It’s begun. The divisive topic of home vs hospital has reached its peak, thanks in part to Covid 19, but also thanks to a new generation of women and birthing people who just don’t want the status quo anymore. Predictably, the outbreak of the virus has been used as an argument FOR or AGAINST home birth, and health authorities have so far come out as looking like the victims of circumstance according to mainstream birth forums.
I see it every time I, or any of my friends in birth work, express any disgust in a system for stripping birthing people of their autonomy. Someone, usually a healthcare worker, inevitably play’s devil’s advocate. The health care system is stretched too thin. They don’t have enough PPE for everyone. They can’t risk spreading the virus. Healthcare professionals are only looking out for the best interests of mothers and babies. Women who are only “thinking of themselves” are “putting everyone at risk” by insisting on “their way”. Blah, blah, blah. Once again, they miss the point. They either don’t see it, or they are so ingrained into the system that it’s against their best interests to agree with the critics or go against the system that employs them.
But the thing that people don’t seem to get is that most of us who are outraged (not scared, but OUTRAGED) about the stripping of our rights and freedoms are feeling that way because the hospital is NOT safe. No, I’m not referring to just this particular time with Covid 19, but all the time. The hospital is not a safe place for those of us who want true autonomy in our births. WE don’t feel safe. You can assure us that you’re taking all the precautions you possibly can to protect us from the virus, but who is protecting us from the system that has turned birth into a conveyor belt where the goal is extracting a live baby from a live mother?
Nurses, some of you might get it. Midwives, you definitely see it enough and I see you. I am not lumping you in with the care providers who decided to place these restrictions on birthing people because you’re the ones warning us about these restrictions. You’re the ones who know what physiological birth looks like, how it works, and you understand better than the rest of the health profession what is needed for a physiological birth to unfold without complications. I know you didn’t choose this, and you certainly weren’t consulted when all these doctors got together and decided for birthing people what was “best” and “safest”.
But, so many other people who do not understand physiological birth don’t get it. “Oh, the hospital isn’t that bad” is what I hear. “They’re only doing this to keep everyone safe” is the proverbial “guilt us into compliance” tactic even if they aren’t aware that’s what it is they’re doing. Well, I’m here to point out WHY we aren’t buying the party line. Because honestly, I’m fed up.
We Were ALREADY Traumatized Once
For most of us who go back to the hospital after one traumatic first experience, mostly in mainstream birth culture, we assume it was our bodies that failed. Those of us with this narrative often pick the same care provider who “saved us” last time, maybe get the epidural this time, maybe schedule a csection, and then lower our expectations of birth.
Then there’s the “rebels” who see their trauma for what it was and refuse to believe it was our fault. We’re the ones who change care providers and refuse to go back to the hospitals that traumatized us. We’re the ones who plan home births after a terrible hospital birth, or even just a hospital birth that didn’t live up to our visions of what birth should have been for us. For a lot of us, it’s a chance for a do-over. For those of us opting out of the hospital, it’s not about the “experience”. The truth is, we already saw what the hospital had to offer. Some of us might even have had unmedicated and uneventful hospital births where you wouldn’t think “that was traumatic”, but as someone who had one of those I can still say that the only reason I got off as easily as I did was because I had to fight and claw for it, and also I just happened to be lucky enough that day to have the one midwife on call who didn’t care what the health authority “rules” were and protected me from most of the arbitrary policies that she knew would upset me. When faced with the possibility of going back there, knowing that it’s all a big Russian Roulette with a lot more bullets in the chamber than empty spaces, is it really surprising that in the middle of a pandemic we are still reluctant to go to the hospital?
We Don’t Trust the System
Those of us fighting hardest against a hospital birth for all birthing people as a “one size fits all” approach are those of us who know that those policies aren’t for us. We learned a long time ago, likely in our first birth or from someone who was close to us who was harmed that the hospital is no safe place for a physiological birth. Sure, it’s great when you’re looking for an epidural and don’t mind if you “need” an episiotomy or an “emergency” cesarean. It’s great for those who truly do need medical care for a healthier birth outcome. But the majority of us can do just fine without interventions in birth. If the system was set up for NORMAL birth, then there would be a birthing SUITE for every birthing person that included a deep tub, a bed pushed into the corner of the room and probably not used at all, medical equipment hidden away, a birth ball or peanut ball, a soft, cushioned area on the floor, and very dim lighting. The nurses and doctors would remain outside the room unless the birthing person wished to invite them in. Babies would be welcomed into the hands of their parents, cords wouldn’t be clamped, exams would wait until after the golden hour, and then everyone would go home a few hours later.
But that’s a birth centre I’m describing, and despite our efforts BC still doesn’t have even ONE birth centre. In the UK there’s something called a Midwife Led Unit (MLU) that’s like a birth centre within a hospital, where an easy transfer of care could happen in an emergency. This isn’t to say that their system is perfect, because MLUs often have the same arbitrary rules about who is “allowed” to use it and when they “have to” transfer care. But it’s better than what we currently have as an option. Our midwives don’t get to “lead” a maternity ward. They have to “consult” with the OBs, and the OBs make the decisions on what is “allowed”.
Those of us who have witnessed the hierarchy at work, or who had a feeling that our rights were being overridden by the healthcare system, or who were flat out lied to in order to gain our compliance know better than to ever blindly trust the system on a normal day. The system has already shown that it will protect itself rather than give birthing people full autonomy and trust our bodies more than machines and their textbooks. Now, in the middle of a pandemic, the system is more concerned with minimizing risks from the virus, but the risks of threatening the very things needed for an intervention-free birth seem to be not considered a priority at all. WHY in the world would anyone who cares about their birth outcome want to put themselves in a position where what’s “best” for the system directly clashes with what is best for their bodies and emotional well-being?
We Don’t Trust The Hospital Without Our Partners
Not everyone can opt out of hospital birth. Some people need specialized medical care and that’s what the hospital and obstetrics was designed for. But those people also deserve to have support and definitely need an advocate. Some interventions might be consented to and discussed, but the person who is going in for an induction also has the right to request that a certain course of action be taken over another. Some people would rather tear than have an episiotomy, but some doctors prefer to just do the episiotomy because it’s easier to stitch a cut than a tear. What is to stop them from doing that cut and ignoring the client who said “don’t cut me” and claiming it was an emergency? There’s no witnesses, other than hospital staff who wouldn’t dare speak out. There’s no one to stop this from happening. No one to warn the client or remind the doctor of what the client wants.
Hospitals exist in a vaccum where everyone who works at that hospital has a conflict of interest. They want to keep their jobs. Therefore, they are bound to work within the policies and standards set by their health authority. What this means is that the client who comes in and says NO to those policies is conflicting with the perceived requirements of the individual healthcare professionals trying to do their jobs. I call it the “ticked boxes” complex. There’s a chart for every client/patient who comes in, and the nurse needs to check those little boxes on the list. So if one of those boxes is “dilation upon admission” and the client refuses a vaginal exam, that box is empty. But then further down there’s another box asking for dilation after x hours and that box is also not checked. Then there might be a box to tick that says “blood test done” and the results of that test. But what if the mother whose chart you have decides she doesn’t want that blood test.
Furthermore, what happens if the nurse is told by the doctor to order Pitocin for a “stalled or slow to progress” labour, but the mother says she doesn’t want it. Does the nurse go against the doctor and honour the client, or does the nurse try to get compliance so that they don’t have to later answer to the doctor about “not doing their job/following orders”?
The reality is that our system is set up where doctors and nurses give orders and patients are perceived to be “not in compliance” when they exert their autonomy and refuse. And in the case of maternity care, you don’t have just one person refusing care, they’re also having a baby. So if there is ANY question of who has bodily autonomy and whose body is more of a priority in pregnancy and birth, then we have every reason to question where the loyalties of the medical profession truly lie. Are they going to “allow” us to refuse an intervention they feel is “in our best interests” or are they going to try to push us into saying yes, or do it anyway?
This is already an issue! It was an issue before Corona and will continue to be an issue after Corona if this current train of thought on who needs to “make sacrifices” in this war continues to point the finger at the birthing person and not the system. So those of us who already didn’t trust that system definitely do not trust it now. And given the trajectory of how things have gone so far, we have every reason not to trust it.
We Don’t Trust Hospital Birth Without Witnesses
In that same line of thought, we don’t trust the healthcare professionals without an advocate/birth partner/doula in the room. Doulas aren’t just some silly luxury item that millennial mothers have come up with for fun just as birth plans weren’t just silly little wishes for tea lights and soft music. They are necessary interventions to the system of birth in a hospital that we felt the need to introduce because we were seeing the writing on the wall.
How many of our mothers and grandmothers ever questioned birth in the hospital? I can tell you that mine didn’t. My mother got an episiotomy without knowing anything about the risks or benefits or that she had the right to refuse it. She didn’t know that she never had to have that IV upon admission back in the 80s and probably could have eaten and drank as she liked instead of starving herself. She didn’t know she didn’t have to be on her back or that she could refuse cervical exams. To her, all this stuff was “part of having a baby” and unavoidable. Is it any wonder that when I heard my mother tell me this, I spent years of my adult life researching ways to birth and avoid all these things? I wasn’t scared of birth, I realized, but I was scared of unnecessary interventions. I was afraid of the needles, scissors, and scalpels.
Most of us who want our birth advocates with us are looking for support so that we can avoid the needles, scissors, or scalpels. We also know that sometimes those things might be necessary, but they give us anxiety and we need our support people to help us relax in the event that those things come up as a possibility. We don’t want to be alone in a room with a bunch of people who don’t know us and whom we don’t know. We don’t want to have to try to say NO to an intervention with nobody “on our side”. Definitely we don’t want to have to do these things in labour.
Labour makes us all highly suggestible, as some care providers know all too well and use it to their advantage. We don’t know who will try to push an intervention we don’t want when we are at our most vulnerable. When we have a doula and a birth partner we can at least have the added protection that things won’t be done to us without our consent, and if they are done to us we will have witnesses to that violation of our rights. It’s also why we might wish to film our births. Kimberley Turbin only managed to get her story out there in such a high profile case because she happened to have gotten it all on tape. And to those hospitals that don’t “allow” filming, maybe we’re questioning why and thinking that there’s a reason to be mistrusting.
The limiting or banning of partners in the birth room doesn’t guarantee us harm, but it certainly makes it easier for hospitals to “pull rank” and bully us into something we would never agree to if we weren’t vulnerable and without an advocate in our corner.
Hospitals Don’t Know What Physiological Birth IS
This is the biggest reason why some of us just don’t want to birth in the hospital. The reality is that the hospital is just not set up to support a physiological birth; it’s set up to manage birth. Those of us who choose home birth don’t need our births to be managed. We can birth our babies freely without ever having a cervical check or any other assessment of progress. We know that we really don’t need all those things that are on the checklists in order to birth our babies. But the problem is that those who are ingrained in the system of checklists and monitors don’t know that another way exists, or even what that looks like.
So when someone comes into the hospital, which as I just said is designed to manage birth, and they actively reject every single part of that management, the hospital staff don’t know what to do with them. How do you explain to that well-meaning nurse who sees you moaning low and swaying with every contraction that vocalizing helps you and that you really don’t need that epidural they keep offering to get you? How do you explain to the doctor who only ever understood labour as it’s depicted in the textbook that your cervix not dilating 1cm each hour or even closing up again is normal and you really don’t need Pitocin or to have your membranes ruptured to “speed up” the birth? How do you explain to the birth attendant who isn’t “supposed to” catch the baby that no, you can’t “stop pushing” and that it’s perfectly fine if you birth that baby on the bed or floor or into your own hands?
The reality is that labors like mine and other variations of the textbook are treated as pathologies in the hospital. I am only here today with two vaginal births and no interventions in those births because I carefully chose to have midwives instead of doctors, learned about physiological birth until I could theoretically get a degree in it, and happen to have a stubborn streak that actively resists control. In my first birth I had my unmedicated vaginal birth in spite of the hospital, not because the hospital staff were supportive of my choices. The only person who believed in me in that room was my midwife, and even she was running out of time before the OBs stepped in and pulled rank on her (and me).
Those of us who understand physiological birth know ourselves well enough that we are well aware of how environment can affect our births. We know that fighting against a nurse or doctor who really thinks that we should just take that epidural or allow that cervical check is not where our energy should be focused. We know that stress is the enemy of oxytocin and we have made conscious efforts to not allow that stress into our birth space. So, if we don’t trust our environment, don’t have our support people, and don’t feel like our decisions will be respected then how can anyone truly question our resistance to being told we have no other option but the hospital? How can anyone question our outrage at being told we can birth without our partners “for the safety of everyone else” and that we “won’t be alone” because nurses are there to support us? How can anyone question why some of us flat out REFUSE to go to the hospital and research free birth as a last resort option to avoid birthing where we don’t feel safe?
I think the real issue is that while we are stating all the reasons why we don’t feel safe and demanding alternatives, the health authorities aren’t listening the way they truly need to. It’s not about making the hospitals seem safer or making statements about how they can’t offer alternatives because of funding, availability of medical staff, availability of ambulances for transfer, or any other myriad of reasons why they don’t offer home birth. It’s not about what’s safer from a perspective of “risk” to mothers and babies. It’s the fact that they have never seen a physiological birth. They don’t know that birth looks so different outside of a hospital. They don’t see that a long labour doesn’t mean a problem. They don’t see the start and stop labor like I had with my daughter over the course of 3 days and so many weeks of false starts. They don’t know how to sit on their hands and do nothing. So when we ask them to sit on their hands and do nothing unless we decide we need them to do something, they don’t seem to understand what we’re saying. They come back with stories of times when something was truly wrong and they didn’t do all the precautionary things that they’re doing now “just in case” the same thing happens again. They tell us that we are being “selfish” to prioritize “experience over safety”.
I don’t know what the answer is to convince the system to change. Maybe it never will. Maybe we will simply have to continue on our own paths and decide for ourselves where we feel safest to birth, and force the healthcare professionals to come to us if we need them rather than go to them in case we do. Maybe it will take a revolution. But I do know that right now, with hospitals imposing all these restrictions on birthing people, it’s making home birth far more appealing and not one of us who values autonomy is going to just sit back and allow the medical system dictate what “safe birth” will look like for us. That’s our decision to make, and the more we make those decisions the more they will have to listen to what we’ve been saying all this time.