By Janet Fraser

Stepping outside the system to birth – embracing women’s power and rejecting obstetric control.
In a woman-hating society obsessed with the control and regulation of women’s bodies, choosing to birth at home makes a crucial statement of withdrawal from patriarchy. Homebirthing women reject the pacifying, numbing, dangerous rituals and routines of hospitals and embrace their right to bodily integrity. The human rights abuses of our current maternity system cannot be denied and refusing to negotiate with the hospital system is a radical statement in removing oneself from the ultimate regulation of the female body in it’s defining act. There are some crucial things women need to know about maternity services before commencing a birthing career and these are not what’s normally told to us in sources available to most women.

*****************************************************************

I would like to talk today about a few aspects of birthing in Australia. Firstly, I’d like to address the ways in which most of us experience hospital birth as the normal way of birthing our babies and how that affects us. I’d also like to talk about how we are manipulated by propaganda so that we become compliant, accepting recipients of medical technology and the timetables of surgeons. I want to talk a little about how we need to unpack a lot of our cultural beliefs around birth, and I want to talk about how consumers are taking back our power and our births. And I want to say emphatically, that birth is one of the safest things you will ever do in your life. Safer than driving, safer than scuba diving, as safe, in fact as life gets.

Despite studies worldwide showing us the safety and desirability of homebirth, only around 1% of Australian babies are born at home. Most states have fairly ready access to a small to medium group of midwives who operate in independent practice, although recently the QNC’s policy of deregistering homebirth midwives in an appalling abuse of women’s human rights has somewhat complicated that up here. Within our current maternity system, more women than ever are reporting trauma as a direct result of hospital birth. Medicalised birth and routine interventions have removed the control women deserve over their birthing experiences and left many wounded and shellshocked. Hospital birth is based on healthy women as “patients” with compliance demanded at every step. Women’s basic human rights are denied as soon as they enter the system, and they are manipulated, or physically forced, into what suits the schedule of the hospital and surgeons. Poorly evidenced obstetrics has become a big money spinner with a nexus between commerce and misogyny doing daily violence to women and babies. Women who are distressed about how their babies have entered the world, are told they are not sufficiently grateful for their “healthy” baby and all that matters in birth is that both are alive at the end of it.

Most of us start out believing that we have the ability to choose what happens to us, our bodies and our babies in birth and to a certain extent, we do. However once we set foot in a hospital, unless we find staff who will also support us in our basic human rights, we no longer have control over our environment or what occurs in it. We believe we should be able to trust those who claim to care for us but in reality, we simply cannot. The dangers of allowing surgeons to define the discourse around birth are manifesting in women’s fear and hatred of our birthing bodies. Healthy women in Australia are experiencing more interventions in birth than ever before, with a concomitant rise in caesarean and other interventions such as instrumental births. A very small group of women are even prepared to have their bodies cut open, before their babies are ready to be born, rather than embrace the power of their birthing bodies.

So do we need "birth reform"? It seems so logical doesn’t it? Let’s have a mass movement to reform our hospital system so women can birth there in safety and with their human rights intact.
Clearly we need reform of some sort, so the treatment of women and babies does not cause the trauma we see emanating from those places on a constant basis, although I rarely see most reformers speaking about this trauma.

So are we arguing for something we haven't truly unpacked yet?

There is an innate difficulty with arguing for the improvement of hospital services regardless of whether or not the majority of us access them. It's arguing from a false assumption in the first place. We have, as a culture, despite the evidence, decided that birth is risky and dangerous and requires the care of people basically trained to deal with sick, potentially dying people with life threatening illnesses.

We had a hospital system set up in our cultures way before any of us were even born but it was still creating a demand based on a myth. The fact that the institutions exist at all is a tribute to this myth, and they have become self fulfilling monopolies continuing to function because large numbers of us buy into the myth that they are necessary to life and limb.

Hospitals (places for sick people) have no business dealing with normal, physiological birth (performed by healthy women) but now that they do, they continue to peddle their own importance and kid us that we need them.

They are also now a significant money spinner in western countries for drug companies providing all the drugs most of us don't need but have forced upon us and the machines testing (usually badly, inaccurately and potentially dangerously) for oft times manufactured illnesses or illnesses which most of us will never get, not to mention the massive industry that is pathology testing for obstetrics! So we've been sold a line that we needed them in the first place.

We've got a whole industry set up providing us with a service we didn't need, doing things to our bodies that we don't really need. And some of us are so hoodwinked by this we continue to argue in favour of it.

Surgeons create repeat business for themselves in a way that if it was another industry, would be seen for what it is - shameless money making. Surgeons put the first cut in a woman's belly which she probably doesn't need then tell her that ever afterwards she must go to a surgeon for any further births. Look at the supposed reasons for surgery in the perinatal data and there are barely any with evidence to support them, so yes I feel free to make that outrageous claim.

So it doesn't matter if she looks for another surgeon, or hospital (they're run by surgeons, did you realise that?) they have this game plan set up between them and they all uphold the rules of it thus immediately guaranteeing themselves future repeat business unless a woman stumbles across genuine information or something called "hospital bashing" which always just sounds like reasonable sense to me.

Now if at least one in three of us have a c-sec for our first birthing experience and then the vast majority are denied the right to vaginally birth, that's a lot of unnecessary repeat business right there. How handy.

People tell me that I should support medicalised birth because "women should birth where they feel safe". Well yes, but let’s unpack that too. Actually if you feel safe in a hospital, as opposed to in your own home you need to really think about why since hospitals are not safe places for birthing women and babies. And let's acknowledge that yes for some women home isn’t good, but if you plan to raise children in it, it can't be that bad to birth in, can it?

Some of us do apparently feel safe being denied the right to embrace our birthing body's power, and having other people make major life decisions for us or we couldn't possibly argue that hospitals are Right For Us.

The glaring reality of institutionalised care is that it is poorly evidenced and causing violence to women and babies every day it continues. A whole industry predicated on a lie is hardly going to provide us with loving nurturing care in an appropriate way.

Women often perceive hospitals to be safe because we are socialised to accept other people making our decisions, socialised to believe that our bodies are innately flawed and probably dangerous to the babies we birth, some of us want to be rescued from performing things with our bodies that clearly mark us as the oppressed. We are frightened of so many things about birth, and yet again, all based on the lie that birth is innately dangerous. We are also socialised to think hospitals are appropriate places for birth and even when they brutalise us, many of us go back without knowing there is an alternative.

So now that we have this self perpetuating industry here as a firm fixture in western culture, don't we also have the right to criticise and critique as necessary? Other industries receive a great deal of criticism without anyone trying to argue that "their local McDonalds" is different, or the Bratz/Barbie dolls in their area are "lovely" or maybe I just haven't seen those arguments. In any case they'd be equally spurious.

We no more NEED junk food in our lives than we NEED hospitals to birth in. Eating is necessary to life and so is birth but no one can claim that junk food is an essential service, it damages our bodies and the environment. So do hospitals and they do provide an essential service to a very few of us, as they should, they shouldn't be praised for it! They're just incapable of providing appropriate services since most of us don't need them and yet are convinced into using them.

Again I say, an industry based on a false assumption creating further need for itself. Hospital birth 30 years ago did not involve constant scanning, blood testing and all those other things the industry has now developed and many of us have accepted as necessary to health.

So it’s hard to argue logically with something that doesn’t really exist – a need for “nice” hospitals for all birthing women. It’s like someone wanting help to stay on the earth if it tips over, coz it’s flat dontcha know, and I might fall off it! Well we need to unpack your assumption that the earth is flat before we can address the fear of falling off it.

No matter how great your fear, it’s based on a myth.

So we live in a system where our consent has to be manufactured to make us accept not only the way hospitals operate but even their very existence. Obviously somewhere in ourselves we know that this birthing environment is plain wrong for us, or we wouldn’t need such aggressive manipulation to make us accept it, right? To apply some of Noam Chomsky’s thoughts, we can clearly see how tacit understandings between surgeons, drug companies, pathology companies and medical technology companies and the media lead us to think within certain constrained boundaries about birth and our bodies. Everything in the media underscores the dangers of women birthing without technology. Even when an article is about birthing at home, a representative of the medical profession is always interviewed to provide what is painted as “balance” but is, of course, how the boundaries are continually stated and restated with regards to birth.
Birth is not women’s business, birth is risky and dangerous and surgeons’ business.
What makes it into the newspaper is chosen to keep these boundaries in place. So back in 2005, for example, when the British Medical Journal had a most illuminating study into homebirth in North America showing that hospitals were indeed not achieving the kinds of outcomes possible at home where women and babies were significantly safer, the press were instead focussing on an appalling study that was done in Adelaide and supposedly showed a reduction in stillbirths resulting from blanket induction at 39 weeks gestation. Of course the dangers to women and their premature babies from this ridiculous obstetric overkill was completely ignored as women were interviewed in hospital clutching their infants and saying how grateful they were that the surgeon saved them from the horror of a fullterm baby. I wonder what the baby thought?

Our birth reform movement also has a part to play in this because we too guard the boundaries of acceptable thought around birth. Birth reformers engage with the surgeons which then allows us as consumers to feel pacified that our cause is being taken up by someone. Small victories are painted as massive inroads, we all send a few emails or have our photo in the paper, it’s all warm and fuzzy and ultimately meaningless if that’s all it is. Of course most birth reform is still focussed on our hospital system thus demonstrating it’s desire to uphold the dominant paradigm. Exhortations to dress a certain way at rallies, to only hold placards with certain officially sanctioned slogans and nothing that might offend those who perpetrate the birthrapes. Surely we got to this point by not wanting to offend anyone and if I have to make a choice between offending an anti-birth crusading surgeon, and having a safe birth, I know what I’m going to do!

When we continue to tell women in small ways, and large, that they can safely birth in a hospital, we continue to spin the myths that the surgeons and their fellow travellers would have us believe. And we lie to women when we tell them that they can have control over their birthing space in a hospital. So yet again, when that falls through as it almost certainly does, consumers are left blaming themselves for not being assertive enough or not phrasing their birth plan in an appropriate way or sadly, relying on their old sense that birth is dangerous anyway and the surgeons saved their baby. Funny how it’s never the fault of the system. We kid ourselves that homebirth is too special or weird to tell the general population it even exists. Or we kid ourselves that since most of the women who work in birth reform give birth at home, then it would appear inappropriately personal of us to push for homebirth to be considered the normal option for all birthing women.
Why do we do this?

We have years of perinatal data to show us that hospital birth is dangerous, the outcomes are poor, women and babies die or are traumatised in our hospital system. We don’t hold back from telling women the risks of smoking or drug taking in pregnancy. We don’t sell women soft soap options on car seats. We don’t reserve the safest car seats only for those who can afford them, or who can research enough to find out they exist. We tell families that car seats are essential, they are the safest way to secure your child in a car, they are even legally mandated in this country. But when it comes to birth, we do worse than refrain from mentioning, we lie. Women aren’t stupid. Many of us live with the pacifying effect of neoliberal notions of choice, but many of us also hanker to find a better way to live, a congruent way to live. We seek out the best information on living gently, leaving a small carbon footprint. We seek out the best ways to nourish our bodies and our babies. But we are continually constrained in our desire to carry this over into birth. If women can research and understand how to purchase a house and apply for a mortgage, we can sift through the data and understand the difference between the medical model and the midwifery model and choose the one with the evidence to support it. Sadly, most of us don’t even know that these models of care exist and that there is a choice outside of private/public or labour ward/birth centre.

Of course, this is not to call into question the motives of those of us who dedicate ourselves to the birth reform movement. That large group of women, and occasional men, particularly those who do not seek the public eye, are often filled with extraordinary drive and enthusiasm, made all the more extraordinary by the few gains sent their way over lifetimes of activism. The reality is that there have been 30 or so government enquiries into birth in Australia in the last few decades and barely any changes benefitting women and a caesarean rate that is rising unchecked. So something isn’t working. To me, it seems that we are always begging the burglars to return our stolen goods rather than facing the fact that not only are we convinced into believing something was stolen which never can be, but that we still have within each of us that which was allegedly stolen. Governments hand out sufficient small gains from time to time, to keep the carrot on the stick always waving just slightly in front of us but overall, nothing changes. Investing energy in things we cannot change when, namely hospital policies and government support for overservicing in maternity hospitals, is never going to give us what we actually want – empowered consumers who seek out the possible care for themselves and refuse to take anything less. We already have a way in which to achieve evidence based care for consumers in this country, it’s called homebirth. Why try to mould and change a massive, hostile money making system to our desires when we could just access the existing best model and with a little tweaking, instantly reduce our morbidity, mortality, caesarean, postnatal depression and posttraumatic stress disorder rates nationally? Leave the surgeons to their system, and work with women to support each woman to find her way in a model which empowers each of us rather than violating and disempowering. No matter how hard we work, hospitals are always going to be inappropriate places for healthy women to give birth.

All our government literature, all our commonly purchased books, our community groups, our birth reform movement, all these pacify us into believing we have choice when in reality, we have no choice within the system. When we seek to engage with surgeons and improve their work place, we merely continue to spin the myth that hospital birth is good for us or even desirable.

If this seems farfetched to you, consider such issues as birth centres and mother assisted caesarean. An important pacifying gesture of the system is to allow us things called Birth Centres where the surgeons still decide the policies but we kid ourselves that we’re “allowed” to have the low tech experience the vast majority of women actually want. Of course the reality of birth centres is that they have high transfer rates, little or no evidence based care, and like any other institutionalised birthing, our experiences are largely dependant on the staff lottery. Only by refusing to engage with the system’s plan for our bodies can we hope to bring about real change.

And if the perversion of birth into Birth Centres wasn’t enough, we now have something called “mother assisted caesarean”. How is that for backwards? We the surgeons will give you permission to feel involved in the birth of your own child as we perform it for you. Women are “allowed” ( ah yes, that word again) to pull their own baby, from their own bleeding bodies in a parody of giving birth. Women are then encouraged to wax lyrical about how it’s “just like a vaginal birth” (Really?) and how it’s an uplifting and spiritual experience to hold a baby from the moment it’s born which isn’t really news to those who birth at home. Many of us have bought this lie and see participation in the usually unnecessary slicing open of our bodies as a step forward. Surely we can think a little more critically about it than that? If your caesarean is taking place in a calm, unhurried manner and you have time to have the screen moved, reach down, have your hands placed on your baby and lift it from your body, you probably didn’t need that caesarean anyway because that’s obviously not an emergency and caesareans are emergency surgery.

We have to stop buying into the myth of hospital birth and simply tell women that birthing at home is most likely to give them the birth they’re after. Recent surveys, and our own experiences, tell us that most of us want a drug-free spontaneous, physiological birth and yet we continue to go to the last places on earth this is likely to happen. Instead of loading women up with lists of ways to protect ourselves, why don’t we just make sure homebirth is the first option? Do you want safe, gentle, evidence based drug free birth with the careprovider of your choosing, in the location most convenient to you? Then have a homebirth! Simple. Until we stop pretending that hospital birth and homebirth are equal choices we will keep on lying to women and setting our sisters up for failure which they then blame on their own bodies.

What are some women doing to address these issues and reclaim their right to bodily integrity? A lot of us are birthing at home in either assisted homebirths or autonomous, family births, sometimes called freebirthing. Many women are deeply angered by a system which seeks to remove their control over their birthing experience and refuse to engage with it. It is an intensely radical act to remove the control of others from the contested female body in a patriarchy.

In Joyous Birth we see birth as only a part of what we do, and we are at heart a feminist group. We support women to change our lives and find our power and then this naturally flows into how women approach birthing. We cannot see birth in isolation from women’s lives. We must always be active consumers, not passive recipients of whatever we’re handed no matter what careprovider we choose or the environment in which we decide to birth. And only we have the right to decide where that is. So let’s not allow those around us to force us to birth where they think we should, whether that’s families, partners or the QNC. Let’s not offer our power to those who do not serve us, let’s keep our power and our integrity intact and birth safely, at home, where we conceive our babies and raise them.