Friday, November 03, 2006

birthing autonomously

I wrote this in response to a forum question that a woman posed asking if anyone on the list had had or would have an unattended or unassisted birth, meaning a homebirth without a midwife or doctor present:

If I ever have another baby, which I still pray that I will, then I plan to have an unassisted birth. My boys are 11 and almost 13 y.o. and their births were both attended by a midwife, resulting in one hospital transport and one gentle, straightforward homebirth.

I have been practicing as a lay midwife for the last 7 years and just attended my first stillbirth last month on my birthday. I had been feeling for quite some time that I was ready to quit practicing midwifery, and that most recent birth has propelled me to accept my own resignation. But you see, the reason I had been feeling that I was done practicing was not because I do not want to attend births, but simply because over and over again I felt like I had no business attending these births as the "manager" or the "expert." I believe so strongly in our bodies' ability to give birth and I also believe just as strongly in the natural cycle of birth and death, that I had begun to feel like the women whose births I was attending, the typical, american, homebirth client, the women who were already taking good care of themselves and eating well and educating themselves about pregnancy and birth and motherhood, they did not need me. I felt there was too much potential for me to disempower them. And perhaps some women wouldn't make the leap to have their babies at home without a midwife, and they feel they need that support in our crazy society that doubts them so heavily and instills them with fear, and so I am glad there are midwives out there to do that good work. But me? I am ready to let go and let birth happen on its own.

When that little girl was born dead into my hands I realized that there was nothing anyone could have done to "save" her, and I also realized that there was no need for her to be saved. It is normal for some babies to die, it is the way of the earth, it is the way of nature, it is part of the cycle of life. I began to feel that all of the prenatal testing that we do and most of our society's choices around prenatal care and birth are all rituals we have ascribed to in order to ward off death, and you know, they just don't work. No matter how hard we try to save them all, there will always be babies that die, at home, in the hospital, in utero and sometimes in our arms. And it is sad, so, so sad. No one wants to lose their child and face that grief. But for millennia human and other mammal mothers have been giving birth and losing their young, and no matter how much we intervene what you will find is that most babies survive their pregnancy and birth just fine, and there are always some who don't, but what I believe to be true is that our culture has such an abject fear of death and has vilified it so seriously that we are no longer capable of accepting the normalcy of death and taking it in stride. We act as if a lost child is the greatest of tragedies, and though it is in some ways (my miscarriage was one of the hardest challenges I have ever faced and I thank god for the safety of my living sons every day), it is also a normal part of life. It is our fear of death that has lead us to behave so irrationally about how we birth.

So, I will support my sisters and friends on their birth journeys. I love birth. I want to be there if I am needed to serve a woman and her family as they go through that life changing experience. Of course, I fully support education for all women, in particular in regard to their needs in child-bearing. Women need help learning how to care for themselves during pregnancy, what to eat, how to exercise, how to care for their changing emotional and spiritual needs, in particular because we have lost much of that wisdom that used to passed down from mother to daughter and from sister to sister before we abandoned our care into the hands of obstetricians. Women need to hear birth stories, read birth books, watch birth movies since most of us are no longer blessed with the gift of being present since childhood at the births of our siblings and our cousins and our neighbors. We need to work towards normalizing the concept of birth, and of death as a sometimes part of birth, so that more and more women will feel empowered enough to birth autonomously.

Many women who believe firmly in homebirth with a midwife in attendance will eschew the idea of birthing unattended, and most of the time it is not because they feel like they need one more person at their birth; they have partners and family and friends to hold their hands and look into their eyes and feed them sips of tea while they labor, but because they want one "expert" present at their birth. Truly for most women, they feel they need that expert there to keep them and their baby alive on the off chance they are the one in thousand or a million who will lose their baby or won't live themselves. And I would be remiss to state that there are never situations that can arise in a birth scenario that could lead to dire consequences, including death, in which a trained professional could manage to keep all parties alive, for that is true, there are situations like that. But does every woman who gives birth need to give up certain autonomies and freedoms, does every woman need to thwart what may be the natural consequence of death simply in order so that a few will be saved? I cannot answer that question for anyone but myself, but I know that I am willing to risk that myself or my child is the one that dies so that I can experience birth as authentically, naturally and spontaneously as the universe intends for me by choosing to birth of my own recognizance.

I support all women to have complete freedom to birth wherever and with whomever they choose. Blessed be.


ashaya said...

Speaking from first-hand experience, I can say that having you as my midwife was really no different than not having you as my midwife. What I mean is that I believe you would have done all the same things in the same way had I asked you to attend my birth as a friend. You never once made me feel that you were more of an expert than I; you never once made me feel that your ideas or knowledge superceded my own. In so many ways, I really condsider Amadahy's birth unattended, because no one was in the way. No one ever pressured me to do anything any differently than I would have if I had been in that room alone. In fact, I spent a good part of it in the room alone! I fully support your choice to resign from midwifery, but there is certainly a part of me that is very sad because it is the midwife who feels she is not needed who is, in my opinion, the right kind of midwife. It is she who doesn't intervene; it is she who steps back; it is she who focuses not on doing but on allowing. Whether or not you come to my next birth, I thank you for being the best "expert" friend I could have asked to hold my hand as I passed through the gate from maiden to mother. I love you.

ashaya said...

She cried...

The heavens parted with each heaving breath.
Her eyes closed tightly,
and I thought to myself

She is the most beautiful mother I have ever seen.

I searched for a tiny heartbeat beneath the many layers of expectation.
Please, God, let me hear something...

And through the taut skin and the heavy womb,
through the water and the worry
there was relief and hope...
da da da da da da da da...

I looked her in the eyes as she searched my face for an answer to a question she need not ask
And I thought to myself

She is the bravest mother I have ever seen.

And with each wave came a push
And with each push, an inching,
forward, downward
And then...
a little wet and slippery body filled my humble hands,

but the weight was greater
than ever before.

And we knew
in that moment
that the tiny body held no life.

A deep heaviness settled over the room filling every stark corner.

There was no color; there was no warmth.
Not a single breath hid beneath her ribs.

And I cried...

And she cried...

And I thought to myself

She is the strongest mother I have ever seen.

just said...

Thank you so much, Ashaya. I feel graciously honored. It would be a blessing to attend your future births, whatever you should call me there.

But, I want to share with you the other realization I had through this recent process of birth nd loss. To midwife the way I do is to potentially call down the wrath of the patriarchy upon myself. Unfortunately, in our culture midwives are forced to practice defensively in order to save their own asses. I have always known that to choose to midwife the way I do is to practice as a renegade, and I felt up to that task for a long time; I wasn't afraid of "the man." But one of the most terrible parts ofattending this
recent sad but blessed stillbirth was having to grapple in the moment that I realized that sweet child was dead with my own fear for myself, when it felt so wrong to me to have to do that.

I wanted to feel only for the family in that moment, to feel sensitive to their needs, to be there for their grief, their shock and anger and confusion. I wanted to be so free of my own bullshit that I could serve them with a clear head, and I did not feel like I could. I could not help in that single moment of realization that we had lost that baby but to concern myself with my fears of losing my own freedom, abandoning my children to be raised without me, selling my home to pay exorbitant legal fees and all the crazy fear-based fantasies that ran through my head. And I felt like a failure. I felt weak. I felt like a poor midwife to let my fears to the surface like that and it made me worry that I could not trust my own judgment as a midwife in that or in future situations, for a midwife who is acting from a place of fear is no different than the obstetricians and medical technicians routinely taking away women's rights to birth autonomously to serve their own fear-based interests. And I can't have that. So unless I feel that I can regain my own bravery and walk into a birth ready to be fully responsible for the consequences of acting on my own beliefs and not let the possibility of that reality in any way affect the family I am serving, I must choose not to put myself into that position. I refuse to let my fear subjugate others.

For you I would strive to regain that strength. I trust you with my life as you do me with yours, and that makes a big difference. Thank you. I love you, too.

Anonymous said...

yes, some women and some babies have always died in childbirth, and always will die in childbirth, but the availibility of hospitals and doctors reduce the risks greatly.

I have worked in rural venezuela where women give birth on their own, far from hospitals and they are much more likely to die. 10 times more likely.

sure, people can have biths unassisted, but if they want the best chance of survival for themselves or thier child they should be in a hospital.

ashaya said...

Let me start by saying that I honor and understand your feelings. I respect your decision because it shows how much you do care about women, babies, and families. Maybe it is because I am on both sides of the mother-midwife relationship that I feel the way I do, but I believe that it is important for the community, families, and mothers to take care of our midwives, just as it is important for our midwives to take good care of our mothers, families, and communities. I would not feel comfortable having a midwife who was so involved only in me that I was unable to relate to her on a personal level and form a true intimacy. I wouldn't want a midwife who was so untouchable. I hear you when you say that you want to be able to walk into a birth and make decisions based only on love and never on fear. At the same time, however, to never experience the fear at all would be almost impossible if you are to live within the community at all. It is probable that the vast majority of those individuals who rarely or never experience great fear are those whose lives are solely dedicated to strict spiritual practices that would prevent them from serving communities as midwives anyways. So, if you cannot, at this point in your life, refrain from acting out of fear at a birth, then I am so proud and also humbled that you take such full responsibility for the type of midwifery that you practice. At the same time, no matter what fears arose for you or when, the process that you are going through now shows that that baby, mama, family was and is served by you in a very high and holy way. The fact that you feel you need to step back from your role as a midwife because you felt you could not "feel only for the family" is precisely what makes you a superb midwife. Like I said before, I wouldn't try to convince you to do anything that you are not fully at peace with in your heart. That's not what this is about. It's about making sure that you see the beauty in your midwifery and not only the fear, doubt, and disappointment with yourself. The true problem lies in the fact that a midwife would ever need to be afraid of being imprisoned, losing her children, or paying exorbitant legal fees in the first place. I'm not quite sure how a midwife, in this time in history, in this medicine-as-god society where traditional midwifery is often illegal, could escape fear altogether. It is a tragedy that those who give of themselves on so many levels and in so many ways are at risk of losing so much to do it, while doctors charge insane amounts of money to not get to know anyone personally or form any real connection, to only take measurements and calculations, to invoke fear and perpetuate the myth of the almighty doctor here to save the day with interventions that only separate us from ourselves and our babies, do not have to worry nearly as much about losing anything personal. So, I say, it is not you who has failed or is weak. It is the goddamned system that puts murderers in the White House, robots in the classrooms, rapists in the EPA, and saints behind bars. Fuck all of that shit.