Speaking out for birth choices
Birth is the feminist issue nobody’s talking about. Milli Hill aims to start that conversation.
It’s not always easy to talk about childbirth, and it’s not always easy to raise feminist issues. People can even argue about what feminism actually is, but to me it’s simple: feminism just means noticing when women are getting a raw deal, and taking action. And this is where the problem lies with childbirth. Not enough people are noticing that women are getting a raw deal, and not enough people are taking action. We’ve become blinkered to the massive imbalance of power in the birth room, and we’ve somehow come to accept that birth is inherently unpleasant and undignified, or even traumatic, degrading and violating. Well, I’ve written a book to tell you that it doesn’t have to be that way, and that as feminists we must no longer tolerate this state of affairs.
Feminism doesn’t have to be complicated, and it doesn’t have to be exclusive. Giving birth like a feminist doesn’t mean giving birth in a certain way: you can give birth like a feminist in any setting and in any way, from elective caesarean in a private hospital to freebirth in the ocean. All that’s required is that you have somehow moved from a passive place where you view birth as something that happens to you and over which you have no control, to a place of understanding that you might get a raw deal in this experience if you don’t wake up and get yourself into the driving seat. Essentially: take charge, take control, and make conscious choices.
When I speak at mainstream maternity events, I am often shocked that telling women and their partners that they have rights and choices in the birth room so often seems to come as a revelation. Many people have no sense of themselves as autonomous or powerful in their labour and birth; nor do they feel that there is anything they can do to influence the way their birth unfolds. They are often misinformed and, to compound this, their belief that they have little or no agency prevents them from seeking out much information. What is the point in learning about your options when the phrase ‘not allowed’ is used with such alarming frequency? In practical terms this means that, on a daily basis, fingers enter the vaginas of women who do not know they can decline. How can this be acceptable? Even the most progressive of maternity conversations emphasises informed consent, with the unspoken assumption that consent, not decision-making or even informed refusal, is the goal. Maternity professionals will speak of how they ‘consent’ women, using it as a verb – “I am just going to consent her” – as if the professional is the active one in the exchange and the woman herself is passive. It’s time to challenge a system that perpetuates this myth of unquestioning cooperation and female powerlessness.
Currently, we are not getting birth right. This matters primarily because birth is a key human experience that will be remembered in great detail by a woman and her partner for the rest of their lives. Intervention rates in childbirth are rising rapidly, and we should all be concerned about that. This is not just my personal viewpoint. Leading bodies such as the World Health Organization have expressed concern that the medicalisation of childbirth, with its focus on monitoring, measuring and controlling, has left the question of how women actually feel about their births completely off the agenda, potentially robbing them of a life-enhancing experience.1
The world’s most prestigious medical journal, The Lancet, has drawn attention to the ‘too much, too soon’ approach to birth, most often found in high-income countries, in which treatments that were originally designed to manage complications are now overused, missing an opportunity for women to feel strong and capable.2 Currently, natural birth – in which a woman has a baby without any pharmacological input such as induction, augmentation, or drugs to expel the placenta – is very rare. Rarer still are what I call ‘hands off’ births, in which women, rather than being ‘managed’, rely on their own instinct, follow their body’s lead, and are not guided into certain positions or told when and how to push. Women who have their babies in this way will most often talk of the experience in evangelical terms, as life-changing moments in which they felt sexual, sensual, strong, vital and powerful. You can’t help but wonder when you hear their stories how much the world might change if more women were getting this transformative power boost as they crossed the threshold to motherhood. Instead, it’s becoming much more ‘normal’ to have a situation in which the birthing woman feels unsupported, disempowered and traumatised. It’s therefore vital that we have a conversation about the value to women of this ‘natural’ type of birth experience, which is currently on the brink of extinction.
We also need to talk about women who don’t want or cannot have straightforward vaginal births. There is no birth scenario in which increasing empathy for the woman, listening to her voice, respecting her decisions, and honouring that this is an extraordinary day in her life will not be valid. There is no type of birth that we cannot improve upon. The best way to find out more about this is again to listen to women. I have learnt so much about what women want in birth from talking to women who have experienced caesarean, and, in particular, caesarean under general anaesthetic – for example, a woman will repeat again and again how much it meant to her to know that her hands were among the first to touch her baby, even if she was not ‘there’ to experience it. Every small gesture matters, and we can always do better.
Two radical suggestions underpin my book. The first is that birth as an experience in a woman’s life really matters and that it’s time to stop telling women that it’s just one day in which they will leave their dignity at the door “because a healthy baby is all that matters”. These are old-fashioned ideas, riddled with disrespect for women, for their autonomy, and for their feelings as sentient humans, that have no place in the 21st century. The second radical suggestion is that the pregnant woman should be elevated to the role of key decision maker and most powerful person in the birth room. I can tell you from a decade of talking to women about their maternity care that, while there may be frequent reassurances that this is already the case, in reality it tends to make people uneasy. We see this most clearly when women try to go against the flow, birth outside of guidelines, or refuse to consent to or accept the standard protocol or approach. These women, and often, too, the midwives or doulas who support their choices no matter what, will often meet huge resistance, and risk sanctions or even punishment. We need a shift in consciousness to trusting women to make the right choices for themselves and for their babies. We need an acceptance that the image of a wayward, misinformed, irresponsible or even ‘mad’ woman, who does not have the best interests of her baby at heart, is a damaging and misogynist stereotype used to justify the control of women and rarely to be found in reality.
I hope thinking about birth as a feminist issue gets you thinking about the ways in which birth matters, about women’s power, agency and autonomy in birth, and about what we could be doing differently or better. We need to add to the dialogue about birth as a feminist issue and move it forwards. And this is essential if we wish to create a future in which women get the positive experiences of birth that they so desperately want, the medical help they truly need, and the power, respect and autonomy they absolutely deserve. Let’s start the conversation.
Milli Hill is a freelance journalist, founder of the Positive Birth Movement and author of the best-selling Positive Birth Book. Her new book Give Birth Like a Feminist was published this year. She lives in Somerset with her partner and three children aged 11, 9 and 6.
Featured photograph by Gaby Sweet, www.gabysweetphotography.com
1. ‘Making childbirth a positive experience’, WHO guideline on intrapartum care, 15 February 2018. www.who.int/reproductivehealth/intrapartum-care/en/
2. Suellen Miller et al., ‘Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide’, The Lancet, 388: 10056 (2016), 2176–92. tinyurl.com/beyond-too-little-too-late
This article was originally published in JUNO Autumn, issue 63. For more information follow the link: https://shop.junopublishing.co.uk/product/single-issues/issue-63/