At the beginning of the 20th century, male Obstetricians dubbed the traditional ‘granny midwives’ in the US dirty and ignorant in order to wrestle control over maternity care and make huge profits. In a breathtakingly Patriarchal and racist move (over half the traditional midwives were Black and their wisdom derived from the traditions protected and taught by slaves), the forces of power and money all but obliterated female wisdom and bodily autonomy. Every birthing person was herded into the hospital and subjected to highly expensive interventions. Drugged with scopolamine and morphine, a cocktail that caused amnesia and made women violent, mothers were literally tied to the bed and prevented from remembering the births of their own children. Thus, women were gaslit into believing their bodies were deficient, broken and dangerous.
In the 1970s a similar power move happened in the UK. After the Peel Report, which recommended 100% hospital birth based on no robust evidence at all, my mother’s generation were subjected to x-rays during pregnancy, given thalidomide for their morning sickness, their pubic areas shaved during labour, given enemas, banned from moving during labour to ease their own pain and every single one of them was cut to hasten the birth of the baby. Yes you read that right – unless the baby wasn’t born vaginally or accidentally born without the attendance of a health professional, everyone’s perineum was sliced open, right through the tail of the clitoris, often causing serious tearing to, or through, the anus and a lifetime of pain, sexual dissatisfaction or even incontinence.
It’s hardly surprising so many of us lost faith in the medical men and the enormous machine they had manufactured.
In the US, midwifery was reduced to obstetric nursing, handmaids to the doctors. True midwifery, that centres autonomy, choice, strength, health maintenance, and the rights of the birthing person, was all but erased. Here in the UK the midwives were herded away from their traditional communities and into the hospitals. Where once they served a caseload of local families, providing friendly, relationship-based care, they were now workers on a factory production line, meeting one stranger after another in a never ending queue of lonely, frightened women begging for the comfort of drugs to replace the comfort they had once received in the bosom of their families.
If you’re a woman reading this, have you noticed how your life is ruled by a certain kind of man? They usually have short back and sides hair cuts, smart suits and crisp, cut class accents. They inhabit committee rooms, classrooms and boardrooms everywhere. They have money, power and a plethora of opinions. They like to tell us what they think. More to the point, they just adore telling us what to think.
Some of them are such sad, lonely little boys inside that the only balm for their pain is to wrestle ultimate power from us. Often their power and money is based on the suffering and even death of the powerless. All I see on the news these days is one entitled man after another, convinced he is right, acting rashly from a place of ignorance, serving himself before others.
The birthworld is no exception to this all too common rule. Wherever I look we are being mansplained. There they are in their offices, in the corridors of power or, as I saw just recently, pontificating on the news. They are in the grand tradition of White Men working to bring down majority female professions and in the even grander, more ancient tradition of men telling women what to do with their own bodies.
They may say a lot of the right things about what’s wrong with the maternity care system – a crumbling infrastructure, a staffing crisis, poor communication across the disciplines, bullying and cover ups – but then they drop their bomb. It’s always the same, tired old trope – the implication that the cause of this crisis is ignorant midwives with a natural birth at all costs agenda.
A recent report into maternity care quotes a midwife pointing out that she thought she didn’t get enough education during her degree on what to do when complications arise during childbirth. She is probably correct. Given the astronomical rise in medical interventions during labour, which statistically increases the risk of adverse outcomes, midwives are being challenged in the birthroom like never before.
You see, the remit of midwives is a rather unique one in the medical world. Instead of being experts in pathology (knowing how to fix things when they go wrong), a midwife’s speciality is salutogenesis, which means keeping us healthy so things don’t go wrong in the first place. Now, that doesn’t mean they aren’t taught how to identify when things are going awry and when to hand over to a doctor, but their superpower is, and always has been, to understand how our bodies work and support us through a process that has been designed and perfected over millions of years of evolution.
So, yes, perhaps the skillset that modern midwives need to cope with the tsunami of complications in childbirth is sometimes not up to the job. But that doesn’t mean, as these men always imply, that midwives have a nefarious agenda to coerce women into natural childbirth.
Men have sold us the lie that natural birth is always inherently extremely dangerous, that the midwives who promote it are irresponsible and those of us who choose it are stupid.
Rather than pushing natural birth at all costs, the lived experience of most birthing people and their supporters is that many, many midwives are having to collude in a system that foists unwanted medical interventions upon birthing people, most of which come with their own, attendant risks.
Sound familiar? That’s because it is. All of us have grown up swimming around in the idea that our female bodies are inherently flawed, nay, dangerous. Our bodies are accused of being ticking time bombs that, left to their own devices, would harm our unborn babies. We’re told that our experience of childbirth doesn’t matter, that we must be rescued from our own stupidity and that, in the end, we don’t matter.
Meanwhile student midwives learn about facilitating physiological birth in the classroom but struggle to attend the necessary 40 spontaneous vaginal births they require to graduate. If they do manage to become registered midwives, they enter a system that all too often prevents them from practising true midwifery. The result are midwives who become de-skilled in their core role to support nature unfolding. They burn out and leave, suffering from moral injury, forced, as they are, to watch women being manipulated and scare-mongered or they become obstetric nurses, complicit in the broken system.
The same tactics are used each time midwives and those they serve need sidelining and silencing. The relatively new profession of obstetrics is held up as the evidence-based, rational, safe way to control the unpredictable, dangerous female body. Midwives are painted as dangerous, ignorant, Mary Poppins types with a silly faith in our ability to give birth unaided. They say midwives have no idea what to do when things go wrong, which, they tell us, is often. In this paradigm midwives quickly lose their autonomy and authority and families lose faith in themselves and become terrified of childbirth.
Highly mechanised, conveyor belt systems that prioritise schedules, staff rotas and avoiding litigation does not make us safer. Blaming midwifery does not make us safer. Blaming doulas does not make us safer. Blaming parents for making birth choices outside of guidance does not make us safer. Painting a picture of ignorant women being served by ignorant women does not improve outcomes, it merely deflects from the real problems that are endemic in the maternity care system.
If obstetric-led childbirth could offer us global solutions I might have a different opinion, but we can’t stop repeating this loud and clear: too much medical intervention, pushed too soon on birthing people, is proven to put babies and their mothers in danger. Medical intervention spattered universally on a birthing population causes emergencies, trauma, mental health problems, life long grief, physical damage and, increasingly, death. So whilst the majority of us get resource-rich care that is expensive and dangerous when we don’t need it, those resources are deflected away from the minority of us that really do need a lot of medical surveillance. The ramifications of all this suffering are too enormous to contemplate.
There is a massive fib circulating that midwives and doulas are lunatics, selling a dangerous idea that physiological birth is ever possible or sensible. Yet our lived experience is watching birth unfold without mishap, over and over again, especially when the birthing environment is conducive.
Most of the time, it’s not women’s bodies that fail, it’s the system that fails the women.
As I move towards the end of my doula career, I’m pretty much done with sexist, mansplaining, entitled White Men. What motivates them, money, or power? Because I’ve stopped believing it’s grief, evidence or compassion. If they really cared, they’d open their hearts and minds. They would watch and learn about physiological birth and realise that, for the majority of us, it is a safe and satisfying option.
At the end of the day, whatever the evidence, whatever clever researchers and doctors with degrees say about all this, what’s being forgotten are the same things that are always forgotten when the debate is about women’s bodies: our choices and our rights. Any doula or midwife will tell you that, despite generations of highly traumatic, mechanised, hospital based birth practises that have cascaded terror down the generations, women’ s hearts, guts and wombs are telling them their bodies work. Instinctively, people know that a fuss-free natural birth would mean quicker recovery so they can keep spinning the plates of family life. You don’t often have to tell people about the lifelong ripple effects of a traumatic birth – they can work it out for themselves. The horror stories abound, and they almost always start with an induction of labour. For many, the allure of respectful midwifery care that minimises intimate touch is crucial to avoid the spectre of sexual assault or abuse rearing its ugly head during labour. For some, despite everything, there is just a deep-seated, wordless knowing that this experience could be ecstatic.
This ilk of self-serving, opinionated men have been tinkering with women’s bodies and minds since the dawn of time. Men like this have always had the ear of other powerful men. They pursue their own warped agenda and pocket the profit – whether that’s money or glory. With characteristic narcissistic posturing, they shout at us, silence us, gaslight us and shape the world in their own grotesque, self-serving image.
In the spirit of #NotAllMen, I am writing this in the week that Michel Odent died. A male obstetrician who absolutely understood the vital role of physiological birth in the lifelong mental and physical health of both the birthing parent and child, Odent dedicated his life to exploring and explaining birth and giving us the tools to take back control.
Because our bodies are not the enemy. All the research finds that staying fit and healthy, finding a kind, clever midwife to be your companion, getting the social and emotional support of a doula and giving birth in a comfortable, quiet, private place increases the likelihood that your birth will be, at worst, boring and uneventful and at best, the most euphoric, empowering, blissfully life changing experience imaginable.
But our bodies certainly are the enemies of the status quo. To control us, to make us economically productive consumers, we must be stripped of our rights and the possibility of cathartic, transformational, healing, empowering birth; birth that teaches us that we can do hard things. It is this kind of transformational birth that shows us that we can walk the earth to our own tune, bring up our kids to question and to shape our lives to suit ourselves not the system.
I wonder what that would do to the Patriarchy?
