Birth Control

When did the movement to empower pregnant women to make informed choices turn into a guilt-laden cult?

The time: Saturday morning. The event: prenatal yoga class. The place: Wallingford's Good Shepherd Center, the sunny brick home of many earnest community groups, including the Seattle Holistic Center—the mother of prenatal yoga in this city. Some 20 of us with bulging bellies have checked in, grabbed a cup of grape juice, and placed our mats and bolsters on the wooden floor.

After a few warm-up exercises, the time has come for "sharing," whether the topic be our latest aches and pains or the emotional changes we are going through. My contribution is simple enough: "My back still hurts." But another woman opens up the broader question of how the medical community treats childbirth—a favorite topic at the Holistic Center. She had recently been shocked to learn that epidurals, spinal shots that block the agonizing pain of contractions, are used in about 70 percent of all births. A murmur of disgust at such lack of enlightenment runs through the room.

Inwardly, I roll my eyes. To me, the widespread use of epidurals indicates not that insensitive doctors are forcing them on women against their better interests, but that most women, given a choice, opt to make childbirth as comfortable as possible. Call me crazy, but I lean this way myself.

And much of the time I do feel crazy—or at least heretical—amidst what I have come to call "birth culture." A phenomenon that has been developing for years, it seems to have reached an apex now—particularly in Seattle, which I have seen cited as one of the best places in the country to give birth. It's a culture of midwives and doulas (who assist midwives or act independently as labor and postpartum support), as well as of prenatal yoga and birth-education classes. It's also a culture of birth plans (giving instructions to hospital staff on everything from medication to the level of lighting preferred), birthing tubs (to soak in during labor), and birth art (photographs of moms-to-be au naturel and plaster-of-Paris "bellymasks," capturing for all time the swollen stomach). It's a culture, too, that has spawned numerous books, including the classic What to Expect When You're Expecting.

With its roots in feminism, this culture has encouraged women to take control of their pregnancy and birth rather than submit to societal expectations of quiet endurance or to patronizing obstetricians who prefer their patients unconscious. Women have let it be known that they want to see their babies arrive into the world and to challenge seemingly unnecessary heavy medical interventions, like the routine performance of cesarean sections and the induction of labor, so that doctors can deliver during office hours. Because the culture refuses to view birth as a messy and slightly embarrassing event, it has brought dads into the delivery room to experience the moment themselves and to give much-needed support to their partners.

These are the aspects of the culture that I am drawn to.

What makes me uncomfortable is its cultish worship of the experience. Not the experience of loving and nurturing a baby, mind you, but of the nine months leading up to it. The same nine months that, for many women, begin with uncontrollable retching, take in a weight gain of 30 pounds or more (which profoundly warps their self-image, not to mention their ability to breathe), and that end with the most intense pain they've ever experienced.

If I seem overly negative, it's only because the image portrayed in birth culture is often so unrealistically positive. Consider, for example, this warning, found in that bible of birth-education classes, Pregnancy Childbirth and the Newborn (written by several teachers at the Childbirth Education Association of Seattle, including well-known guru Penny Simkin), about how a woman might react to a labor that is—gasp—unusually short: "You may experience disappointment because your labor passed so quickly you were not able to savor it, use all the breathing and relaxation techniques, or share it with your partner as you had planned." So labor is to be savored. Believe me, if I could get away with delivering a baby in five minutes, I'd jump at the chance. But that's a perspective seldom heard among "birth junkies," as one doula-in-training described herself to me.

It's not just birth in general that is so idealized, however. Somewhere along the line, the movement to empower pregnant women to make informed childbirth choices turned into a pressure-laden, guilt-inducing campaign for the right kind of birth—that is, the "natural," unmedicated variety. The reasons seem to have less to do with mom's or baby's health and comfort than with some abstract notion of the hardy earth mother who takes birth in her stride as yet one more demonstration of her power. "Isn't it interesting," my husband said to me one day, "that the movement that's supposedly feminist is the one that insists on women feeling pain?" It is indeed.

The birth culture approaches pregnancy with a reverence similar to the reverence it holds for birth itself. It all makes for an eerie echo to the traditional, outmoded culture surrounding pregnancy and birth—the one that assumes that bearing children represents women's highest fulfillment. Where's a woman to turn who wants to be neither a sincere earth mother nor an old-fashioned demure mom, who feels that kids will add meaning to her life but worries about how to fit in work at the same time, who hopes to develop her nurturing side without giving up her sense of irony?

IN TRUTH, I HAVE LONG been scared of childbirth. My mom, an early women's libber, was the first woman in her Atlanta hospital to have natural childbirth, using the Lamaze method, which was then making its way here from Europe. At the time, the only alternative to that was a heavy form of sedation that basically knocked women out. Even though the advent of pain medication during childbirth had been a cause c鬨bre decades before among suffragettes, women in my mom's time were rebelling against the passive role drugs forced upon them.

Epidurals now allow women full consciousness and an active role during labor. But my mom's example made me assume that natural was the only progressive, educated way to go (although I knew from her experience that it hurt like hell; she once described it as feeling like she was being split in two).

My assumption was shattered when some very progressive, educated friends started telling me that they had no intention of doing without medication. "It's like choosing to have a root canal without medication," one told me. Suddenly, I realized I had a choice, and giving birth seemed a lot more bearable.

Beyond that, my pre-pregnancy deliberations focused on the expected joy and work of raising children. I gave no thought to the pregnancy itself, nor did I have a clue as to its physical challenges. They hit me hard and fast, though, when I became pregnant last March. I developed the inaptly named "morning sickness"—actually a 24-hour condition—in a big way. In the beginning, my insides churned so disconcertingly that I yearned to run away from myself. Soon I began to throw up three and four times a day, often in response to as subtle a motion as sitting up or as innocuous a smell as that of my own body. (Unfortunately, showering also produced a motion sickness that made me upchuck.) This continued day after demoralizing day, for a good month.

Although all pregnancy books discuss morning sickness, nowhere did I find a description of how bad it could be. Instead, they seemed to soft-soap the malady by suggesting that it could be alleviated with a better attitude and herbal tea. What to Expect When You're Expecting offers this useful observation: "Morning sickness is unknown in some more primitive societies where lifestyles are simpler, more relaxed, and less demanding." (Birth culture loves primitive societies, where everything is so natural that the infant mortality rate is abysmally high and life expectancy abysmally low.) "Also quite revealing," the book continues, "is that some women suffer debilitating nausea and vomiting with unwanted, unplanned pregnancies, yet experience no morning sickness at all in pregnancies they are happy about."

Nothing there to make me feel guilty.

One troubling mantra to have emerged from birth culture is "Pregnancy is not an illness." Among its implications are the propositions that we don't need well-meaning exhortations to sit down, thank you, and we certainly are not going to stop working. Yet I felt sicker and more miserable than I can ever remember. At my worst point, I simply could not work. And even before I started vomiting, when I merely felt odd and exhausted all the time, work was a struggle that left me considerably less productive than usual. It made me wonder about attorneys who handle high-profile trials while heavily pregnant. My feminist soul was torn: On the one hand, I was grateful that it had become socially unacceptable to marginalize pregnant women at work; on the other, I wondered whether I myself would choose a pregnant woman to handle a big lawsuit, given what I knew about my own productivity.

But because little I had read or heard validated my physical and psychological decline, I was embarrassed about it. I didn't want friends to call or visit me. Luckily, one persisted and looked up for me an Internet chat group that was chock-a-block full of messages from pregnant women who felt like dying. I learned from this and from my doctor that my experience was far from unique. In fact, some women have it so bad they have to be hospitalized.

GIVEN MY CONDITION, I was in no mood for sappy sentimentalism about pregnancy, like the dose I got in the "prenatal diary" I received during a tour of the hospital where I will deliver. The diary looked like it had been produced in the '50s. Covered with little hearts and titled, "Love Notes to My Baby," it offered its own entries, supposedly written in my voice, like this one: "I think my clothes are getting tighter, but it's probably because I'm so anxious for everyone to recognize my pregnancy" (irrational woman that I am). And this one: "I went shopping today and bought your first toy. I was so happy I almost started to cry."

I wanted to hold the diary over a cigarette lighter.

In its modern way, What to Expect When You're Expecting makes similar assumptions about your feelings. One of the authors, Heidi Eisenberg Murkoff, sets the tone by describing her experience: "I was pregnant, which about one day out of three made me the happiest woman in the world." The other two days, she was the "most worried" because of, among other things, the caffeine and alcohol she imbibed before discovering she was pregnant.

I too was excited and nervous upon discovering I was pregnant. But what I was nervous about, frankly, was what I was letting myself in for: the 24-hour demands on my attention, the sleep deprivation, the inevitable strains on my marriage and work.

It didn't help that the book, with its rigid list of what I must and must not eat, imparts an early message that fulfilling my baby's needs means obliterating my own. Caffeine and alcohol are big no-nos, for example. Yet reading between the lines, it's clear that science hasn't turned up any evidence against modest (and I stress modest) consumption of either. The zeal to prohibit mommy for the sake of the baby, even when unnecessary, stands in striking contrast to the attitude of many of these same folks when it comes to abortion—namely, that women's bodies are theirs and theirs alone.

Murkoff and other pregnancy mavens, moreover, make it sound as if pregnancy is the biggest thing that ever happened to them. Well, I feel like I've done a lot of big things, including traveling the world, making my way as a writer, and getting married.

Don't get me wrong, I expect that actually having a child will open up a world for me that I can't yet fully understand. My husband and I decided to do so because we have seen kids bring an indescribable meaning to the lives of those close to us. As my due date gets closer—it's six weeks away as I write this—I'm starting to imagine more keenly the fun and sense of rediscovery that will come with watching new life grow. While many people want to make up for their unhappy childhoods by creating their own families, I'd like to think I could reproduce the kind of loving household I grew up in.

Rather than evoking some type of rapture, though, pregnancy for me has brought a slow deepening of emotions. Despite the physical ordeal, I have felt the dawning of a new sense of family and an even closer bond with my husband. But I do not find myself wanting to dwell on the details of the delivery that awaits me, beyond understanding the basic process and learning about anything I can do to make the experience easier.

On that score, I'm out of luck. Today's expectant parents are expected to take birth education classes that log in 16 hours over the course of four to eight weeks. Quite likely, we'll spend as much time learning about labor as being in it. We are encouraged to mull over every aspect of the experience as we prepare a birth plan to give to the hospital. Do we want an enema if it's necessary to stimulate labor? How about the drug pitocin? Which would we prefer be used to measure the baby's heartbeat—the fetal stethoscope, the handheld ultrasonic fetal stethoscope, or the external electronic fetal monitor? What are our feelings about an episiotomy, a cut made in the vagina to enlarge the birth canal? Any difference if the baby is coming out so fast that we know we're going to tear anyway?

I appreciate the opportunity to have more control. But I'd rather be asked some of this stuff as the moment demands, especially since labors are so variable that we may never be faced with many of these choices. It's as if before going into cancer surgery, we were briefed on every cut the doctor might make, every instrument he or she might use, and every possible complication—and then be asked to second-guess every move before it happened. I have my suspicions that this extensive deliberation for often months in advance makes the event seem more, rather than less, overwhelming.

WE NEED SURPRISINGLY little class time to learn the "breathing and relaxation techniques" we're told we won't want to miss putting into practice. That's because what there is to learn—mainly how to breathe slowly, quickly, and both ways in succession—is intuitive or can be absorbed in five minutes. We practice these "techniques" every class for long stretches at a time. They are relaxing and, I've heard, helpful during labor. I have a hard time believing, however, that they are an effective substitute for pain medication. Yet the bias against drugs is so strong that they are barely mentioned during the description of labor offered in class and in our textbook Pregnancy Childbirth and the Newborn. Even though the vast majority of women use drugs, as my yoga classmate discovered, we are taught what labor feels like under the unspoken assumption that we're going natural. At no point are we told: "This is what labor feels like if you choose drugs, this is what labor feels like if you don't."

When we do learn about drugs several weeks later, it's in a way that's not very informative. A long list of drugs is thrown at us, without much guidance as to which to concentrate on. Buried is the fact that the epidural is the most effective and widely used means of alleviating pain. Along with a description of the advantages of all these drugs, we are also given a far longer description of potential side effects. Missing is a perspective on how frequently they occur. It's like reading the packaging on aspirin: Yes, it might cause ringing in the ears or hearing loss, but is the risk great enough to stop a reasonable person from taking it?

Maybe—at least among this circle of folks who harbor a new-agey disdain for western medicine in general. "In contemporary western culture, the emphasis is greater than ever on development, perfection, and wide utilization of drugs for every health care need," our textbook sniffs. So these professed experts apparently don't even bother to check out actual statistics. When I told my teacher recently that I planned on having an epidural, she mentioned that the medication makes a cesarean twice as likely. Worried, because this was the first time I had heard such a figure, I questioned her more closely. Fuzzily, she indicated that she was referring to the use of an epidural in the presence of a specific complication. How much did your chance of a cesarean go up with use of an epidural in a normal labor? A "little" bit, she said. How little? She didn't know.

I am not a reckless person. If I heard a clear case against using drugs on the grounds that they endangered me or my baby, I'd face my fear and prepare to do without. What I hear, however, is that fear should be faced for the sake of it, that labor is some kind of psychological test, and that only wimps take the easy way out with drugs. The almost misogynistic message is no less plain for being subtle, as in our textbook's explanation of why women opt for medication: "It is when you think that your labor is worse than it is supposed to be that you begin to worry and seek relief with pain medications or anesthesia." God forbid women should seek relief from labor's all-too-normal torment.

I have a friend who experienced labor with and without drugs in giving birth to two children. She went natural the first time, which she says put her into an extremely focused, Zen-like state and gave her a feeling of tremendous accomplishment. She's glad she did it that way. The position of the baby in the second birth, however, prolonged her labor and intensified her agony. She finally got an epidural. And she found out an interesting thing: Freed from pain, she was able to appreciate the moment of her child's arrival in a way she had not been able to the first time.

Funny how the birth culture never talks about that.

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