Beyond the Birth Wars

The Grieving Parents by Kathe Kollwitz

Since writing two essays which address the natural childbirth movement (first in 2011, then again last week) I feel a bit as if I've been sucked into the tunnel vision of the Birth Wars. 

Taking a step back, I see it all as a paltry debate among those of us who are lucky enough to have quality and choices when it comes to our health care.

Don't read me wrong; it's clear that there is a whole lot of natural childbirth woo out there that is distinctly anti-science, anti-medical establishment, and anti-feminist. It is clear that lay midwives attending high-risk births in homes instead of hospitals has resulted in the preventable deaths of babies and women. 

It's just that in reading about the broader picture of birth in both America and across the world, I see a much greater concentration of death and harm among the economically disadvantaged, and especially women of color. I feel compelled to check my priorities. It's not that every woman and baby doesn't matter. It's that every woman and baby does matter.    

The Widow II by Kathe Kollwitz

For many pregnant women and their newborn babies, the difference between rich and poor is the difference between life and death. For instance, according to Save the Children's State of the World's Mothers 2013, in Cambodia, babies born to the poorest 20% of parents have a 144% elevated risk of death compared to babies born to the richest 20%. More than a quarter million women die every year because of complications from childbirth.The dead babies (and consequentially the grieving mothers, many of whom must endure their grief without sufficient social or mental health support) number over a million every year. Without question, most of these deaths are preventable, connected to, and exacerbated by the conditions of poverty.   

America's GDP doesn't make Americans immune to the deadly disadvantages of poverty. In 2011 the World Health Organization reported that the USA had a higher newborn mortality rate than 40 other nations. And a 2010 publication by Amnesty International reported about the high rates of maternal deaths and complications associated with pregnancy and birth for American women. 

In addressing these issues, natural childbirth advocates cry out about overused medical interventions and unnecessary c-sections. But it seems apparent to me that the problems for women and babies at higher risk begin long before a woman becomes pregnant. Food insecurity, poor nutrition, unsafe and/or highly stressful living conditions, and inconsistent access to preventative health care set women up with issues such as high blood pressure, diabetes, and obesity, all of which can easily lead to complications in pregnancy, which then may very well require all those interventions and c-sections. 

Then there's the elephant in the room that nobody wants to talk about, and often if anyone does, they are shut down: racism. Race is the strongest predictor of outcomes for birth in America (with black women and babies suffering the worst outcomes), and yet when these huge disparities are reported and discussed, the focus tends to stick exclusively to economic disadvantages and ignore the *gasp* possibility that black women are treated differently by doctors, nurses, and other health care workers (not to mention employers, teachers, social workers, or anyone else they encounter and who might impact their lives.) But is it so hard to imagine that pervasive and damning stereotypes of pregnant black women, especially poor, young, pregnant black women, could have at least a subtle impact on the way they are handled and advised by medical professionals during prenatal care, birth, and postpardum care? 

Authors of the 2010 article Closing the Black-White Gap in Birth Outcomes: A Life-Course Approach, outline a 12 point plan which includes suggestions which seem indirectly connected to pregnancy and birth, such as "Invest in community building and urban renewal", and "Reduce poverty among African American families." People who enjoy strong communities and financial security often take their huge benefits for granted and fail to see how they dramatically impact a person's overall health, behavior, and choices. 

Of course the broad suggestions in this 12 point plan need to be refined into specific programs, many uniquely tailored for particular communities, but the overall point is sound. 

The issues that result in dead or injured women and babies at birth can't be solved by either warm and fuzzy homebirth midwives or even a well-trained OB with a scalpel. The physical, emotional, and social needs of impoverished women not being met are far too great. 

On Some Liberals' Distrust of Doctors

Baby Gaga is in for a checkup.

I make no secret of the fact that I'd be thrilled if one of my kids grew up to be a medical doctor. Doctors have job security and respectable status in society, which would please any parent concerned about our kids' futures. But another part of the appeal to me is the ethics. A doctor's job is to use knowledge obtained through science to try to heal people. What could be a more noble profession from the secular humanist perspective? 

The medical field isn't for everyone. Not only does it require a strong ability to study difficult subjects such as organic chemistry. There is also the gross factor: blood, guts, tissues, fluids, horrible smells, and basically being able to look at human bodies just as a mechanic looks at a car. I couldn't even handle dissecting a frog in high school (I got light headed and ended up being excused to the library. Oddly enough, I'm okay cooking a chicken.) 

Monkeys need doctors too!

Given the rigorous training and noble objectives, it surprises me that not everyone shares my deep respect for the medical profession. 

Some of my friends are dismayed that I would encourage my kids to be doctors. It's sort of the bizarro version of adults who discourage kids from taking an interest in the arts for fear they'll grow up to be impoverished, drug-addled bohemians. In this case, the fear is that as doctors the kids will grow up to be arrogant automatons, brainwashed by scientism and serving the corporate greed which supposedly drives the medical establishment. 

These are the sort of liberals - mostly highly educated, middle class, and white - who drive today's Anti-Vaccination, Natural Childbirth, and other Alternative Medicine movements. 

I was reminded of this sort of contempt toward doctors while reading/viewing New Mom's Uncensored Photos Reveal the Beautiful, Messy Reality of Homebirth. It includes an interview with writer Ruth Fowler followed by the live documentation she and her photographer husband did of her son's birth on Twitter and facebook. 

Right off in the video, the interviewer refers to the "intrusive" nature of modern "technology", and it is clear that this story is framed as a human interest story about the beauty of a natural childbirth in contrast to the sterility of a conventional hospital birth. 

Ruth Fowler describes herself as not the extreme. She says to the interviewer, 

I'm not the kind of crunchy, granola mama who's like "Women who go to hospitals are bad mothers" I'm somewhere in the middle. My birth experience kind of reflects that. I'm somebody who had a natural, un-medicated home birth, but then I had to go to the hospital afterwards to get treatment that probably saved my life. And so I'm not an anti-hospital person. I just wanted to birth at home with my husband, with the people I care about, in the environment I care about. 

Doctor Lysi and Nurse Bebe get to work.

I found this statement puzzling. First of all, her birth experience doesn't reflect a moderate position. She had to be transferred to the hospital because she had a postpartum hemorrhage and would have certainly died otherwise. So according to Fowler, she isn't extreme because her distaste for the medical setting isn't so severe that she's willing to die to avoid it. That's a pretty low bar for extremism. 

She makes a point of saying she chose an "un-medicated" birth, but then used a whisky sour to help ease the pain. So in her view drugs designed to ease the pain of contractions and dispensed by medical professionals are undesirable, but hard liquor is just great? I'm not faulting her for the whisky sour (I've been in labor without pain meds for 24 hours, I know what that feels like), only the hypocrisy. 

Even though the headline of the Huffington Post article includes the word "messy", nothing messy is actually shown. The series of photographs show a beautiful, pregnant woman enduring great pain with dignity and ending up in a naked embrace with her newborn son. Then, suddenly, there is a jump to a couple of photos of mom and baby (hauntingly gorgeous) in the hospital, and the statement: 

… Nye was occidental [sic] posterior. He flipped to come out but shoulder dystocia ripped me apart. Then the placenta wouldn’t come out – some medical termI don’t know – which basically mean, it tried to detach and ripped more of me out! So I lost over half my blood and got transferred by great emt’s [sic] after the birth.

Felt awful but now recovering in UCLA Santa Monica on a TON of fentany1 (it kicks ass!) and blood transfusions and will be back home with Jared and Nye Soledad Iorio tomorrow. This mad experience Just reiterated how goddamn crazy birth is…

I don’t want to be an ass but this experience has taught me birth is beautiful and primal and mysterious and painful as ****. Thanks to my amazing midwife Racha Tahani Lawler for getting me through that, and her assistant Tanya and my brilliant doula Allegra Hill.

At this point my mind is screaming, what the fuck!? Does Huffington Post not realize that the messiest (and also terrifying) part of this birth experience has gone completely undocumented and downplayed? On her blog The Skeptical OB, Amy Tuteur lists crucial elements of this experience that have been omitted from any photographic or written documentation, including: 

Where is the photo of the postpartum hemorrhage with the blood pouring from between your legs?

Where is the photo of your husband’s face, horrified and frightened, as it dawns on him that you may bleed to death and leave him as a widower with a new baby?

Where is the photo of the EMTs hustling you out the door, racing against time to save your life?

What I find also concerning (and is noted, too, by Amy Tuteur) is how Fowler makes a point of thanking all the people who made her feel warm and fuzzy, but then neglects to thank the doctor/s and other medical staff who literally saved her life. Just as she wanted to give birth at home because that environment was one she "cared about", the midwife, her assistant, and doula are people she cares about, and the medical staff are to be treated as cogs in a machine. 

Little sis tries on big sis's lab coat.

A lot of people complain about the poor bedside manners of doctors as if the rift of contempt and distrust that often exists between doctors and patients were all the fault of one side. And as if things like a jolly bedside manner are worth a damn when one is lying on a table bleeding to death. 

This really gets me on a personal level since I am someone who attempted a totally natural childbirth with my first kid and vaginal birth with a CNM. (Neither were homebirths. I view homebirth as a reckless choice.) With both labors I experienced complications which ended with necessary surgeries. In the case of my second child I had a uterine rupture that threatened the lives of myself and my child. 

And I'll tell you what, while I appreciate the care I received from the very professional CNMs who did my prenatal care and were there with emotional support while I was in labor, I damn well feel immense gratitude toward the skilled obstetricians - both stern, serious-looking women - who opened me up and got my babies out safe! 

Sure, Fowler's not saying other people should do things the way she has chosen to do them. But she is romanticizing her experiences and then allowing that prettied-up narrative to be presented as reality. For a writer using documentation supposedly to better understand her own experiences, she seems utterly oblivious to the irrational prejudice she has against the medical establishment. 

My daughters may grow up to enter any number of careers. Right now my four-year-old wants to be a ballet dancer and painter, either of which would be amazing paths to follow. I certainly don't discourage those interests. But if either of them happen to grow up to be a stern, serious-looking obstetrician who saves the lives of women and babies, I'd be as proud as if they were Martha Graham or Louise Bourgeois.