Give Birth Like a Feminist. Milli Hill

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СКАЧАТЬ of Appeal in a case known as MB, in 1997, which could not put it more clearly:

      ‘A competent woman, who has the capacity to decide, may, for religious reasons, other reasons, for rational or irrational reasons or for no reason at all, choose not to have medical intervention, even though the consequence may be the death or serious handicap of the child she bears, or her own death.’[15]

      That sounds pretty definitive – and yet more than twenty years on, women are still asking ‘Am I allowed?’ in their birth space. The reason this power imbalance continues to pervade, and indeed the roots of everything this chapter has already laid out, can be found in the fact that we live in a patriarchy.[fn3] With the hashtag #metoo snowballing on social media in late 2017, a sudden uprising of women has collectively been saying, ‘Keep your hands off us from now on, unless WE say so.’ A vital and public conversation has been started about women’s bodily autonomy, consent, and the power imbalance and patriarchal structures that, for too long, have been enabling men to behave in ways that make women feel everything on the spectrum between mildly uncomfortable and downright violated. We now need to turn the #metoo spotlight on the experience of childbirth.

      #metoo: the power of no

      Currently we are only just beginning to acknowledge that we have a big, ongoing problem with the way we treat women in our culture, with our collective relationship to their bodies, with our respect for their bodily autonomy, and with consent. We would be foolish to think that women’s experience of maternity care is somehow exempt from this.

      Let’s look at vaginal exams (known as VEs). During labour, at regular intervals – usually around every four hours – a midwife or doctor will place fingers inside you and estimate the dilation of your cervix. In this way, the speed with which your body is opening up to allow your baby to be born can be neatly marked on a graph and your progress – or lack of it – can be readily assessed. You may be asked to lie on your back to have the VE, or get out of the birth pool. If there is any kind of ‘hold up’ with your labour, a VE can be a very helpful assessment, but standard practice is to perform VEs routinely, even if labour is patently ‘cracking on’ and there are no concerns for either woman or baby. Some women don’t mind them, some really like knowing their dilation, others find them intrusive, distracting, uncomfortable, or violating. No matter how you feel about them, they are part of a standard package, and you will get them anyway.

      The interesting thing about VEs is that they are completely optional – but not a lot of people know this. You would think it would be obvious – of course nobody can put their fingers inside your vagina if you don’t want them to, right? But the majority of women are unaware that they are perfectly entitled to decline. Furthermore, some women report a nagging sense that they are entitled to decline, but are unable to voice their refusal, whereas others do manage to decline but are then either directly or indirectly coerced, for example by being told they cannot be admitted to the ward or use the birth pool unless they comply, or by simply being told they ‘have to’ – which is of course incorrect, as you don’t ‘have to’ allow anything to happen to your body against your wishes. Still others consent to the VE but are told afterwards that the midwife or doctor gave them a ‘sweep’ or broke their waters ‘while they were in there’. Women to whom this happens report finding it extremely violating and yet rarely complain formally about it, perhaps because there is a widespread and unspoken acceptance that maternity care requires you to ‘leave your dignity at the door’ and can at times be violating by its very nature.

      Of course, you may actively want a VE, or indeed any other birth intervention. Giving birth like a feminist isn’t about declining everything, it’s about knowing that you can, and the shift in the power dynamic this brings. To use another example, in your sexual relationship, you hopefully know that if you say no to your partner at any point, they will respect your wishes. You may have been with your partner for just a few years, or for decades, and in all that time you might never have said no to them, not once. You might have said yes, yes, YES to everything! But all along, you have known that, if you wanted to say no, you could say it, and be respected. Just think how the power balance of your relationship would change if this fundamental and often unspoken understanding was not in place? And yet this is the exact dynamic in which the majority of Western women give birth.

      Good girls

      There is a wider issue of compliance to those in ‘white coats’ that can affect all of us and is not purely a women’s issue. Most of us, male and female, have been conditioned to accept without question that ‘doctor knows best’ and to follow their ‘orders’. However, there is something about being female that makes challenging authority of any kind particularly difficult, perhaps because, as young girls looking around us as we grow, most of ‘authority’ is male. Politicians, lawyers, scientists, doctors, artists, philosophers: the default human-on-a-plinth is almost always male, and we grow up looking up to them and, consciously or unconsciously, absorbing maleness as synonymous with ‘leader’. The feminist campaigner Caroline Criado Perez has tackled this head-on, getting the first statue of a woman – Millicent Fawcett – in Parliament Square, along with Jane Austen commemorated on the new £10 note, but even in the twenty-first century, these are notable exceptions – and it’s worth remembering too that Criado Perez has been vilified in the media[16] and even sent death threats for her activism in this area.

      As women, the social conditioning of a world dominated by men comes in tandem with consistent messages that compliance makes us more favourable humans. From birth, or even before, our culture encourages us to give girls toys, books and movies that suggest that being a girl has some connection to being passive rather than active, and conformist rather than confrontational. Even if we try to escape this as parents, our daughters will inevitably be given ‘home and beauty’ based toys of mirrors, cleaning equipment and plastic food, and often taught to sit neatly with their legs together, quite literally taking up less space than their male counterparts. Shoes, bags and even duvet sets are targeted at specific genders and carry similar messages: the emblem of the girl is the shy and gentle butterfly, while boys have dinosaurs and sharks as their totem animals. Even the clothes we are socially encouraged to choose for our daughters, and that they in turn are encouraged to choose for themselves, hold them back – and I speak as a mother who has spent many hours in parks watching little girls struggle to navigate climbing frames in a dress, while the boys are already ahead in their more practical and durable fabrics. Perhaps due to this early conditioning, once they hit school age girls are generally better at ‘self-control’ than boys,[17] and hence will be praised more consistently for being ‘good’, which tends to mean, ‘quiet’, ‘still’ and ‘not challenging’.[18]

      Believe it or not, although you may not have been referred to as a ‘good girl’ for at least a couple of decades, you may well find the phrase returning to your life if you are pregnant, and even – yes, really – you may hear it loud and clear while you are ‘pushing’ your baby out. In February 2018 medical student Natalie Mobbs, NICE fellow Catherine Williams, and Professor of Maternal Health at the University of Liverpool Andrew Weeks – wrote an opinion piece for the British Medical Journal entitled ‘Humanising Birth’,[19] about the use of language in maternity care. In it they called on health professionals to consider more carefully the words they used to pregnant and labouring women, and alongside several other problematic examples, they called out the phrase ‘good girl’ as disrespectful to women as autonomous adults.

      ‘While some may mourn the days when the doctor was in charge and their advice was gratefully received and unchallenged, there are now multiple, alternative sources of healthcare advice available to women both before and after consultations. With improved knowledge among women and a renewed recognition of respect for human rights in childbirth, comes СКАЧАТЬ