Want to see a natural birth? Go to a sheep farm

Humans just aren't very good at giving birth - we produce magnificently big-skulled babies and have skinny little pelvises. A natural birth may sounds wonderful in theory, but in practice it's wise to give nature a helping hand.

One of the cool ways that pregnancy prepares you for having an infant of your own is by thoroughly infantilising you. And so it was that I found myself – a grown-up person of 20 years with another person growing inside me – looking another woman in the face and inviting her to praise me for rubbing sweet almond oil onto the skin between my vagina and my arsehole. “I’ve been massaging my perineum,” I said, eagerly. “To stop me from tearing.”

My midwife had patiently talked me through my fears about caffeine consumption and pre-pregnancy test binge drinking, but this was too much. She fixed me with a look of piercing sympathy and said: “I don’t think that will help.” I was, of course, devastated. I believed sincerely that there was a right way and a wrong way to do pregnancy, and having got pregnant in the wrong way (by accident, living in a halls of residence), I wanted to do the rest of it right.

And that meant natural. There would be no C-section and no epidurals; there would be no tearing. I would follow all the advice down to the last drop of sweet almond oil. If the Royal College of Obstetricians and Gynaecologists had published its guidance on chemical consumption in pregnancy back then, I would have diligently avoided Tupperware and paracetamol too. In exchange for my good behaviour, I expected to be rewarded with a blissful, natural labour that would end with my baby resting contentedly on my suddenly vacant belly, skin to skin.

If I’d been pregnant a few decades earlier, none of this would have been an option for me to consider. Choices weren’t available. Instead, you had doctors holding all the power in one hand and some alarming surgical steel implements in the other. In some hospitals in the 1970s, for example, it was routine for uninformed women to be given drying-up pills with their post-labour breakfast. They didn’t need to be asked, because the idea that anyone would want to breastfeed was so unthinkably gross to the medics in charge.

Such obstetric cruelty is what natural birth campaigners like Caroline Flint, interviewed in the Guardian at the weekend, opposed. It’s thanks in part to people like Flint that I was given a birth plan to fill out, and could hand it over to my midwife in confidence of it being observed. It’s also thanks to people like Flint that I believed there was a profound moral weight to what happened in my labour.

In her book, she writes that babies welcomed with the bright lights and loud voices of a hospital are taught “they may not always be welcome”; have a home birth, on the other hand, and you’re practically guaranteed to deliver a sensitive genius. (She also recommends that women should be “sexually aroused” while giving birth, which rather airily assumes that everyone is capable of getting turned on in a situation where it’s 50-50 whether you’ll shit yourself.)

All this assumes that nature is a kind and generous entity whose only concern is in getting babies from womb to world as safely and efficiently as possible. But nature is a half-arsed craftsman, capable of doing things perfectly when time and circumstances allow, and equally capable of doing things just well enough to shove a handful of DNA into the next generation.

Humans have many fine and distinctive qualities. We are a magnificently brainy animal, creating magnificently big-skulled babies. We’re also impressively upright, with skinny little pelvises to support our vertical frames. We are just terrific at walking and thinking. And as a consequence of those things, we’re not very good at giving birth. The best that can be said for our species’ efforts with labour is that it’s non-lethal often enough that we haven’t been forced to evolve anything better.

Birth is incontrovertibly a biological process, but you could hardly say humans are naturals at it. Want to see a natural labour? Go to a sheep farm during lambing and watch the offspring just slither out of the ewes’ behinds. And even the lambs get it wrong sometimes and try to bust out sideways or backwards. We do so much worse.

After two deliveries that could have finished me off without hospital assistance (one slow suffering, one shockingly swift), I decided that nature and me would only get on with a medical mediator. Safe labour requires listening to women and giving them confidence in their own decisions, but it also requires not telling them fairy tales about how everything will be OK if they just cast the right charms and follow the right rituals. Women are not, after all, the children when it comes to giving birth.

 

A pregnant woman with a painted baby on her belly takes part in the Movement for a Humanised Childbirth demonstration in Brazil. Photograph: Getty Images

Sarah Ditum is a journalist who writes regularly for the Guardian, New Statesman and others. Her website is here.

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Junior doctors’ strikes: the greatest union failure in a generation

The first wave of junior doctor contract impositions began this week. Here’s how the BMA union failed junior doctors.

In Robert Tressell’s novel, The Ragged-Trousered Philanthropists, the author ridicules the notion of work as a virtuous end per se:

“And when you are all dragging out a miserable existence, gasping for breath or dying for want of air, if one of your number suggests smashing a hole in the side of one of the gasometers, you will all fall upon him in the name of law and order.”

Tressell’s characters are subdued and eroded by the daily disgraces of working life; casualised labour, poor working conditions, debt and poverty.

Although the Junior Doctors’ dispute is a far cry from the Edwardian working-poor, the eruption of fervour from Junior Doctors during the dispute channelled similar overtones of dire working standards, systemic abuse, and a spiralling accrual of discontent at the notion of “noble” work as a reward in itself. 

While the days of union activity precipitating governmental collapse are long over, the BMA (British Medical Association) mandate for industrial action occurred in a favourable context that the trade union movement has not witnessed in decades. 

Not only did members vote overwhelmingly for industrial action with the confidence of a wider public, but as a representative of an ostensibly middle-class profession with an irreplaceable skillset, the BMA had the necessary cultural capital to make its case regularly in media print and TV – a privilege routinely denied to almost all other striking workers.

Even the Labour party, which displays parliamentary reluctance in supporting outright strike action, had key members of the leadership join protests in a spectacle inconceivable just a few years earlier under the leadership of “Red Ed”.

Despite these advantageous circumstances, the first wave of contract impositions began this week. The great failures of the BMA are entirely self-inflicted: its deference to conservative narratives, an overestimation of its own method, and woeful ignorance of the difference between a trade dispute and moralising conundrums.

These right-wing discourses have assumed various metamorphoses, but at their core rest charges of immorality and betrayal – to themselves, to the profession, and ultimately to the country. These narratives have been successfully deployed since as far back as the First World War to delegitimise strikes as immoral and “un-British” – something that has remarkably haunted mainstream left-wing and union politics for over 100 years.

Unfortunately, the BMA has inherited this doubt and suspicion. Tellingly, a direct missive from the state machinery that the BMA was “trying to topple the government” helped reinforce the same historic fears of betrayal and unpatriotic behaviour that somehow crossed a sentient threshold.

Often this led to abstract and cynical theorising such as whether doctors would return to work in the face of fantastical terrorist attacks, distracting the BMA from the trade dispute at hand.

In time, with much complicity from the BMA, direct action is slowly substituted for direct inaction with no real purpose and focus ever-shifting from the contract. The health service is superficially lamented as under-resourced and underfunded, yes, but certainly no serious plan or comment on how political factors and ideologies have contributed to its present condition.

There is little to be said by the BMA for how responsibility for welfare provision lay with government rather than individual doctors; virtually nothing on the role of austerity policies; and total silence on how neoliberal policies act as a system of corporate welfare, eliciting government action when in the direct interests of corporatism.

In place of safeguards demanded by the grassroots, there are instead vague quick-fixes. Indeed, there can be no protections for whistleblowers without recourse to definable and tested legal safeguards. There are limited incentives for compliance by employers because of atomised union representation and there can be no exposure of a failing system when workers are treated as passive objects requiring ever-greater regulation.

In many ways, the BMA exists as the archetypal “union for a union’s sake”, whose material and functional interest is largely self-intuitive. The preservation of the union as an entity is an end in itself.

Addressing conflict in a manner consistent with corporate and business frameworks, there remains at all times overarching emphasis on stability (“the BMA is the only union for doctors”), controlled compromise (“this is the best deal we can get”) and appeasement to “greater” interests (“think of the patients”). These are reiterated even when diametrically opposed to its own members or irrelevant to the trade dispute.

With great chutzpah, the BMA often moves from one impasse to the next, framing defeats as somehow in the interests of the membership. Channels of communication between hierarchy and members remain opaque, allowing decisions such as revocation of the democratic mandate for industrial action to be made with frightening informality.

Pointedly, although the BMA often appears to be doing nothing, the hierarchy is in fact continually defining the scope of choice available to members – silence equals facilitation and de facto acceptance of imposition. You don’t get a sense of cumulative unionism ready to inspire its members towards a swift and decisive victory.

The BMA has woefully wasted the potential for direct action. It has encouraged a passive and pessimistic malaise among its remaining membership and presided over the most spectacular failure of union representation in a generation.

Ahmed Wakas Khan is a junior doctor, freelance journalist and editorials lead at The Platform. He tweets @SireAhmed.