Interview with Birth Activist Janet Fraser

Conducted in July 2006

Janet Fraser is a mother, homebirth advocate, and radical feminist. Janet's experience of abuse during childbirth led her to establish the formidable force that is Joyous Birth, a network of (predominantly) women seeking to transform pregnancy and childbirth into joyous and empowering experiences for women, as they should be! Janet was kind enough to give me some of her time, despite her hectic schedule of raising a two year old, running a national support and information network, administrating and moderating a number of online forums, and being only moments away from the birth of her second child.

How did Joyous Birth come into existence?

After my son was born via caesarean (transfer from a planned home birth in 2003) I found that there was no real support for me and figured other women must be having similar experiences. I had noticed as I planned for my home birth how there were informal friendship groups across Melbourne comprised of women who supported one another to birth at home but there was no formal group which supported or promoted home birth. There was also no support for women who transferred to hospital during a home birth which meant my traumatic experience of hospital was unsupported by midwives or other home birthing consumers around me. My experience of the worst of hospital staff and their behaviour combined with what I already theoretically knew about the poor outcomes associated with obstetric care led me to put together a group which would provide the kind of information women needed to find that there are better ways to birth than through institutions.

What is the problem with birthing practices in Australia, or the industrialised world, today?

This isn't something which can be answered quickly or glibly. A few main points are as follows:

1. A complete lack of feminist input into birthing practices mean that women's rights in hospitals and birth centres are almost completely lacking.

2. Despite reports and inquiries ad infinitum at every level of government, all of which point out the appalling failures in our maternity system, appropriate reform is never implemented.

3. The haphazard way health is administered in Australia means that there is no continuity between state and federal governments to implement the much needed change.

4. In the absence of feminist input and critique, a surgical culture has been allowed to develop which sets the agenda and discourse around birth in Australia in a way which normalises surgeons as care providers and women as powerless recipients of their skills.

5. Groups like the AMA (Australian Medical Association) and RANZCOG (Royal Australian and New Zealand College of Obstetrics and Gynaecologists) are constantly unchallenged in our media so that even the most outrageously untrue statements with no basis in fact are left to set the tone of public debate while evidence based information is derided and ignored.

6. Those same groups, along with other medical groups across the country, have a deliberate anti-home birth agenda despite the overwhelming worldwide evidence that home birth produces the best outcomes for women and babies.

How big is Joyous Birth today?

Our online forums grow at roughly 1.5 members a day. We've been going since March 2004, been an online forum since May 2005 and today I noted we have 460 members from across Australia and beyond*.

What have you personally got out of Joyous Birth?

A beautiful way to join my politics with real action, a great deal of personal support, and many dear and true friends!

What, would you say, others get out of their involvement with Joyous Birth?

One of the first things many women say is, "I thought I was the only one traumatised by my hospital experiences and now I know I'm not!" Other women who've had wonderful home births are thrilled that they have a place where their births are honoured and enjoyed and not denigrated as luck or irresponsibility.

What are your hopes for Joyous Birth in the Future?

As we grow larger and are shortly to incorporate, we reach more women and have more resources both online and at our gatherings which can support women to birth safely and in ways which evidence and experience show are just marvelous! We have grown already from a first meeting of about 7 women in Melbourne to gatherings now in Sydney, Hobart, Brisbane, Adelaide, Perth and still also in Melbourne. Ultimately we are about a lot more than birth because birth is only a reflection of women's status in a society. Once we provide the information and support women need to make the necessary changes on a personal level it also opens up a whole world of empowerment for those women.

Are you saying that; by realising their options in birth (beyond the medicalised status quo) women become empowered, and this has a flow on effect into other areas of their lives?

No, I'm saying it round the other way. Women who realise that their lives are limited in other ways can become equipped to work through that and then apply that same knowledge and those same skills to choosing birth options which don't limit them. Women whose lives are constrained in every other way are not suddenly going to make a leap into birth being a different scenario, they can only take those constraints with them. Remove the constraints and birth by necessity becomes different.

Birth education cannot be solely about the mechanics of labour and birth but in a poor system like Australia's must honestly come to grips with the reality of what happens to women who birth with strangers in institutions. Just because this is the norm doesn't mean it's acceptable.

Finally, for readers who may not be familiar with this, can you elaborate on exactly what that reality is?

Worldwide, birth in institutions is limited by narrowly defined parameters of "normal" which are set by surgeons using outdated notions with no basis in evidence. So most women see a different person at each appointment which by necessity has to be brief because there are so many women and so few appointments. They form no relationship with their supposed careproviders who are meant to be supporting them through some of the most vulnerable times in their lives.

The nature of hospitals means that they run much more smoothly for the staff if protocols can be adhered to regardless of the needs or wishes of the client, so women are frequently fooled into thinking that they have no right to say no to what happens to their bodies. Sadly saying no doesn't necessarily result in what the woman desires anyway, as the deeply paternalistic nature of maternity hospitals means the staff feel empowered to just insist or force despite a woman's clearly stated wishes. No does NOT mean no in our maternity system.

The supposed "choices" offered by staff to pregnant or labouring women are couched in terms like "I just need to..." or "You have to..." rather than honestly speaking to women as if they are adult consumers with a right to decide what happens in their birth, "How do you feel about...?"

Women frequently go into hospitals and birth centres pacified into feeling they have control only to realise when it's too late that they have little or no control over their environment and what control they have is entirely dependant on the quality of the staff available to them that shift. No wonder our breastfeeding rates are so low and our postnatal depression rates are so high!

Our rates of post traumatic stress are not yet being counted as they are in other countries such as the UK, but from the experiences of women in Joyous Birth they're clearly very high. Loss of control over one's body leads to post traumatic stress after birth in the same way that loss of control during rape leads to post traumatic stress. We deceive women when we tell them that hospitals and birth centres are there for them and will cater to their needs. Women are so used to this deception and to having no say over their own bodies that most of us accept this loss of control as normal and even when it has devastating consequences we don't speak out against it.

We are told that "birth" is traumatic and to blame birth and our supposedly defective bodies when in reality it is trying to birth while strangers violate your body that is, unsurprisingly, traumatic. If "birth" were traumatic, home birthing women who experience just birth and no interventions would be dropping like flies from postnatal depression and post traumatic stress disorder, right? Postnatal depression is almost unknown in home birthing populations, and likewise post traumatic stress disorder.

Interventions regardless of women's individual circumstances have now become the norm in institutions around the world. Conveyor belt maternity services are convenient for administrators and staff and easily maintained in the light of women's broader experiences of life in a patriarchal society.

Thanks to Janet's activism, you (or someone you love) don't have to be a victim of poor reproductive care and the subsequent trauma from such treatment. Know your options!

To Find out More:
Joyous Birth Website
http://joyousbirth.info/

Joyous Birth Forum
http://www.joyousbirth.info/forums

Scroll down and watch the sidebar for Joyous Birth Articles. Check out the "childbirth" category for a section entitled "women talk about birth":
http://joyousbirth.info/childbirth.html

The article categories also include "birth trauma":
http://joyousbirth.info/birthtrauma.html

And "for women"
http://joyousbirth.info/forwomen.html

Janet's Birth Story
http://www.joyousbirth.info/forums/showthread.php?t=12

*In 2008 Joyous Birth has over 1000 members

"Wild" Birth

Wild Politics by Susan Hawthorne, critiques globalisation and the international political economy. While reading this book it occurred to me that Hawthorne’s definition of “wild politics” provides a useful framework for birth activists seeking to define birth: Un-medicalised. Un-industrialised. Pure. Natural. Powerful. Woman’s. Wild!

Hawthorne adopts Kate Millett’s definition of politics, as Millett outlined it in her 1972 classic Sexual Politics: “power-structured relationships, arrangements whereby one group of persons is controlled by another” (in Hawthorne 2002, 21).  Reproduction is a political issue, particularly in the contemporary setting where certain medical practitioners such as obstetricians enjoy power over birthing women (whose pacification is made evident by the fact that they are referred to as "patients" in this setting) and over other health care providers such as midwives.

Hawthorne’s use of the term “wild” also offers something useful to advocates for empowered birth. Hawthorne writes:

When I use the world “wild” I mean to capture the whole range of meanings, from wild as in angry or vicious; wild as in diverse, wide-ranging, rebellious; and wild in the way it is used idiomatically, comparable to cool, neat: wild, outside the barriers of control by the dominant party (Hawthorne 2002, 24)

Birth activists, such as myself, are angry that many women are treated like objects during pregnancy and childbirth. Some women recovering from traumatic birth experiences are also angry that they have been abused by the system that promised it would meet their needs. Feminist birth activists and mothers alike, are angry at the oxymoron of “care provider” in the current maternity system, where so many of our so-called care providers turn out to be the perpetrators of abuse.

Birth activists recognise the importance of diversity. Each woman and each birth is unique, and therefore each woman has a different set of needs and desires for her birth. Natural birth activists know that the current medicalisation of birth means that diversity is ignored. In fact, diversity threatens the system, because the system depends on uniformity – processing women and their births according to protocol and schedule. Women need a maternity system that is flexible and all-inclusive, that can actually meet the needs of women and their babies, even when those needs fall outside of a medical understanding of birth (for example the need for privacy, the need to feel safe and protected and loved, the need to do nothing and simply let birth be as long and as painful as it is).

Birth activists rebel against the medical maternity system that demands women submit to the tests, procedures, technology, and protocols of medical professionals. Natural birth activists do not believe that birth should be neat or controlled; it should not be forced to fit into a hospital timetable, and women’s choices should not be controlled by the medical model, which is the dominant party.

Hawthorne also considers the meaning of “wild” in relation to “wild animals” and “wildlife”. She states:

Removing a wild animal from its locale to, say, a zoo, in order to preserve it, moves it away from its status as “wild”. Even when zoos attempt to reproduce “environments”, they can never replicate the local ecology and its relationships for the wild animal (Hawthorne 2002, 22).

This can equally be said of women during birth. Rounding up birthing women into a hospital in order to “help/improve/assist”, removes them from their wild nature. It domesticates birthing women. Even when institutions such as birth centres attempt to reproduce “wild” conditions they can never truly create the natural environment and its relationship to the woman in labour. The woman has been removed from her natural habitat, her home.

In her natural habitat the pregnant woman is comfortable, she has a special understanding and appreciation for how the ecology of her home works. She is an agent of her surroundings, meaning she has control. By removing her from that context and putting her into another building (and an institution) she is robbed of that comfort, and her birthing experience becomes bogged down in having to learn a new system and environment as she births.

During birth she may be forced to think about more than just her birth experience, she may consider the staff around her (as well as the other women giving birth there). She may consider not getting in the staff’s way, not inconveniencing them, she also will deal with staff change-overs and learning to adapt to each new person. The very fact that she is in an institution that has different tools in it means that she has to consider those tools – will she allow this, or that? What will the consequences be if she refuses this or asks for that? Her energy is spread thin across a number of issues, rather than being focused intently on herself, her body, her baby, her birth. These are not issues she would have to worry about in her own home/habitat where she would not have strangers or their foreign objects or tools.

No matter how hard an institution may try to replicate the natural habitat, with nice hotel-looking maternity suites, it is not the woman’s home. Her wild birth experience has been captured, and civilised by medical hunters.

Birth can be seen as an issue of wild politics. Birth itself is wild, in the sense that it is natural, and ultimately beyond the complete control and comprehension of humanity (like death, and much of life). Women, like nonhuman wildlife, have been captured and domesticated in birth. Birthing institutions such as hospitals and birth centres are zoos for women in labour. But feminists, mothers, and birth activists alike are turning their rage into productive political ends. They are staying at home to give birth, setting up information and support networks to increase other women's awareness. And in so doing, these women are sending a strong message to the current maternity system: we will not tolerate women's bodies and their birth experiences being controlled within the parameters of your dominant system! We must birth wild and free. Just as birth should be.

Source

Hawthorne, Susan (2002) Wild Politics: feminism, globalisation and bio-diversity, North Melbourne, Spinifex Press. http://www.spinifexpress.com.au/non-fict/wp.htm

Birth Servants: Mortal Ilithyiai

A birth servant is a professional birth attendant, often referred to as a "doula". The word "doula" is derived from the Greek word for "female servant" or "handmaiden" (Kitzinger 2005: 156. See also; Targett 2006: 144; England & Horowitz 1998: 207; * ). Her role involves providing emotional and physical support to a family during pregnancy, birth, and the weeks after birth.

A birth servant is employed and paid by the family as a private birth attendant (*). She has no medical training and cannot give medical advice or administer any medical treatment, her role is purely supportive. In her book A Labour of Love (which is endorsed by the Australian College of Midwives) Gabrielle Targett states:

A doula is often referred to as the "missing link" in maternity care, because the medical care providers often don't have the time to offer the sort of care and comfort that a doula can, as they may be looking after other women at the same time. As well as this, medical staff often can't provide massage for the labouring woman for hours on end, or simply be in the birthing room as emotional support. p.145.

Today's birth servants are what midwives of old were: women who are with women during birth. They occupy a totally different space to those at birth with medical training, they're focus is not on all the things that can go wrong in birth. Rather the birth servant's focus in on serving the woman in labour, making her as comfortable as possible and assisting her in getting the birth experience she wants for her and her baby:

Typically, a Doula will meet with the family on a number of occasions during the pregnancy to build a strong and trusting relationship. The Doula listens to the mother and empowers her to seek out any relevant information so that she can make informed birth choices. When the woman goes into labour she will contact her Doula and they will arrange to meet at the hospital [sic]. The Doula is not responsible for any medical care, as this is entrusted to the hospital staff [sic]#. She will undertake many comfort measures [as] requested by the mother during her antenatal consultations. The Doula will then remain with the woman throughout the labour and into the immediate post-partum period, until the mother feels comfortable and ready to rest with her newborn. The Doula is a professional support person who understands the processes of labour and nurtures the mother, enabling her to have the optimum birth experience. (*)

For some pregnant women a birth servant is seen as superfluous because they assume they will get all the support they need from their partner, or a friend, or a relative, or the staff at the institution where they have chosen to birth. But there is a vast difference between the kind of support a birth servant will bring to your birth experience compared to any of these people.

Birth servants provide women with continuity of care. Unlike an obstetrician, or a nurse, or hospital midwife, a birth servant provides constant support to the labouring woman during birth, as well as ongoing support in the weeks after birth. Research in the United States shows that nurses only spend 6% of their time providing support to women in childbirth (in Kitzinger 2005: 156). No matter how supportive they might like to be, they simply do not have the time.

The importance of continuity of care during birth cannot be underestimated. Kitzinger (2005: 157) writes:

There is strong research evidence to show that continuous support in childbirth reduces the use of pain-relieving drugs and lowers the epidural rate. It makes stimulation of labour with artificial oxytocin less likely, shortens labour, reduces the likelihood of forceps or vacuum extraction, cuts the caesarean section rate, reduces the chance that the baby may have health problems after birth and need to go to the special care nursery, reduces fever and infection in the mother and bleeding after childbirth, and reduces levels of anxiety and postpartum depression. Mothers have a more positive experience of birth and feel more in control. Having a doula increases the chances of breastfeeding successfully, even when there has been no discussion about breastfeeding.

Throughout pregnancy the birth servant and expecting family have regular meets to get to know each other, exchange important information (birth servants each have their own set of resources such as books, CDs, DVDs etc. which they loan to their clients as part of their services), and plan for the birth ahead together. Individual birth servants may have additional skills that the expecting family can benefit from, for example one of the birth servants I hired to attend my partner and I during our freebirth was a bach flower essence practitioner. Another example would be formal training in massage or breastfeeding consultancy/counselling.

While a supportive partner is a fantastic asset to a woman during childbirth he or she could become a liability once labour really kicks off. It can be hard work for someone who cares about the birthing woman intimately to watch her endure the natural challenges of labour, and it is not uncommon for these loved ones to suggest unnecessary interventions in order to ease their own concerns about the woman they love. But a birth servant does not replace the partner/father in birth, Targett (2006: 145) writes:

A concern that fathers often have when a doula has been asked to attend a birth is, "What is the doula's role and where do I fit in?" In no way does a doula replace the partner - if anything a doula is present to reassure the partner that the birth is going how it should be and to keep the partner informed and educated about what is going on. This ultimately helps fathers to feel more relaxed and calm about seeing their partner in labour.

She quotes one father's reflections on having a birth servant present at the birth of his child:

Initially I was reluctant to have an "outsider" at our birth. In hindsight, however, I am incredibly grateful to have had Gaby's intuition, skill, sensitivity and support, which she brought to every aspect of the birth. It took an enormous amount of pressure off me and allowed me to enjoy the whole experience in a way I don't think would be possible had we not had a doula. (Targett 2006: 145).

One study found that hiring a birth servant actually strengthened a couple's relationship (in England & Horowitz 1998, 209). 71% of couples in the study who hired a birth servant felt that their relationship had improved, and 85% of the women reported increased satisfaction with their partners six weeks after the birth (in England & Horowitz 1998: 209).

Unlike a sister, friend, or mother, a birth servant is hired specifically to serve the birthing woman as she wishes to be served. When allowing a close friend or relative to enter the birth space labouring women run the risk of their support people bringing their personal attitudes, experiences, and agendas with them, and the possibility that they will push these onto her. For example, I have heard of instances where a close friend or relative has acted as a support person and has previously had caesareans or used drugs in their own births and undermined the woman in labour's attempt to have her own natural birth by suggesting that she do the same as they did. A birth servant has training in how to be the best possible support to the birthing woman, and part of this training is learning to put her own agenda aside and focus entirely on assisting the woman get the birth that she wants, not the birth that the birth servant herself had. With a birth servant your birth is all about you, not your mother, sister, or friend!

Furthermore, birth servants have experience within the current maternity system. Pam England and Rob Horowitz said it best when they wrote of a loved one: "He may be smart and trustworthy, you may love him, but in the Himalayas you'd both be a lot better off with a Sherpa!" (England & Horowitz 1998: 207). Birth servants know birth and they are used to working with and within the contemporary birthing culture (unlike a grandmother or a partner). The sad reality is that "[currently the system] is too focused on the needs of the hospital rather than women" (Kitzinger 2005: 162). For example birth servants are aware of the time constraints put on labour and the methods that might be used to speed things up when it isn't medically necessary. Imagine watching someone you love endure labour for hours and then a medical professional suggest things could be going better or faster and telling you that if it were them they'd opt for intervention a), b), or c). Many people aren't aware of the massive power imbalance they will be confronted with when they enter a medical institution for birth, and how scary it can be (particularly after many hours of no sleep!) to have an expert suggest things could be going better. It's during these times that a birth servant is the greatest asset!

A birth servant can eliminate some of the fear and anxiety for both the birthing woman and her support team by asking the hospital or birthing staff to give them space and time to discuss all the options and make a decision when the birthing woman is sure it is the right thing to do (as opposed to as soon as when it is suggested). Even though she can't make the decision for the birthing woman, or recommend which option she should take, a birth servant will be able to help her discuss all her options and give her information other people present at the birth might not be aware of, or have neglected to share. England and Horowitz (1998: 207) summarise this aspect of a birth servant's role thusly:

When procedures or drugs are being considered, the doula helps parents become an active part of the decision-making process by teaching them to ask the "right" questions. Without adding her own agenda, the skilled doula assists parents in making informed decisions.

My partner and I learned one such technique from the very experienced birth attendant Rhea Dempsey at one of her birth workshops. Dempsey suggested that partners take a flash card with them with the following written on it:
Benefits?
Risks?
Alternatives?
Now?

She recommended that when any interventions where suggested, to ask the following questions before making a final decision: what are the benefits and risks of the intervention, what the alternatives are and when the decision must be made? Having a birth servant present to help answer these questions and provide additional information can help a couple reach a decision (for example, a birth servant may be aware of alternative options that others present at the birth are not).

To really understand the difference a birth servant can make to your birth experience just look at the statistics. Having a birth servant present at birth has shown to:

• Reduce caesarean rates by 50%
• Reduce epidural request rates by 60%
• Reduce induction by oxytocin by 40%
• Reduce analgesia use (pethadine hydrochloride) by 30%
• Reduce forceps delivery rate by 40% (Targett 2006: 144, *)

The presence of a birth servant has also been shown to reduce the length of some women's labours by a couple of hours! (see England & Horowitz 1998: 209).

Given the many forms of support birth servants offer, and their power to ease women's discomfort during birth, it can be said that birth servants are mortal birth goddesses, or Ilithyiai.

birth servant at work

Resources

Rhea Dempsey. Embracing the Intensity: Transforming the Pain. Workshop. Melbourne. December 2007.
Pam England and Rob Horowitz. Birthing From Within: An Extra-Ordinary Guide to Childbirth Preparation. Albuquerque: Partera Press. 1998, pp. 207-
Sheila Kitzinger. The Politics of Birth. Edinburgh. Elsevier. 2005, pp.155-164.
Gabrielle Targett. A Labour of Love: An Australian Guide to Natural Childbirth. Fremantle. Fremantle Arts Centre Press. 2006, pp.136-148.
Marsden Wagner. Fish Can't See Water: the need to humanize birth in Australia. 2000. Available from: http://www.acegraphics.com.au/articles/wagner03.html

Online Information
http://www.findadoula.com/Parents/Aboutdoulas/what.htm
http://www.gentlebirth.org/archives/doulnots.html
http://dialadoula.com.au/resources-for-parents.html
http://www.australiandoulas.com.au/
http://www.findadoula.com.au/
http://www.bellybelly.com.au/articles/birth/doula-revolution-doulas-birth
http://www.joyousbirth.info/forums/showthread.php?t=3023

Take a glance at the sort of things doulas learn in their training:
http://birthingwisdom.com.au/training.html
http://dialadoula.com.au/doula-training.html
http://www.childbirthinternational.com/birth_doula/syllabus.htm


* This information was originally obtained from a website that (unfortunately) is no longer available, which was http://www.doulasaustralia.com/
# In the case of homebirth this role is entrusted to a midwife and the birthing woman, and in the case of a freebirth the birthing woman, and to a lesser extent her partner, assume this role totally.

A Matter of Trust

I wrote the following article during my first year as a PhD student. It is an adapted version of an oral presentation I gave at university, which was subsequently published on the Joyous Birth website. For more of Joyous Birth's articles click here!

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Imagine that you or a loved one has been trying to have a baby for years and you have just discovered you or she is pregnant. This is one of those magical moments in your life, a very personal and sacred experience. What images come to mind? Forty weeks of excited bliss? Bonding with your closest friends as you witness those foetal kicks?

And what of the birth? Do you picture those first few minutes after the child has been born? When you finally have the opportunity to breathe in the smell of that new baby? These are among the greatest parts of the reproductive process, and yet in our society we loom dangerously near to removing some of these from reproduction entirely. For many women the actual experiences of pregnancy and childbirth are riddled with feelings of fear, doubt and anxiety. Many women are not given the opportunity to meet their child in those first few moments of her life. How can this be happening? This is the result of a process I refer to as the medicalisation of reproduction.

In this process pregnancy and childbirth are perceived as medical problems rather than natural elements of the human life-cycle.[i] Technological intervention is then employed to “treat” pregnant women. Frequently individual knowledge and experience become devalued and replaced with the “expertism” of professionals.[ii] You may well ask: what’s wrong with this? Professionals know what they’re doing, surely it is safer for individuals to put their trust in experts when having a child? The reality is; experts do not always know best. This paper will focus on instances when professional know-how has been acted upon at the expense of the individual. These instances are not as rare as one would hope, which is not to say that doctors are inherently untrustworthy, or that there is never reason to call upon professional assistance during the reproductive process. Rather I hope to challenge popular beliefs that technological intervention is always necessary to pregnancy and childbirth. I wish to expose the negative implications that these beliefs can have for doctor-patient relationships. I want to demonstrate how the medicalisation of reproduction encourages a climate of distrust between individuals and the professionals they have been told they can trust.

When considering the relationship between medical professionals and pregnant women it is evident that trust is bound to reciprocity. It is difficult for trust to exist between a medical professional and a patient if it is not mutual. Indeed in the medicalisation of reproduction an experts lack of trust in her or his patient, can lead to an abuse of their patients trust. One example of this takes place if a doctor fails to give weighty consideration to a pregnant woman’s concern about having a particular procedure and goes forth without her explicit consent, which, as shall be explored in greater detail shortly, has been the case for some patients.

Individuals have to place a certain degree of trust into members of the health services, such as general practitioners, nurses, obstetricians, and midwives, in order for these professionals to carry out their work effectively. However, it appears that this level of trust is continually rising to the point where individuals are expected to float passively through their experiences of pregnancy and childbirth accepting guidance as gospel. [iii]

This phenomenon can be attributed to an emerging culture of “expertism”.

Fundamental to the medicalisation of reproduction is an elitism that declares the patient’s knowledge inept. Within the politics of reproduction it appears that there is only a finite amount of trust. That is: as more and more trust is placed in reproductive experts the less there is in the patient’s knowledge. This, once again, begs the question: is placing trust in an “expert” necessarily a negative factor? Surely a professional who has studied the human reproductive system, and who devotes forty plus hours a week to observing and advising pregnant women, can be trusted to know what is best for their patient? This knowledge counts for very little to the pregnant woman whose voice is either ignored or dismissed, or the patient whose bodily integrity is compromised in the name of clinical routine. As one woman recalling her traumatic birth experience writes:

Why did I ever trust an [obstetrician] with a yacht called “Bit of Fluff”????... He asked me to get on the bed and proceeded without my consent or any prior warning to “strip and stretch my cervix” I exclaimed “Owww!” to which he replied, “Oh yes, I just did a strip and stretch. We should see this baby within 24 hours,” I was horrified and scared.[iv]

And another woman stated:

A registrar did an internal and announced, [“]you’re one centimetre dilated and I’ve stripped your membranes[”](excuse me, don’t you ask for consent before doing a procedure?).[v]

In both these examples a procedure was carried out without the patients consent or even her knowledge. These women know better than most that an obstetrician’s understanding of the body’s mechanics means little to a patient without trust. Implicit to both these examples is the assertion that reproductive experts do not believe their patients can be trusted to know what is in their own interests. The pregnant woman may not be a highly trained scientist, as such it is assumed that by entering a relationship with a medical professional she has given implicit consent to whatever procedures that professional deems necessary. Her explicit consent and sometimes even her awareness are inconsequential.

This distrust of the pregnant woman has been demonstrated by instances where women have been either physically forced or legally constrained to undergo certain medical procedures.[vi] In her article “Foetal rights: more than a mother can bear?”[vii] Journalist Louise Chunn cites a case in the United States where a woman was shackled to an operating table and forced to have a caesarean section against her will because it was thought by medical experts to be in the interests of her foetus.[viii] Sadly more than one woman can relate to this story. Throughout Australia today more and more pregnant women are being coerced into having caesarean sections. While The World Health Organisation stipulates that “There is no justification in any specific geographic region to have more than 10 – 15% caesarean section births”[ix], 30% of all births in Australia are caesarean births.[x] The Royal Women’s Hospital March 2005 statistics revealed that caesarean births made up 45% of all births within that institution in one year.[xi]

A recent article in The Age would have readers believe that pregnant women are demanding these high-risk, invasive medical procedures against their doctor’s wishes. However it also states that only between 5 and 10% of women giving birth throughout the entire country request caesarean sections.[xii] How does The Age account for the remaining 35 to 40% of women giving birth at the Royal Women’s Hospital?

There are times when caesareans are a necessary procedure to ensure the health of the pregnant woman and her child. I do not wish to suggest that caesareans should be outlawed or that no caesarean has ever saved a patients life. However, there is a particularly high rate of caesarean births in Australia presently. I believe it to be a suspiciously high rate, and I attribute this to the medicalisation of reproduction.

When aware of the emotional and physical risks associated with caesarean births for both mother and child, most women would favour the vaginal option. As pregnancy and childbirth are increasingly conceptualised as illnesses to be dealt with by technological intervention, vaginal births are becoming a right women must attempt to claim as opposed to the accepted norm. The following testimonies are from women who have suffered birth-trauma as a result of coercion to accept caesarean sections. These accounts illustrate how birth-trauma can be the result of an abuse, or lack, of trust between medical professionals and pregnant women. To protect the identities of these women, who have generously shared their experiences with me for the purpose of this paper, I have used pseudonyms.

Melissa:
[The obstetrician] suggested a c-section as soon as she could…There was no reason for one, except that she was concerned about me and it didn’t occur to her or to the obstetric nurse on duty that preventing me from taking in food or drink might be contributing to my fatigue or that I might have continued to progress if they hadn’t confined me to a bed on my back. In the end, two scalp blood samples from my daughter sent her into extreme distress.[xiii]

Nesam:
The doctor was angry with me from the start as I didn’t go straight in when my waters broke, then I refused the epidural which they thought I needed… I really only saw [the doctor] the one time when she checked dilation and then after about thirteen hours, when the induction hadn’t worked and we were waiting because all contractions had stopped. She just walked in and said; “right we’ve tried everything you are having a c-section”.[xiv]

Simone
At seven AM I was c-sectioned after being deemed “failure to progress”. I hated the operation, hated feeling like a big sack of potatoes being pushed and pulled, and that eerie feeling of having a baby pulled from you. It took me four days to even want to hold my baby.[xv]

Jan:
The OB[stetrician] came back at around 10AM and told me that if my blood pressure didn’t go down I would have to have a caesarean and he said he would give me a bit longer to see how I go…[At 11am he] came in and told me he had already called the anaesthetist and the theatre was being prepped for me. [he] now told me my only real option was a caesarean and I had absolutely no idea what was happening and agreed to the caesarean.[xvi]

Louise:
[The obstetrician] said “So you had a c section last time, you will be having one again” I practically yelled “NO!” At this point she lent back in her chair, rolled her eyes and sighed in a manner which definitely said to me “Oh no, another one who thinks they can do it naturally,”.[xvii]

Hilary:
I never consented, not once. They have a signed consent form alright, but I was tricked into signing that three days earlier, when devastated by the fact that I was pushed into booking the unwanted c/sec, the ob[stetrician] told me I needed to sign a booking in sheet. It was in fact the consent [form]. Regardless of that, I had actually told them I didn’t want this….I STILL DON’T CONSENT.[xviii]

Nicole:
I could see the reflection of them painting my belly with that yellow stuff. My husband thought it looked like they were basting a turkey. And that turkey was me…. It seemed to take so long. Then finally my firstborn was pulled from me and I looked up to see him come out…I cried. Not because of sheer joy, but because of [the] sense of detachment I felt. My second child I birthed with a different Ob[stetrician]. I had a [vaginal birth], not without its interventions…induction, epidural…Still, it came out the right hole, and this to me, is everything.[xix]

Many pregnant women live in fear of having caesarean sections, particularly those who have had them previously. These women often find it difficult to trust medical professionals attending their births because of a perceived pressure to be obedient and not to inconvenience the doctor anymore than is necessary.[xx] Indeed one woman who shared her experiences with me stated that she felt ‘like an egg under a timer.’[xxi] This environment is clearly a breeding ground for distrust between health care providers and patients.

Without reciprocal trust in such a relationship, health is difficult to maintain. A woman could become hesitant to share her experiences and concerns with her doctor, which could be detrimental to her well-being. Furthermore her emotional and psychological strength are central to healthy reproduction. Without a trusting relationship with her health care provider the pregnant woman may struggle to create the necessary conditions for successful childbirth.

The medicalisation of reproduction relies heavily upon technological interventions, such as caesarean sections. In perceiving pregnancy and childbirth as clinical dilemmas medical experts look to technological means of “treating” these experiences. The medical profession’s primary concerns are improving the health of those who are sick, finding break-through solutions, and alleviating pain[xxii] and suffering. Pain, to medicine, is pathological, however pain in childbirth is natural.[xxiii] The role of the doctor in dealing with say a heart disease patient is necessarily active, while the patient is helplessly passive. The failing heart requires technological assistance because it can no longer function effectively. As a result of the medicalisation of reproduction the pregnant woman is increasingly conceptualised as the failing heart. In contrast to the patient suffering a heart attack the pregnant woman is an incredibly active patient. In many instances throughout history, and in some parts of the world today, birthing women have been both doctor and patient during labour.

Historically pregnancy and childbirth have sometimes been difficult and risky experiences for women, and it is often argued that it is because of the medicalisation of reproduction that women stand a much better chance of experiencing a healthy, uncomplicated childbirth.[xxiv] The problem is the degree and extent of this medicalisation. Today many people believe it is irresponsible to give birth outside a hospital. There have been lawyers who have pushed for women who plan home-births to be convicted of child-abuse.[xxv] Pregnancy and childbirth should be approached from the understanding that they are natural experiences that women’s bodies are designed to do effectively. The reality is that the majority of women do not need intervention or technological assistance to give birth.[xxvi] But there is a huge lack of trust in women’s abilities to reproduce properly without technological intervention, or obsessive monitoring. A fact that too many people struggle to grasp is that women’s bodies are all the technology required.

Society’s lack of trust in women to adequately care for their foetuses without technological intervention is highlighted by the existence of certain pamphlets supposedly designed to help pregnant women. One such pamphlet is a seventeen page booklet entitled A guide to tests and investigations for “uncomplicated” [my emphasis] pregnancies.[xxvii] How many more pages need be added should the woman become anxious about the state of her and her unborn child’s health? This pamphlet is accompanied with cartoons of pregnant women lying or sitting down while a doctor towers over them carrying out which ever test is relevant to that page. The pregnant woman smiles happily while the doctor wears a serious face, in one cartoon the doctor’s eyes are closed and her nose lifted high in the air. The message sent to pregnant women is clear: sit still, smile politely, the doctor is busy making a baby.

One technological intervention that has become a routine practice and is today synonymous with pregnancy is the ultrasound. Readers may be shocked to learn that it has never been established that ultrasounds are safe.[xxviii] Quite the contrary, many researchers have found evidence to suggest that the risks far outweigh the potential benefits. Studies have shown that ultrasounds increase the risks of newborns having low birth-weights[xxix], increased risk of retarded foetal growth[xxx] and postnatal mortality.[xxxi] When exposed to ultrasound adult mice experienced impaired brain function.[xxxii] And another study showed that children who had been exposed to ultrasound in utero were twice as likely to have speech problems than those who had not.[xxxiii]

According to the World Health Organization:

Ultrasound screening during pregnancy is now in widespread use without sufficient evaluation. Research has demonstrated its effectiveness for certain complications of pregnancy, but the published material does not justify the routine use of ultrasound in pregnant women. There is also insufficient information with regard to the safety of ultrasound use during pregnancy, including: clinical effectiveness, psychological effects, ethical considerations, legal implications, and safety.[xxxiv]

The medicalisation of reproduction is a dangerous phenomenon. This paper has considered but a few examples of how this process can be detrimental to both the physical and psychological health of women and, in some cases, their foetuses.

It is also important to consider that the negative effects of the medicalisation of reproduction are not restricted to patients. Health service providers could find their jobs becoming increasingly difficult due to a lack of trust from their patients. Mutual trust between health care providers and patients should not be permitted to deteriorate. It must be fostered and encouraged. Only then will complete health be a possibility for pregnant women. The first step is to start conceptualising reproduction, and the functions women’s bodies perform in reproduction, as natural and healthy conditions. Furthermore we need to treat pregnant women, and indeed encourage pregnant women to perceive themselves, as experts of their own bodies

Finally I wish to challenge readers to see pregnancy and childbirth as the natural wonders that they are, rather than medical problems to be overcome or solved by technology. I challenge you to enjoy these experiences and refuse to fear. I leave you with the words of a new mother overcoming her traumatic birth experience:

In hindsight, what have I learned?...That I am STRONG, that birth is NOT painful. It is sexy, powerful, full of love, and is a journey to help you learn to put faith and trust in YOURSELF![xxxv]

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[i] Janice G. Raymond, Women as Wombs: Reproductive Technologies and the battle over Women’s Freedom, Melbourne: Spinifex, 1995, pp.xv-xix. Renate Klein (ed.) Infertility: Women speak out about their experiences of Reproductive Medicine, London: Pandora Press, 1986, p.1 See also Renate Klein, The Exploitation of Desire: Women’s Experiences with In Vitro Fertilisation, Melbourne: Women’s Studies Summer Institute,1989, p.229.
[ii] For more on “medicalised birth” see Marsden Wagner MD MSPH, Fish Can't See Water: The Need to Humanize Birth in Australia, 28 July 2002 [cited 13 July 2005. Available from http://www.acegraphics.com.au/articles/wagner03.html See also Marsden Wagner MD MSPH, The Active Management of Labour, December 4 2002, http://www.acegraphics.com.au/articles/wagner01.html, last accessed 13 July 2005.
[iii] See Wagner, The Active Management of Labour.
[iv] Anonymous, Personal Communication, 18 April 2005.
[v] Anonymous I, Personal Communication, 4 April 2005.
[vi] See Susan Bordo, Unbearable Weight: Feminism, Western Culture, and the Body, Berkley: University of California Press, 1993, pp.77-87. See also Robyn Rowland, Living Laboratories: Women and Reproductive Technologies, Australia: Sun, 1992, p.123.
[vii]Louise Chunn, “Foetal Rights: more than a mother can bear?” Elle, July, 1988, pp.33-34.
[viii] In Ibid, p.124.
[ix] “Birth is not an illness: The Fortelesa Declaration, WHO 1985” Birth Matters, Volume 7.3, September, 2003, p. 16.
[x] “Australia's Mothers and Babies 2002,” Birth Matters, March 2005, p. 7. See also Andrew Darby, “Caesareans could soon outstrip normal births” The Age, April 12, 2005, http://www.theage.com.au/articles/2005/04/11/1113071910730.html, last accessed 12 April 2005.
[xi] Royal Women’s Hospital Obstetric Statistics, March 2005, http://www.rwh.org.au/maternity/ObStats.htm Last Accessed 19 May 2005.
[xii] "Australia's Mothers and Babies 2002," Birth Matters, March 2005.
[xiii] Personal Communication, 18 April 2005.
[xiv] Personal Communicaiton, 18 April 2005.
[xv] Personal Communication, April 2 2005.
[xvi] Personal Communication, April 7, 2005.
[xvii] Personal Communication, 21 April 2005.
[xviii] Personal Communication, 21 April 2005.

[xix] Personal Communication, 18 April 2005.
[xx] See The Brighton Women and Science Group “Technology in the Lying-in-Room” in Birke, Lynda et al Alice through the microscope: the power of science over women's lives, London: Virago, 1980, pp.169-73.

[xxi] Personal Communication, 22 May 2005.

[xxii] Sarah Eaton, “The Medical Model of Reproduction”, New Antigone, vol 1, October, spring, 2005, p. 28.

[xxiii] Eaton, “The Medical Model of Reproduction”, p. 28
[xxiv] It is also important to note that there are studies that have shown that there is no relation between perinatal mortality rates and the level of medical intervention, see Marsden Wagner MD MSPH, Fish Can't See Water.
[xxv] In Robyn Rowland, Living Laboratories: Women and Reproductive Technologies, Australia: Sun, 1992, p. 129.
[xxvi] Wagner, Fish Can't See Water.
[xxvii] “A guide to tests and investigations for uncomplicated pregnancies,” 3 Centres collaboration, www.3centres.com.au, last accessed April 15, 2005.
[xxviii] 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.
[xxix] 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.
[xxx] 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.
[xxxi] Ibid.
[xxxii] 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.
[xxxiii] 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.
[xxxiv] In Wagner, "Ultrasound: More Harm Than Good?"
[xxxv] Anonymous II, Personal Communication, 22 May 2005.

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