Whatever Happened to Choice?

How often have I heard the words, "I really want a water birth (or insert birth method here), but my doctor won't allow (or my insurance won't cover) it." If I had money for every time, I'd be sitting in Cancun right now, downing Margeritas, supplied by a really good looking Cabana boy. No, really, I would.

Then, there are the responses I get from the question, "Why don't you change doctors?" If I had money for each time I've heard, "But he's a good doctor..." I'd never have to come back. Ever...

We are told to ask questions, we are told to pay attention to the answers, yet we never seem to know what to do with the information we get. We are never told that, if you don't get the answers you want, walk out and find another doctor. If the episiotomy rate is too high, we ask not to be cut during delivery, then act like victims if our wishes aren't heeded. Instead, we should say, "Sorry, your methods don't meet my needs, so I'm leaving now." If we did that, doctors would probably change, insurance companies would change, our lives would change, because they can't make money off of us if we don't use their services, can they.

Ultimately, we are consumers of services. If we take our money elsewhere, what we ask for will be offered more freely because they have no choice. We, as women, are reluctant to use the power we do have to affect change. Why do we buy what's offered instead of what we want? Isn't it an insult for doctors to expect us to just put up with what they want to give us, and not walk out the door?


There are many forms of insulting women. Doctors do it all the time. One that I see most frequently, is that doctors limit women's choices, depending on what would be easiest or best for them, and telling women that it's for their own good. A doctor that tells a woman that, she can't have a water birth because she's "high risk," is basically telling the woman that she's not capable of deciding what's best for herself. When a doctor tells a woman that she has to have an IV port put in at the beginning of labor because "something might go wrong" is telling the women in her care that she's way smarter than they are, and that they can't judge for themselves how they want to have their baby. In my opinion, they're also insisting on the port to cover their own ass. in case they don't see the signs of distress early enough.

I'm not saying that no intervention is best in every situation. I am not saying that precautions should not be used to safeguard the life of the mother and child. If you have a risk factor, such as gestational diabetes or high blood pressure, such precautions are beneficial. However, if there are no risk factors, routine use of interventions such as an IV port, episiotomy, or medications for pain or labor progression shouldn't be used. At the very least, under these conditions, the laboring mother's wishes should prevail over medical convenience.

We, as women, need to demand choice. We need to make it clear that we, not the doctors or our partners, are in charge of our bodies. We need to start advocating for ourselves, in advance of the birth, for what we want. We need to ask questions, demand adequate answers, and act decisively on the answers we get. We also must be wise, and take medical advise, not just when that advise agrees with what we want, but when the situation dictates.

As women, we have choices that we don't follow through on. If we don't like a doctor, we tend to stay because we don't want to hurt their feelings. We accept what's offered instead of changing. We are not victims of the medical profession, we are consumers of services that can gain change and choices by walking out on those that don't provide what we want.

Pain and Suffering

Pain is inevitable. Suffering is optional.

I don't know who said it first, but it is true. Unfortunately many, if not most in our society, have forgotten this. Though they do sometimes walk hand in hand, there is a difference between the two. There is no greater proof of this than in childbirth and the raising of children.

First of all, I take it as a given that giving birth is painful. There are studies to suggest that, in some cultures, this isn't the case, and some women claim that they have had pain free births. I'm not certain I believe them, but I'm not calling them liars, either. I take it to mean that they have experienced a birth that had pain, but that they didn't suffer during the birth. You can argue with me, if you like, but having been through childbirth twice, and one miscarriage, I will beg to differ. Let's agree to disagree, and call it a day.

There are ways to suffer that have nothing to do with physical pain. If you're a parent long enough, you're going to find that out the hard way. The first time your child has his or her heart broken, you're going to suffer right along with them. The first night my daughters slept through the night, I woke up thinking that they had died while I was sleeping, and I suffered agonies until I realized that they weren't dead, just sleeping. It's this kind of thing that I mean.

Then, there's the pain without actual suffering, stubbing your toe, tripping over the dog. They are usually short lived, and quickly forgotten.

Here we come to childbirth. For many, it's relatively long lasting. Since it varies so widely, there really isn't any sense of how long it goes on. This is why, I think at least, we conceive of it as suffering, and not just pain. Are we really suffering? Does the pain not have a purpose? Did we not choose to have a child, and thus are we not going through this painful process in full knowledge of what we're doing it for?

I think that maybe, it's time for a new paradigm of birth. If you believe in the Judeo-Christian mythology, you are doomed to suffer childbirth in pain as a penance for Eve's sin? Maybe that makes it worse, this idea that the child was somehow begotten in sin, and that you need to suffer for it. That idea is ingrained in our culture, and the idea is almost impossible to shake.

Maybe we have heard one too many horrifying birth stories, where the teller, usually the mother, tells us about how horrible it was. "Take the epidural," she says. "You won't be sorry." That sort of comment makes us fearful, we become afraid of the pain, and the implied suffering behind it. We look forward to the birth with a sense of awe, that we're going to finally meet this new little person, and with profound dread. "Can I handle the pain? Oh my god, I hate pain, I'm lousy at handling pain. There's going to be so much pain!"

This fear that we are going to suffer, agonies untold, make the pain worse, and the suffering very real. Instead, can't we see this as something other than suffering? Can't we see that this, like other pains, will pass. It will be replaced by a new family and new love to be had and give. This is just a moment it time, all we need to do is let it happen and pass us by.

Let go of the fear. It serves no purpose at this point, and makes it far more likely that we will suffer, and that this will turn into an experience we wish to forget. We want this to be a memory to cherish, to visit over an over, seeing it with the eyes of wonder and awe with which it deserves.  

Unplugging

When was the last time you unplugged from the world? Really unplugged, I mean. When was the last time you turned off the cell phone and the computer, turned off the TV, and just spent time with your mate, your children, or other loved ones? When was the last time you spent time with just yourself? I'll bet you can't remember, can you? It's a fact of modern life, that we, and those we deal with, feel that if they can't get in touch with us at any time of day or night, that there is something wrong.

Why? Why do we do this to ourselves? What is it that makes us think we have to be available to others? Is it necessary to be on call 24 hours a day, 7 days a week? Parenting is a 24 hour a day job, but does being an employee, or a daughter, or a patron of the Dry Cleaners need to be? What about time for ourselves, do we not deserve some time to just be? Will the office fall apart if we take an hour or so to nurture our relationship with ourselves or our families?

The last time I asked someone this question, what I got back was a look of profound confusion. "Turn off my phone?" she said. "But what if someone needs me?"

"Then they have to wait, I guess," was my reply.

You would have thought that I had suggested torturing a small animal then staking it out on the front lawn. You would have thought, by her reaction, that I had gone insane and needed to be locked up. Immediately, if not sooner. Yesterday or the day before would be the best option.

Why not unplug for an hour or so a day? Why not tell the world to wait so we can take care of, what we say, is the most important things in our lives? Do our mates, children and ourselves not deserve our undivided attention?

Pregnancy and early motherhood are both introspective times. We need to go into ourselves to find what we need to do our best. We must find what we're made of, so to speak, to learn what's important. How can we do that, when we are constantly dealing with others? How can we take care of ourselves, or relationships and our children if the office, or the dry cleaners, or the nosy neighbors can always intrude?

Even later, when the children are grown, don't our husbands or partners deserve attention as well? We also need to take time for ourselves, away from the grind, to find out who we are away from them. We need to find the core of ourselves, our beliefs and convictions. We need to have a self away from the expectations and demands of others.  We need to be whole people, not just somebody's Wife or somebody's Mother.

Women, in general, live longer than men, and children grow up and move out, so when those are gone, who are we? What do we want and need? Unplug for a while and find out.

Henry Ford, Frank Herbert, And the Process of Giving Birth

Henry Ford said, “Whether you think that you can, or that you can't, you are usually right.” It's absolutely true with the process of giving birth. Want to know how? Read on...


From the time we are small, women are told that giving birth hurts. As a matter of fact it does. It hurts a lot. I've been there, and you won't hear me telling you any differently. We are also told, that it hurts so much, that we're going to need pain medications, like epidurals, in order to stand the pain. This much is NOT true. I know this for a fact as well. My baby number 2 was born without any pain medications at all. 


So, did baby number 2 hurt any less than baby number 1? I doubt it. It was probably the same. There was one big, huge, gigantic difference, though. My second daughter was born after the first one. (Here's where you day "Duhhhh" and we can get on with the lesson.) 


You see, when I went into labor the second time, I wasn't as afraid. I knew what to expect, and since I had been through it before, I hadn't had to listen to the "Oh God, you're gonna want to DIE!!" stories for the previous nine months. I was better prepared for the pain, and I knew that I could make it through without the drugs. 

Voila!! Henry Ford was proven right. The first time, I thought I needed the meds, and I did. The second time, I knew just as surely that I didn't, and I didn't. As a matter of fact, I was so certain that I wouldn't need the meds, that I resisted some very serious pressure from the hospital staff to take the medications, and did without the medications anyway. 


Amazing, isn't it? The way the mind works in these kinds of things is almost diabolical. 


Frank Herbert, in the book Dune makes one very astute observation. He says “I must not fear. Fear is the mind-killer. Fear is the little-death that brings total obliteration. I will face my fear... And when it is gone past I will turn the inner eye to see its path. Where the fear is gone there will be nothing. Only I will remain.”

In my humble opinion, it's not the pain that does us in, it's the fear of the pain. It's the fear of the situation we're going into, and the fear that we're going to decide wrong. We are afraid that we can't handle what's coming, and we are afraid to question those that we think "know best." Yet, if what others are urging us in a different direction than we want to go, we often question ourselves, and not the other person. It's as if trusting ourselves is so much harder than trusting someone else.

Do we think so little of ourselves and our abilities that we can't see that we are the best judge for us? Why are we so afraid of a natural process? Women have been doing this for thousands upon thousands of years, and it's only in the past 50 or so years, that we have felt the need for the massive amounts of medical interventions. 


Do not be afraid of birth. Yes, there is pain, and things don't always go as planned. I will tell you this... If we trust ourselves and walk boldly and fearlessly into the world, things will go far better for us in the end.

Finding Our Center

Madeleine Albright said, “Engagement does not mean endorsement.” I happen to agree with that. We, as women, can engage and discuss without saying that whatever we are discussing is right or wrong. We can talk about something without giving permission for someone to go out and do it.

I was reading and article today about teens and sexuality. It would appear that, in the US, the teen pregnancy rates are up, (again) and that the use of birth control is down. Somewhere, teens have gotten the idea that the "rhythm method" of birth control is just as effective as condoms. 

Oh, joy. While, as a Doula, that means that there is a good chance I'll be getting more business, it's really business I can do without. I don't consider this good news at all. I had my first child at eighteen, and it was hard. I don't recommend it for anyone else, and I can't even imagine being younger and having a child. 

So, how do we change this perception? What do we need to do in order to change this trend, and reverse these rates? It's a very simple answer, and one that many in the US oppose. 

Education and access to reliable birth control.

Now, here's the sticky wicket, and where we lose many people, most of them Conservatives. They believe that sex education belongs in the home, and they don't want the public education system involved in it. I can see the point of that argument. I see where it's the best way to proceed with this problem. There is a bigger problem, though, Most people don't educate their children at home. It simply doesn't happen. I can't say it any clearer than that. 

We have to ensure that the playing field is level. We have to ensure that young men and women are learning the basic facts they need to make and informed decision. To do any less is doing our young people and immense disservice. It's sending them into the world without a basis in fact, and a way to make decisions, and determine for themselves what they want to do. Would you advocate sending your teenage daughter or son out into the world without knowing how to read? That's what we're doing.

We are sending people out, telling them to form bonds, make attachments, and have relationships, and they are functionally illiterate in the matters of love and sex. They don't know the difference between love and sex because we never teach them that there is a difference, much less what the difference is. We don't teach them the basic respect for themselves and each other that lead to good relationships. We don't teach them, that if you don't know someone well enough to talk about sex, then you shouldn't be having sex. 

If we don't trust our kids to be making these decisions, why don't we? Mostly because we know they are ignorant, and we are afraid that if we gives them facts, we are also giving them permission. That sounds crazy to me. After all, are we giving them permission when we keep them ignorant? They're doing it anyway.

May be it's time for a new model. A model in which we give our youth what they need, then actually trust them to make the decisions they are going to make anyway. If time has shown us one thing, it's that the old ways haven't worked. The definition of crazy is to continue to do the same things, and expecting different results. Let's stop being crazy, okay?