15.8.09

I'm a Birth Advocate... not a Midwife Advocate

There was recently an interesting discussion on a mailing list to which I subscribe. It was, as so many conversations are, an offshoot of a previous thread. When retitled, its new name became "Is birth for everyone?"

The original author went on to elaborate her position. I'd like to quote most of a paragraph: "Nearly every basically healthy, normal woman can give birth entirely on her own. The most serious handicap most of us face is our mental state. After that are general health concerns like adequate nutrition, sanitation, and serious disease or malformations."

She further makes a statement which with anthropological researchers such as Wenda Trevathan would take issue.

"Birthing on our own is normal. 'Assisted' birth is a choice."

Another respondent rephrased that statement as "People don't NEED doctors/midwives for birth... they want them."

This also then began a good discussion on the fact that true choice must be truly informed to be any sort of real choice. Further, it was pointed out that it is very difficult to know how many women are truly benefitted by having an assisted birth, and since that knowledge is missing, it can be hard for mothers to make an informed choice. One of the theoretical, somewhat rhetorical questions then posed struck a chord with me (and I apologize for the pun) - "Does a cord around the baby's neck make a midwife a hero?"

Because too often I see midwifery advocates and clients not offering up midwives as partners, who can help women to reclaim both responsibility and freedom, but instead substitutes for obstetricians. Yes, the skills of a midwife can be important in some births, in ensuring the health of the mother or the baby. Yes, the support of a midwife can make a true difference in a woman's emotional and mental state, giving her the power to continue through a difficult labor or long period of pushing. However, midwives are frequently portrayed as saviors, just as obstetricians are. How they act as saviors does differ - obstetricians often save the day with the snip of a perineum or the slice of a belly, and the "saving" they provide may be unnecessary and necessitated by their own actions earlier in the course of labor. Midwives, on the other hand, are presented as the saviors in that women hand their own power to the midwives. Rather than "I did it," the woman may, in effect, say "My midwife and I did it!" The woman may give credit to an intervention performed by the midwife that "allowed" to experience a natural or vaginal birth. Many times, motives and actions will be ascribed to the nameless, faceless Hospital Doctors, and the actions of the midwives will be contrasted with those that the woman supposes would have happened had she been in a different location, with different care providers.

Make no mistake - location of birth and choice of provider (and choice to have a provider) are fundamentally important, and no two decisions will have greater impact on a woman's eventual birth experience. However, there often remains an ascribing of actions to an external locus of control, even by the women who had their beautiful, midwife-attended homebirth. This redirection of power is a negative thing, and can only serve to stroke the ego of midwives across the country.

Unassisted birth is emphatically not for everyone. However, the premise that midwives can be heroes and saviors must, I feel, be rejected. What must be remembered by all birth advocates is that birth is ultimately about the mother and the baby, and all involved in a birth should be careful not to take the power of the mother from her.
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"A little rebellion every now and then is a good thing." - Thomas Jefferson