When We Talk About Birth

​I've been thinking a lot about birth lately. About live birth and miscarriage, about pregnancy and postpartum, about so-called natural birth and highly medical births. Most pressingly, I've been thinking about the ways we view those things as a culture.

I've been a doula, officially, since 2013. It's not my job anymore, but it's still part of who I am. I think it probably always will be, and I suspect it shares some similarities with ministry in this regard.

I think the musing was kicked off by the birth of baby S, which was lovely, and the relatively worry-free first month of her life. It was urged onward by a friend's pregnancy announcement, another friend's rediscovery of traumatic birth narratives, and this article, which honestly made me a little frustrated.

I've been a doula at twelve births, taught prenatal classes to three other families, and have been part of the new-parent world for many others. You might think that as a doula I primarily worked with people who wanted low-intervention pregnancies and labors, but the truth is that the split is about fifty-fifty. I know people who adored their epidurals and would never have done without, and I know people who hated them and found them so uncomfortable and restrictive that they went drug-free their second times. I know people who dreamed of a cesarean and ended up with a quick, uncomplicated vaginal birth as well as people who dreamed of an unmedicated vaginal birth and got a complicated surprise cesarean. 

In most cases, it wasn't so much about goals and wishes as it was about mood and tone, and that's one of the first things I learned as I went along. I don't think this is a lesson that every doula comes across, and I think many consciously avoid learning it even when it's presented to them. There are many reasons someone might choose a natural birth, but one of those reasons is intensely, furiously feminist; it is a fierce and fiery rebellion against men who have taken over birth with drugs and invasive surgeries and "care" that neglects the ongoing health and recovery of birthing parents. 

There is, of course, also a strong feminist argument in favor of medicalized birth, of pain relief and control, and I respect that argument as well. That said, I think it's even more important to ensure you're well-informed and that you have providers who prioritize your consent if you're going that route. We talk a lot in the birth community about finding a provider who'll respect wishes for a natural birth, but the conversation doesn't really happen around the other end of the spectrum, and it absolutely should. Welcoming one intervention shouldn't mean ceding control altogether, and the mistake we've made is in treating medical vs non-medical as two extremes when really what both sides and everyone in between most need is respectful, appropriate care from providers who respect them as whole humans rather than seeing their bodies as simply barriers between a baby and the world.

Ultimately, the thing is that we're talking about it the wrong way most of the time. We use words like "empowerment," especially in the low-intervention world, but in my experience very few people need to be empowered in pregnancy and childbirth. They do, however, need to be supported, and that's a harder thing to describe. Support is both practical and theoretical. It's about ensuring there are water bottles near where the baby is fed and food in the freezer, diapers and blankets, time for naps and rides to postpartum appointments. But also, and often more importantly, support means acknowledging successes and losses without dictating which is which. It means listening. It means providing reinforcement for desirable outcomes and the processes for achieving them. It means answering text messages at 4am because they need someone, anyone, to tell them they're doing just fine (or, alternatively, that it's time to seek help, and that doing so is also part of doing fine).

Arguing is easy, and the birth community--parents and professionals alike--do a whole darn lot of it. Support, though, is hard. When it comes to children's well-being, there are actually remarkably few times when it's necessary to tell someone they're doing things wrong, but that's how we approach it most of the time, and that's not creating better parents. What creates better parents is when their community notices the gaps and helps fill them without judgment (because nobody can do this alone, and we all have gaps).

That's the place I try to stand, and if I can get even one of you to stand there with me, I'll feel a lot more hopeful.