Obstetric Lie #92- You Need To Fit In This Box

Sometimes I wonder if I am the only person who was required to take a statistics class in order to graduate from college. I can't say I enjoyed statistics, but having just a basic understanding of the wide range of normal seems to be a concept that is currently lost in the field of obstetrics. Rather, we have taken to looking at gestating women, human beings in fact, as though they should all fit into nice, neat, and identical cardboard boxes. We have forgotten that the mean is not something that EVERYBODY is, but is just an average of all things combined.


I had the privilege recently of meeting with a former class of students that I had taught. Six couples came. As we sat around they all told their birth stories. Would you believe that not a single one of them was the same?! We had a mom who had a short seven hours of labor and almost had her baby in the parking lot. We had a mom who labored for days and pushed for over four hours. There were a few mom's who experienced back labor, one who felt like pushing at six centimeters and two with compound presentation (arm next to the head).

There were babies born with the cord wrapped in various ways around their neck or body. There was variation as to how many weeks mama was along when she went into labor. Some had their babies a week or so before their due date, others a week or so after.

All the mothers gained various amounts of weight. One was GBS positive. Some had their water break before labor started, others later. All felt their labor differently and dealt with it differently. Some had epidurals for pain relief. Many did not. They had their babies at different hospitals with different attendants.

Despite all of this, all were able to have their babies vaginally. All gave birth to beautiful babies. Some had some minor complications post-partum, most did not.

In some ways, as the woman who tried to prepare all these very different women for their very unique labor, this amount of variation is incredibly intimidating. How can you possibly teach a class and prepare a woman for the vast range of things that could happen, that she could feel or experience?

I think the answer is, you can't really. What we can recognize though is the unique and decidedly NON-BOX LIKE beauty of labor and birth. We can realize that it is different for everybody- and that this isn't a bad thing- it is an AMAZING thing. In fact, one of the most empowering things about labor and birth is that each is uniquely suited for each mother and baby.

Sadly, this is not the case in obstetrics, is it? Rather, more and more we are seeing different women, of all shapes, sizes, ages, genetics, and lifestyles, all asked to fit into the same plain old cardboard box.

"You have your babies after at LEAST 42 weeks gestation? Not OK, not safe, not happening! We need to induce you!

You have quick labors? WHAT?! We should induce you to make sure you don't have the baby on the floor outside.

You gained 45 pounds during your pregnancy?! Who cares how you ate, that isn't fine! You are a fatty!

Your baby is breech/posterior/asynclitic?! Those can't come out vaginally! C-sections all around.

There is only one way to have a baby- precisely at 40 weeks, after about 25 pounds of weight gain, 17 hours of labor, two hours of pushing and a placenta that delivers within 15 minutes. That is how we do it and that is the ONLY WAY. All others will be expelled from perfect patient university."

When we look at birth, labor and women like this we not only pressure them into many unnecessary interventions (and I am talking about interventions that are not put in place due to real danger, but interventions that are pushed simply because of normal variation) that harm the experience, the mother and the baby precisely because they are UNNECESSARY.

Not only do we force unneeded stress and anxiety on a beautifully gestating mama when we expect her to conform to our cardboard box, but we significantly alter the experience for every woman.

Instead of recognizing that the variation of people, mothers, babies and birth is normal and necessary we treat women as though they have somehow failed by not doing things "just right."

What is strangely sad about the "You must fit into this box" mindset is that it is harming birthing women and babies by:

~Causing a lot of unnecessary stress~
How many of you have known somebody in an absolute panic because she has reached 41 weeks gestation without giving birth? How many of you have been that woman?

~Causing a lot of unnecessary interventions~
How many women are not even ALLOWED to reach 41 weeks because an induction is scheduled before that? What is this doing to the baby that is born before he triggers labor? How does it alter the birth experience? How many babies are born via c-section because of breech presentation simply because they were different that most other babies?

~We devalue the unique joys of birth~
Rather than allowing and even encouraging women to embrace their own journey, the lessons that they and their babies need, and embracing the unpredictability of birth, we teach through thousands of different messages, that there is only one way to be. The one way we all need to be basically boils down to a text book average of labor and birth.

If we take the time to step back and actually look at this entire situation rationally, it is obvious that this brown box approach to obstetrics (or in fact LIFE) is down right stupid. It is more than stupid. It is silly, irrational, it denotes a deep need for control and order and a distaste for nature and femininity and variation.

If you walked into a college university and told all the female students that the only safe way to be a human woman was to be 5 feet 5 inches tall, 135 pounds, have medium brown hair, blue eyes, two arms, two legs, 20 freckles and a size 7 shoe you would be instantly ridiculed, denounced and asked to leave. You would be considered a racist, bigoted jerk.

And yet, if you walk into any labor and delivery unit in this country you will find that thousands of professionals in their field are doing this exact same thing to laboring and birthing women.

We must recognize that diversity is not just a political catch phrase or a great thing to put on a resume. It is simply a human reality. Valuing diversity doesn't just apply to colleges either, it applies to birth. We are all different. Really. You are not a text book nor are you a brown box or any other type of paper product. You are a human woman.

We must stand up for ourselves. We must recognize that different is not necessarily bad. We must proudly share our unique birth stories that were specifically designed for us and our babies. We must break out of the brown box and embrace the way that we alone can birth our babies.


Mars said…
Thank you!

I should show this to ALL of my clients.

Nichol said…
Beautifully said!! Thank you.
fantastic. thank you, i'm so glad i discovered this. i think about this stuff all the time.
Unknown said…
My asynclitic, posterior, chin-first baby was born at home just fine, thank you. :) So much for not coming out! And I didn't have even a minor tear!
sarah1990 said…
I had my first baby naturally in a hospital, and am GLAD that they (for some reason) couldn't tell she was posterior until she was coming out, am now on number 3 and have OB's telling me all the time that i "shouldn't have been able to have her" and asking what i want to do if this baby is posterior, my response "have him, i know i can do it" to which they looked shocked, yes, an Anterior delivery is easier but it can still be done!