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Thursday
Aug252011

Choices 

This blog post is a somewhat random collection of three pieces relating to women, but wandering as it is, I didn't want to break it apart into their own posts. Yet. I wanted to get my thoughts out there, even if they are somewhat disjointed. I hope you're able to follow along okay.

I read a blog piece entitled “Your Home Birth is Not a Feminist Statement” by a research scientist “named” Isis. I’ve not read through her blog On Becoming a Domestic and Laboratory Goddess yet, so don’t even have a gauge for how feminist she is compared to me. Her post, however, was too important to ignore. 

Defining “Feminism” must be done and while many of us have an idea of what it is and if we call ourselves feminists, we certainly have a personal definition, but for a discussion like this, my definition has to be out there. 

Wikipedia certainly isn’t a reliable resource, but I found a decent description of my feminist beliefs there. 

Feminism is a collection of movements aimed at defining, establishing, and defending equal political, economic, and social rights and equal opportunities for women. Its concepts overlap with those of women's rights. Feminism is mainly focused on women's issues, but because feminism seeks gender equality, some feminists argue that men's liberation is therefore a necessary part of feminism, and that men are also harmed by sexism and gender roles.” 

I’m in a place of exploring gender roles right now anyway, what with my partner of 25 years recently coming out transsexual (female to male), but I’m clear of my own gender (cisgender being a new term I discovered that means my sex [female] matches my self-identification of [our] societal expectations of a woman) and am comfortable in it. Finding the societal patterns of male and female roles and combining those within the context of childbirth is an on-going project. I'm glad Isis brought it up, but a lot more discussion is needed.

Isis says:

Home birth as a way to find a loving supportive environment and fight the enslavement of the patriarchy is absolute, utter nonsense.   It’s one of the only medical scenarios I can think of where women place health and welfare in jeopardy in order to feel “in control” and avoid intervention.” 

I’m not sure where fighting the “enslavement of the patriarchy” comes in, but women and men are often found to require their medical care be a collaborative adventure instead of a authoritarian one. I’ve been unfortunate to have a slew of family members, all of whom think I was nuts to birth at home 27 years ago, be sick and dying in the last five years and every single one of them wanted a hand in their care… from choices of medications to take, which treatments to begin or forego, and the ultimate decisions about leaving medical care and entering the world of hospice. Others in their same shoes might have chosen completely differently. I absolutely didn’t agree with every decision they made, but they were given the autonomy to decide, up to and including the end. Each of them was in a situation of having very little control and they, too, grasped it where they could. A woman in pregnancy or birth should be permitted the same “luxury” of deciding what her care looks like and where it takes place. 

Personal autonomy is the cornerstone of the abortion issue and I am constantly amazed at women who are vociferously for choice believing a woman in birth should not be afforded that same right. Seriously baffling. I haven’t yet heard an adequate explanation for the change in thought processes… I simply don’t think they exist. On the continuum from 100% Choice of abortion on one side to the other side where there is No Choice for abortion, is there a tipping point I can’t see where a pregnant woman moves into the No Choice If She Continues the Pregnancy segment of the line? Who decides where that tipping point is? And why do they get to make that decision. If women are smart enough to make the determination to continue the pregnancy or not, they are certainly smart enough to decide how they want the birth to find completion. 

Choice is choice is choice. If one choice is removed, all choices are gone.

Reader Comments (17)

AMEN!!!

August 25, 2011 | Unregistered CommenterMichelle Maisonville

Comments on posts like that...sigh. Is it possible for women to dig just a little bit deeper than "I felt plenty empowered by my hospital birth where the staff respected all my wishes, all these hippies need to get their heads on straight". Isn't it feminist to consider that it's possible that you come from a place of greater privilege and/or luck than other women, and that when women talk about abuse in hospitals they should be heard and respected? No, you are not more (or less) feminist if you give birth at home, that much of the post is accurate. But you are also not acting very feminist if you hate on other women for their choices, never examining their lives or decisions for any context.

August 25, 2011 | Unregistered CommenterRebecca

Well, I clicked the link, got as far as Dr. Tuteur, and closed it. I know I should be objective and listen to all sides, but she's so stubborn and frustrating. I figure I can find the same information elsewhere.

I'm an RN and hope to do my time in L&D so I can become a CNM. I really think I could make a difference as an L&D nurse, mainly because I'm not afraid to have docs be mad at me because I did or did not do x,y or z. That being said, there is NO WAY I'd have a baby in a hospital if I could avoid it. To much focus on what's easiest for medical staff, and they try to turn those beds over like the tables at the diner I used to work at.

August 25, 2011 | Unregistered CommenterSamantha

I have been meditating on that blog post all, day and I agree with you spot on. I chose, consiously to take the risks associated with homebirth over the risks associated with hospital birth. I do not live in a dream state where one choice or the other carries no risk, but decided that i could live with the outcome of a homebirth even if it were negative. thank the Goddess I have not had that assumption tested. I am a sexual abuse survivor, and for ME the loss of control and autonomy in a hospital setting would put me at greater risk. My blood pressure elevates, I cannot dialate properly with people I do not fully trust(I learned this the hard way even at a homebirth). I am a person. I deserve the right to make educated decisions governing my body.

August 25, 2011 | Unregistered CommenterTabitha

Feminism = Choices. That is what it is about, choice to be who you are, and what goes on with your body. If I had a gun to my head then that would be my definition of feminism. How hard is that to grasp?

I have a real problem with feminists who don't see motherhood as a feminist issue.

August 26, 2011 | Unregistered CommenterCrowbabies

I agree that feminism is about choices, but it's also about improving the options available to women. I would personally never be comfortable choosing a homebirth, but I fully support it as an option for women. That being said, I cannot accept the current system of homebirth midwifery in the United States because I believe that there are far too many incompetent and underqualified midwives practicing right now. I know that there are some great CPMs out there who strive to gain more education and training than the minimal requirements for NARM, but it's also quite clear that there are a lot of CPMs who are outright dangerous.

While homebirth will always involve an element of risk, there are practices that can make it much safer for women and their babies. The CPM credential should be abolished in favor of the CNM (I know I'm going to catch flack for this, but NARM's minimum requirements are a joke. I see no reason why all midwives should not be held to the educational and clinical requirements of the CNM). Homebirth should be reserved for low-risk women (this means no breech deliveries, VBACs, multiples, and precludes women who develop pre-eclampsia, gestational diabetes, etc. from homebirth). Clear guidelines for transfer should be established and followed, and women should pre-register at the hospital so they can receive quick care should a transfer be required. All homebirth midwives should be required to carry malpractice insurance. Midwifery review boards must adequately censure colleagues who commit malpractice, and a midwife who repeatedly ignores the guidelines of her profession should be banned from practicing permanently.

I also believe that we can continue to advocate for better conditions in hospitals for birthing women. I was lucky enough to deliver my son at a large university hospital that has a variety of providers (including CNMs), and that supports both natural and medicated birth. I think that hospitals are trending in this direction, but I know that smaller hospitals (particularly in rural areas) provide far fewer options to women. If we can work to improve maternity care across the board, this should make it easier for high-risk women to have more options and better support during hospital births. I would also like to see a workable solution that would make it easier for women to VBAC, if that is what they want to do.

It is the antithesis of feminism to argue that women should be attended during birth by incompetent providers.

August 26, 2011 | Unregistered Commentermoto_librarian

"While homebirth will always involve an element of risk, there are practices that can make it much safer for women and their babies. The CPM credential should be abolished in favor of the CNM (I know I'm going to catch flack for this, but NARM's minimum requirements are a joke. I see no reason why all midwives should not be held to the educational and clinical requirements of the CNM). Homebirth should be reserved for low-risk women (this means no breech deliveries, VBACs, multiples, and precludes women who develop pre-eclampsia, gestational diabetes, etc. from homebirth). Clear guidelines for transfer should be established and followed, and women should pre-register at the hospital so they can receive quick care should a transfer be required. All homebirth midwives should be required to carry malpractice insurance. Midwifery review boards must adequately censure colleagues who commit malpractice, and a midwife who repeatedly ignores the guidelines of her profession should be banned from practicing permanently."

I had to copy and paste that whole thing because I agree 100% with the entire paragraph. One hundred percent.

August 26, 2011 | Registered CommenterNavelgazing Midwife

Barb, reading your blog gives me hope that there are people out there who really do want to ensure that women have safe options for childbirth. Thanks for all that you are doing.

August 26, 2011 | Unregistered Commentermoto_librarian

Moto-librarian,

I agree that Homebirth Midwives should have the same skill set as CNM's. However, I will say that until hospitals stop banning vbac's and breech deliveries, these births, a majority of which can be managed safely, especially in a hospital setting, will still be at home for many women. I think if hospitals had to have a set of midwives on staff AND on the board, there would some major changes and much more compassionate care in all departments. Until midwives make decisions as to patient protocols however, midwives, no matter what kind, will be treated like the red-headed stepchildren of the medical world.

August 27, 2011 | Unregistered CommenterCrowbabies

I'm a birth assistant in a state where midwifery is "illegal" and have worked with several types of midwives. I have seen young CNM's come out of school totally clueless about how to be with a birthing woman. I even saw one that had to be "schooled" on how to suture from a CPM. Barb, how can you agree that the CPM should be abolished for the CNM? I know we can only speak from our individual experiences but I've seen tons more wisdom and knowledge from the local CPM's in my area than from the CNM's, especially the newer ones.

August 31, 2011 | Unregistered CommenterKP

When and where have I EVER said CPMs should be abolished for CNMs? Nowhere and NEVER have I said that.

"Tons" is a relative term.

September 1, 2011 | Registered CommenterNavelgazing Midwife

Did you hear about the mother in Montreal that was asked to do a vaginal exam to prove that she gave birth with an unlicensed midwife????

September 1, 2011 | Unregistered CommenterTeresa Hoover

Hi Barb,
Thanks for your post! I think the previous poster is referring to the paragraph that you cut and pasted from moto-librarian, saying you pasted it because you agreed 100%. In that paragraph it says "the CPM credential should be abolished in favor of the CNM".
anyway I agree completely with your characterization of women's choice being the feminist issue. I think there is a lot of misinformation swirling around about homebirth right now, and one of the things I see a lot is the idea that the only reason women are choosing homebirths is that they are not being given true informed choice about the risks and benefits. Now, while I know there are always bad apples in every profession, I see that as such an anti-feminist position! This assumption that the only way women are making choices that one doesn't agree with is because they are being tricked into it! I was actually thinking about it in relation to abortion too, and considering the bills that come up every now and again that require women to have an ultrasound and here about the viability of the baby before terminating a pregnancy. Based on the idea that if a woman really knew what was going on in there, she would never make that choice. Well, they do, and women choose homebirth, even knowing the risks. I'm not saying all clients are well-informed-- I can't speak to that. All I'm saying is, the assumption that the only people choosing it are ill-informed isn't true, and it's offensive to women.

September 1, 2011 | Unregistered CommenterFlora

Crowbabies - I would like to see VBAC as an option for women that want them, but how do we make this happen? Even with proper documentation that a patient was informed of the risks of VBAC, a mother that loses her baby as a result of a uterine rupture is virtually guaranteed to win a malpractice case against her OB. According to juries, a woman can't truly be "informed" about the risks of VBAC. Tort reform is going to have to be part of this discussion.

Access to VBAC is also a question of resources. I don't know that small, rural hospitals are ever going to be able to implement ACOG's guidelines for allowing VBACs. You really do need an anesthesiologist on site, along with a dedicated OR, in case of uterine rupture. While I would love for every hospital to be as good as a university medical center in a large city, that's probably not going to happen. If you really do want a VBAC, you can probably travel a couple of hours for one.

Please bear in mind that there are lots of women who are quite happy with obstetric care in this country, and many of them have no interest in seeing a midwife. I happen to love my CNMs, but I also know that they fully support pain medication during labor, if that is what I want. There are too many midwives out there who are busy promoting ideology at the expense of women and children.

September 1, 2011 | Unregistered Commentermoto_librarian

Well, the paragraph you quoted and said you completely 100% agree with included this statement: "The CPM credential should be abolished in favor of the CNM". So I think that's where KP is getting it.

I chose homebirth for my second child -- well, I chose birth center birth, but the birth center of my choice was full when it was my birth time, and we converted to home birth at the last minute. I thought, and think, that it was a great choice. I've since learned that the common-sense regulations and licensing requirements of midwives in my state (Washington) are REALLY, REALLY far from universal! In Washington, midwives have a very well-defined, well-supported, well-regulated, and well-respected scope of practice. Would that it were so anywhere.

That having been said: I have a friend in prodrome right now who is approaching an HBAC with DEMs in a state where midwifery is alegal. Her first birth can be charitably described as a horrorshow, and she had decided not to have more children as a result but got pregnant by accident literally days before her husband's scheduled vasectomy. She's in an enormous city, but she can't VBAC in a birth center, freestanding or otherwise; CNMs aren't allowed to attend VBACs, and she won't go back to a hospital because of PTSD from her first birth. For her, clearly this is the correct choice, but what a sad rock and hard place to be between.

September 1, 2011 | Unregistered CommenterKathryn T.

"When and where have I EVER said CPMs should be abolished for CNMs? Nowhere and NEVER have I said that."

In defense of KP, I also understood that that is what you said from your comment that I copied below.

" "The CPM credential should be abolished in favor of the CNM"
I had to copy and paste that whole thing because I agree 100% with the entire paragraph. One hundred percent."

September 1, 2011 | Unregistered CommenterAnna

*kinda laughing* Can you see how red-faced I am?

I just became a Nana yesterday, so haven't been able to go read through what I apparently said. SHAME ON ME. I don't know what context it was said, so please forgive me that I can't go read right this second. I'll attend to this later today, though.

For now, I'm sorry!

And I have to run off and be a new grandma. :)

September 2, 2011 | Registered CommenterNavelgazing Midwife

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