The Politicization of Childbirth

At thirty-seven-weeks pregnant with my first child I did something almost unthinkable to my obstetrician (OB): I decided to switch care providers to a midwife practice that delivers out of a local hospital. After nine months and dozens of appointments with doctors, I rolled the dice, not because I had an overwhelming faith in my new midwives, but because I had so little in my OB.

What was it about my appointments with my doctor that sent me running? For one thing, we had a very different idea of whose preferences mattered in my child’s birth. They insisted that their preferences were the priority; as long as my baby and I were safe, my view was that they absolutely did not. Their paternalistic tone and unwillingness to consider the fact that different women might consider different kinds of births, and that these different births might all be acceptable as long as they’re safe was the driving force behind my departure from the practice.

The author of the blog Skeptical OB, Amy Tuteur, is precisely the kind of doctor who sent me running. Tuteur sees no value in natural birth and misses no opportunity to deride women who make that choice. In a recent article promoting Tuteur’s new book, Push Back: Guilt in the Age of Natural Parenting, Slate interviewed the author on what she believes are the major problems with natural childbirth and attachment parenting. It’s clear from the interview that Tuteur has a highly idealized view of what birth is like for most women in America. She told Slate:

Their ideas gave women some agency during a time when the medical system, including obstetrics, was very patriarchal and paternalistic. Everyone was treated terribly back then. And the natural childbirth movement did a lot to change this. They started asking questions: Why is it this way? Why can’t my husband come in? Why can’t I be awake? And the medical system thought about it and realized that it could change. Natural childbirth achieved everything that it supposedly wanted by the early 1980s.

To quote a popular Internet slang expression: O RLY?

Cristen Pascucci, Founder of Birth Monopoly and Vice President of ImprovingBirth.org has devoted her life to bettering how American women are treated in labor. She told me,

Labeling women for how they give birth [as “natural birthers”] is absolutely misplaced. The system is the problem. It’s a multi-billion-dollar-a-year industry that has produced a 1-in-3 Cesarean rate, a rising maternal mortality rate, and a constant stream of reports of ethical and legal rights violations. In fact, I don’t know that there is a natural childbirth movement today; of any major advocacy organizations that have sprung up in the last five years, the movement is all about supporting each woman in her needs, on her terms. The whole point is that all women can’t and won’t give birth the same way, but the care that most of us have access to is a one-size-fits-all, highly interventionist model. Our daily reality as advocates is listening to the stories of the nightmares these women are experiencing, like being wrestled on their backs as they are trying to push a baby out, having ten vaginal exams from ten different people during labor with no option to say “no,” being told they “aren’t allowed” to have a vaginal birth if they’ve had a big baby before. This is reality. Blaming women, labeling them, and pitting them against each other is the very last thing anyone should be doing.

Tuteur, throughout her blog and in her interview with Slate, wastes no opportunity to take swipes at midwives, despite the fact that what draws many women to the midwife model of care isn’t that they’re gluttons for pain and punishment, but quite the opposite. Midwives are known for spending more time in appointments, and for spending that time actually listening. Midwives are stereotyped as maternal figures who love to hug for a reason.

Tanya Wills, the owner of Manhattan Birth and a Certified Nurse Midwife is passionate about evidence-based care. She told me of her profession,

Midwives are not going away and, in fact, our numbers are increasing in the US to meet the overwhelming growing demand for midwifery care. Many midwifery practices are fully booked early because women know their midwives will truly be “with woman” throughout the journey of the childbearing year. I think women are seeing that the midwifery model of care is one where they feel cared for and respected through shared decision making. They know that because midwives sit with women in labor and understand how physiologic labor works, they are more likely to have a safe and healthy birth—and most often, one in which the outcome is measured beyond whether or not everyone comes out alive.

Birth is, no matter how one does it, a transformative event in a woman’s life. Ask any woman about her birth story, no matter how it happened, and she can and likely will want to share the story (or stories) at length. No woman wants the birth of her child to be just a “means to an end.” Not when it involves our most sensitive areas, both physically and spiritually.

Dr. Amy Tuteur has built her entire career trying to delegitimize the midwifery model of care and natural childbirth. To be fair, on her blog she makes valid points about some of the dangers of home birth attended by unqualified midwives (who are in fact responsible for a miniscule number of births in this country). Unfortunately, the vast majority of Tuteur’s vitriol is directed at a community of women and care providers, the latter of whom pose a direct challenge to her livelihood. Midwife-attended birth is on the rise and is becoming increasingly popular for a reason. Tuteur is dismissive of the phenomenon, but if she and her likeminded medical colleagues were capable of a bit of introspection, they might realize this attitude of dismissiveness is exactly what is driving women from their waiting rooms in the first place.

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