Mia Freedman’s recently republished online Mamamia piece on the women she calls ‘birthzillas’ sets women’s rights back by about a hundred years. It’s really disappointing from someone who could do much good for the next generation of mothers.
A woman Freedman “had only just met” at a barbecue asked Freedman, “Did you have a plan for your placenta?” The woman repeated the question which left Freedman cocking her head “quizically like a labradoodle trying to understand a complex sentence.” Delivering the placenta was in the woman’s ‘birth plan’, Freedman learned, “as its own subhead with half a dozen bullet points underneath.” Freedman’s personal view of birth plans was that they’re “most useful when you set them on fire and use them to toast marshmallows”. All very funny.
I worked on a review of maternity care in Queensland in 2005 and what I learned was so worrying for women and families that I spent several years researching and writing The Birth Wars about the conflict in maternity care that Freedman’s piece sits on one side of. I interviewed many women but none of them was the straw monster, the Birthzilla Freedman spends the rest of the piece knocking down.
Some of the women I met had appalling experiences and sometimes chilling stories to tell about contemporary maternity care. Some were punished or abused or neglected by obstetricians or midwives just because they wanted something their carers didn’t like – to hold their babies straight after birth, to save their cord blood, or – like the woman Freedman met at the barbecue – to avoid an injection of synthetic oxytocin to deliver the placenta, or not.
Like many aspects of maternity care, the evidence about the use of synthetic oxytocin for the third stage of labour is still contested. Making fun of women struggling with decisions about their bodies during pregnancy and labour is easy sport, and I hope the woman Freedman met at the barbecue, if she read about herself, took it in good form. But it reminds me of the way some people treated women in the early 20th century who wanted to vote or work, or the way some societies still treat women today.
Freedman says ‘birthzillas’ speak about “empowerment” and “control”. Many of the women I interviewed talked about control although empowerment was not a word used much and I quickly learned that maternity care can disempower women in ways we would no longer tolerate in any other area of life. Work, for instance. If bosses talked to women the way some doctors and midwives talk to them, they'd be charged. I say some because many doctors and midwives are working hard to help change maternity care for women and families. Pieces like Freedman's don't help.
Over the last century, ostensibly we’ve come a long way – we have control over conception, effective pain relief during labour, more or less, and remarkably reduced infant mortality rates in most countries – but we’ve lost as well as gained. Birth moved from home to hospital without a good evidence base, making obstetrics the first recipient of the international Cochrane Wooden Spoon award for its failure to rely on evidence in providing care. Postnatal depression is on the rise, post-birth care has been decimated and women have little or no choices about their maternity care, even though choices should be both possible and safe as they are in other places.
Perhaps if Freedman’s birthzilla exists at all, she’s one of the women who's had a traumatic experience of contemporary maternity care, perhaps even in the 4 to 10 per cent who suffer post-traumatic stress disorder as a result. Maybe her epidural failed so she felt pain and her obstetrician yelled at her to shut up. Maybe she feared for her life or the life of her child, with no one to reassure her. Maybe she was young, alone, facing a caesarean and not quite sure what that word meant. Maybe her baby died because midwives and doctors in a hospital birth centre couldn't work together. I met all of them.
When she comes to have another baby, what should she do, return to the place that traumatised her and her family, or find an alternative? In Australia, there are few alternatives now. If a woman wants to have a baby at home, for instance, because she's frightened to go back to a hospital or birth centre, or for any other reason, it’s all but impossible.
Freedman’s birthzilla uses “a lot of personal pronouns”, Freedman says, but the women I interviewed were simply seeking some control over their experience in the same way anyone who has experienced trauma will seek to control the environment.
The crux of Mia Freedman’s objections to the ‘birthzillas’ is that they put their own experience ahead of their baby’s safety. This is a view often put by those on one side the birth wars. You know what? I met or read about the experiences of hundreds of women, who had babies in hospitals, birth centres and at home. I didn’t meet anyone who was “… more interested in having a birth experience than a baby.”
Birthzilla doesn’t exist or if she does, she’s a victim of the birth wars not a monster. She’s you and me and a whole lot of women out there struggling to make sense of the war zone of Australian maternity care. And Mia Freedman ought to be helping her. Because – and I’m sure Freedman is wrong on this point – birth does matter. It matters a great deal.