The National Institute for Clinical Excellence (NICE) has published new evidence-based guidance on the care of women and babies during childbirth. I like the phrase “evidence-based”. It sounds so reassuring, particularly when we’re dealing with an area where it’s so easy for women themselves to get it wrong. Finally someone’s going to give it to us straight. So, what’s the deal, NICE? Are we too posh to push? Reckless home-birthers? Intervention addicts? Let us know just what it is we’re doing wrong and believe me, we’ll try harder.
Of course, this isn’t really what the guidance is for. It’s aimed at healthcare professionals, not pregnant women. The information is detailed and specific, although this isn’t what the press have picked up on. For them it’s the fact that home births are now, apparently, “best” for many mothers, and so we’re back to pregnant women and their “choices”. While this is good in principle, there are times when I wish it could stop.
The emphasis on choice in childbirth is one I’ve always found bewildering. While I can’t fault the intent it still feels like a game. You’re encouraged to write a birth plan, all the while being told that “no one really sticks to it” but that you should still do it “for your own reassurance”. Why? It’s as though you’re being asked to create your own illusion of control, one which sets you up for failure and, inevitably, self-blame. It’s not really informed choice when the specifics of your own labour – and your own responses to something you’ve never experienced before – remain so variable. Childbirth is unpredictable, even for women who are statistically at a low-risk for complications, and whatever choice you make could end up being the wrong one.
For instance, I initially wanted a home birth with my second child. I’d had a relatively straightforward – and fast – first labour and I liked the idea of being able to bond with my own child in my own home. A hospital consultant talked me out of it, warning me of the potential risks. She was correct in her assessment that for me, the desire to give birth at home was based on emotion rather than any practical knowledge. Since I had a family history of complicated births, I ended up agreeing that it didn’t seem worth the risk. My midwife was obviously disappointed and I felt I’d let her down, shunning the natural wisdom of women in order to succumb to patriarchal evil that is medicalisation. It didn’t matter that my thinking had been more along the lines of “both will probably be fine, but I’d prefer to be in hospital just in case”. It wasn’t an ideological decision but somehow it was made to feel like one.
As it turned out, it probably wasn’t the right decision. I had an even faster labour than before and didn’t make it into the delivery ward at all, instead giving birth on the ground in the hospital car park. “Next time, plan a home birth” was the universal response (oh, but if there is a next time, I’ll be over 35 – another risk factor! Does that change the received wisdom? Either way, if there is another time, I still won’t know with any certainty what the right choice will be).
To be able to make decisions at all is a luxury, but it doesn’t mean that even the most privileged women aren’t having to make them, if not in the dark, then at least in shadow. Giving birth is intimate, painful and life-changing; we can’t be asked to choose whether what we’re going through is a medical, personal, cultural, psychological or natural event. It is all of these things. The principles we might hold to in everyday life don’t always stand up so well in such an extreme situation. As a feminist, I’m in awe of just how powerful female bodies can be, but that doesn’t mean I’m wholly comfortable with the “know your own body” narrative as far as labour is concerned. I want women to be proud of their bodies they have, not the bodies that the perfect labour narrative tells them they have to believe in. There is a difference between mistrusting our own capabilities and taking a realistic view of what we can and can’t control. To really know your body also means accepting that it’s not interested in whatever cultural ideals we may or may not have concerning the “right” way to birth; your body is not a moral battleground. You have nothing to prove.
Like losing your virginity, giving birth is one of those events in which it’s difficult not to invest too much. You can end up feeling it defines you (in the first case as a sexual being, in the second as a mother) and hence a bad experience can seem like a disaster. But in both cases it’s just a beginning. If you come out of it relatively unscathed, you still have just as much of a say over what happens next (although with a new baby in tow, the meaning of “having control over one’s own life” will inevitably have to change somewhat).
Women should be able to make informed choices over their own labours, and they need access to the resources that allow them to do this. But they also need to know that the “best” birth – the safest, the most peaceful, the most painless, the most natural, the most responsible – is an illusion and the most of us will “fail” according to one or more of the endless criteria. And yet we can still ask for more support and give ourselves a break. We’re just doing our best at what is the most ridiculous, amazing, god-like thing ever. Giving birth at all – however you do it – is preposterous. Don’t let a focus on the details detract from that.