Misogyny, Paternalism and Dice 'Em Up Obstetrics

I am constantly irritated by the seemingly endless stories of bad births I hear about from unsuspecting mothers.  

These bad births are often rooted in a system of paternalism still prevalent in obstetrics.  If you don't believe me, read the definition of paternalism. 

(From Wikipedia)
Paternalism- refers to an attitude or a policy reminiscent of the hierarchic pattern of a family based on patriarchy, that is, there is a figurehead....that makes decisions on behalf of others ... for their own good, even if this is contrary to their wishes. The paternalism of a parent (strictly, a father), even one who restricts the liberty of a child in the child's own interests, has not generally been thought to require extensive justification.
It is implied that the fatherly figure is wiser than and acts in the best interest of its protected figures. The term may be used derogatorily to characterize attitudes or political systems that are thought to deprive individuals of freedom and responsibility, only nominally serving their interests, while in fact pursuing another agenda which is directly against the interests of the individuals.

I am sick and tired of this attitude.  It is rampant.  The whole pat on the shoulder, and the gentle reassurance to the mother that the doctor will "Take care of everything" is ridiculous.  I used to be just angry at the profession as a whole.  No longer.  I am disgusted that women continue to buy into this in the hopes that it will somehow make the entire event of birth somehow painless and easy.  

Letting somebody take care of you for your pregnancy and birth is not the way to have a great birth.  It is a sure fire way to have a horrible experience that often resembles assault and that is traumatic to recover from.  

Let's think about this in action:

A first time mom is excitedly pregnant!  She is looking forward to inviting a baby into her home and family.  She is however apprehensive about the pregnancy and birth.  Why wouldn't she be.  She has her whole life heard horror stories from her mother, other women, and the media about the miseries of pregnancy and the pain of birth.  

She makes an appointment with a care provider.  She is interested in a natural birth and mentions it in her first visit.  He seems to brush aside the idea, and mentions that most first time mom's need an epidural to endure labor.  After all, why should she suffer?  He says. "Don't worry, I know what I am doing.  I have been doing this for years.  After all, it is what I went to school for."  

Mom continues to trust her doctor.  He continues to in offhand ways refer to her inability to give birth on her own.  Her visits with her are brief.  But there is comfort in knowing that he is an expert.  

The time for the birth approaches.  Mom is huge and uncomfortable.  The doctor suggests an induction.  After all, she doesn't want to be pregnant forever, does she?

An induction is performed on the appointed day.  Pitocin, followed by an epidural, followed by distress, stress, and the eventual "necessary" c-section ensues.  

Mom is grateful that she had her doctor there to save her.  Otherwise, she and the baby surely would have died.  

Mom returns  home to recover from her  surgery and try to raise a baby.  She has no confidence to do so.  She is  in pain.  The system has convinced her that she is incapable of basic  female functions, and she believes it.  

This happens every day.  Every single day.

Whose fault is it anyway?  Is it the system that treats women like incompetent vessels  of a foreign object?  Is it the doctor who assures her of his expertise?  Is it the mother who goes along with this line of bull?

There is probably enough fault to go around for everybody.  I refuse though to place all the blame on the system and the care providers alone.  I refuse to place all the blame on a culture that is simply misogynistic and in which women are only valued when they resemble men.  

We as women must take responsibility for our own births.  We can not pass the buck.  
Who is going to recover for weeks from this surgery?  Who is going to deal with postpartum depression?  Who is going to struggle with breastfeeding because of this surgery?  Who is going to have a baby with increased risks for countless things?  Who is going to have to struggle to VBAC?  Who is going to have to limit her family size because her body can not handle any more surgeries?  Who is going to catch a dangerous infection in the hospital?  Who is going to wonder why things happened that way?  

The answer is you.  YOU ARE THE ONLY PERSON WHO WILL ULTIMATELY CARRY THE BURDEN OF YOUR CHOICES.  That doctor, who was so comforting and said he would take care of you is not going to come to your house when you have a breakdown.  He is not going to do your laundry when you can't lift the basket.  He is not going to feel like he has a broken body because his birth did not go as it should have. 

It is easy to to let somebody take care of us.  We all have a little girl in us that would like to do this.  It is the same little girl who doesn't want to experience any pain.  This same little girl wants to give up when the going gets tough.  

But you are not a little girl any more.  You are a woman.  You are a mother.  You are stronger and better than that.  

You want to take responsibility.  You want to do this even if it means eating better than you ever have.  Even if it means exercises, reading, switching care providers, and just being different than everybody else around you. 

It is time we took responsibility for our own births.  I can guarantee you that this is the only way that things will change.  ACOG and their cronies have ZERO motivation to change obstetrics.   We do. 


Christina said…
I was kind of upset after reading this post, especially since I was wondering if my earlier comment inspired this. I actually un-followed, then re-followed, because I decided you probably weren't intending for me to feel attacked at having "irritated" you - I do know when I'm being oversensitive and ridiculous. I just want to (respectfully) disagree with the following statement: "Letting somebody take care of you for your pregnancy and birth is not the way to have a great birth." Er... this got really huge. I just made it into a blog post. (here, if you're interested.) But I do disagree. I want to be taken care of while I'm pregnant, and at other times, too. I just don't want it in the way you're assuming it has to be.
Mama Birth said…
Mama! Certainly not aimed at you or because of you! (I just read your comment after I had written this post, and a footling breech is a good reason for a c-section) This is not meant as an individual judgment of anybody.
More what I am saying is that so often those of us who are pro- natural birth tend to only blame the institution. What it comes down to is that the institution will not change unless we force it too. I think that women don't want to make the hard choices sometimes that will get them a good birth, it seems easier to let somebody else take responsibility. It is less about being taken care of, and more about taking responsibility.
Very glad to have you reading. Glad I made you think even if we disagree, and I look forward to reading your response!
Christina said…
I said I linked to it and then didn't.
Christina said…
Thank you for your response :) I don't disagree with that, or with anything else I've read on your blog so far (aside from the caring thing, which I think hit me a big because I've seen so many things lately where women believe in order to give birth naturally you have to be a super-woman and do it all yourself, which I don't believe!). I plan to have an HBAC next time (we're trying to conceive now). I was afraid to try until recently, because I was traumatized by my birth - not because I felt a c-section wasn't warranted (I went and got my medical records later!) but because I felt like I "let THEM" take away my choice with no discussion. I think there's plenty of blame to go around, and plenty of responsibility to be taken. We do have to take charge of our lives, and our births. But I think we can do that while caring, and being cared for :) - I love your blog, by the way. I'm in the Central Valley, so not far from you!
Mama Birth said…
Read your blog mama! Good one. I guess what I am talking about more specifically is the trend so often of women looking at themselves as VICTIMS. I don't think pregnancy or birth are horrid and the mother a victim of her body, her OB, and her sexuality. I think these things are a joy. I don't think birth is suffering. And because she is not a victim, she should be treated with respect. This also however demands that we ask for respect and act as adults, not children incapable of making our own decisions. We are the ones who carry the burden of the consequences.
Thanks for reading!
Reese said…
This was my story. I'm grateful - I'm beyond grateful that I found the support I needed to have a successful VBAC. I also found empowerment in my birth, and I came out with the knowledge that I am not broken. I can do this.

I'm now a doula and childbirth educator to help remind women of exactly what you said. It is their birth, they must take responsibility. They have options.
Thank you so much for sharing. You're writing is beautiful and I wouldn't change a word.

I felt I had to say, I agree the misuse of the paternal pattern can and does become abusive with people who aren't careful enough with it. The paternal pattern does not have to be bad in the context of a family. Parents bears great responsibility to consider carefully the effects their decisions will have on those they're choosing for. We as mothers have to do make decisions for our children all of the time as well. Like I'm not going to allow my 2 year old to run out in the road with an oncoming car no matter how much she cries, but there may be a lot between that dangerous situation and very safe irritations I may erroneously disallow (or not) There is a lot of room for gray in there. We all ought to be more careful and considerate. And we all must ultimately do what we feel is best, just as in childbirth.
The more I immerse myself in this field, the more I learn about my responsibility as a parent.

There may be some situations where it's necessary in the medical world as well. I've talked with someone I'm close to who is a doctor (pediatric nephrologist) at length about this issue. He says he will put antibiotic ointment in every childs eyes - even a family member, no matter their request or situation. His position is that he doesn't know who is lying, and a matter of "a little antibiotic" versus a lifetime of blindness is a risk he will not take. He sees many of parents who come in and do lie or are negligent and are reckless with their children's care, placing responsibility squarely on his shoulders. In those instances he feels responsible for the care of the child. He also asks how can he "profile" or discriminate one parent from the next when it comes to blindness?
So, it is another classic case of everyone paying the price for the one who steals something from a shop.
I'm not saying he's right, but I'm glad I'm not in his position. And I suppose I'm agreeing with you that each party has a part to play.

Thanks again for a beautiful post.
I will share this with others with your permission?
Reese said…
The best paternal leader more often says, "what do you think is the best thing?"
Mama Birth said…
Thanks so much for your comment Cherise- You made some excellent points. I actually have no problem with a patriarchy in its proper form, which I think of as a humble, servant, who at the same time leads his family, beside his wife.
When I think of paternalism outside of this context (a healthy family unit, possibly religious, where the father has a leadership role) I do however think of the description I used. In this instance paternalism is used to talk down to those you are around and lord your authority over them, when you do not have their best interests at heart. When in fact the figurehead actually is in it for himself. I think this accurately portrays much of obstetrics today.
It is tragic that something as amazing as birth has come to have to cater to the lowest common denominator because people lie to their birth team. One of the things I love about home birth is that the midwife can and does take the time to get to know that couple.
Molly said…
No matter how many times I try to write about making informed decisions and considering the consequences of actions taken in the name of making life "easier" only to find that it complicates things, I always get backlash from mothers who deny ever wanting to have a positive birth experience and insist that they were so happy to have epidurals and who cares about breastfeeding anyway, their children are still fine!

I just get so angry and rather than thinking about what I have said, which is, consider the consequences, they think I'm being judgmental and think I'm better than them for not having had epidurals and successfully breastfeeding my kids.

S. Scalise said…
@Mama Christina...
being taken care of is very different from being removed from the process. it is false to assume that natural birth is equivalent to throwing you to the wolves.
The Goon said…
Best article ever! I think I love you, lady.

I've been reading a book called, "Pushed: The Painful Truth Behind Childbirth and Modern Maternity Care" and I cannot, for the life of me, figure out why women put up with this crap?

I've never had any kids, but if I ever do get pregnant and have a baby, there's not a chance in h*ll that I'd step foot into any American hospital--not unless it was a proven fact that if I didn't go I would die. And even then, I'd at least try to make my way to a Canadian hospital. Since I'm in Michigan, I am close to Canada and I think they treat their women better than we do in the dumpy US. I live right around the coroner from a hospital too, but I'd still make my husband drive me to a Canadian hospital in the event of a birthing emergency. If I didn't have any troubles, I'd just stay home and have my baby in my bathtub. I just wouldn't go into an American hospital to give birth. I wouldn't. OB's can stay away from me, with their junk medicine and their paternalism and their unnecessary interventions.
F*ck all ya'll.
All they really want is my money anyway.

Why do women put up with the way they are treated by the medical INDUSTRY????? I cannot understand it.