This week, I had the opportunity to talk about my birth experiences at a local university. I was one member of a panel of three women representing ICAN, the International Cesarean Awareness Network, to speak to a women’s studies class about the issue of birth and women’s treatment by the medical community. About half of the students in attendance were on track to pursue a career in the medical field. Most were young women, a few were young men, and all were childless.
I first learned about ICAN from a friend after I had a cesarean section for my sixth child. ICAN began as a woman-to-woman cesarean prevention movement that ultimately influenced the medical community’s standards for reduction of repeat cesarean sections.
I first reached out to ICAN to navigate the recovery from my own cesarean with the birth of my sixth child. What began as a home birth became a transfer to the hospital once it became apparent that my son was a complete breech, which occurs when both of the baby’s knees are bent so that his feet and bottom are closest to the birth canal. After four prior unmedicated deliveries at home, a cesarean was a completely new experience for me, and friends at ICAN offered wonderful support.
If you’ve never had a baby, you may not have given much thought to the various options available for giving birth. I only became aware of the options through my own experiences of giving birth in a hospital as well as at home. The two settings are representative of the two distinct ways to approach birth: the medical model and the midwifery model.
My first birth is a classic example of the techno-medical model. According to Ina May Gaskin, considered the mother of modern midwifery, the techno-medical model looks at the woman from the perspective of the three P’s: the passenger (the baby), the passage (the pelvis and vagina), and the powers (the strength of uterine contractions).
According to the three P’s, if a woman’s body doesn’t deliver the baby in the time prescribed, then either her body grew too big a baby, her vagina is too small, or her uterus is too weak, rendering interventions necessary. However, this way of thinking doesn’t allow for individual differences in the way each woman’s body progresses through labor since birth experiences differ from woman to woman.
I had no knowledge of any of this prior to having my first baby. Like most American women, I obtained prenatal care from my OB-GYN, received a mid-pregnancy ultrasound, and took a natural birthing class.
Unfortunately, natural birth was not compatible with the kind of care my OB was prepared to offer. She insisted on an unnecessary episiotomy. My curiosity about natural birth was met with hostility and defensiveness. At 38 weeks, I was told I had to be induced due to the development of pre-eclampsia although my condition was mild.
After the delivery of my daughter, I was drugged without my knowledge and unable to hold my daughter for 24 hours after her birth. I was given no agency and shamed for wanting to breastfeed my daughter. My body sustained trauma and permanent damage due to laboring on my back for four hours.
I brought our daughter home utterly exhausted and anxious and came to realize that I’d been traumatized by the experience. Once my six-week postpartum checkup was complete, I refused to visit another OB for a long time.
Once pregnant with our second child, I was determined to have a better birth experience. I knew about midwives and sought care from one, which was difficult to do since the practice of direct-entry midwifery (midwives trained on the job by other midwives) was illegal in the state of Missouri at that time. However, I eventually found a knowledgeable birth attendant and prepared for a home birth using what is known as the Midwives Model of Care.
This model respects and honors the individual differences in the way each woman’s body responds to labor. Ina May Gaskin’s Sphincter Law, often employed in the Midwives Model, recognizes the cervix as a sphincter along with the other excretory sphincters. These sphincters function best, Gaskin points out, in an atmosphere of privacy and familiarity.
My second child was successfully born at home, a welcome contrast from being at the hospital. At home I felt fully supported. I had privacy and agency. I trusted my midwife. She’d taken the time to get to know me and my body. She was nurturing and cared for me like a mother, tucking me in after the birth. Despite a minor complication with the delivery, my baby was born healthy, and my recovery was amazingly brief.
This birth taught me how to work with my body to deliver my baby, thus reducing pain and maintaining my dignity. Perhaps the biggest difference was the lack of fear surrounding the birth. My birth attendant was knowledgeable, and there was always a plan in place in the event of an emergency. My next three babies were also born peacefully at home, with no need for interventions.
By the time my sixth, seventh, and eighth children came along, I was much better versed at advocating for myself in the medical setting. This resulted in our twins being born non-surgically; however, the delivery was still not without incident. I was harmed by one of the male OB/GYNs, who, after introducing himself, simply thrust his hand into me to check my cervix without telling me what he was going to do before he did it, thus producing a wave of feeling violated. Still, setting that aside, I had a successful VBAC (vaginal birth after cesarean), with one twin delivered feet first. This delivery became the talk of the hospital for how unusual it was—and all because I dared to demand care that was rooted in skillsets that most current OB’s simply do not have.
Given how important birth is to the preservation of the human race, one would think it would be approached with more reverence and care, but our current medical model simply does not incentivize this approach. All doctors are bound by the Merit-Based Incentive Payment System, which came about when the Affordable Care Act was passed. What seems like a system benefiting patients is actually something quite different. According to Dr. Casey Means in her new book Good Energy:
The Merit-Based Incentive Payment System, a new program under the Quality Payment Program, where a physician would now receive substantial adjustments to payments from Medicare if they met specific quality-of-care criteria. One would think that ‘quality’ and ‘merit’ in medicine would mean that the patient was actually getting better … but, these quality criteria were primarily based on whether doctors prescribed drugs regularly or did more interventions.
In maternity care this looks like more inductions, more epidurals, and more cesareans. But the procedures that are meant to control delivery and alleviate pain often result in unnecessary surgeries, painful recoveries for moms and babies, and sometimes permanent emotional and physical damage.
This was my primary motivation for participating in the ICAN panel. I wanted to educate and inspire young women to consider the amazing design of our bodies that can conceive, grow, and birth a new human being without fear and without trauma. I wanted to persuade these young men and women that motherhood isn’t a terrible thing but in fact a promotion to one of the most meaningful jobs on the planet. And I wanted to teach them about how current birth practices in the medical community cause harm by performing unnecessary interventions when women have known for centuries that doctors should focus on support and knowledge of women’s bodies. If we want to encourage family formation, reforming our approach to birth is a good place to start.
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Image credit: Pexels
