Men did this to us?

How invested are you in the idea that women have a harder time than men?

To me it feels as though as a society we have never been more attached to our victimisation as women as we are now. Take America Ferrera's famous monologue in the Barbie movie for instance. It was shared over and over on social media as a victory for women (this character finally said what had to be said, there!) and, no matter how hard I tried, I could not see how this did anything other than feed the narrative that women just cannot win, regardless of how hard we try.

We are victims and men are to blame.

Recently I was reminded how much this narrative is ever present in our understanding of how the medicalisation of childbirth came to be and it got me thinking.

My reflections were initiated by a chat with a fellow body worker about women, pregnancy and birth. 

I loved how passionate this body worker was about supporting women’s health. 

She told me that she meets many women who have experience of trauma and I said that I did, too. In fact, I think that there are very few people who go through life completely unscathed. 

Trauma can occur in many ways. It can be very obvious physical or emotional trauma that occurs during a significantly difficult situation. Other times trauma occurs unbeknown to our conscious minds and we may be unaware of how we carry this trauma.

Whether you have encountered an obvious physical or emotional trauma or your body is dealing with a subconscious trigger, trauma leaves tracks in your body.

Our soft tissues remember. 

Here’s an example that I suspect many of my clients will be able to relate to given the amount of people with upper body tension I encounter:

Have you ever found yourself tense your shoulders in anticipation of something you are worried about? 

A test at school perhaps or a job interview? 

What about anticipating a doctor’s visit? 

If you worry long enough, hold on to that tension in your body for hours, days or even weeks, then your muscles will remember. You might even feel pain. 

You might ignore a subtle ache for months or even years and the tension stays in your body and with it the underlying emotion. There’s a constant feedback loop between you and your body. 

Now imagine that your body is far wiser than your logical mind. What if your ancient animal body responds to its environment without you even noticing?

Someone says something that is hurtful to you for instance? It could be a throwaway comment, seemingly insignificant to the person who said it or it could be words that are meant to hurt. Your body won’t know the difference and it can hold on to the chemical expression of the emotion you experienced for years. You can enter into a habit of evoking the emotion with your thoughts and thus your body and mind enter into a cycle that can impact your quality of life a great deal.

This is why somatic yoga practices can trigger huge emotional responses. When the soft tissue finally gets to let go, the emotions can pour out of you. 

I have experienced this and it is truly incredible. 

As women we can hold this type of tissue memory in our pelvic bowl, too and there are various modalities that can help you address this. This was the type of work that my fellow body worker was most passionate about.

What struck me as a former midwife who performed vaginal examinations regularly was that this therapist told me that many women trace their trauma back to intimate medical procedures. Could be a smear test, a coil insertion or their experience of birth. The birth related trauma is most often based around what was done to women or how they were spoken to in this vulnerable time and not generally around the bodily function of birth (although I have  seen examples of this, too). Of course this makes total sense and does not come as a surprise at all.

It puts the concept of safety in childbirth in perspective doesn’t it? 

What is safety?

What do routine vaginal examinations do to women in general? Do our bodies respond to this invasion in ways that we have never thought to measure. Could labours be longer and ‘stall’ because of vaginal examinations rather than the ‘stall’ merely being diagnosed by them? And what about long term outcomes of having been exposed to multiple vaginal exams?

My colleague and I agreed that regardless of what the answers to these questions might be, women needed better support than the type of treatment that they currently received via the institutions that see the ways of modern medicine as the only answer.

Inevitably our conversation moved to the topic of women actually giving birth and, again, there was so much enthusiasm in how this woman talked about it. She told me about how birth was best accomplished when a woman could stand, squat or kneel. Upright positions were the best positions for birth, she told me. I adored her certainty and her energy and I recognised my younger self in her words. I’ve had this conversation many times and I have also seen birth unfold over and over and over again and I learned as I watched. 

Like many midwives would probably agree, the subject of how to best give birth is so much more nuanced than ‘all you need is gravity’. I’ve spent endless hours trying to figure this out in theory and in practice. In my early days as a midwife I used to encourage women in labour to get up on their feet, to kneel, to lie on their sides. In the end I learned from those women who were most spontaneous in their movement and I have come to the conclusion that the only ‘right’ position for birth is the one that the woman choses freely. 

If that is flat on her back then so be it! 

As long as she can move freely then she doesn’t need anybody to suggest anything to her. 

But free movement is not routinely available to women and that’s the issue. Somewhere along the line that freedom to move into whatever position you see fit was lost. 

The default position in hospitals to this day is the lithotomy position. The vast majority of women lie on the bed to give birth.

This fellow body worker knew this, too, and she proclaimed that ‘men put us on our backs to give birth!’. Unfortunately, that’s when we had to suddenly part ways before I could even think of how to respond.

Of course she was talking about the medicalisation of childbirth; About the barbers and later obstetricians who moved into the women’s sphere of childbirth and those barbers and obstetricians were… men.

My man Gerald was with me in the car on the way home and I told him about the encounter. Chatting with Gerald gave me the opportunity to enquire with myself if I actually believed this claim. 

Had those bad, bad men really put us on our backs?

Did ‘The Patriarchy’ steal childbirth from us?

As I was talking, I recognised that I was never particularly invested in the construct of the idea of ‘The Patriarchy’. Or, shall we say, I was aware that a woman’s status depended on when and where in the world she was born. Where I was, I could see that our status as women had changed a lot since when my gran had been young. I could see that my ancestors had moved the needle for women but I never personally saw myself at a disadvantage because I was a woman. No, I felt pretty lucky to have been born in Germany in the 70s. By the 90s, when I was seeking opportunities, I experienced myself on level footing with my male counterparts, a position that I attributed to having had free access to education like every other woman I knew. 

As I saw it we all had the choice to excel. If you didn’t want to be held back, you didn’t have to be. Not in Germany in the 90s (and not today in Northern Ireland). 

So what about the issue of women giving birth on their backs then? Is it really *just* due to the fact that men started to take a footing in the landscape of childbirth as barber surgeons and obstetricians? 

No, I don’t believe it is!

Women had to allow it. And given that midwives are positioning themselves with women, midwives had to allow it (and midwifery is a predominantly female profession). The choice to stay upright and pay no heed to the suggestions of anyone, or to not invite anyone else into your space, least of all a strange man, has always been available.

When they first stepped onto the stage, the barber surgeons and obstetricians marketed themselves in a way that promised superiority over the ways of midwives despite a lack of evidence to substantiate their claims of better birth outcomes (and they still do).

If you want to read a detailed elaboration of why to this day we can’t prove that the medicalisation of childbirth contributed to the decline in stillbirths and infant mortality, I highly recommend the book ‘Safer Childbirth’ by Marjorie Tew. Tew also explores the general dynamic between men and women through the 17th, 18th and 19th centuries in the context of the medicalisation of birth. In those times women had less access to formal education and therefore midwives at the time had less theoretical knowledge of anatomy and physiology than the men in the birth arena. But midwives had far more practical experience and, although the social standing of men was one of greater authority than women, not all midwives conceded their role in birth to men. 

There have always been voices that challenge the medical model of birth.

I inherited a naturopathy book from my gran that was published in 1894 in Germany. Gran had inherited it from her father. In the childbirth section of the book you can find the very same issues described that we struggle with today (only to a much larger extend). According to Platen, the author of this book, childbirth was over-medicalised in Germany in the late 1800s and women were best advised to adapt healthy lifestyle habits and rely on their physiology.

Go figure.

So, there was information out there at the time that suggested that childbirth was a bodily function and as such it could generally be considered to be 'safe' and yet the medical model took hold. 

Why?

Because fear tactics are a fantastic sales strategy and families bought into it.

Midwives got scared, too, and they were far less likely to be scrutinised in the event of a tragedy if they called for a doctor (this is still true today and it contributes to the continued narrowing of the midwife's scope of practice). Doctors were in direct competition to them and they sold themselves better. Just like it is the case today, midwives were too afraid for their livelihoods to assert the power of women and their innate physiology. They decided to become regulated instead so that they could improve their social standing.

As I see it, midwives rolled over first and they took the women with them. 

It is hard to imagine what it might have been like when medical obstetrics was in its infancy. Could traditional midwives have chosen a different path or would they have become almost extinct either way? Why did midwives give up on their ways and instead allowed doctors to decide how long a pregnancy was allowed to last, how long we could consider labour to be ‘safe’? Is it because they truly could not speak up to the men who showed up in their arena or is it because they chose to remain silent? I cannot know. 

What I do know with certainty is that every woman today has a choice.

If you want to move freely in labour it is best to avoid obstetric labour wards. Do not be fooled into thinking that you will be listened to unconditionally. I heard a birth story recently that made my toes curl. And while you might meet the super duper midwife who is lucky to be on duty with the most compassionate and woman centred team, chances are that you will have a midwife who is conditioned into the medical model, they are in the majority! And even with the best team in the world, the protocols that are in operation do not lend themselves to supporting birth physiology. 

They. Just. Don’t.

And so you will have conversations in labour. You’ll get drawn away from your primal instincts and into your logical mind even with the best birth partner, even with a doula.

Knowing this you’ve got a lot of weighing up to do because, undeniably, some women and babies need medical help in order to survive. This is how we find ourselves in this conundrum. And here the conversation must become very refined. There are as many situations as there are people and you need the space to explore what is right for you. 

Your answer might be as clear as day.

There are some very clear cut situations. You might have an underlying illness, for instance, and you might feel that it is best that you and your baby are observed closely at all times.

If you don’t know of a very clear reason that your birth might become a medical rather than a physiological event and you are accessing routine maternity care, please ask your care providers these questions if free movement in labour is important to you:

What risk factors have you identified at booking and how will this impact my choices at the end of pregnancy?

Will there be an indication for continuous fetal monitoring in labour as far as you can tell now?

Will there be an indication to offer me an induction of labour before I am 41 weeks pregnant as far as you can tell now?

If the answer to any of these is yes, then ask what your ‘risk factors’ are.

Then start reading.

Get as much information as you can to get perspective and know that you can opt out anytime. 

There is so much information out there that you can lean on to inform your decision making. Check out my book (purchase link below) for perspective on risk and for an exploration of what underpins each intervention in the routine maternity care pathway.

Join our Anchor community and if you live in Northern Ireland you even have the option to get regular massages with me as an Anchor member (email [email protected] to enquire)

So did men really put us on our backs? 

I truly believe that, just like today, there’s always been a choice. Any kind of social construct requires our opt-in in order to be upheld, even 'The Patriarchy'. Instead of allowing ourselves to be divided by ideology, let's find a way to build on each other's strengths. Men and women complement each other just as much as physiology informed birth and medical birth do. Read my blog post 'About Birth And Whiskey' for more on how men and women can unite in birth. 

We all have the choice to stand in our power and take full responsibility for our decisions.

How important is it to you to be able to move freely in labour?