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(en) Ireland, Dublin, The anarcha-feminist magazine RAG #1 - Anger: Birthed and Transformed

Date Mon, 12 Nov 2007 18:46:54 +0200


My experience of childbirth was not an unusually traumatic one. In medical parlance I had an NVD: a Normal Vaginal Delivery. The midwives were pleasant. I was given an epidural. I was admitted to hospital at 2pm and delivered a healthy baby boy (8lb 7oz) eleven hours later. This is the essential information, is it not? This is the only kind of information that we ever really hear about other women's experience of birth. But there is a lot more to it. --- It took me a while to sort out my feelings after giving birth. The elation you feel at the presence of a new life and the physical exhaustion leave room for little else. I never really experienced the hopeless grief of the flippantly named "baby blues" in the weeks or months that followed. What I felt - when I finally sorted out the reasons for my confusion surrounding the birth - was anger.

What is anger anyway? Is it only blame and self-pity? Or is it ever illuminating? For me, anger has travelled beyond blame, beyond the individuals involved and my personal experience and shocked me into changing my whole outlook on life.

I wasn't angry during my pregnancy at the lack of options for childbirth. I never knew what else I could expect. I wasn't angry during any stage of my labour: As soon as I was admitted, I was told that I was two centimetres dilated and my waters were to be broken with something resembling a crochet hook ("ok"). After that I wandered the halls and breathed through contractions for a few hours. When I was re-examined, I hadn't "progressed" enough. I was told this was dangerous for the baby, and I needed a syntocin (oxytocin) drip to speed up and strengthen the contractions ("ok"). Now, these heightened contractions would be very painful so would I be requiring pain-relief? ("ok"). The epidural is probably the most effective ("ok!") I gritted my teeth and I wasn't angry as the drip was repeatedly and painfully mis-inserted into my hand, or as the epidural took twenty minutes to stick into my spine. I wasn't angry that I wasn't allowed to eat anything even though I was very hungry. Or that my parents weren't allowed to see me in the delivery ward after driving for hours to be there. As I watched the clock pass midnight into Halloween, fireworks cracked and flared outside the hospital. I smiled knowing that my baby would have great birthday parties to come. And for this next hour, I shivered in freezing shock, immobilised on the delivery table, uncaring and un-angered as the drugs wore off so I could finally push. I wasn't angry because those involved were doing their jobs, it seemed so normal for them. I was moving towards having my baby, and this is what every mother went through.

The point at which I started to get a twinge of anger was when, after delivery, I couldn't get to feed my baby. It was only then that my instinct was strong enough to say, "No. This is really wrong." There is a period of about an hour after the birth where the newborn is alert and breastfeeding can be established. However, after a brief hold, he was taken away as I was given a syntometrine injection and his placenta was delivered (by tugging on the cord). He remained away as I was stitched and examined and had to wait for a doctor to examine me. By the time I was given the all-clear (in tears at this stage asking "can I feed him now?"), I had to be moved from the delivery ward and down to the post-natal ward. It was 2am by this stage, so friends and family in the waiting room were told to go home without ever having seen me or baby. The baby's dad had been present at the birth but now was also sent home. Yet again I asked, "Please, can I try to feed my baby?" but he had to be taken away again - this time for a Vitamin K injection and for the nurse to bathe him and put his first vest and babygro on. When she brought him back he was tired and wanted to sleep. The nurse asked if I still wanted to feed, she gave a little perfunctory hold of him up to one breast and then the other and said - incredibly - "No. He's not a boob man is he?" She then put him down to sleep in the cot beside me, told me to sleep too and that I could try again when he woke up. I spent that first night wide awake, watching every twitch my new son made, desperate to hold him, horrified that I hadn't managed to take him to my breast after he was born. When he finally did wake up, I remember ringing for the nurse - looking for her permission to pick him up! This same nurse was the one who would throw back the curtains from around the beds at night if anyone dared to wish for some privacy.

Thankfully, my baby started to feed hungrily the next day. In fact, it was all he ever wanted to do. My grief for our first night together was all the more pointed as I started to realise that I wouldn't be getting any sleep for longer than two hours at a stretch for the next six months or so! The rest of my stay in hospital was a blur of zero sleep, noise, crying babies, food times, masses of visitors for two hours and then being left with no-one. On day two I remember being allowed to meet my teary mom at the end of the corridor as she passed me some supplies. Later that day I finally managed to have the baby fed and sleepy at a time when there was a lull in hospital activity. I was just dropping off - for the first time in about 70 hours - when I was woken up to bring the baby in for a BCG injection. I did so in floods of exhausted tears.

The National Maternity Hospital in Holles St., Dublin was established in 1894 to deliver the babies of the poorer women of Dublin, who were no doubt dying in their droves during childbirth. (Ironically, the mortality rate was likely to have increased as soon as it opened, due to the prevalence of puerperal fever - an infection of the genital tract passed on to women by examining fingers.) Holles St. and the two other maternity hospitals in Dublin (the Rotunda and the Coombe) now account for almost 40% of all the births in this country.1 In the past hundred years, rates of midwife-assisted homebirths have declined, now they account for less than 1% of all births. What little diversity there had been within the given system is also being eroded with the closure of many smaller maternity units in recent years.2

Holles St. has pioneered (and spread Europe-wide) a policy of "active management"3 - an obstetrician-led intervention-rich process which begins with ARM (artificial rupture of the membrane of the amniotic sac or "breaking the waters", leaving the foetus unprotected and vulnerable to pressure and infection) and continues to monitor the birthing women and administer to them when they aren't doing it right. For example, in Holles St., the decided-upon correct rate of cervical dilation is 1cm/hour. If this is not achieved, and the mother "fails to progress", she is hooked up to an oxytocin drip which causes the onset of sudden intense contractions. In Holles St. in 2004 (the year I gave birth) 55% of first-time mothers weren't doing it right and needed to be speeded up in this way (unsurprisingly enough, a slightly larger percentage opted for an epidural to ease the pain.) 4

In years gone by in Ireland childbirth could be a death-sentence. This is the most oft-stated defence for today's medicalised births. The reality is that, as in present-day "developing" countries, in the past most complications during pregnancy and childbirth occurred due to poor maternal nutrition and infections which are now easily treatable or preventable with better hygiene5. The high-tech interventions which are now available certainly save some lives but in many cases, especially where "active management" is practiced, these interventions are used unnecessarily. There is an often noted "cascade of intervention" where once one medical procedure has been carried out, another follows, then another leading to more invasive and traumatic interventions and often culminating in caesarean section. In Ireland, the average rate of C-section is one of the highest in Europe at 25%.6 The midwife-endorsed alternative to this policy of aggressive intervention is "wait and see". Strangely enough, this usually works wonderfully.

In theory, a woman has the right to refuse any of the interventions offered to her. In practice, with the high turnover of "patients", the normality of intervention and the culture of minimisation of risk (read minimisation of liability) women do not feel empowered to say "no". I certainly never thought about saying "no" or asking "is there an alternative?" I blame myself for this - that I was not more informed and proactive. But I am also angry at the bullying system in place. It is overwhelming and more than you are able to cope with to defy medical opinion as to what is right for you and your baby. In general, as we are taught all our lives to do, we place our lives and well-being in the hands of professionals. We become numbers, subject to routine interventions.

In Holles St. membrane rupture is carried out routinely. It is routine for the nurses to bathe, dress and inject the newborn. A "managed" third stage of labour is routine, with hormone injections and cord tugging to deliver the placenta. This is justified by saying that it reduces the risk of postpartum haemorrhage. This is disputed by many midwives, who argue that the early cord-clamping involved is potentially injurious for the newborn and that the third stage of a normal birth should never need to be managed.7 Until recently, episiotomy (cutting the perineum to allow more room for the baby) was routine. It is now being shown to be usually unnecessary and at worst a mutilation.8 In most hospitals labour is routinely artificially induced once pregnancy reaches 42 weeks (which is now thought to be the normal term of labour in some women9). Up until recent years, if you had one caesarean section, you could not expect to be allowed to try for a vaginal delivery in subsequent births (this is now slowly changing). In Our Lady of Lourdes hospital in Drogheda, Dr. Michael Neary carried out unnecessary routine hysterectomies post-caesarean-section over the course of twenty five years before it was brought to light in 1998.10 In the same hospital (and in Holles St., the Coombe and others around the country) between the 1950's and the 1980's, hundreds of women underwent a procedure known as a symphysiotomy. Here, a woman's pelvis was literally sawn apart during childbirth, as an alternative to caesarean-section. The justification seemed to be a good catholic one - the pelvis would heal widened and the woman would be able to bear more children11 - even though most were never even told what procedure had been carried out on them and many suffered life-long pain, incontinence, problems walking and arthritis.12 This is the history of routine interventions by those who know what's best for us.

Our televisual idea of childbirth is pretty nasty - all that blood and fluid, the panting and screaming, the stretched anatomy, the emergent gooey greyish-purple alien… Horrible! Remember when you first heard about sex? Remember how horrible that seemed? But sex isn't horrible, is it? What's missing - and indescribable to a virgin child - is the emotional element. Sex is a natural and beautiful process, all entangled with love and passion. So too, and a million times more, is birth. In essence, our modern patriarchal institutionalised world has a childish view of childbirth. It can't imagine that something that looks that gruesome can be anything but a horrendous experience and one that should be shortened and medicated. But childbirth is not a medical procedure any more than sex is. Now, I don't have many13 illusions about primitive feminine birthing rituals in mud huts (as fear and patriarchy have even greater strangleholds on women's bodies in most third-world countries). I am not saying that every woman should have a pain-free, blissful, complication-free birth. What I am saying is that fear has no place in the process.

Fear causes adrenaline production. This initiates the "flight or fight" response where blood drains from the uterus to the limbs, slowing the process of labour until the primeval woman escapes to a safe place to give birth. Meditation and relaxation techniques during childbirth - which are often described to women as methods for coping with pain - can in fact be methods of preventing pain - by preventing fear. As with sexual intercourse, if a woman does not feel safe, relaxed and preferably loved, she will experience tension and pain during childbirth. Without ever taking a single deep breath or doing a second's meditation, what woman wouldn't feel more relaxed anywhere but on a table in a hospital delivery "suite"? Looking back on it, it seems like the most ridiculous place to try to give birth. As with sex, your body wants a darkened, intimate, safe and private place to give itself over to its natural urges and processes. Instead, while no longer strapped and stirrupped, we retain those bizarre postures, under the bright lights, the ready interference and the stares of strangers. Could you orgasm under the same conditions? Are you surprised then that our labours "fail to progress", with fear and adrenaline coursing through every vein in our bodies? Overcome it with drugs. Pull, drag and cut those children out of us. Then tell us to be thankful. If we are strong enough, maybe we can get the resources together to birth at home1415. Mothers, partners, sisters, doctors; tell us we are endangering lives. We are taking risks. Fill us, oh fill us with fear. No woman wants to endanger her child's life so almost every woman does what she's told and gets hospitalised.

Here's where it gets very difficult. I hope I don't shock you if I tell you that many women liken the experience of even a "normal" hospitalised medicalised childbirth to the experience of sexual assault16. Aside from the obvious - the exposure of your most intimate areas to complete strangers - there is an utter lack of control over what is being done to your body. Your consent may never be sought for certain procedures, or it may be sought, but in the coercive manner of institutions that count on your fear for your cooperation. The feelings that may be experienced afterwards are those of shame and guilt that you weren't able to give birth naturally, that you didn't ask the right questions, that you gave up control and weren't strong enough to resist certain things being done. You might feel cheated if you had hoped vaguely for a natural childbirth by the reality of what took place. These feelings can be particularly strong if the mother is separated from her newborn - for example after an emergency C-section or if a baby is incubated. In some of these cases, mothers (aside from being traumatised at the time) can experience bonding problems with the infant. Even once bonding is achieved, the guilt that accompanies this can be life-long.

Why would I bring this up? Surely, many mothers experience medicalised births without mental trauma? Surely, the fact that there is a healthy infant in your arms makes up for anything you went through? Aren't you safe? Shouldn't you be grateful to the hospital for delivering your baby? (Do any women get to feel grateful to themselves, to feel the power and ability of their own bodies?) Won't revisiting the event just cause unnecessary pain and distress for women who should just forget about it and move on with their lives? Like survivors of sexual assault, survivors of medicalised births may live years, or their whole lives, unconscious of feeling anguish or anger about their experiences. But this doesn't mean that they are unaffected by them. It is my belief that at some deep level we are robbed and moulded. We pass through our childbirth initiation into becoming disempowered, disconnected, long-suffering, patriarchal mothers. We tell our horror stories as just that, or we say nothing at all. It doesn't have to be this way. If I ever have another child, it will not be in the same way. But it doesn't stop there. I will never again blindly place my trust in authoritarian professionals and institutions. I will recognise all capitalist patriarchy for what it is and I will do my best to speak out against it.

Every day, in every way, my son is a wonderful gift. I would actually go through another ten hospitalised births in the morning just to keep him. I am sorry for his shabby entrance into this world but I am thankful to this little person for helping me to see something: the bald, blatant, oppressive, damaging, misogynistic forces at play in the most vital aspects of women's lives. Revisiting his birth has made me angry, but that has made so much else clear; how blinded we can be by the guise of protection; how crippled we can be made by fear. I wish that we talked about it, that we didn't feel that we were whinging by talking about it. That we could stop revelling in horror-stories and better place our fingers on the reason for our traumatic births - not the curse of Eve medicated to by our benevolent system - but the systematic violence that delivers our babies for fear that we might give birth to them ourselves. For in the process we might begin to understand our own strength and find words for all our angers. We might begin to disobey.

by shonagh
1. Figures calculated from those given in The Better Birth Book and those published by the central statistics office www.cso.ie
2. Tracey Donegen The Better Birth Book. Liffey Press 2006 - A great resource for anyone giving birth in Ireland
3. O'Driscoll K, Meagher D, Boylan P. Active management of labor. London: Mosby, 1993. (A hefty reference for you - no I haven't read it!)
4. Tracey Donegen The Better Birth Book. Liffey Press 2006
5. State of The World's Mothers 2006 is a report put out by the charity Save the Children and has some shocking information about how women and babies are dying unnecessarily during and soon after childbirth. Available from www.savethechildren.org.uk
7. These and other midwifery issues at www.gentlebirth.org and www.radmid.demon.co.uk
8. Hartmann et al (2005) Outcomes of routine episiotomy: a systematic review. Extract available at jama.ama-assn.org.
9. Some info and lots of links from this page thought you have to pay to become a member of birthlove: www.birthlove.com/free/ten_month_mama.html
10. The Lourdes Enquiry makes for an interesting read and is available at www.lourdesinquiry.ie
11. Jacqueline Morrissey Midwifery of Darker Times - Irish Times Article 6/9/99
12. The grassroots group Survivors of Symphysiotomy can be contacted on 01 4961013
13. In fact there are many accounts of powerful, blissful, even orgasmic births! Start at www.unassistedchildbirth.com if you are willing to suspend disbelief.
14. The Homebirth Association of Ireland: www.homebirth.ie. This UK site is also very good: www.homebirth.org.uk
15. Johnson and Daviss (2005) Outcomes of planned homebirths with certified professional midwifes: large prospective study. - Shows equivalent rates of mortality for homebirths and hospital births, and substantially lower rates of medical intervention, available at www.bmj.bmjjournals.com.
16. Jasmine Smyth (2000) Rape of the Twentieth Century - I warn you, this is a harrowing read. Available at www.birthlove.com/free/rape_complimentary.html
* Jo Murphy-Lawless (2000) Reinstating Women's time in Childbirth: I found this wonderful article after I'd written my piece, so it's not a specific reference - but definitely recommended reading. Available at www.aims.org.uk.
* Get invaluable peer-to-peer pregnancy, birth and parenting advice at www.rollercoaster.ie and www.magicmum.com.

* I would be happy to hear your experiences/stories, or to talk to anyone about issues touched on in this article. Contact me (shonagh) at the ragdublin/riseup.net email.
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