From delusions of being able to create the master race to the idea that you can reduce or even eliminate risk in life, medicine and science have sought to control and dominate nature.
Nowhere is this more apparent than in the area of reproduction and in particular, for western women. Western women have come under increasing surveillance, control and criticism from medical ‘experts’ and the population at large during childbearing and parenting. Conflicting advice abounds creating confusion and distress for women, all of whom want the best for their babies and want to do ‘the right thing’. Women are told on the one hand that the rate of stillbirth doubles after age 40 and so induction around 37 weeks is recommended. On the other hand, other experts say that babies born early around 37 – 38 weeks with induction of labour are at risk of health problems.
What’s hard to reconcile with the constant negativity with what is a very normal, human activity is that evidence shows that medical error causes more death and disability to people in hospital than motor vehicle accidents, breast cancer or AIDS. You may note that childbirth doesn’t get it a look in with the comparison because the real problems with childbirth, even those caused by intervention, are so low in the western world. The other disturbing fact about hospital culture is that people are afraid to report errors because they fear recrimination. So really, we don’t know what actually goes on in hospitals. Our only clue in NSW for example, is the Mothers and Babies report and that is a broad brush view.
Various individuals and groups challenge medical domination of birth and the medical profession’s dismissiveness of the social aspects. There are thankfully, some enlightened doctors championing “patient” centred care and calling on clinicians to “relinquish the role as the single, paternalistic authority.”
Films such as the Face of Birth, which aim to defuse the hysteria and show the social view of humanity’s most primal act, have a tough gig. The media’s delight in traumatic tales, coupled with ‘reality TV’s’ depiction of birth all flavour enhanced by the medical profession’s staunch opposition to birth at home and midwifery care, especially in Australia, has led to public opinion becoming increasingly hostile and disapproving of those who choose other than the ‘doctor in charge’ status quo. As a result, western women are becoming increasingly fearful of birth. They are increasingly feeling under ‘siege’, a state of perpetual fearfulness. What is not so well known is how ‘fear’ affects a person’s physiology. The biochemical correlate of fear is cortisol. There is a lot of work being done on the effect of cortisol on physiological functioning and brain development for the fetus. Prenatal programming is a burgeoning field of inquiry investigating how a person’s lifetime risk of disease or health is actually ‘set’ in the womb and dependant upon the mother’s social world. We need to really wake up to what that means.
Western women are also becoming increasingly insecure about their parenting, which for heaven’s sake is hard enough without the avalanche of ‘advice’ and disapproval from all and sundry. I have been reading the comments under the mass media’s articles on birth at home and the different perspectives are fascinating and show how we all see life through our own lenses of beliefs and experiences. What, however is alarming, is the punitive and nasty way that some people respond to people’s choices.
The scorn and criticism heaped on women who choose to do things differently, no matter what ‘norm’ is being touted by whichever interest group, is horrendous and needs to stop.
Where a woman gives birth and who she gives birth with is her business. For anyone to think they care more about a woman’s life and baby than she does is the height of ignorance and arrogance. Our job as a society is to support women’s choices because the evidence is clear that when a women feels supported and has choices her cortisol level is lower and her physiology and therefore her baby’s physiology is more likely to be ‘normal’.
Birth is NOT a competition.
It is about feeling safe, supported and respected. Interestingly, the outcomes, including those of maternal satisfaction, are very very good when that is the situation. On another note, so many people downplay the need for the woman to feel good after birth – the health and wellbeing of the family are enhanced when a woman feels loved, respected and cared for, so that should be the focus of society. We need to ask ourselves where does she feel safe and how can we, as a society support her in that?
Meanwhile, in too many countries, women are dying in childbirth. The current estimate is that around 1000 women die every day giving birth. That statistic is shocking and, with the right conditions, preventable. These statistics illustrate clearly the social determinants of health and disease. Women are dying because in their cultures, they are “nothing” – they are worthless in the eyes of their culture - they are the possessions of their partners or parents; they have no access to contraception and often have (too) many children, their nutrition is very poor, they are dreadfully anaemic, in some areas have malaria, HIV/AIDS and live with domestic violence and the threat of more of it hanging over their heads. Their living conditions are harsh. If we use Maslow’s Hierarchy of Needs to think about the social determinants of health, you can readily see that these women exist without even their basic human needs being met. No wonder the challenges of reproduction are sometimes too great for them. These women do not have the best conditions at home to give birth there – even the hospitals are poorly equipped and lacking in staff, but at least there may be someone there, with some education and training, who can support them and help them give birth safely. We know that when there is a strong and capable midwifery profession, childbearing women and their babies do well. Capacity building midwifery education is one of AusAid’s projects to improve maternal and neonatal wellbeing and decrease mortality and morbidity rates in PNG.
People in the western world who are so concerned with what childbearing women do and where they give birth need to turn their attention to the developing world and work on making it safer for all women and their children. We are, after all, living in a global village. What affects one, affects us all.
Instead of making birth a “who’s right or wrong’ competition, let’s make it about cooperation, compassion and support.
If we want a peaceful society and happy mothers and babies, we would do well to ensure women felt loved and cared for, respected and nurtured, fed good food, rested, kept away from bad news and surrounded by loving family and friends and able to give birth the way they want to, with people they know and trust around them.