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Tuesday
May102011

Thoughts on "No Woman, No Cry"

Christy Turlington Burns narrates “No Woman, No Cry,” a two-hour documentary being aired on Oprah’s OWN channel. I can’t possibly “review” this piece, not knowing enough about the topic, but I can share my thoughts as a midwife doing monitrice-doula work in the United States in 2011.

Seeing the lack of food and clean water in the Tanzania and Bangladesh segments was horrible. The extremely long labor (six days?) that opens the film includes explaining that the mother had not eaten in days and brought no food with her to the “birth center” five miles from her home and, despite needing to go to the hospital, an hour-long car ride away, had no means to get there or pay once she was there. She also had no way to obtain food. Thinking about how we pay for water that is often the same (or worse!) than what drips out of the kitchen faucet gave me pause.

With the food issue, I think about the millions of mothers who’ve admonished their children over the decades, ordering them to eat everything on their plates because there are starving children in <fill in the blank>. I don’t think the reality of that truth for most of those moms could even be comprehended; I know I can’t fully grasp it. I’m sitting here writing this post with a bowl next to me that has extra spaghetti left over from lunch and a half a slice of bread lying next to it. I will throw these leftovers away and, sitting here, I wonder at my casual disregard for the starving in the world.

I was very, very glad to see Ms. Turlington address the lack of care right here in the United States, and quite surprised to see her in my friend Jenny Joseph’s Birth Place in Orlando! (I worked in that birth center in 1994-1995, but that was before Jenny was there.) I suspect Jenny’s segment caused plenty of folks’ eyes to glaze over, thinking, “Oh, for crying out loud, women in the United States have all the help they need! They are just too lazy to ask for it.” My hope, of course, is that what Jenny and other activists have tried to impart for decades is heard… that whole factions of women are disenfranchised and are unable to obtain prenatal care. Our society must set an example; no woman should be left outside the prenatal circle.

An American father spoke about his wife’s dying died of an Amniotic Fluid Embolism in what sounded like after/during an induction. Pitocin during inductions and augmentations is a distinct risk factor for AFE/DIC. Obviously, it isn’t just lack of care that kills women, but sometimes over“care.”

So, how are the maternal deaths preventable? I think the film was really bad about enumerating the ways to decrease the (said repeatedly) 90% preventable complications. The short list they did highlight was at the end during a conversation with Ms. Turlington and her husband Ed Burns. These ideas include:

  1. making sure providers are culturally sensitive and speak the language of the women
  2. letting women birth upright instead of on tables
  3. the whole maternity system serves women better when doctors, midwives and nurses work together in harmony

Seems easy enough, right? Funny, but our own culture can’t grasp those seemingly simple ways to work with women during the childbearing year. If we can’t figure out the details of implementation within our own privileged communities, how will we ever lead by example?

Postpartum hemorrhage is the number one reason women women die around the globe. From other organizations, training midwives and traditional birth attendants is the number one priority to lower maternal mortality.

The loudest voice of reason was Dr. Linda Valencia in Guatemala. Her message of removing paternalism and authoritarianism from the physician’s (and midwife’s?) demeanor and language as the only way to gain compliance (for lack of a better word) was brilliant. I love this woman! Her non-judgmental attitude towards women who’ve attempted self-abortions and her intense desire to help women wherever they are in their walk brought tears to my eyes. She said she could surely make more money in some other professions, but how would she feel about herself as a human being? She said her work with women has brought her a deeper understanding, a closer relationship with humanity and that she could never replace that. Dr. Valencia was eight months pregnant in the film; I would give anything to know where she delivered her baby. If only there were a million Dr. Valencias!

On the heels of the wonderful doctor in Guantemala, comes the “care” providers in Bangaladesh. We’re introduced to Monica who explains the deep cultural and spiritual need to deliver in the home and includes a couple of practical reasons including the selling of babies and well-babies dying unexpectedly in the hospitals. It wasn’t stated, but it was graphically illustrated that it is in the home where a woman feels her most power. We know that feeling, don’t we? We see this demonstrated when a Community Health Worker comes by to see her, the woman on a mission to get women to deliver in the hospital. Her visit included scaring Monica into going for an ultrasound for suspected post-dates at the local hospital. Monica had no intention of having anything to do with the hospital, but felt pressured to go after feeling her baby might be in danger. Predictably, she went into labor the next day.

When Monica goes for the prenatal ultrasound visit to the disgustingly filthy hospital, she is flanked by her family… at least six family members. The message is clear; anyone in the hospital needs protection. By the looks of it, I’d agree. (This obviously translates to our own country, doesn’t it?) During the ultrasound, the doctor yells at the woman, her family and even the health worker, demanding to know why no one knows the first day of the woman’s last period. Seriously? I mean, he was angry. If he was so angry over her due date, how was she going to be treated in labor?

The image of Monica lying mute on the ultrasound table yanked me into the juxtaposition of her freedom and powerful demeanor when she was at home. She became a completely different woman within the walls of the hospital. Our own hospitals, gleaming with washed floors and clean sheets, all too often do the exact same thing to women. It’s as if walking past the threshold from outside to inside, women put much of their power and self-assuredness into the same plastic bag their street clothes go into. And if women don’t start out with a great deal of self-esteem and/or knowledge about the whole birth process, how much deeper into submission will she go? The whole situation is terribly ripe for domination and abuse. Is it any wonder women hire doulas and bring in family members for company?

When Monica went into labor, she fully intended to deliver at home, but got scared when she started bleeding and secretly went to the hospital. I say secretly because she was ashamed she had to go; it was a humiliation for her to leave her home during the birth. At the hospital, she did deliver a healthy baby and during her postpartum recovery, the worker visited and instead of praising her decision to go for help, she berated her for trying to have the baby at home. She yelled at Monica! I was seriously stunned. Now, I may be missing a great deal of cultural subtext, but when comparing Monica’s body language and tone of voice before the birth, during the hospital visits and then comparing those to her postpartum visit with the health worker, it was clear to me she was a different person after the birth than before the birth. Afterwards, her explanations were meeker, hemming and hawing about the truth of wanting a homebirth. When she did “confess” to the worker she did want a homebirth, the worker castigated her with (and I directly quote), “What kind of people are you? How do you think we feel? How can you even think about having the baby at home?” Now, that’s the way to gain compliance, right? How could anyone expect to trust someone who makes a woman feel like shit about herself and her choices?

Hospitals here in the US don’t always have the best reputations either, even if they aren’t as horrific as they are in developing countries, it is all in the context of our reality. Amidst the critiques and complaints about hospitals, it brings me great joy to hear about homebirth transports that end with “I was so surprised by the hospital’s attitude towards us! They made us feel welcome and treated us so well, I’m not nearly as afraid of hospitals as I was before the birth.” It’s when people have service in mind that agendas go out the window. Attending to the woman in front of us, staying present with her, meeting her exactly where she is… all of these tasks help keep moms and babies far safer than anger and fear do. I’d like to see all of us foster this type of kindness and respect towards women with birth plans, homebirth transports and women who initially wanted a natural or homebirth but, for whatever reason, needed to alter their plans.

I’ve thought a lot about Monica’s reasons for wanting to birth at home, wondering if some here would scoff at her reasons, saying she was being selfish, caring more for the "experience" than the health of her baby. But it goes deeper than that, deeper than wanting to be in familiar surroundings. I think Monica was a graphic example of what many American women feel when they make the decision to birth at home –that feeling of not just autonomy, but of clear and pronounced safety… even if that safety is wrapped up in safety of the spirit, not just the physical safety of the baby. Trying to separate the different layers of reasons is futile; each layer is inextricably attached to the others. Believing there are only two choices –wanting an experience vs. wanting a healthy baby- demonstrates an extreme lack of understanding of a woman’s complex emotional, spiritual, mental and physical facets. Belittling women who want a home or natural birth, compartmentalizing their desires into one of two boxes, will never create the bridge of compassion and understanding women who need medical care might find themselves crossing should anything untoward occur during their pregnancies or births. Disdain for non-nurse midwives creates the same isolation, having these midwives and women shying away from seeking help in the earlier stages of difficulties. If doors and arms were open for dialogue, for consultations and for transfers of care, I believe women and babies would be safer. This sort of collaboration will require a great deal of humility on both sides of the issue. Do we have what it takes to do this? Can we be the example we want others to follow?

I found “No Woman, No Cry” thought-provoking, but truly believe it’s because I am a midwife who thinks about these issues a lot. I don’t know how someone who doesn’t know birth the way we here do would view this. Would they be confused? Would they have any idea how they can help here in our own country? I also can’t help but wonder if any physicians are watching and having any epiphanies… a-ha! moments that might transform their own practices, incorporating added respect and patience for those that sit on their exam tables, women working within their own cultural and social boundaries. I’d like to think so.

Finally, the entire message from Ms. Turlington can be summed up in this one sentence from Monica.

“I haven’t died, so I’m alive.”

This is truly a starting point. Keeping women alive is crucial. But, it is how we do this that becomes a tangled mass of confusion. Somehow, together, we have to figure it out.

Reader Comments (5)

I've been following Christy on Facebook and Twitter and finally got to see the movie yesterday. I'm glad you posted your opinions. I consider myself an advocate' for women-centered maternity care and probably know a little more than the average american after my first birth experience, to get a better birth the 2nd time around.

In many ways, I don't think the documentary is going to change the minds of people in this country that much. Some of the distinctions that you would catch are not going to register with the majority of people.
I think most people are going to continue the impression that homebirth is risky and miss the importance of the role of a skilled midwife that was briefly touched on. This can so easily get shape to only promote more cultural sensitivity for the medical model- so that's not bad, but it's such a small step when we need to make huge leaps.

There were a lot of little things that you might be able to assess on a deeper level but the average person is not going to get the finer points and they often lead to further distrust of birth and/or midwives.
For example, diagnosing women with pelvis too small for delivery. Indeed this is more valid in countries where women are malnourished and bearing children too early- but since that is too common a diagnosis in the US it didn't do anything to make a distinction or improve the information available about this 'diagnosis'.

You saw how the medical worker was dismissive and unhelpful, the doctor was rude- but I think too many people would not go further and see how that undermines the safety of birth. I don't think many people saw the comfort and strength the woman gained by being at home or with her family that you interpret

I also think the dangers of too many interventions, although mentioned, were not well elaborated- leaving the majority of people with their beliefs unchecked.

I wish I had time for more comments... I think the movement tends more towards the medical model and may have more political support in other countires and will be valuable, but it didn't go where I was, of course, hoping. Maybe I'm not optimistic enough.

May 10, 2011 | Unregistered CommenterJessica

Anon: If you want to leave your email in the comment, yes it does show up. If you want to email me privately, email: Na vel Gaz ingMid wife AT g ma il DOT com

May 10, 2011 | Registered CommenterNavelgazing Midwife

I love this piece. I haven't seen the documentary, but the general points you make are stellar.

May 10, 2011 | Unregistered CommenterMegan

I think there is hope for working toward a more family and patient centered birth experiance in our near future. I have entered nursing school to persue a career as a certified nurse midwife, in the hope that I can be an agent of change. We are not alone in understanding the harm that is done by inflicting a strickly medical model of care in birth. I beleive the most important step to take at this time is to educate the public as a whole why the experiance that over 90% of mothers get is substandard. The movement is rising. Someday, we'll get there, I am sure of it.

June 9, 2011 | Unregistered CommenterJenny

My son and daughter-in-law had their four children at home with the help of a midwife - two water births, two 'bed' births. They are all lovely, perfectly beautiful, having been birthed with few medical interventions; the midwife followed the mom's behavior with little interference but with open communication. Mom was the 'one' - the person to hear, the person to encourage, the person to understand as she moved from one emotional aspect of labor to the other. Dad was close by if not holding mom sharing in what was his event, too. Four births, no threats, no harrassment, no bedfast, no separations from family or baby, all happening as if it was a natural process! Really..
Barb S.

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