Many reviews have hailed 2012 as the year of women’s rights, mostly because we’re now allowed to call sexism and misogyny sexism and misogyny. Women are still paid less than men, they still do most of the childcare, most of the housework. And in maternity care, which I’m interested in, they appear to have less choice than when I wrote The Birth Wars in 2009.
I’m not sure why but maternity care isn’t even on the radar screen when people think about women’s rights. The drive for change is now so marginalised that leading women make nasty fun of those who want something different. One of Mamamia’s most popular posts for 2012 was Mia Freedman’s piece about ‘birthzillas’. I wrote about Freedman's piece here when it was republished recently, but I've since read a wiser piece by Andie Fox here about the mothers we love to hate, written when Freedman's piece was first published in June last year.
For some reason, feminism seems to go all quiet and compliant about pregnancy and birth, or worse, feminists like Freedman promote a dominant paradigm of maternity care which has a rich history of sexist, misogynist (thanks 2012) and plain cruel practices.
When I worked on a review of maternity services in 2005, we identified two sets of beliefs in maternity care. There were the organics who see birth as mostly normal and natural; women need gentle support and encouragement in order to let their bodies do what they’re meant to do. And there were the mechanics, who see pregnancy and particularly birth as potentially high risk medical situations requiring highly trained medical professionals and technology close to hand. Since birth moved from home to hospital in the post-war period, the mechanics have dominated. The organics exist in sometimes segregated birth centres and other models of midwifery care and midwife-provided homebirth.
My experience researching The Birth Wars was that most midwives and doctors care deeply about about women and families. But organics and mechanics don't work optimally without each other and sadly, that’s the situation we’ve been in for decades.
I thought what would change the wars would be a middle ground, enough women and midwives and doctors who could see the value of both sets of beliefs and of learning from one another. I thought feminism, which so much wants women to have control over their bodies, would play a role. I thought we’d soon have a new kind of mechanically aware organic care, in community birthing pods, hospitals, or at home, seamlessly transitioning to a kind of organically infused hospital mechanic care when needed, the humanised caesarean. There may be pockets of this now. I’m not sure.
But we're not heading towards peace in the birth wars and the new deal that reform promised. It's more like we're in the business of destroying the organics altogether, with help from some of our women leaders.
The UK’s College of Obstetricians recently decided, based on evidence, that homebirth has advantages for low-risk pregnancy. When they talk about homebirth in the UK now, it’s in the context of how you might encourage women to have their babies at home and best train midwives to care for them. In Australia, our College of Obstetricians says homebirth is unsafe and won’t support it. Conversation over. Women determined to birth at home can’t find a midwife because there are so few homebirth midwives still practising. If they decide to have their babies at home anyway, without a registered professional present, they are blamed. If their babies die, it’s widely reported in the media. Even coroners point a finger, not only at midwives but also at mothers. The stories always start “I don’t want to blame a grieving mother but” and then go on to blame a grieving mother.
To me, we’re asking the wrong question anyway. Instead of, “How could these women have done this?”, we should be asking, “How come homebirth is safe in the UK but not in Australia?”
In the last story in The Birth Wars, baby Jemima has a stormy passage into life. Her mother Marie developed obstetric cholestasis, a condition which makes a pregnant woman insanely itchy and puts her baby at risk of death in the womb. The treatment is to monitor the pregnancy so the baby survives long enough to be viable outside the womb and then deliver. Marie had wanted a homebirth but accepted, on advice from her midwife, that this would not be possible. From then on, she was cared for by her midwife, who consulted an obstetrician, and the obstetrician, who monitored the baby’s health. Marie did have a wonderful birth, she said, cared for by her midwife, the obstetrician on standby in case anything went wrong.
They were special, this particular midwife and obstetrician, and I really wish there were more like them involved in maternity care right now.