Birth and Bias

Dear Doctor Ninja,

I’m a first time mother and I’m learning about all the pain management techniques, medications, and birth interventions. I can’t help but dread the process of delivery considering what mainstream media and fear-mongering mommy groups portray. So many women are traumatized by their birth experience and I feel that health care standards are too low. (For example, if 80% of women have perineal tears, why has nothing been invented or researched to decrease this statistic? Compare this to when a small portion of men reported slight negative symptoms for potential male contraceptives, clinical trials were halted immediately.)

At the same time, I have unwillingly curated the narrative that the health care system is highly patriarchal and practices have been established by men/male doctors without considering the comfort and verbal symptoms relayed by women. Several studies have cited that when women present verbal feedback about signs and symptoms, they have been neglected or sent for psychiatry treatment instead of having physical treatments. Interventions such as Vacuum Extraction, Forceps, Episiotomy seem highly aggressive with increased harm to mother AND baby.

Where do / How have birth intervention practices come about? Who are some thought leaders in the specialization? Is my narrative untrue or distorted? What can be done individually or nationally, to push the standard for better health care for women?


Feminist First Time Mother

First of all, congratulations on the coming new chapter of your life!

What I see in your letter is the fear of not being heard, and the fear of your needs being ignored, misunderstood, and the fear of being mistreated outright in a situation where you feel you have very little control. Pain is the great disabler–it changes what we want; how we see the world, and others; and our priorities. So, confronted with a scenario in which pain seems to be an inevitable, and predictable part of the event, you are wise to look ahead into the future from a place where pain doesn’t yet have quite this power over you.

There’s nothing distorted by your narrative. Tears happen. Traumatization happens. As with all things, childbirth carries risks that are unique to every mother. And yes, there are studies that have shown that women can be taken less seriously when they talk about pain. And interventions are used when the judgement of the physician deem the risk to be high enough to the mother or baby to use them. There isn’t a frame of reference in which these events don’t exist; and we would be wise not to ignore them.

But, regardless of where birth intervention practices come from, and who the so-called thought-leaders in obstetrics are, and what can be done to push for better healthcare for women (all topics of great significance and interest), the singular reality is this: You are going to have a baby. You, specifically. This baby, specifically. And with the attendance (if you’re choosing to have a hospital birth), of a specific physician or group of physicians, as well as the entire healthcare team that will be part of the process. AND hopefully, whoever you’ve chosen as your “helper”. You might feel that standards of care in general are quite low, but it’s the standards and quality of the specific care you’re going to receive that matter in this scenario.

When it comes down to you and this event, reassurance and trust are paramount, regardless of who is present and making decisions. What can you do specifically to push for better health care for yourself? Book that appointment with your doctor. The one who you’re hopefully seeing for pre-natal visits. Make it clear that you need a chunk of time and that it’s not a quickie visit. Be prepared with your questions; but remember, that this visit (or series of visits) is about your fears and worries, and not about getting clinical information. Redirect your doctor if they seem to be talking about specific procedures in a general and abstract kind of way, as opposed to addressing how and why you feel the way you do. Because doctors are human too; they have their own fears and worries. Being “cold and clinical” can be a default kind of place when the conversation becomes uncomfortable.

Find out if the location  you’re planning on giving birth has tours. If they don’t, ask if you can have one. Bring your helper with you. Find out whether you’re in a practice that has group call for deliveries. It’s okay to meet those other doctors too, depending on how big the call group is (otherwise, it might be a lot of appointments!)

Part of what doctors are paid to do is to listen to you tell them your worries and fears. The other part is to be good at all of the other skills that are needed to provide care in the best interest of their patients. But sometimes they forget that this is your first birth and not your 1000th. And it’s okay to remind them of that too.

As for what can be done about raising the quality of healthcare for women in general:

  1. Take your own experience forward, including this one, and consider the spaces in which you see room for improvement

  2. Get involved locally with patient advocacy groups and develop your own sense of the story through hearing the stories of others, both positive and negative. It’s only through hearing and seeing others that the question of an untrue or distorted narrative can be answered. Global practice is shaped by the critical mass of local ones.

Ask your question to Dear Doctor Ninja!