So, how do we support mothers?


Just in time for Mother’s Day last month, the Washington Post published a flame-y opinion piece by Amy Tuteur. Perhaps this is why I was a bit cynical in my own reflections on Mother’s Day this year (aside from my son reminding me that I had ruined his day, twice). 

As a mother who has given birth & is preparing to give birth again soon (not to mention those miscarriages that were like mini-births in their own way), I had to chuckle when I saw that the title called out the natural birth movement as an “industry.”

To call the relatively minor support system that has grown around the (relatively) recent awareness & desire for natural birth an “industry” (when the presumed “opposite”—the medical system—is literally an industry, and a very lucrative & powerful one) is a gross exaggeration, to say the least. And coming from a former obstetrician, the motives of the author are a bit suspect. 

Tuteur complains that midwives make an average of $75,000-$99,000 dollars. Funny, since most midwives are highly trained nurses working in a hospital setting. And those working outside the hospital setting, assuming they are equally highly trained nurses, deserve that & more, considering they have to fight insurance for coverage of the basic costs of attending births. 

But I digress, because what I really want to talk about are moms. How do we support moms? Birth is just the beginning, but it is a signpost for how we treat moms & families generally. It matters how we talk to moms about birth.

Tuteur is right about many things. For instance, we ought not to forget that “natural” is not always better. As she aptly points out, women have been birthing “naturally” for eons & for most of that time birth was dangerous for both mother & child. 

But on how we should treat birth today in the United States, now that healthy outcomes are the norm, I think Tuteur’s inflammatory, “us vs. them” approach is absolutely wrong. 

As is her style, Tuteur treats birthing women as black & white pawns, women who are either for or against natural birth or medicalized birth. In Tuteur’s world, it seems you must either be catching your own baby under a tree in a remote forest or scheduling your c-section so that you can squeeze in your pedicure appointment.

Let’s be honest, most women realize that birth & motherhood is a much more complicated affair. 

My first birth was natural-ish. I was hooked up to an IV. Using Hypnobirthing techniques to manage discomfort. Attended to by midwives. In a hospital. My son was administered antibiotics (with my consent) shortly after birth. I required interventions of a personal nature that I’d rather not talk about on the Internet. My son took some hospital-provided (definitely-not-organic) formula while I recovered. A lactation consultant taught me the key nursing positions.

I felt empowered by my birthing experience. I regret none of the interventions I required (even if I do wish we could have avoided those pesky antibiotics…). 

I realize that I was lucky. I had great insurance as a law student at a fancy school. I had choices! I lived in an area with a good hospital & an even better group of midwives (along with back-up OBs) whom I trusted completely.  

My birthing experience was not natural or medicalized. It was a little of both. It was messy & complicated because that’s what birth is. We cannot control the birthing process, only our reactions to the experience. And even that emotional control sometimes only comes after the fact. Sometimes, I can imagine, it never comes at all, leaving women to feel their birth experience was both physically & emotionally out of their hands.

We cannot necessarily control the circumstances of our birthings. When women can’t choose their care providers. When they aren’t empowered to choose a basic starting point or offered options that align with their values & priorities. Which is why some women legitimately feel hurt or traumatized by their birthing experiences. 

We shouldn’t discount these women’s voices or insist that all that matters is taking home a healthy baby. 

Which is why I get so ruffled by Tuteur & her polarizing writing. 

I don’t think it helps mothers to demonize one group or approach to birthing in an attempt to help some mothers feel better about their own birthing experiences.

Don’t get me wrong, Tuteur’s ultimate point—that making mothers feel guilty or bad about interventions in their own births is a terrible thing—is right on. Shame on any person (another mother, healthcare provider, natural birth advocate, etc.) who makes a woman feel guilty for choices or necessary interventions made during her birth. But does a basic respect for all women in birth (& the myriad choices those women might make given the modern miracles of today) require shutting down & belittling advocacy for natural birth?

It’s a mistake to simply flip the board over & upturn the players. When we mistake advocacy for an ultimatum, we create boogie men (or women, as the case may be) that haunt our parenting decisions. We see those who chose differently than we did as judges & bullies, especially when those others embody the choices that we might have made under more ideal circumstances. 

But in truth, advocacy serves a purpose & the overwhelming majority of advocates aren’t judging or finger wagging. Where would c-section rates climb to without natural birth advocates? What would the state of homebirth midwifery be without advocates who caution against homebirth or who promote safe homebirthing options?

The ugly truth is not that you are doing it wrong. The ugly truth is that all of these issues are terribly messy & navigating the myriad of birthing & parenting choices (to the extent that we have choices) is taxing, emotionally & otherwise. Which perhaps helps to explain why it’s so easy to feel under attack. 

The better question for women who feel hurt by their birthing experiences is simply, “Why?” And then we should listen. 

If it’s another mother on the playground or on an Internet message board, well, we can help those mothers better understand each other. It’s an interpersonal & a basic manners issue. If it’s a natural birth advocate or one of those pesky natural birth instructors or programs that Tuteur picks on in her article, it’s a little bigger than mom-to-mom conflict, but it’s still essentially an interpersonal issue, or even a training issue. 

If it’s an OB or a hospital, well, then we’re moving into institutional & systematic issues that raise serious questions about power & patient rights. It’s a bigger problem & something we should take seriously if we care about birth. If it’s an incompetent or militant midwife, that’s also a very serious issue that gets into legal & systemic problems that are complicated & sometimes seem to be intractable. 

Tuteur’s mistake is to focus on the interpersonal issues to the exclusion of the systemic problems, at least in this article. (She deals with homebirth issues extensively on her website & other fora, though she perhaps is not entirely fair in her approach to the issue & tends to simply demonize all midwives.) Mothers may be legitimately hurt by any of these interpersonal or systemic actors & I agree that we should be cautious about idealizing a “perfect” birth. We should carefully listen to any mother who feels bad about her birthing experience. I try to listen as a way to curb my own enthusiasm for natural birth. I do my part by trying hard not to be an asshole. 

But I have to say that my limited observation tells me that those women who have been most traumatized feel that it was a systemic issue that hurt them. What can we do for them? It’s a harder issue. Tuteur’s solution—take down the natural birthing “industry”—is entirely inadequate. 

There is nothing inherently wrong with education focused on natural birthing techniques. That women who are passionate about birth can sometimes make a living or a bit of money by supporting like-minded mothers does not make natural birth advocacy an evil empire, intent on setting women up for “failure.” 

Could some of these folks do a better job preparing women for Plan B (e.g. medical interventions)? Probably. Could some of them be a bit more focused on the reality of messy birth & less on how many candles you’ll have in your bedroom? Probably. 

I wholeheartedly agree that natural childbirth education needs to embrace the contingencies of birthing. But many already do that. In my Hypnobirthing class (which I took when I was pregnant with T), the instructor showed us many videos of quiet, peaceful births. Then we also saw a c-sections delivery & got the low-down on induction & forceps. All delivered practically & without judgment. In the Hypnobabies course I’m taking, visualization exercises remind me to be prepared for any direction my birthing might take. The company also offers a course for mothers planning a c-section. It’s not all gloom & doom, as Tuteur’s article makes it seem. There’s a lot of sympathy & understanding for a myriad of birthing experiences in the natural birth advocacy world.

We have to give ourselves grace for our mistakes and misfortunes alike.  And we have to extend that grace to others, as well. 

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Filed under Attachment Parenting, Breastfeeding, Feminism, Food, Living, Mothering, Parenting, Working

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