Likewise, there can sometimes be protests that we should be doing more to celebrate the wonderful men – and in the same way the wonderful maternity care providers – who are ‘getting it right’. It’s true, there are some brilliant midwives, doctors, obstetric units and organisations out there who are providing the most fantastic, refreshing, woman-centred, personalised maternity care – and yes, praise is a good thing, and yes, some of them are in this book. But do we really need to repeatedly celebrate those who are simply providing what women need and deserve? Do men who treat women with respect need a great big pat on the back? No – they are simply behaving normally, with the required, standard levels of kindness and compassion. There should not have to be medals for this, and for the same reasons I have not devoted endless pages of this book to good, decent, rights-based maternity care. Listening to women, caring for them as individuals, and respecting them as the key decision maker in the birth room should cease to be seen as a shining beacon in the darkness and start to be viewed as the baseline norm.
Currently, we are not getting birth right. This matters primarily because birth is a key human experience that will be remembered in great detail by a woman, and her partner, for the rest of their lives. In this book I have tried to ask some difficult questions about the kind of births women are currently experiencing vs. the kind of births that may be possible or desired. These are not easy conversations to have, not least because all women are different and will want and prioritise different things. Added to this, there is a weight of emotion brought to the discussion by those women who have already given birth and had traumatic or disempowering experiences. In spite of the complexity of the topic and the difficult feelings that discussing it evokes, I sincerely hope that this book will pull women together to work on this problem by truly listening to each other and in the true feminist spirit of solidarity. We owe it to those who are yet to give birth to ensure that we all collectively approve of the direction that the birth experience is taking.
Intervention rates in childbirth are rising rapidly, and we should all be concerned about this. This is not just my personal viewpoint. Leading bodies such as the World Health Organisation have expressed concern that the medicalisation of childbirth, with its focus on how to monitor, measure and control birth, has left the question of how women actually feel about their births completely off the agenda, potentially robbing them of a life-enhancing experience.[1] The world’s most prestigious medical journal, The Lancet, has drawn attention to the ‘too much too soon’ approach to birth, most often found in high-income countries, in which treatments that were originally designed to manage complications are now overused, missing an opportunity for women to feel strong and capable.[2] You will notice that in this book I have given plenty of attention to the issues around ‘natural’ or ‘physiological’ birth, because I do feel that this is a key topic for feminist focus. In writing about natural birth, I have often had the sense that I am ‘championing the underdog’. Because we have to accept that, currently, natural birth – in which a woman has a baby without any pharmacological input such as induction, augmentation or drugs to expel the placenta – is very rare. Rarer still are what I call ‘hands-off’ births, in which women, rather than being ‘managed’, rely on their own instinct, follow their body’s lead, and are not guided into certain positions or told when and how to push. Women who have their baby in this way, feeling totally confident in the loving support (and, if necessary, medical help) that they know is in place in the background, but left to give birth entirely under their own steam, will most often talk of the experience in evangelical terms, as life-changing moments in which they felt sexual, sensual, strong, vital and powerful. You can’t help but wonder when you hear their stories how much the world might change if more women were getting this transformative power boost as they crossed the threshold to motherhood. Instead, it’s becoming much more ‘normal’ to have a birth in which you feel unsupported, disempowered and traumatised. I therefore feel it’s vital that we have a conversation about the value to women of this type of ‘straightforward’, ‘physiological’ or ‘natural’ type of birth experience, which is currently on the brink of extinction.
We also need to talk about those women who don’t want or cannot have straightforward vaginal births. There is literally not one single birth scenario in which increasing empathy for the woman, listening to her voice, respecting her decisions, and honouring that this is an extraordinary day in her life will not be valid. There is literally not one single type of birth that we cannot improve upon. The best way to find out more about this is again to listen to women. I learned so much about what women want in birth from talking to those who have experienced caesarean, and in particular, caesarean under general anaesthetic – often the most difficult birth experience to process and recover from. From them I learned that the smallest of gestures can make the biggest and most life-changing differences. Taking a few moments to photograph the newborn on their mother’s chest, for example, even if she is still unconscious, will create something she will treasure for a lifetime, a tangible antidote to her trauma. Women repeat again and again how much it means to them to know that their hands were among the first to touch their baby, even if they were not ‘there’ to experience it. Every small gesture matters, and we can always do better.
Two radical ideas underpin this book. Firstly, birth is a really important experience in a woman’s life and it’s time to stop telling women that it’s ‘just one day’ in which they ‘leave their dignity at the door’ because a ‘healthy baby is all that matters’. These are old-fashioned ideas, riddled with disrespect for women, for their autonomy, and for their feelings as sentient humans, that have no place in the twenty-first century. This book will try to unpick these ideas by looking at some of the history of birth, at various feminist perspectives, at the links between birth, female sexuality and power, and at the current culture of fear and disempowerment that continues to prop up these faded ideologies. Simultaneously, the book will try to replace these outdated perspectives with new considerations of women’s rights in childbirth, their bodily integrity, in particular through the lens of #metoo, and take a fresh look at what we might find, both literally and figuratively, in a birth room built with women’s needs in mind.
The second radical suggestion that this book will make is that pregnant women should be elevated to the role of key decision maker and most powerful person in the birth room. I can tell you from a decade of talking to women about their maternity care that, while there may be frequent reassurances that this is already the case, in reality it tends to make people uneasy. We see this most clearly when women try to go against the flow, birth outside of guidelines or refuse to consent to or accept the standard protocol or approach. These women, and often too, the midwives or doulas who support their choice ‘no matter what’, will often meet huge resistance, and risk sanctions or even punishment, as we will see in several stories in this book. We need a shift in consciousness,