a seated position. How hard is it to order a SED rate, sheesh.

          • mabelcruet

            It was frightening to see her like that-she’s an outdoors woman, strides around the countryside and thought nothing of hiking for miles. At 80, she was caring for a couple of elderly neighbours, doing their shopping and housework on the grounds they were too frail and old (they were younger than she was at the time!) It came on so quickly-she phoned me on the Friday evening to say she felt a bit stiff but she’d walk it off the following day, and by Sunday she couldn’t get off the sofa.

            The only time she’d ever gone near anything medical was when she first joined the GP practice years ago, and she had to go in for a registration well woman check-up, and then when she was called for breast screening, which had stopped because of her age a few years ago. Despite this, with absolutely no history whatsoever, her fuckwit GP wrote her off immediately. After the 3rd visit in a week, he referred her to the local pain clinic. Of course, the local pain clinic refused the referral on the grounds that there was no diagnosis (I’m not sure if you have the same system-here the pain clinics are hospital based aimed at pain management in intractable pain in patients with a known diagnosis) so obviously she didn’t fit their pathway and they refused to see her. And he claimed that the fact that they had refused to see her meant that her pain wasn’t significant and there was obviously nothing wrong with her.

            And then, at the end, when we had the diagnosis and the treatment protocols all sorted, he treated her with the most obvious patronizing contempt. I have friends who are GPs, and I know that its a difficult area and that there are patients who can be hard to manage, but there was absolutely no excuse for his manner, attitude and tone. I went with her to a couple of appointments and he was just plain ignorant and rude.

        • AnnaPDE

          In this case, finding a new GP might be a good thing anyway. This case was already really bad, but “just” pain. Next time it might be a heart attack that he dismisses as nothing, just as breezily.

        • BeatriceC

          We are currently dealing with something similar with my MIL. She is 88 and generally healthy. Her eyesight is very poor, her hearing is bad, and she has dementia. She is in the stage of dementia where she can still cope and hide how bad it is in short bursts, and her doctors are blowing off my sisters-in-law’s concerns. She needs a 24/7 caregiver but since her doctors are blowing off concerns, we cannot get her declared incompetent, and she keeps firing the caregivers and is refusing to move to assisted living, as none of the facilities in her area will allow her to live in a regular unit and insist that she must go to a memory care unit. We have decided that MrC will take a trip to her and have a come to deity meeting with her doctors. Perhaps a man saying the same damned thing his sisters have been saying for the last two years will make a difference. She is simply not safe and we are all holding our breath waiting for catastrophe.

          • PeggySue

            Believe me, I get this. It’s terrifying and so unsafe. And most doctor appointments are so short that it might be hard to see the evidence of dementia. Let’s hope the almighty Male Presence will get attention.

          • mabelcruet

            I think I’ve mentioned this before-my grandfather died a few years ago, he had cancer that metastasized to bone and was in horrible pain. But he was a very stoical Yorkshire man and came from that era where people didn’t complain, so although he had standard pain medication prescribed, it wasn’t given. He was supposed to be on a syringe driver (which is commonly used in terminal care, it delivers a steady small dose of a cocktail of painkillers and anti-nausea meds via a battery operated pump slow release thing). The district nurse refused to set it up because whenever she asked him if he was in pain, he said no. I told her to ask ‘how bad is the pain?’ because that acknowledged the pain without him having to own up to being in pain, and gave him the ‘excuse’ to ask for it.

            I understand fully why caregivers and health care professionals are very strict on patient confidentiality and needing consent to discuss an individual’s care with family members and all that, but I think they should also acknowledge that we know their personality and their behaviour, and know how to approach it so that the best care can be given. You could physically see he was in pain with every movement, he was skin and bone, he could barely breathe when he was being turned in bed, but because he struggled to say the words ‘I’m in pain’ because he was such a stubborn old bloke, they refused to consider pain relief even though we were all insisting he was. Sounds very similar to your situation-they are taking her at face value and refusing to accept that your knowledge of her should provide some guidance as to the next steps of treatment and care.