Sunday, February 25, 2007

The Rape of the Twentieth Century(20th) By Leilah McCraken

Rape of the Twentieth Century
-by Jasmine Smythe. Written in March of 1998; revised April 2000.

I have had seven children move through my body, and I have much to tell you. Mothers who have given birth to many children have become a rarity; we are no longer the ones who teach the mysteries of birth- the voices of wisdom and reason instructing attendants in the proper care and assistance of parturient women. Modern obstetric knowledge is based on false hospital outcomes: doctors know how patients give birth, but they don't know how women give birth. We, as a society, have largely forgotten that birth is trustworthy- it doesn't need a lot of meddling. Birth is beautiful; it is passionate, wild, and hormonal. And it is wounded. Incomprehensibly intrusive, painful and humiliating hospital procedures have injured birth; it is bleeding, and weeping. The twentieth century has witnessed the institutionalized rape of childbirth.

I had the privilege- and misfortune- of conceiving my first baby at nineteen. Privilege because my body was young and resilient; misfortune because I was woefully ignorant of birth. The usual route was my path- I found a doctor, read lots of books about pregnancy written by doctors, and went to prenatal classes that told me to always obey my doctor.

In the last weeks of my pregnancy, I had increasingly strong contractions- I always thought I was going into labor, but never did. This was to be the seed of my massive self-doubt in giving birth- that my body couldn't perform; didn't know what to do when it was supposed to do it. I learned many years later that this is prodromal labor (I wish we could get rid of the word "labor")- one of Nature's many different ways of perfectly easing a woman's body into birth.

My water broke at 42 weeks, and as instructed by my books and prenatal instructor, I rushed to the hospital. I was introduced to hospital birthing by a giddy young doctor who had me strip down, lie flat on my back, and put both feet together on a bed pan. I was made to drop my knees open. He inserted a speculum in my vagina, and came in really, really close and had a good long look. There were two nurses in the room, drolly looking on. I said, "this is the most humiliating thing that's ever happened to me." No one else said anything.

I was hooked up to endless hours of fetal monitoring. My contractions were cramped, irregular and spasmodic- which happens very often with women attempting to give birth in hospitals, inherently stressful places to be in.

The next twenty-four hours were a maze of interventions: a large number of pelvic exams by many different people; being moved from room to room; blood work; an enema; obsessive fetal monitoring; tubes; needles; signing strange forms. I was not allowed to eat or drink, and became very weak.

My doctor (via telephone) put me on Pitocin drip. The contractions almost immediately became unmanageably intense. I had an epidural, but it didn't work (most local anesthetics don't work on me). Four hours later, my baby was born. I was starving, exhausted, traumatized, and thrilled at the birth of my baby daughter. My husband wept with joy.

It is the custom in North America to induce a woman's labor twenty-four hours after her water has broken; in many other countries, this is extended to over a week. The key factor in both philosophies is that induction must happen only if birth is not imminent within twenty-four hours of the first pelvic exam. But if no fingers are introducing possible contaminants, the risk of infection is minimal. So contrary to most popular birthing belief, after the natural rupture of her amniotic sac the worst place a woman can go is to the hospital: there, she is guaranteed of a contaminating pelvic exam upon admittance.

My second child came sixteen months later. My water broke: again I rushed to the hospital. I had irregular contractions and lots of pelvic exams. I was missing my baby at home so badly; I caught my reflection in a mirror. "I look so tragic!", I said through my tears.

Nothing was happening; my husband went out for a burger. An obstetrician with a team of students came in; he pushed my hospital gown up and stuck two fingers in my vagina. "Hmmm." He had a student do the same; "vertex (head down) and two centimeters dilated", she said. The obstetrician disagreed; he gave my cervix a REAL good feel and roughly twisted my uterus around. "You have a breech here." I wept! I had strangers casually touching my most secret parts; my husband was gone; I was hungry. The student asked if she could check me again, in the "interest of science". I annoyed everyone in the room with more weeping. The doctor told me the baby was in a transverse lie (lying sideways).

My husband was back now: I felt battered; spent; hopeless. We were told my labor and birth would be agonizing, dangerous and slow; but with a cesarean section the baby would be in my arms in forty minutes. What would you say?

I was wheeled to the operating room. I shakily climbed on top of the table. My arms were strapped away from my body; my feet were immobilized. My body was shaved. Needles and tubes were inserted. I said I felt like I was being crucified. A nurse tried to reassure me- "but with this kind of incision, you'll still be able to wear a bikini!"

Through the thick maze of moonsuited strangers I saw my doctor- I noticed for the first time how much eye makeup she wore. I heard a tableful of pagers beeping. After four attempts at an epidural, and lots of morphine, I was given spinal anesthetic. The baby was delivered- I felt an overwhelmingly bizarre extracting tug from my abdomen; I said, "oomph!" The staff looked up in alarm. The anesthetist smiled and said, "I always like to leave a little sensation for the mothers at birth." It's a boy! Relief and ecstasy flooded my body.

He was taken away to be examined. I heard his cries; I pestered the staff to hurry up so I could hold him. The obstetrician blandly explained that my bladder was sitting on my belly and had to be reinserted. I would also have to have all my layers of muscles and fat stitched together, and then my belly would have to be stapled shut. Oh. I was told to be a good girl.

Finally, it was done. In the recovery room I breastfed my baby, to the astonishment of the hospital personnel. At least I claimed that for myself... I learned much later that my baby wasn't a transverse lie at all, but a Frank breech, bottom presenting first- the easiest kind to deliver vaginally. I wasn't told the truth; I had a cesarean section for nothing.

Frank breech babies are best born vaginally, according to a study published in the American Journal of Obstetrics and Gynecology. It was found elsewhere that overweight women are more likely to be cut: when I looked at my hospital records years later, the obstetrician repeatedly mentioned my "obesity": curvy women are not more likely to have difficult births, but they are more likely to be discriminated against.

I'm grateful, thought, that the surgical staff didn't put me under general anesthetic- it can be lethal to the bonding and breastfeeding of brand-new babies, and make a mother feel even more powerless.

After a sad miscarriage eight months later, I was pregnant again. At six months pregnant I injured my hand in a cooking mishap. I was whisked to the hospital, and waited two days for microsurgery; all the while fasting and on IV drip. While in the OR my family practitioner phoned (I was aware of this because I refused general anesthetic- and yes, it took several attempts to find the right kind of local anesthetic); my one-hour glucose tolerance test was a bit high. I said to tell her I would get tested for gestational diabetes right away.

I was hungry when I got home the next day: I ate a birthday cake and several large orders of french fries with Coke. Early the next morning I had the three-hour glucose tolerance test. Two of the blood glucose levels of the three that matter most were high- a positive test result for gestational diabetes. What a week I was having! In learned retrospect, the diagnosis was a sham: I have to wonder why no one asked me about what I had eaten the previous day, and why wouldn't it matter about the fasting, the surgery, and stress I had been under?

So the next few months were spent largely with doctors- in the hand clinic for occupational therapy; in the diabetes clinic at the hospital; seeing my own family practitioner; seeing the cursed obstetrician who gave me the c-section and also the go-ahead for a VBAC (vaginal birth after cesarean).

In the last weeks of the pregnancy I had been having my usual strong contractions. And since I was worried about my "gestational diabetes" having a harmful effect on my baby, I went to the hospital- I thought I should be induced; my body didn't work for birth anyway. I was sent home.

Then at forty-two weeks, my contractions were picking up, and I was having show (pink mucous or light blood from the vagina). I went to the hospital- I was two and a half centimeters dilated, and a bit effaced. But I was distraught at the thought of being sent home again! I implored the nurses to do something to help me give birth. I was positive I was defective, certain I would have died with my previous births if I hadn't been in the hospital. So my membranes were ruptured.

This birth, compared to the others, came quickly and easily. My husband was stunned- he said- "is that it?"

My fourth baby came twenty-six months later (no "gestational diabetes" this time). I was fanatically fit and extremely uncomfortable in this pregnancy- fit and uncomfortable because I exercised like mad, even at the end, out of fear of developing diabetes.

At forty weeks I had light contractions and a touch of show; I phoned the hospital. On a nurse's advice we rushed in, and my body stopped working. I hated my body, called it stupid and useless. They broke my water at one-half centimeter dilation. (Segue- isn't it funny how women who have hospital births say "they" when referring to those who attend and badger them in labor and delivery? Women who have homebirths say "me", and "I".)

Still nothing much happened; just a lot of niggly, irritating spasm-like contractions. I remember trying to find a quiet place to "nest". I had two obstetric nurses and a doctor (a stand-in for my doctor, who was on a ski trip) literally sitting and waiting for my every sensation. A student, too: she had short fingers, and was having difficulty finding my cervix in pelvic exams. I placed my fists under my hips so her fingers could reach inside my vagina more efficiently. What a good helper! No wonder I wanted to retreat, to get away!

Every now and then I would cry. The staff were concerned; I said not to worry, because it seemed to be a hormonal thing- it happened at every birth.

My uterus was palpated, and I was assessed to have a baby in posterior presentation- "facing pubes" (babies are normally born facing the mother's spine). The pain soon became ferociously intense: hysterically agonizing contractions as I kneeled on the shower floor with a man-midwife (male obstetric nurse) hosing my lower back with a tepid shower nozzle. My husband held my hand. I screamed that the baby was coming. I made it to the bed and flopped onto my back and shrieked him out. I vowed never to have another child.

I recently learned that my baby most likely went into that position because my membranes were ruptured prematurely. The most agonizing of all my births did not have to be that way at all.

I relocated during the pregnancy of my fifth child, a year later. I got a new doctor. Again, no gestational diabetes. I passed the forty week "best before date" and was advised of a new policy that women must be induced at ten days past their expected delivery date. I questioned the validity of this; my doctor told me of worries of placental insufficiency, of placental calcification- worries that my baby would be deprived of oxygen and nutrients. This sounded reasonable to me. (Though not reasonable to a study published years later that found that routine inductions at 41 weeks will increase labor complications and operative deliveries, but will not improve infant outcomes.)

Nine days went past my due date without any excessive uterine activity. I went to the hospital, was monitored for an hour then had Prostin (prostaglandin gel) smeared on my cervix. I was monitored for an hour more. I was released, but told to come back either in six hours or in actual labor. So my husband and I walked around, trying to get my labor going. I started feeling strange, shooting pains in my cervix and down the backs of my legs. I suggested we find a place to have illicit sex, because the sensations I felt from the gel, it occurred to me, were identical to those I feel after having sex in late pregnancy.

I learned much later that the idea for the gel itself- which is reported to have a base of pig semen- actually came from human sperm, which is rich in the cervix-dilating, prostaglandin hormone. Human sperm, though, is a better way of inducing labor, because it can be compounded with natural oxytocin. Loving and orgasmic sensations- hopefully intrinsic in the lovemaking process- are known to stimulate the secretion of oxytocin in a woman's brain (and interestingly, in a man's), and oxytocin is an integral hormone for birth. Nipple stimulation releases it in abundance as well.

My husband passed on the quickie; it seemed that he felt my vagina had somehow become the hospital's property, now that it had been meddled with. We went back to the hospital. Thinking of my fourth child's birth, I was terrified of what was to come.

I was confined to a fetal monitor. A strange, haggard looking man (the staff obstetrician) examined me, and found that my afternoon's progress amounted to two centimeters dilation. Oh. I commented on how tired he looked- he told me that he had been working for the past three days. Did he sleep?- I asked. Yes, sometimes, he said; there's a cot in the doctor's lounge. We must speed things along, he said, to "get this nasty business over with".

He ruptured my membranes, and instructed me to semi-sit for an hour, so the umbilical cord wouldn't prolapse. Cord prolapse, often fatal for the baby, happens when the cord drops below the baby's head and comes out first. Artificially rupturing the membranes is known to be a cause of this! My babies had always been at risk, and no one even told me how. Where was my "informed consent"?

I played some cribbage with my husband. I felt myself drifting into a strange land I had never been in; my terror was replaced with a wonderful calm. I felt peaceful and introspective; sleepy and restful with every birth sensation. The nurse-midwife attending me was amazed. But my progress was slow for a fifth child- it took twelve hours from my first prostaglandin smearing until I was moved at six centimeters dilation to the delivery room.

The table- not even a bed anymore- was my birthing enemy. My lovely contracting became cramped and sore. I instinctively pushed the nurse-midwife's hands to my breasts, to stimulate the release of oxytocin; she rigidly pulled her hands away. After a while, my baby was born. The doctor tugged painfully, inexplicably, on the umbilical cord.

A new nurse took over within a few minutes of the birth. This was her last day of work, ever, as an obstetric nurse: thirty-eight years of this place, of countless episiotomies and shavings, of love and death and birth and the whole damned thing. She wanted to tell me about herself and her husband and how the times are a'changing, as I tried to breastfeed my brand-new baby. I listened politely. My husband went out for a smoke and some phone calls. The nurse reluctantly left when I shooed her out of the room.

Then I was finally alone with my baby. There we were, alone and entranced, hospital-tagged and naked, when I heard the screams of the woman giving birth in the room beside me. I said aloud, "get me out of this chamber of horrors".

We went upstairs, and got settled into a semiprivate room. I tried to breastfeed and sleep, but the woman next to me had difficulty in caring for her baby- they were both crying. I heard phones ringing. I was hungry; I had to get my own toast from a kitchenette on the other side of the ward.

I took my baby everywhere; I wouldn't let "them" touch him to bathe him or weigh him or pester him. I insisted on doing everything myself. There were people everywhere, in my room, in the halls, in the nursery; everyone saw my leaking breasts hanging out, my matted hair, my tears. I crept to the day lounge with my baby swaddled in hospital towels. I sat with him and mourned, how I cried over all that was lost! I wept and shook. A nurse came in. "You should be in your room!" I said, "I need privacy! I have to come here to cry!" I pulled my baby under my chin.

A year and a half later, when I summoned my hospital records through the Freedom of Information Act (please, everyone, do this!), I saw that this nurse wrote that I was handling my baby roughly. (I was holding him tightly to me as I wept and shook.) I would never hurt my babies! I was being watched, scrutinized. Another nurse accused me of bruising my baby when she saw a birthmark on his leg. These cold, semi-sterile strangers believed me to be a child abuser! Even the most kindly-faced nurse was watching every move, every whimper, like a malevolent hawk. I left shortly thereafter.

A few days later, at home, this thought went through my head- a swirling black flicker of sentience that translated into the following sentence- hospital birth is the rape of the twentieth century.

Women are systematically, routinely, and willingly assaulted every day by individuals and institutions who claim to have their best interests at heart, and most women have no concept of what is lost. Yes, it is rape: just as a man forcing sexual intercourse on a woman strips her of her powers, and wounds her in sacred places, so does birth rape. Women are left shaking, enraged and filled with sorrow after both rapes, because the rape is the same. And just as it would matter if our children were conceived through rape, it matters if they are born through rape. And in both rapes we bleed.

~~~~

Women are made to bleed, often uncontrollably, in hospital births. They bleed because of the standard shot of oxytocin in the leg after birth: a woman's natural oxytocin-making mechanisms (which contract the uterus to its previous size) shut down when a huge dose of the synthetic hormone is in her bloodstream. And when the artificial stuff wears off, a woman will suddenly feel faint and collapse in a pool of her own blood. (The uterus has stopped contracting, and the placental site is nearly as large and raw as it was after birth. Artificial hormones used to induce labor cause excessive bleeding, too.) Hemorrhage also happens when "fundus fiddling" is involved: impatient birth attendants will externally manipulate a woman's uterus to expel the placenta, and will even tug on the cord. This is agonizing, as well as bloody.

A bigger cause of bleeding is episiotomy. Most blood loss in a typical birth will actually come from an episiotomy wound; so much so that a woman can even become anemic. Episiotomy is a foul, malevolent invention- created out of the incredible logic of trying to prevent a perineal injury by inflicting one. When vaginas are cut open, women suffer: episiotomies can rip through a woman's perineal tissues, causing extensive tearing; they hurt intensely- doctors will often not even wait for the local anesthetic to kick in before cutting (or even bother administering one); women will cry when they pee for a month. Scar tissue can make sex painful or difficult, often for a woman's lifetime; and sexual sensation can be diminished because episiotomy permanently severs the nerves that flow far into the perineum from the clitoris.

The wound often becomes painfully infected- in which case the sutures need to be removed to drain the wound, and the perineum needs to be painfully restitched. Deathly gangrenous infections- necrotizing fasciitis and clostridial myonecrosis- are caused by episiotomy. Cancer, endometriosis, and brain abscesses are known to be seeded from the episiotomy site, too.

Episiotomies permanently weaken the pelvic floor muscles and can cause hidden injuries to the anal sphincter. This is the reason that 6% of women have anal and fecal incontinence after childbirth. And sometimes after severe tearing, a rectovaginal fistula (a gap in the wall between the rectum and the vagina) will develop- and women will pass feces through their vaginas. These women are left feeling abused, mutilated, dirty- and are often told to consult a psychiatrist. They will need more surgery to repair the initial injury, and future babies will have to be delivered by cesarean section.

Babies can get cut in episiotomies too. There have been reports of eyelid lacerations, and even castration in breech-borne babies. Episiotomies cause the need for hazardous and painful suctioning: when a woman's vagina has been cut open, it cannot tightly squeeze the baby's shoulders as they pass through the birth canal. Nature has her own way of "suctioning"- the pressure of the walls of an uncut vagina squeezes the baby's shoulders and chest, making fluids burp out of the baby's nose and mouth, easily and naturally.

Natural tears are easier on the body- they heal far more quickly, and are less painful than razor-sharp, deep scissor cuts. Despite this- and the fact that there is no scientific support, whatsoever, in favor of routine episiotomy- over 60% of hospital-birthing women will still get one. Many doctors (and even nurse-midwives) are loathe to give up the old ways, and resist eradicating this most unfair cut.

Forceps, created through the unbelievable reasoning that babies' heads will be protected from birth by clamping metal tongs, are often used in conjunction with episiotomy. Forceps (and to a lesser degree vacuum extractors) cause rectal injuries, and anal difficulties- such as chronic, painful hemorrhoids: the veins inside pregnant women's rectums are naturally very thin. And when artificial extraction equipment is used- especially in association with coerced, forced "purple pushing" births- these delicate veins become engorged, distended, weakened and bruised. Any existing hemorrhoids become fiercely painful, and often manifest themselves into lifetimes of drugstore analgesics and sitting on rubber rings at movie theaters.

Use of forceps can permanently disfigure women's genitals, and cause bladder injuries- sometimes women's bladders are so badly bruised that lifelong urinary stress incontinence problems result. For babies, forceps use can cause cerebral and Bell's palsies, cephalhematomas (pools of blood forming under the scalp), skull fractures, and great pain- and painful birth brings an increased risk of violent suicide later in life.

In 1920, the article "The Prophylactic Forceps Operation" by Joseph B. DeLee became the touchstone for physician-managed vaginal deliveries. It detailed DeLee's ideal birth: first cutting a large episiotomy on an etherized, unconscious, bound woman, then pulling her baby out with forceps. Then manually removing the placenta, and giving large doses of ergot to curtail postpartum hemorrhage. Then pulling the cervix down with forceps to examine it, and stitch up any tears. Then carefully reconstructing the vagina to restore "virginal conditions". Scopolamine and morphine are given in the birth, and then for the lengthy post-delivery work to "prolong narcosis for many hours postpartum and to abolish the memory of labor." This one man's torturous birth ideal became the standard for women's births for the bulk of the twentieth century. Incredibly, there is a prestigious award given in his name… the "DeLee Humanitarian Award". It is awarded to doctors who have made outstanding contributions to the health of women and infants.

Epidural anesthetic has replaced scopolamine as the birth drug of "choice"- in some centers over 90% of birthing women will have an epidural- and it can lead to terrible consequences (none of which women are routinely told about when they ask- "is it safe?"). 70% of women will experience side effects- such as low blood pressure, fecal and urinary incontinence, paralysis of the lower extremities, allergic reactions, respiratory depression, headache, vomiting, and seizures. 20% will develop fever for which the baby will need to be treated too. 15-35% will have to be catheterized because they can't pee. 30-40% will have severe backache for hours or days after birth, and 20% will have severe backache one year later.

Epidurals cause one in ten babies to be born "blue" (severe fetal hypoxia- lack of oxygen; induction drugs cause it too). The Caine-derivative anesthetics used in epidurals rapidly cross the placenta and can harm both a baby's central nervous system and cardiac function. Epidural drugs- especially when given with a cocktail of other drugs- cause jaundice, as newborns try to metabolize the powerful drugs with their immature livers. Epidurals lead to a decrease in muscle tone and strength in the newborn, affecting the baby's ability to breastfeed properly. And since dose is calibrated to maternal weight, babies can easily get an overdose (a baby is about one-twentieth the size of the mother). Babies receiving epidural drugs, as well as any other kind of painkilling drug in their births, are more likely to be addicted to drugs later in life- and have learning disabilities and violent behavior. Epidurals make women four times more likely to have forceps or vacuum extractor deliveries, and twice as likely to get cesarean sections.

Cesarean sections are done for many reasons, mostly relating to impatience in the hospital staff. "Failure to progress" being the most common and infuriating reason: this is when a woman's cervix is not dilating according to the hospital's preset idea of how a labor should unfold, and she is literally stood over and told to dilate. She is threatened with surgery if she doesn't. Of course her body won't open for birth in such a dangerous and stressful scenario; and if the baby can't be blasted out by artificial oxytocin or dragged out by forceps, it will be cut out by an obstetrician.

A c-section may also performed due to the observance of normal fluctuations of a baby's heart rate (as noted on a fetal monitor, often the first intervention in the classic cascade of interventions); these fluctuations may sometimes lead medical personnel to erroneously believe that the baby is in "distress", and needs to be removed immediately. Activities like thumb-sucking, sleeping and even maternal thirst will cause dramatic differences in fetal heart rates. (Though sometimes the baby will be put in genuine distress through drugs or hormones given to the mother.)

Cephalopelvic disproportion is another common excuse for a cesarean section: it is often claimed that many women's pelvic outlets are too small for babies to pass through. This is nonsense! If so many women had such useless pelvises for birthing, their ancestors would not have survived- and the only women alive today would have enormously wide pelvises! Modern women's bodies aren't broken- they know how to give birth, if only left alone; women who are said to be incapable of birthing without modern obstetrics are very likely to be supremely able to give birth without intervention- as long as they are nowhere near the institution that is so quick to intervene.

In most hospitals, one in five women will have a cesarean section; in some centers the number is as high as one in three. This statistic should not be any higher than three in one hundred! And the cruelty of cesarean section must not be diminished because of its frequency: women should be focusing on babies, love and breastfeeding in the first weeks after birth; not staples, catheters and weeping incisions!

After my section (as in cross-section; vivisection) I understood misery: trying to care for my new baby while recovering from major abdominal surgery on a hard hospital bed was the most heartbreaking thing in my life. Every move was agony; gas pains ripped sickly through my savaged abdomen; my catheter hurt me when it was inside my urethra, and left sharp pains when it was out. I could barely move to change my baby's diaper, and the hospital staff were too busy to help me care for my baby. The tape that held the IV tube in my arm constantly had to be repositioned, and each time it ripped at my skin and hair.

I wasn't allowed to eat: first the liquids on Day One after surgery, then the gruel on Day Two, then the mash on Day Three was not the sustenance I needed to fuel my breasts for milk-making, nor to feed my healing, ravaged body. I was a patient, a sickly invalid, a twenty-one year-old woman who had to pee in a bag, and hold her belly together before rolling over in bed. I was helpless to care for my new baby, and I will always remember his first days of life as grotesquely uncomfortable, and full of sorrow. I couldn't even get up to brush my teeth.

And why are the significant risks of cesarean section not discussed? I didn't even know of the danger I was in. Women are up to sixteen times more likely to die after a cesarean delivery than a vaginal birth. Cesareans cause hemorrhage; women during cesareans are ten times more likely to lose their uteruses because of unstoppable bleeding, and hemorrhage is actually the leading cause of all maternal deaths. Cesarean sections cause ileus (intestinal paralysis associated with abdominal injury), intestinal obstructions and adhesions, pulmonary embolism, and Mendelson's syndrome (acid pulmonary aspiration). There is a 20% chance of a dangerous infection developing after the birth- a big problem with the proliferation of antibiotic-resistant hospital microbes.

After a cesarean, women suffer more from postpartum depression. And birth trauma, a much misunderstood condition that most doctors haven't even heard of, which stems directly from feelings of powerlessness and worthlessness that come from violent hospital births.

Women can develop lifelong urinary stress incontinence when the bladder is peeled away from the uterus, and bladder and uterus injuries happen, as well accidental injuries to other organs, tissues and vessels. Cesareans cause respiratory distress syndrome in newborns- a leading killer of babies, and between 2-6% of babies will be accidentally cut by the scalpel.

After cesareans, women are more likely to develop ectopic pregnancies (if they even manage to get pregnant at all); and future babies are at risk of poor outcomes. Women are also more likely to grow placentas that either block their vaginal outlets (placenta previa), or detach themselves while a woman is still in her pregnancy (abruptio placentae)- and both conditions can kill the mother and baby.

Future births will be considered high risk because of the slight chance of the cesarean scar rupturing, and a ruptured uterus can cause death for the baby and a lost uterus for the mother. VBAC women being administered induction drugs are at particular risk of uterine rupture, especially with the drugs Prostin (I was blissfully unaware of the danger I was in during the birth of my fifth), and Cytotec- an ulcer drug not even approved for obstetrical use by the FDA or its manufacturer: it makes women up to 28 times more likely to have their uteruses rupture in childbirth (despite this, its use has spread like wildfire in the medical and nurse-midwifery communities). The pain of cesareans just goes on and on.

In a cesarean section, a private, secret, and sensual event becomes a sterile crucifixion in a room full of slicing, staring strangers. And the ultimate rape is that we are told we need to be cut. The sanctity and power of birth becomes a meek "yes, doctor" and we become spectators to our own violation; we even thank the doctors as they scurry on their way out of the operating room.

In the hospital, an overwhelming, poisonous complacency overtakes us as we are stripped of our privacy, our dignity, and even our clothing. We hold our doctors in a position of utmost trust; we believe in their good intentions, and their upholding of the Hippocratic Oath (do no harm). But they do do harm- they do harm every day. And they are given societal sanction to do as they please with us.

This reminds me of children being abused by trusted people in positions of power: the abuse, committed selfishly and without regard for the children's future, is insidious and generational, and the children always believe they deserve what happens to them. The abuse of women's bodies in birth is committed for the selfish convenience of medicine, with little regard for women's immediate and future health. Generations of women have been told their abuse is necessary, that bloody birth is universal, and unavoidable- due to the frail malfunctioning of their own bodies. Women and children are told to put up, and shut up. This is no longer tolerable. Just as abusive authority figures are being increasingly held accountable for the suffering of children, exploitive medical practitioners must be held accountable for every stitch, every stab, every scalpel slice that is inflicted on women's bodies- even decades after the cut.

The underlying motive for every hospital birth is the safety of the baby (as if the hospital environment is salve to new life). A woman is told that her healthy baby is all that matters, that the end justifies the means- if she's sliced and diced in birth, then so be it; that the baby in her arms at the end is all that matters.

But a woman matters. Her vagina matters, her belly matters, her intact veins and perineum matters, feces emerging from her vagina matters, her self-esteem matters, her love of birth matters, she matters! Not allowing a woman a powerful birth is like never letting her achieve orgasm; sort of like saying "orgasms don't matter, dear, as long as you conceive!"

I call the whole ritual of sacrificing the integrity, power, and sexuality of birth "puerperal infibulation". Just as women in some cultures have their clitorises clipped and their vulvas shaved of flesh and sewn shut (infibulation), women in our culture quite often have their vaginas, perinea, and bellies cut open by doctors, then have their bodies sutured or stapled shut after it all. In both cases, women are either held tightly or strapped down to restrain them when the knives or scissors come out- and have little say regarding the outcome of the knife.

Interestingly, the underlying purposes are the same: to rigidly control female sexuality (yes, childbirth is an inherently sexual event), and to protect children as they are being born. Many cultures practicing routine female genital mutilation (FGM) are insistent in their belief that in birth, if an infant touches its mother's sexual tissues, it may well die (hence the removal of external genitalia). On average, one out of four North American women are told that unless their babies are delivered by cesarean section, their babies may well die (and of course, babies don't even come close to their mothers' vaginal tissues). Or unless our vaginas are cut open, our babies may be injured in the tight passage of birth. ("Crushed against a tight pelvic floor", as Joseph B. DeLee said.) Vaginas are very threatening things to some people!

Westerners hearing of FGM are adamant in believing in the sinister backwardness of practicing cultures. But how can we call the former culture barbaric when our own actions are so monstrous? Whether a woman has her vagina cut open in an isolated hut or in a world class teaching hospital is irrelevant: she's still having her vagina cut open, her suffering is still severe, and will inevitably endure.

Another reason women's vaginas are mutilated is to ensure a tight fit for their male partners. In some societies, models are made of betrothed men's penises- these models are inserted into the vaginas of the brides-to-be; then the women's vaginas are cut and sewn to fit the models' dimensions. In our society, I hear of doctors who tell women before their cesarean sections- "Your husband will thank me"; or asking the fathers, before episiotomy stitch-ups: "Do you want me to put a couple of extra stitches in for you?" Yes, this is happening now- not twenty years ago.

Puerperal infibulation is as deeply rooted in our culture as FGM is in the cultures that practice it. Here, women are myopically coerced into giving their birthing bodies to intervention-eager practitioners; there, women are vehemently encouraged to have themselves made surgically chaste. And we are both made to believe in the purposefulness of such mutilation, compelled to succumb to the sublime wisdom of those who profess to be more learned, more wise, more virtuous in mind and in practice than the simple women we appear to be- we are taught to trust in the righteousness of authority, and to disdain our most basic urges to flee.

And overwhelmingly, resistance is futile- because sadly, in both cultures, our own mothers and grandmothers- the ones who claim to love us most- usher us the most eagerly into the hands of the practitioners waiting to perform the cruelest cuts; mother-cutting is generational, and insidious. The elder generation can rarely see the pointlessness of this painful cycle- their own suffering seemingly will not go unfelt by the younger generations.

And birthing bloodshed isn't about to end- Western women are reluctant to give up their beloved doctors, and their worship at the altar of Modern Medicine. Exasperatingly, I have found that most women don't even come close to believing me when I tell them they don't need to go to the hospital to give birth; they especially refuse to believe that childbirth is trustworthy, and doesn't need gloved fingers, neurotic monitoring nor surgical scissors to perform its inevitable, evolutionary task.

There is a fantasy bond that develops between those involved in the high drama of Western medical birth deliverance. The anxiety created in the birth process is relieved by the emergence of a live baby and the ultimate survival of the mother. The stressed family believes that they were saved, and they love their violators- returning time and again to the scene of violence unless they wake up, and begin to question the whole structure.

Puerperally infibulated women strive to find reason in their pain, a utilitarian purpose for every poke, every cut, and every scalpel slice. We need to believe in the righteousness of what's done to us- the sadness and horror of it all would be too much too bear, otherwise. Perhaps some women's worship of doctors is stemmed in a history of dysfunctional "enabling" relationships- it seems that the women who are the most abused at their doctors' hands are the ones who are the most unlikely to move away from their doctors' control (I know I was- I was always desperate to be a good girl, to please my doctors; I was always effusive in my forgiving of their errors). Disabling birth responses are based in our collective cultural birth hysteria, and women's fear and distrust of birth are so ingrained that someone who speaks of birth as an intimate, sensual event is likely to be feared and reviled.

But telling a puerperally infibulated woman about the beauty of birth must be like telling a woman with her clitoris snipped off that sex can be erotic and orgasmic. They will both think you don't know what you are talking about. But I have had my clitoris reattached, so to speak, and I must tell the world about what is lost.

It is only logical that childbirth should take place where a women feels most secure and comfortable- in her own home. Homebirth is safe: the countries with the highest incidence of midwife-attended homebirths have the lowest infant mortality rates, and women have much better overall outcomes. In a homebirth, interventions are taken very seriously, and are considered and reconsidered before resorting to (at hospitals, the very ease with which interventions occur lead to their phenomenal commonplaceness). Homebirth would only be dangerous if the common obstetric interventions were brought from hospital to home.

Home waterbirth in particular encourages excellent outcomes. Immersion in a birthing pool soothes away fear and discomfort; mothers need no artificial pain relief; labors are quicker and easier; big babies come more easily, and, due to how relaxed and supple perineal tissues remain, women rarely tear. Women can easily move their bodies for the smooth passage of their babies, and find optimal birthing positions without the cumbersome effects of gravity, as "on land". Women with knee or back problem can find comfortable birthing positions more comfortably.

And after giving birth in their own homes, in water or on a firm surface, women have joyful memories of their births and recover quickly. So why don't more women have homebirths, when the cost and trauma involved are so minimal? Whose interests are served by the women's enforced ignorance, and the ritualized invasion of childbirth? Not any mother's, nor any baby's.

If women and children are to thrive, they must be left alone in the genuinely trustworthy passage of birth. And choosing to stay home, far away from the equipment and practitioners that so easily and routinely foul birth, is the best way to ensure a healthy outcome.

So why are we mostly told to give birth in hospitals? There is a deep cultural fear of natural processes, especially of women's sexuality; and our medical establishment is a reflection of our society. It is "safer" to medicalize birth than it is to understand the true power of women, and the trustworthy functioning of female bodies.

As long as we think rape only involves sexual intercourse, sensual can only mean erotic, and bottlefeeding is a healthy alternative to breastfeeding, we are not realizing the magnificence of our own existence: orgasmic lovemaking, being pregnant, giving birth, breastfeeding, and feeling goofy baby love all come from the same hormones; are all the same sensual swoon. And all must be left alone: we need privacy and dignity to explore our most secret and loving places.

Of course, there are exceptions to homebirth. Certain women have health conditions that may need advanced obstetrical care, and these women should never be condemned for not being able to give birth without intervention. Each obstetrical intervention benefits a small number of women. But when interventions are applied to women as a rule, the risk/benefit ratio reverses, and more harm is caused than good.

~~~~

Thirteen months after my fifth child was born, I was pregnant again. I did not want another hospital birth.

I began searching for a better way to give birth. I read the helpful and powerful "Homebirth", by Sheila Kitzinger. I contacted various midwives registered with the College of Midwives of British Columbia, but understood that they would medicalize my pregnancy too much; would give me too many tests and interfere unnecessarily with my birth.

I heard of midwife Gloria Lemay through friends. I spoke to her of my experiences on the phone. I asked her how many babies she delivered- "Oh, I don't deliver babies, the Moms do that! I've attended over six hundred births, though." I asked her if she would touch my breasts for me if I needed that done in my birthing time. "I'd stand on my head naked in Mundy Park if it would help you get your baby out." We talked for hours. My husband and I went to meet her; she would attend my birth.

I got enormous amounts of hostility and concern from my extended family regarding my choice, and after hearing their experiences with forceps, rectal exams and stirrups, I understood their paralyzing fears. I summoned all of my medical records, and found the many inconsistencies, half-truths and outright lies that had occurred in my colorful obstetric history.

Forty weeks came quickly. My due date! Four liters of Labor Aide waited for me in the fridge, my mattress was covered in a painter's drop sheet- I was ready. But nothing was happening! The old dread came back. My body's busted! I can't give birth without intervention!

As the days crawled by uneventfully, I would call Gloria, crying. "I'm not like other women! I can't give birth by myself!" And she would say, "Of course you can, and of course you will. Your body will give birth whether you believe it or not. Your body knew how to conceive your babies, it knew how to breastfeed your babies, and it knows how to give birth to your babies." "You trust my body?" "Yes, I trust your body. Your birth will be beautiful." For a little while, I would believe her. She would give me these pep talks as I would need them.

At forty-two weeks my mother became very concerned; I myself was born almost a month late: my mother attributed my eye troubles as a child to her lengthy pregnancy with me. I called Gloria. "My baby will be born half-dead and blind!" "No! You're baby's fine!"

He was very active, and had a consistently strong heartbeat. I was healthy- my blood pressure was fantastic, and my diet was great. She said, "I can't think of any environment healthier for your baby than inside your uterus." Yet I knew that I would have been induced with almost any other midwife, and certainly with any doctor. Sometimes I had deep doubts about what I was doing- I knew that almost no one would agree with our waiting it out.

But I learned that forty weeks is just an average length of gestation- different women will give birth at different lengths of pregnancy, in the same way that every birth and every person is unique. We are born, learn to crawl, walk and talk at our own special pace; we can only learn and grow according to our own unique developmental schedule. No one has the right to intrude with preset notions of how a birth or life should unfold.

I grew afraid of my impending birth. I was afraid of the pain. I read a book written by another woman whose sixth child's pregnancy also went beyond forty weeks (Chris Griscom's "Ocean Born- Birth as Initiation"). She said, "Don't be afraid! Birth is yours to give! Claim it for yourself!" I would repeat this to myself in times of fear.

Forty-three weeks of pregnancy went by; I started a debate about midwifery in a local newspaper. It kept my mind occupied. I learned how to check my own cervix; I was more than three centimeters dilated already, really soft and beautifully open- thanks to my lovely, ongoing prodromal labor. I passed my mucus plug; Gloria said she had never seen a woman lose it and go more than four days without giving birth.

One week later: stumbling sad in the snow, feeling as though my pregnancy was a straightjacket I couldn't get out of. Why hadn't I given birth yet? There was no confusion about my dates; I had done a home pregnancy test two days after I expected my last period. This was a time of intense fear for me; I was terrified by all the medical documentation that said my baby would be unhealthy, that my placenta was dying. How could I trust in this one woman when so many others would have had me induced almost three weeks ago?

Then one night, at forty-four weeks pregnant, I woke up to pee. As I sat down, I felt a little pop!- my water had broken! I called Gloria. We quietly chatted, and she was on her way. My children were nearby; I touched their hair as they slept. I prepared a warm bath for myself. I caught my reflection in the mirror- I was radiant, joyful, beautiful.

My birthing sensations felt like squeezing hugs across my belly. Jacob helped me out of the tub, then put some African music on. We kissed and danced. For the first time ever, I was joyful in birth, and left alone- no needles, knives, fingers, hooks, scissors, staples, drugs, tubes, synthetic hormones, medical students, nonsense.

And no crying! The tears I had always had in labors before were not hormonal, but environmental...

My body worked beautifully: each birth sensation was elegant, and forceful. After three hours, the time had come. I kneeled on our couch, and panted, sighed and screamed my baby out. He was ten and a half pounds and adorable! My husband caught him in his big, warm hands, and I laid back to receive him onto my body. I have never felt such bliss.

Every woman deserves such bliss! Interfering with this bliss must be recognized as the criminal act that it is! Blissful birth is the birthright of every woman; a gift from her body to her soul!

My placenta was perfect. An induction would have been brutally unnecessary. I buried my placenta on day four. I never knew how much my placentas mattered to me; some cultures say they are the bodies of children's guardian angels. I still cry for all that has been lost.

We are living in strange and savage times. This century will be remembered as one of war and genocide; and violent, coercive childbirth. Birth is weeping, and bleeding. We are made to believe we must give birth in sometimes hostile and mostly indifferent hospitals, where interference with a woman's natural birthing rhythms is the norm. Our vaginas can be stared at and cut by strangers, and abnormal emotional and physical behaviors- such as excessive fear, crying, and stress-induced stoppage of labor- have become normal and expected. Babies are routinely harmed; and the perpetrators are exalted as life savers, instead of reviled as child abusers. A birth without unnecessary intervention is now unusual, even though we all have the potential to birth beautifully- if only left alone.

One hundred years ago, hospital birth was considered to be the radical and dangerous alternative to a midwife-assisted homebirth. Women avoided doctors and hospitals for many reasons: they didn't want to be experimented on (and many still are- especially poor, minority, very young, and/or non English-speaking women); highly contagious puerperal fever was a deadly reality; disease ran rampant (and still does); the of idea having men (almost all doctors were male) in the "lying-in chamber" seemed dangerously immodest. Hospitals and doctors were expensive. But quite quickly, doctors became the accepted providers of maternity care; and after a century long, worldwide smear campaign by the medical establishment, midwives and their wisdom have almost become extinct.

But women are becoming unwilling to be pawns that are moved, positioned and sacrificed by the medical "profession". We are increasingly, and passionately, healing birth for ourselves; and women who have borne many children can be instrumental in helping other women understand the mysteries and myriad variances of pregnancy and childbirth.

Hospital birth must once again be considered the radical alternative to a planned homebirth. If women still insist on having hospital births, they must consider having experienced labor support people, such as strong doulas, with them at all times- to vociferously and passionately "guard the normal". Homebirth is the obvious way to avoid unnecessary interventions altogether. Midwives have the potential to be our greatest allies in this; but they, too, must resist the temptation to try to "hurry things along", or interfere unnecessarily.

Most importantly, women must remember that childbirth is sacred- it is the most primal and hormonal event of our lives. And it is the most beautiful- it is when we meet our babyloves for the first time.

But we cannot expect others to respect and love our births and our bodies when we do not ourselves believe them to be sacred. I find it most heartbreaking that women still need to be convinced that being cut and stabbed at in birth is an inherently bad thing.

Please, women. Claim birth for yourselves. It belongs to you.

For medical resferences for Rape of the Twentieth Century, go here.

2 comments:

Housefairy said...

This is by far the most comprehensive well written definitive piece in favor of reclaiming birth I have read. LOVE your blog.

Wellness Blogger said...

Thanks for all the great information on this blog. I had my first child at 19, and went to the hospital for fear of what would happen if I didn't. I was told so many times that to do otherwise would "put the baby in danger." The information on here has really convinced me to look into other options for future children. Do you know of a way to find a good midwife in my area?
Thanks, endlesswellness
endlesswellness.blogspot.com