Give Birth Like a Feminist. Milli Hill

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СКАЧАТЬ tree, like the floaty dress, is an attempt to poke fun at ‘earth mothers’ who want everything to be ‘natural’, and neatly portrays Meghan as demanding enough to want a particular kind of tree at her birth. It’s all intended as humour, but underneath the surface is the rather chilling idea that a kind of satisfaction or sense of triumph might be gained from seeing a woman’s ideal hopes for her birth go to the wall.

      In Ireland, the Eighth Amendment – which gives the pregnant woman and the fetus equal rights in law–has recently been repealed, but the legacy of hundreds of years of blurred lines between Church and State mean that women’s rights in birth still have a long way to go. Here, midwives in Dublin reliably inform me, a woman with a birth plan and strong ideas about what she wants is commonly referred to as ‘a difficult woman’ by her care team. Indeed, in early 2018 an obstetrician from a Dublin maternity unit, Dr Aoife O’Malley, described women who make birth plans as ‘middle-class birthzillas’, adding that her audience of fellow birth workers would ‘know the women because we’ve all had them’ who ‘think they are the only woman who’s ever given birth and they certainly think they are the only woman giving birth in the labour ward that day’[6].

      Selfish, opinionated, controlling and difficult: women can often be treated like wayward children when they try to create this grown-up document. Lawyer and board member of Human Rights in Childbirth, Bashi Hazard, has described the birth plan as ‘the closest expression of informed consent that a woman can offer her caregiver prior to commencing labour’. Hazard also reminds us that the medical institutions where we birth will always have a birth plan themselves; ‘one driven purely by care providers and hospital protocols without discussion with the woman’.[7] An intelligent consideration of birth plans reveals that they are a fantastic opportunity for women to consider their many birth options and open a meaningful dialogue with their care providers about their choices. Why would anyone find this problematic? one wonders.

      There is even controversy about the label ‘birth plan’ itself, with some birth professionals arguing that they shouldn’t be called ‘plans’ at all, because this gives them too rigid a feel in a situation where it is important always to be flexible. ‘Women need to go with the flow in labour’, we are often told, as if we have the mindset of 5-year-olds. ‘Preferences’ is the most oft-suggested alternative, but it’s interesting to consider why the word ‘plan’ is the source of such anxiety, in a world where women can make plans in other areas of their lives and be considered perfectly capable of adaptability, contingency or, indeed, dealing with the emotional fallout of disappointment itself. Why must we present our needs and wishes in childbirth in the style of Oliver Twist, holding out our empty bowl tentatively and apologetically, when in fact we have the legal and moral entitlement to take the lead in every single one of our childbirth choices? Imagine if business people or our politicians spoke about their ‘shortand long-term preferences’ – we would quickly lose confidence in their strength and leadership. Indeed, the very hospitals we give birth in have ‘policies’ and ‘protocols’, and nobody is asking them to tone that language down.

      Regardless of what a woman decides to call her birth plan, she can expect to receive subtle discouragement at every turn, because birth is ‘unpredictable’, and you ‘can’t really plan for it anyway’. She will be urged to ‘go with the flow’, rather than try to ‘control’ what happens to her in labour: but whose ‘flow’? As midwife and academic Dr Elizabeth Newnham puts it, ‘Going with the flow is fine, as long as it’s the physiological flow, not the institutional flow.’[8] Debby Gould and Melissa Bruijn, founders of the Australian birth trauma organisation BirthTalk agree: ‘Most women’s interpretation of “going with the flow” is “to put ourselves in the hands of our health carers, and accept the interventions they suggest as inevitable, unquestionable and in our best interests”. Every week we talk with women whose birth plan was to “go with the flow”. And now they are contacting us for support after a traumatic birth.’[9]

      Encouragement to take a passive role in birth is everywhere, but if a woman does push ahead and make a birth plan she may find the cultural prediction that it’s ‘pointless’ coming true: in a 2016 survey from Positive Birth Movement and Channel Mum, nearly 75 per cent of respondents said that they made a birth plan, but only half of this group said that their birth plan was read by professionals, and 42 per cent said that their plan was not adhered to.[10] In some cases, plans simply have to change: you cannot have a home water birth if you develop placenta praevia, for example, but women understand these situations and when they complain about their birth plans being disregarded, this is not the kind of example they are giving. Rather, they talk about plans not being read due to a hospital shift change or because they are ‘too long’, or aspects of their plan which could have held in almost any situation, such as optimal clamping, minimal talking in their birth space, or keeping their placenta, not being observed, or being told at the last minute that what they are requesting is not possible, or even not allowed.

      MAKING A BIRTH PLAN LIKE A FEMINIST

       There is a point in making a birth plan

      Don’t let anyone tell you otherwise. There are also ways that you can approach making that plan that will make it a valid and useful document. Firstly, know that you matter. What you want matters. You are important and your needs are important. This is your body, and your birth.

       Knowledge is power

      The process of making a plan will in itself educate you on your options and get you thinking about what YOU want – that’s a reason to make one right there.

       Shoot for the moon but also consider the stars

      Just as you plan to party on the beach but know where the nearest cafe is if it rains, you should also think about birth plans in this way. Make a Plan A that sums up your hopes for your ideal birth. Don’t be afraid to have a strong vision of what you want – with birth, as with all other areas of your life, a strong vision can help you reach your goal – but it’s not a guarantee. So, once you’ve got that vision, make contingency plans – a Plan B (and maybe a C or D). Think about what you might want if birth deviates in any way from Plan A. Consider as many eventualities as you can.

       Ask for what you want even if it is not what others want

      Only one person can have this baby, and that’s you. Because of this, you absolutely get to call the shots on how and where you want it to happen. This is about you, and what you need. If you think your mum being in the room will make you feel loved and safe, great. If you think it will make you feel self-conscious and anxious – she’s barred. If you want a certain type of birth – be that a home birth or a caesarean – but family members don’t agree, show them the evidence behind your choice, and stick to your guns. It’s your party.

       A birth plan is not ‘all or nothing’

      There are some parts of a plan that should only go out the window in exceptional circumstances. For example, if you want skin-to-skin contact immediately after your baby is born, or optimal clamping, this should be available in almost every circumstance. Make sure you are clear with your partner and your care providers that, even if your birth veers a long way off track, there are still some choices that you want to be honoured, no matter what.

       Make a full plan for caesarean, whether you hope to have one or not

      There are lots of choices that you can make if your birth takes place in the operating theatre. Learn about ‘woman-centred caesarean’ and think about what might be important to you in a surgical birth. Then make a full caesarean plan.

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