When my daughter was 15 months old, I remember clearly seeing a pregnant woman walking down the street and remember thinking, viscerally, that I needed to save her. That if I could just talk to her, I could stop her from giving birth, from having the same kind of awful, frightening, traumatic experience that I did. I knew in my thinking mind that this was an impossible thing — if she was pregnant, she was going to give birth, no matter what I said — but it was something my animal brain thought anyway. It was a theme in my life — I was in graduate school for public policy, and I considered dropping everything to become a doula — saving women from the fate I suffered.
I think many women who have experienced trauma want to prevent others from experiencing trauma, but it’s important that we approach the situation appropriately. I think there are two main things that should be addressed, if you want to appropriately help women seeking to avoid traumatic: Individual Empowerment, and Community Change.
Empowerment is a tricky concept, and it sounds like something you can do magically. Lay your hands on a woman and say, “YOU ARE NOW EMPOWERED.” Or pump a woman up to go into the L&D fighting — fighting for their autonomy, for intermittent monitoring, for their VBAC —that’s empowerment, right? Or is this setting up expectations for birth and the experience of birthing that are liable to be broken, or blocking of the flow of the event?
I like how Anni Daulter, founder of the Sacred Living Movement, puts it: “I no longer give advice to women to be empowered during pregnancy + birth. I SHOW them”1. Daulter wants to have people find “a place of spiritual centeredness, a place of calm and grounding, of personal awareness” by teaching them multiple techniques to find these places and awarenesses—until women find the right one.
Empowerment is teaching of knowledge, skills, and strategies appropriate for the journey you’re about to embark on, and then trusting the woman you’re teaching to find her own path—and to cope on the path she’s on, regardless of the environment.
In that vein, this is what individual empowerment looks like in the context of the current maternity care system:
- Teach, and also encourage seeking out, child birth education that teaches skills about not only birthing successfully, but also skills that are applicable to the entire life span—such as finding personal awareness and finding calming and grounding.
- Women who can use these skills out of the context of birthing have a lot more practice before they are birthing, and can continue to improve the world by parenting with these skills.
- Acknowledge, and teach skills to address, the attacks against women’s autonomy in receiving medical care.
- Teach women the value of evidence-based information regarding care, including where to find such information—websites that may be useful include vbacfacts.com and evidencebasedbirth.com.
- Teach women the limits of evidence-based information, especially where complicated medical realities occur. For example, there isn’t much peer-reviewed, researched evidence regarding how to prevent preeclampsia, despite best efforts.
- Teach women what their human rights are in medical care, and what their consumer rights are as consumers of hospital services—websites that may be helpful include: http://www.humanrightsinchildbirth.org/, http://birthmonopoly.com/, and http://www.birthrights.org.uk/
- Teach women and their birthing partners about fully informed decision making—about how to engage doctors on their turf and demand their full attention to your personhood, including challenging evidence if appropriate.
Individual empowerment and support is certainly very important to the movement in improving maternity care. It’s the front line. It’s where our eyes are opened, and where we want to change so much. But some things that help women in the labor and delivery ward can only be orchestrated from organizing at the community, state, or federal level. I’ll be talking about what organizations are already doing this work, and how we might be able to get involved as individuals. In this case, these are what changes I want to see for individuals that need to be orchestrated by organizing at a higher level:
- Access to doula care, to provide support and comfort measures, education, and advocacy.
- This would involve communities organizing to provide doula for low-income and low-middle-class income families. While there are different models for this kind of structure, it would be important to make sure that the organization of the doula were kept sufficiently separate from the hospital setting in order to ensure that the doula are not part of the problem of abuse within maternity care
- Increase in the geographic, and economic access to excellent, respectful providers.
- For example, 16 states actually allow home birth funded on Medicaid, and 30 allow birth in birthing centers funded by Medicaid (Mapping Health). This would probably be a state-by-state reform, as these allowances depend upon how each state organizes its Medicaid program.
In my local area, there are at least four hospitals that staff with Certified Nurse Midwives, and homebirth is safe and legal (though direct entry midwives are still working on a certification process with the state—they themselves are well-trained), and yet we still have such a high rate of birth trauma that there is a Birth Recovery group that meets once a month and often sees new women coming in trying to heal their birthing experience. Some places may have, by appearances, everything they need for a healthy birth culture, but there are still things that we can do as a community to come together to change how we approach the culture that exists.
First, we need to change our language around birthing. We need to change it in how we talk about our medical providers, and we need to change it in how we talk about our birthing stories, especially to pregnant moms who have not given birth before.
Cristen Pascucci of BirthMonopoly.com left a career in public affairs in 2011 to pursue activism and advocacy in the maternity care system and women’s rights within it. She has worked closely with Human Rights in Childbirth, as well as being a Vice President of ImprovingBirth.org.
Pascucci originated the popular phrase of birth activists, “You’re not allowed to not allow me,” and in more depth, this is the message she wants to send: “It’s time to change our language to reflect the legal and ethical reality that it is the patient who chooses to allow the provider to do something—not the other way around”. This is, in fact, something that even the American Congress of Obstetricians and Gynecologists (ACOG) admits. Pascucci quotes an ACOG ethics statement that says, “In the obstetric setting, recognize that a competent pregnant woman is the appropriate decision maker for the fetus that she is carrying”—a statement that originated in 2007 and continued in 2013.
We need to change our language, as mothers, doulas, and childbirth educators. It’s not about “being allowed”—it’s about asserting that when we choose a healthcare provider, we are hiring a provider of services, and we are the ones who choose which services we want—obviously, we want to trust our providers and their expertise, but we are the ones who choose.
Pascucci provides these tips for change on this particular subject (one of many she’s eloquently written on):
- Don’t stay silent when you hear this kind of language in casual conversation. Say something—even if it’s just a little something. Don’t let it go unnoticed.
- Be gentle while you are being firm. Remember that most people are just repeating something common and accepted, and they probably haven’t thought much about it. Make it your goal to inform, not convince.
- Choose to give your business to providers who use respectful language. If you’re hearing this language during pregnancy, you can be pretty sure you’re going to hear it during childbirth—and that can be a problem. You can’t act like a mother when you’re being treated like a child.
- Partners, stand up for your loved ones. When she is vulnerable, be her voice. There is no one better positioned to be a vocal advocate for her and her baby (Not Allowed).
The second change in language is about how we tell stories of childbirth, and how we ask to hear about the stories of childbirth. We already know that the media contributes to our understandings of the realities of childbirth (American Sociological Association, 2015), and that we’ve been in childbirth education since childhood learning from every story we’ve ever heard. We usually hear social stories, which can emphasize what the teller wants the audience to hear/understand—sometimes it’s to emphasize how heroic she is, how scary birth is, etc.
Instead of allowing these social stories to become the only context, we need to start changing how we tell these stories to others. Rather than focus on the blow-by-blow of each birth story in a circle, we need to begin to focus on passing on knowledge, instead of a contagion of fear or instilling a sense of competition. Pam England, in Birthing From Within, suggests these questions: “What helped you most when you gave birth? What was your spiritual experience of giving birth? If you could do it over again, what would you do the same? Is there anything you would have done differently? What do you wish you had known beforehand?” (1998, p. 19).
Most of all, you need to offer empathy.
As a someone who has the capacity to help teach women to claim their power, your job is to hold the space of women telling stories and help them towards healing. Focusing on these elements of their birth stories in a group setting, where they can find meaning and their own power, they can transmit powerful information to others about the Ordeal of birth, and the skills you need to come successfully through it. This will take away from the “mythology” of birth, and contribute to building a toolbox of skills for both. This, combined with a realistic view of the context of birth, will provide women with more of a Huntress’ view, an initiation into the Ordeal, rather than going in unprepared as others have before them.
If you are a birth doula, midwife, nurse, or doctor — anyone who is looking to support women who have had previously traumatic births — consider recommending Transforming Birth Trauma to your clients. In order to make an informed decision about this resource, please click this link to join my mailing list and receive a free excerpt from the book, detailing an evidence-based way to evaluate if a client has experienced trauma, thus teaching them how to talk about their experience.
- Daulter, 2014 ↩