*This is a personal testimony, which touches on a number of complex multifaceted issues, including the safety of homebirth over hospital births, feminist critiques of systems of dominance, and the treatment of women in western society, but does not explore these at great length. Such discussions were beyond the scope of this piece. However, for futher information please consult the references included at the end, as well as additional resources as provided at http://www.joyousbirth.info/articles.html and http://www.joyousbirth.info/resources.html
Support can be difficult to define. It can be even more difficult to give to someone you love, particularly when they make choices you would not. Feminism is concerned with offering support to women, and as simple as this may sound, it can be quite complex in practice. The following piece is a personal account of my own struggle in trying to figure out how best to support my pregnant sister as the birth of her child approached.
I am a feminist academic, the major subject of my research is reproduction. I read, write and think about the politics of reproduction, that is, how reproduction is constructed and experienced within western industrialised society. I apply feminist principles such as “the personal is political”[i] to menstruation, conception, pregnancy and childbirth, arguing that personal expereinces and decisions cannot be separated from the political context in which they are made. I have had pieces on the “medicalisation of reproduction” published[ii]. When my sister announced “you're going to be an aunty”, I was ecstatic, but as I've written elsewhere[iii] I knew that my academia and my politics would make being a supportive sister and aunt-to-be trying.
As a result of my academic interests I became involved with a wonderful support, information and homebirth advocacy group known as Joyous Birth[iv]. This group has been endlessly useful, particularly at providing information about the options women don't always know they have when it comes to birthing. Through discussions with these women, atop of my own research, I had a wealth of information that could benefit my sister. I discovered the risks of prenatal tests and screening[v], the importance of selecting the perfect place to give birth[vi], the stark contrast between receiving care from a midwife compared to an obstetrician[vii], and the safety of home birth over hospital births[viii]. I felt prepared for my future, should I choose to reproduce. Based on my findings I decided I would resist prenatal tests and screening, I would avoid involving medical professionals, as if pregnancy and childbirth were illnesses, I would not take my healthy body into an institution for sick people, I would birth at home. But what about my sister, for whom these decisions had to be made in a matter of weeks? What had she decided? One would think, given my interest in the subject, that I would have been keen to discuss all this with my sister, to hear her plans, help educate her with the wonderful knowledge I had acquired. But no, I refrained from talking about birth to her for the first thirty-five weeks of her pregnancy.
Justifications for “Supportive” Silence?
Why would a feminist who argues the personal is political, whose career is consumed with issues relating to reproduction, who believes herself to be a passionate advocate for empowered birth, for empowered women, shy away from broaching the topic of birth plans with her sister? My sister had told me of her own accord that she was having regular consults with midwives, but I didn't ask any questions, I assumed she was planning to go to a birthing centre. She had had a fabulously healthy pregnancy, one even without morning sickness, so the liklihood that she would step into a hospital seemed minimal to me. I took a lot for granted, and was surprised to discover that she had booked herself into the local hospital. This prompted me to enquire about the midwives she had been consulting, who I discovered were hospital midwives, and she never saw the same woman twice. My feminist senses were tingling, but I took a deep breath, smiled politely, and thought to myself: I will never do that.
I continued to bite my tongue for a number of reasons:
1. My sister was young, her pregnancy was unplanned, and for a while I had been the only member of our family willing to enjoy the experience with her. She needed someone in her life who wouldn't frown at her, or lecture her about how young and foolish she was, about how unprepared she was. She needed someone who would gush over baby clothes with her, smile at her, tell her what a wonderful mother she will make. I didn't want my involvement in her pregnancy and birth to go beyond this. Primarily for her sake, but undeniably also for my own.
2. In this world it is difficult for women to claim ownership of their bodies. They're bodies are socially constructed to exist for the sexual pleasure of others[ix], to bear children for others[x], to do the (low) paid employment others don't wish to do[xi], to volunteer their time and engergy to others[xii], to nurture others[xiii]. Their bodies belong to others, and no time in a woman's life is this more obvious than during pregnancy. A pregnant body belongs to everyone, so much so that strangers have no qualms about touching a woman's pregnant stomach in public, in stopping her on the street to enquire about her personal life (“When are you due?” “Do you know the sex?”), and perhaps most frustrating of all, strangers, family, friends, acquaintences alike all have advice, lectures, or their own stories the pregnant woman must hear to have any idea what she's doing. As my sister was young, and a woman, and pregnant I decided she had enough “helpful advice” being thrown her way from every corner of society without me adding my own.
3. I thought that surely if I were to begin sharing my own knowledge about reproduction I would be no better than the others who insist on regailing pregnant women with tales of their own experiences. I did not want to do or say anything that might be interpreted as robbing my sister of her very special and unique pregnancy and birth experience. This was not about me, or my research, this was about her. In addition to this I have had educational opportunities that my sister has not, and I would hate for her to ever feel inferior to me because of this. Even if I wanted to, how could I find a way to educate my sister without rubbing my intellectual success in her face? Worst of all for me, what if passing on my knowledge resulted in conflict between my sister and I? I couldn't bear this, especially at such an important moment of her life.
4. What if, once I began talking, I couldn't stop? What if all I wanted to say was “you may find it hard to get the birth experience you want if you go to hospital”, but it turned into a mammoth sermon about all the things that could go wrong in a hospital birth, a never-ending series of stories I had collected from other women about birth trauma and coerced caesareans? That would not be supportive, it would not even be useful, it could potentially terrify my sister and undermine the confidence she had had to work so hard to build. If there was one thing I had learned from my Joyous Birth friends it was that fear is the pregnant woman's greatest enemy. I was going to keep my mouth shut.
Finally, she knew enough about my work to know I had information if she wanted it. I decided to leave it up to her to approach me if she wanted my help. All of these reasons for being silent may seem justifiable, but in fact they were born out of cowardice. These reasons were excuses, they were insensitive because they failed to recognise my sister's intelligence and strength (I had judged for myself what she could or couldn't handle, and in so doing was behaving just as patronisingly as those who bored her with their own “expertise”). These excuses were selfish and they were unfeminist. I was willing to let another woman be exposed to unnecessary dangers because it was “none of my business”, because it was “her choice”. I was denying my sister the opportunity to make a choice at all, for what choice could she possibly make without knowing what the dangers involved were, or what all her options were, first?
If she had come to me and said she was going to start working in prostitution because she needed a new job and lots of women are doing it these days, would I have stood idly by chanting “it's her choice, it's her life, it's best if I stay out of it”? Never! Because I recognise that a choice like this is made within a context, because I know that if she were fully aware of the nature of prostitution, and the potential for violent physical abuse and emotional trauma, this would not be a “choice” she would make[xiv]. For all my education, for all my politics and research and feminist principles, I failed to see that, like prostitution, giving birth takes place in a world where women are given a limited amount of freedom and minimal control over the conditions of their lives. A world where selling one's body is just another way to make ends meet, and giving birth in a hospital and having surgeons on stand-by has become so normalised that giving birth elsewhere is seen as irresponsible[xv].
The weeks continued to roll by, my sister continued to grow as did her healthy foetus. She bought baby clothes, organised a nursery, and had a baby shower. I continued my silence, and focused on my thesis. I wrote about “false choice” and systems of dominance in which our “choices” are constructed[xvi], refusing seeing the connection between my personal life with my sister, and my political life with my thesis.
“It's not about choice”
“Your sister's having a baby”, one of the Joyous Birth women addressed me at a social function. I nodded my head and felt my stomach tie itself in knots. She was going to ask me how I had supported my sister so far, whether my sister was haivng a home birth, what information had I provided her with? And I was going to be paralysed with guilt because I had said and done nothing, because my sister was going to have her baby in hospital, where she would most likely have a birth full of interventions that increased health risks for both her and her baby[xvii].
I confessed she was going to hospital, and mentioned that I had yet to speak to her about it. I knew I was being deceptive and that I had no intention of talking to my sister about her birth. I had already decided against it, but this woman wouldn't understand my situation. She couldn't understand that my situation was different, that advocating homebirth for others was necessary feminist action, but not in my sister's case.
This woman uttered the most profound statement I had ever heard, the basic contention of my thesis, the underlying problem of all my feminist concerns, something I had said time and again to others in relation to a host of other issues, but never birth. She said “People say it's about choice. It's not about choice! It's about a system that rapes women!” Only last week I delivered a lecture on this very topic[xviii]. It's not about choice! It's about a system that rapes women! A system where women do not have control over what “choices” are considered socially valid. As radical feminist Robin Morgan so poingantly asks: “Who defines the choices among which we choose?”[xix]
I thought about the issues I spoke and wrote passionately about, those feminist issues that were personal but also political. Issues that needed to be “politicised”, by which I mean: they needed to be shown to the nonfeminist world that they are political issues. That choice is never as simple as: I choose this because I want this. That choice is: I choose this because I want this because this is what is economically feasible, socially acceptable, what I know I can choose, etc. As Australian journalist Melinda Tankard Reist asks:
What does so-called “freedom of choice” mean in a society where choices have becom so prescribed, where there are fewer and fewer opportunities to opt out, where it is becoming harder to say “No” to certain technologies [and we might add procedures and practices] and the expectations which automatically flow from their application?[xx]
I had depoliticised birth. Because it was birth, because it was my sister's birth, it wasn't the same as all the other difficult choices a woman must make in her life, this choice was “just personal”, just “her choice”. I ignored the fact that she was choosing it because she didn't know what other options she could choose from, because everyone else was doing it that way, because other options hadn't been presented as legitimate, or smart, or even possible.
The woman from Joyous Birth reminded me that I had a duty of care to my sister. In fact, she added (knowing my feminist principles), I had a double duty of care to my sister, because she was also a woman, my feminist sister. If she was exposing herself to risks that I was aware of and she wasn't, the only responsible, decent, and feminist thing to do was to speak up.
I had unwittingly decided that the best way to support my sister was to keep her ignorant, to deny her knowledge that I had. Silence had become more important to me than my politics, my allegiance to my Joyous Birth friends, and most frightening of all it had become more important to me than my sister's safety. I had convinced myself that this case was different, my sister's situation was different to other women. I had said to myself that I would discuss the homebirth option in any other circumstance, to any other woman, just not this time, because this time it was different, it was personal.
With approximately four weeks to go until the birth, my sister and I spent a wonderful day together. We shopped, we talked, we took photos of her enormous and fabulous stomach, and she asked me to help her with some reading she had relating to the birth. I asked her if she had thought much about the birth and what it would be like giving birth in a hospital. She had an outline of a birth plan she wanted to complete, but there were things she wasn't sure about. She told me she wanted to walk around during the birth, to eat and drink and listen to music, that she planned to focus on the breaks between contractions while she endured the pain, that she really wanted a natural drug free birth, but was afraid it wouldn't be possible because Mum had never done so. She wanted to breastfeed, she didn't want a caesearn, she didn't know what an episiotomy was. I filled in the gaps, and I said “I'm worried that you won't be able to do everyting the way you want to do if you're in a hospital. Hospitals have pretty set routines and they might try to make your birth fit to their routine, and that's not fair”. She thought about this but decided she was confident in her and her mother and her partners ability to communicate what she wanted to the hospital staff. I was wary of this, but said “Alright, just remember that it's your birth, it's all about you, so if you want something or you don't want something, don't be afraid to boss everyone around. Anything anyone wants to do make sure they explain it to you and you say it's okay first”. Later I had a similar conversation with Mum.
I told my sister about doulas, how if she wanted she could have a woman trained in attending births and supporting women during birth, to be there with her and help communicate with the hospital staff on her behalf. She was reluctant to do this, I don't think she saw the point in hiring someone when she felt her mother and partner could do that. While I could see the point, this wasn't my birth. I said having another person there to support you couldn't hurt, and gave her some reading on it and phone numbers of doulas in her area, but told her it was up to her what she did with the information.
My sister's situation was not “different”, neither was it purely “personal”. Just because she wasn't an academic, or a homebirth advocate, just because she was my sister, did not mean that she was any different from other pregnant women facing the challenges of giving bith in a particular socio-political and medicalised system. My sister's situation was not simply a matter of “choice”, just as no woman's birth is simply a matter of choice. All births are personal, but they are also political. Women do not necessarily control the circumstances in which they give birth, many of their choices are dictated to them based on the routinisation of a particular practice, a lack of knowledge or understanding about alternative options, and a lack of support for some “choices” from family, friends, and society more widely. In the words of feminist philosopher Hilde Hein: “It is a fallacy of liberal individualism that any behavior is purely personal. Whatever we do takes place in a social context and has an effect upon other human beings.”[xxi]
What I should have learned from political analysis, I learned from personal experience the personal birth is political, and we cannot begin to support our sisters until we accept this.
[i] Jocelyn Scutt, “The Personal is Political”, in Diane Bell and Renate Klein eds Radically Speaking: feminism reclaimed, North Melbourne: Spinifex, 1996, p.102.
[ii] Sarah Eaton, “The Medical Model of Reproduction: a path to artificial wombs”, New Antigone, vol. 1, no. 1, October, Spring, 2005, pp.28-37, http://www.newantigone.com/oscommercedownload/the%20medical%20model%20of%20reproduction.pdf, last accessed 19 April 2006. See also Sarah Eaton, “The Medicalisation of Reproduction: a matter of trust”, Joyous Birth: Australia's birth information and support website!, http://www.joyousbirth.info/articles/medicalisation.html, last accessed 19 April 2006.
[iii] Sazz Eaton, “Aunty Sazz the Social Critic”, Sazz's Blog, (http://sazziesblog.blogspot.com/2005/11/aunty-sazz-social-critic.html, last accessed 19 April 2006.
[iv] See http://www.joyousbirth.info/
[v] Marsden Wagner MD MSPH, "Ultrasound: More Harm Than Good?" Midwifery Today 50,no. Summer (1999). http://www.midwiferytoday.com/articles/ultrasoundwagner.asp?q=ultrasound. Last accessed April 14, 2006, Dr Sarah Buckley, “Ultrasound Scans: Cause for Concern”, Dr Sarah Buckley MD: gentle birth gentle mothering, http://www.sarahjbuckley.com/articles/ultrasound-scans.htm accessed 20 April 2006, Sarah Buckley “Weighing the Risks: What You Should Know about Ultrasound”, Mothering magazine, issue 102, Sept-Oct 2000, http://www.mothering.com/articles/pregnancy_birth/birth_preparation/ultrasound-risks.html last accessed April 20 2006. J.P. Newnham, Evans, S.F., Michael, C.A., Stanley, F.J., & Landau, L. I. (1993). Effects of Frequent Ultrasound During Pregnancy: A Randomized Controlled Trial. The Lancet, 342(Oct.9), 887-891, M.P. Hande, & Devi, P.U. (1995). Teratogenic effects of repeated exposures to X-rays and/or ultrasound in mice. Neurotoxicol Teratol (NAT), 17(2), 179-88, Devi, P.U., Suresh, R., & Hande, M.P. (1995). Effect of fetal exposure to ultrasound on the behavior of the adult mouse. Radiation Research ,141(3), 314-7, J.D. Campbell, Elford, R.W. & Brant, R.F. (1993). Case-Controlled Study of Prenatal Ultrasound Exposure in Children with Delayed Speech. Canadian Medical Association Journal, 149(10), 1435-1440. See also, Barbara Katz Rothman, The Tentative Pregnancy: prenatal diagnosis and the future of motherhood, London : Pandora, 1988, and Melinda Tankard Reist, Defiant Birth: women who resist medical eugenics , North Melbourne: Spinifex Press, 2006.
[vi] Janet Fraser “Home is Where the Heart is” Joyous Birth: Homebirth Information Sheet, http://www.joyousbirth.info/homebirth.html last accessed 20 April 2006, Jenny L. Grienbenow, “Homebirth: Q and A” Joyous Birth: Homebirth Questions and Answers, http://www.joyousbirth.info/articles/hbqa.html last accessed 20 April 2006. “Home Birth” editorial, British Medical Journal, vol. 313, 23 November, 1996, 1276-1277. Albers Leah L. Albers, CNM, Katz Vern L, “Birth setting for low-risk pregnancies. An analysis of the current literature.” Journal of Nurse Midwifery, vol. 36 no. 4, July-Augast,1991, pp.215-20.
[vii] Marsden Wagner MD, MSPH, “Fish Can't See Water: the need to humanize birth in Australia”, Birth International, last updated 4 December 2002, http://www.acegraphics.com.au/articles/wagner03.html, last accessed 20 April 2006. Sheila Kitzinger, “Obstetric Metaphors and Marketing”, Birth, vol. 26, no. 1, March, 1999, p.55, see http://www.sheilakitzinger.com/ArticlesBySheila/BIRTH_March1999.htm accessed 20 April 2006.. Ronnie Falcao, LM MS, “Midwifery Advocacy and Statistics”, Gentlebirth.org, http://www.gentlebirth.org/archives/advocacy.html, last accessed 20 April 2006. Sakala, Carol, “Midwifery care and out-of-hospital birth settings: how do they reduce unnecessary cesarean section births?” Social Science & Medicine, vol. 37, no. 10, November, 1993, 1233-50.
[viii] Johnson, Kenneth and Betty-Anne Daviss, “Outcomes of planned home births with certified professional midwives: large prospective study in North America.” British Medical Journal, vol. 330, no.7505, 18 June, 2005, p.1416. Alison Macfarlane, McCandlish, Rona, Campbell, Rona, “Choosing between home and hospital delivery. There is no evidence that hospital is the safest place to give birth”. British Medical Journal, vol. 320, no. 7237, 18 March, 2000, p.798. Olsen, O. “Meta-analysis of the Safety of Home Birth.” Birth. vol. 24, no. 1, March, 1997, pp.4-13. Sheila Kitzinger, “The Politics of Birth”, Birth, vol. 30, no. 3, September 2003, p.203. Janet Fraser, “Hopsital Birth” Joyous Birth: Hospital Birth, http://www.joyousbirth.info/hospital.html, last accessed 20 April 2006.
[ix] For a feminist analysis of the functions women serve within patriarchy see Julien S. Murphy, “Is Pregnancy Necessary? Feminist Concerns About Ectogenesis,” Hypatia, Vol. 4, No. 3, Fall, 1989, pp. 66-84. Murphy suggests that women’s value within patriarchy can be summarised as five functions: reproduction, serving men sexually, stroking men’s egos, providing a cheap source of labour, and performing society’s major nurturing roles, of which she includes: motherhood, nursing and secretarial work.
[x] See Adrienne Rich, Of Woman Born: motherhood as experience and institution, London: Vigaro, 1977, pp. 41-83, 110-127. Jeffner Allen, “Motherhood: the annihilation of women”, in Joyce Trebilcot ed. Mothering: essays in feminist theory, New Jersey: Rowman and Allanheld, 1983, pp.331-330. Azizah al-Hibri, “Reproduction, Mothering, and the Origins of Patriarchy,” in Joyce Trebilcot ed. Mothering: essays in feminist theory, New Jersey: Rowman and Allanheld, 1983, pp.81-93. Janice G. Raymond, Women as Wombs: reproductive technologies and the battle over women’s freedom, North Melbourne: Spinifex, 1995, pp.29-75.
[xi] Women exist as a cheap labour force. See Jan Jindy Pettman, “Gender Issues”, in John Baylis and Steve Smith eds The Globalization of World Politics: an introduction to international relations, Oxford: Oxford University Press, 2005, pp.675-79.
[xii] Women exist to spend energy on others See Janice Raymond “Of Eggs, Embryos and Altruism,” in Patricia Hynes (ed.) Reconstructing Babylon: essays on women and technology, London: Earthscan Publications, 1989, pp.83-91.
[xiii] To nuture others. See M. Rivka Polatnick “Why Men Don’t Rear Children: a power analysis”, in Joyce Trebilcot ed. Mothering: essays in feminist theory, New Jersey: Rowman and Allanheld, 1983, pp.21-40.
[xiv] Melissa Farley ed. Prostitution, Trafficking and Traumatic Stress, New York: Haworth Maltreatment and Trauma Press 2003, Sheila Jeffreys, The Idea of Prostitution, North Melbourne: Spinifex, 1997, Evelina Giobbe, “Prostitution: buying the right to rape”, in Ann W. Burgess ed, Rape and Sexual Assault III: A Research Handbook, New York: Garland Press. 1991, Evelina Giobbe, “Confronting the Liberal Lies about Prostitution”, in Dorchen Leidholt, and Janice Raymond, eds, 1990). The Sexual Liberals and the Attack on Feminism, New York: Pergamon Press, 1990.
[xv In Robyn Rowland, Living Laboratories: Women and Reproductive Technologies, Australia: Sun, 1992, p. 129. A recent example of women being conceptualised as vessel's for others appeared in an online article urged young women to live healthy lifestyles, not for their own sake, but because they are all potentially pregnant bodies (see Michael Maiello “Sneak Our of Work Right Now” Forbes http://www.forbes.com/2006/05/20/laziness-working-good_cz_mm_06work_0523lazy.html last updated May 23 2005 3:00 PM ET, accessed May 29 2006.
[xvi] Sarah Eaton, “False Choice: The Limits to Rights Discourse” Guest Lecture in Ethics, Biotechnology and Genetics: current issues in bioethics, School of Philosophy and Bioethics, Monash University, Clayton, Melbourne, 28 March 2006.
[xvii] O. Olsen, “Meta-analysis of the safety of home birth”, Marjorie Tew, “Do obstetric intranatal interventions make birth safer?”, British Journal Obstetrics and Gynaecology, vol. 93, no.7, July 1986, pp.659-74, H.C. Woodcock, A.W. Read, C. Bower, F.J. Stanley, and D.J. Moore, “A matched cohort study of planned home and hospital births in Western Australia 1981-1987” Midwifery, vol. 10, no. 3, September, 1994, pp.125-35, A. Mark Durand, MD, MPH, “The Safety of Home Birth: a farm study”, American Journal of Public Health, vol. 82:, 1992, pp.450-452.
[xviii] Sarah Eaton, “False Choice: The Limits to Rights Discourse”.
[xix] Robin Morgan Rowland, Living Laboratories, p.279.
[xx] Melinda Tankard Reist, Defiant Birth: Women who Resist Medical Eugenics, North Melbourne: Spinifex, 2006, p.7.
[xxi] Hilde Hein, “Sadomasochism and the Liberal Tradition”, in Robin Ruth Linden, Darlene et al. Against Sadomasochism: A Radical Feminist Analysis, London: Frog in the Well, 1982, pp. 83-89.