Give Birth Like a Feminist. Milli Hill

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СКАЧАТЬ ‘I have delivered hundreds of babies, you have not delivered any’.[31]

      It’s very important to be clear that the vast majority of medical staff do not knowingly perpetrate obstetric violence. This is because, as academics and experts in obstetric violence Sara Cohen Shabot[32] and Keshet Korem point out, obstetric violence is ‘structural’ not ‘behavioural’: ‘the staff merely perpetuate the violence of the existing structure’.[33] In other words, this way of behaving towards labouring women is not only institutionalised but also held up and perpetuated by our culture, and, like other gender-based violence and abuse, accepted as normal and allowed to go unchallenged. Health care workers will almost certainly not be aware of how their behaviours towards women are experienced, unless we find our voices and tell them. We also need to challenge the ‘small’ attitudes and actions that underpin obstetric violence. ‘Locker room banter’ is not rape, but it does normalise misogyny and, by extension, violence against women. Likewise jokes that mock or degrade labouring women help to prop up a system in which disrespect and abuse take place, and we should therefore continue to challenge them just as we challenge all other ‘everyday sexism’. Every single denial of a woman’s autonomy and power in the birth room, great or small, is part of the same problem. Call it out.

      Interestingly, and also in common with other forms of violence against women, it is often the woman who is left carrying the blame and shame in the aftermath. Just as the woman who has been attacked may feel that the clothes she wore or the route she took home at the end of the night may have contributed to her violation, women traumatised by birth will spend the days, weeks or even years afterwards going over the events in fine detail and asking, ‘What could I have done differently?’ And, just as men are rarely asked to reflect on what they could do to reduce violence against women there is similarly considerably less postnatal analysis – and often none at all – done by the individuals, institutions and systems that inflict birth trauma. Women are left with the shameful reflection that they ‘should not have got their hopes up’, ‘should not have made a birth plan’, or ‘should have just gone with the flow’ and these messages are consistently reinforced in popular culture. Those who try to take control of their births, and antenatal courses and teachers who encourage them to believe they can do so, are consistently derided and mocked. ‘Yes,’ the woman thinks to herself, ‘I was totally unrealistic to think I could have a positive experience of birth, and that is why I now feel so awful. It is my fault I feel this way.’ This is victim-blaming, pure and simple.

       ‘Can I hold her now?’ Who owns the baby?

      In 2018 research into skin-to-skin contact after caesarean, academics observed the mother’s body was perceived to be divided after the birth, with obstetricians ‘owning’ the bottom half, anaesthetists ‘owning’ the top half, and midwives ‘owning’ the baby.[34] Mothers may wish to hold their newborns desperately, but in both caesarean and vaginal births, the first hands to touch the baby are often not the woman who birthed them, and she may have to wait to hold them. Often, in a vaginal birth, the moments directly before the birth will have been strictly controlled by the professionals, too, with the woman being told when and how to push, or even instructed not to push at all until given permission. And the imbalanced power dynamic does not end with the arrival of the baby. One question I have been asked many times by pregnant women is ‘What do I do if I want to keep my placenta? Am I allowed?’ It’s fascinating to me that women are uncertain about this, when clearly the placenta belongs to them and came from their own body, just like the baby. This permission-seeking speaks volumes about the dynamics of power in birth and about the background against which we see the violation of women and their bodies being normalised on a daily basis. Just as the baby was once whisked off to the hospital nursery without so much as a by your leave, the placenta (in many cultures considered a meaningful or even sacred organ) is often disposed of without question or consent. Most women aren’t bothered by this but that isn’t really the point – the point is that, among those who are bothered, there is an uncertainty about ownership, and, on occasion, a violation of their rights to keep the placenta or at least be consulted about their wishes.

      Similarly, the cutting of the umbilical cord has become almost symbolic of power and ownership in the birth room. Midwife Amanda Burleigh has campaigned for fifteen years for ‘optimal cord clamping’, sometimes called ‘delayed cord clamping’.

      ‘We know that there is plenty of evidence to support the health benefits of delayed clamping and it has been a NICE guideline since 2014,’ she told me. ‘However, in spite of myself and a number of others campaigning for clinicians to wait just a few minutes, some are still cutting the cord immediately which is not recommended and research shows can cause harm.’

      Indeed, in a survey by the Positive Birth Movement[35] of parents whose babies were born in the UK between 2015 and 2017, nearly a third stated that their baby’s cord was cut less than a minute after the birth, with one in five stating the cord was cut immediately. Arguably, cutting the cord too early with no clinical reason could be described as an act of obstetric violence, and yet it clearly continues to happen in UK birth rooms and globally – why? Some say it’s just because change takes a while and ‘that’s the way it’s always been done’, others suggest that in a time-pressed world, it can be difficult to pause. I wonder. Could it be there is something about the moment of birth that is so powerful, that somehow there is an unconscious need to lay claim to the cutting of the cord and holding of the baby (perhaps the ultimate ‘prize’)? It is certainly very interesting to look at the behaviour of birth attendants in the first hour of life, and notice just how much disturbance can take place to the mother–baby bond and interaction.

       It seems as if the moment the baby arrives the focus on the mother is lost. It becomes about the staff’s interactions with the baby. The doctor who insisted on delivering my baby cut the cord, announced the gender and held her aloft like a hunting trophy. She illustrated her take on who was relevant in the room and who wasn’t. My husband and I did not feature, let alone the baby.

      Hannah Carter, UK

       A poignant ventouse delivery – it’s a mum I saw in infertility clinic at the very start of this job. I feel like holding the baby aloft like Simba and blasting out my best ‘Circle of Life’.

      Adam Kay, This is Going to Hurt[36]

      I have called the first hour after the birth the ‘Hour of Power’. I call it this for two reasons: partly because it’s a time when, ideally, a woman should be feeling pretty triumphant, and partly because it’s a ‘supercharged’ time in which a new human begins their first experiences of the world, and a woman and family meet that human for the first time. It’s magical, and, just like birth, we should be thinking about what we can put in place to make this time special and memorable for everyone involved, and what our plan B is if this doesn’t work out.[fn4] Ideally, the time should be calm and undisturbed – as pioneering obstetrician Michel Odent puts it, ‘don’t wake the mother’.[37] During this time a complex set of hormonal and biological processes take place that affect bonding, lactation, the colonisation of the baby’s skin and gut flora, and the baby’s adaptation to the world of breathing, gravity and thermo-regulation, to name just a few. Of primary importance is the hormonal dance during which the mother falls in love with her newborn; if left to their own devices, this will take place with mother and baby in skin-to-skin contact, quietly meeting one another’s gaze. It’s very unusual to see this unique time unfold naturally without interruption, however, and not just in Western culture, but globally – where everything from a belief that colostrum is bewitched to bathing, eye drops, suctioning the nose, swaddling or ear-piercing disrupt the golden time between parent and child.

      The Hour of Power is not always experienced as empowering. In the time immediately following the birth, women most often readily accept that professionals have important checks to do that must take precedence over what is often an overwhelming and СКАЧАТЬ