Yes Means Yes

A long time ago, during what some people call First Wave Feminism, women argued that men were unrestrained animals, easily overcome by lusts and that women’s purity was what fitted us up to vote and be politicians in a way that beastly men could not. Motherhood was held up as a high honour, as evidence both of sexual purity being
sex resulting in offspring not for the purpose of satisfying lusts, and also because it showed that men trusted women to care for the most tender and malleable of all: our children. If women were trusted to raise future warriors, and mothers, it was argued, why were we not trusted with the vote? The alleged brutishness of men also meant that women must be on guard to exhibit only modest asexuality and not cause men to fall into the trap of their own
lusts which spurred them to rape. We were on notice to prevent ourselves being raped by being sufficiently chaste and unavailable. It was thus women’s fault, not men’s, when we were raped. And so it has continued into recent times, in large measure.

As noted by some feminists, women are treated as if we live in a permanent state of consent. The comparison between burglary and rape is sometimes made and shows up the double standards we hold around consent. Rape must be proven to have occurred. A homeowner notifying police is considered to be trustworthy enough to be believed that goods have been taken. They’re not asked about their charitable donations because if you’ll
just give stuff away, then how could you be robbed? They’re not quizzed about why they have windows and doors which obviously are just begging burglars to break in and remove stuff. A woman who has been raped must demonstrate the crime occurred in a way that no other victim of a crime is expected so to do.

For many years we have been exhorted to care for ourselves, be safe and avoid being raped, as if our behaviour makes this is possible. We have been told to not walk alone at night, to be careful what we wear because clearly a glimpse of knee causes some men’s attachment to legal behaviours to fly out the nearest window. We were once told husbands could not rape because marriage implied that state of perpetual consent. Feminists changed this only recently although I would suggest the remnants of these beliefs are alive and well and walking into a maternity hospital conveys a similar state of perpetual consent in the minds of many staff and consumers.
We still live in a victim blaming culture where women and children who are assaulted are overtly, and covertly, blamed for our own brutalisation. Birth activism, so woefully uninformed by the feminisms (just as feminisms are woefully frightened of embracing birth activisms), has now begun to face up to obstetric violence and this is
tremendous news. I believe that this is one profound way forward for the recognition of women’s bodily autonomy but it is a hard road because of the invisible layers of meaning contained within the bodies of birthing women.

Recently I saw a brief, and laudable of intent, blog post by a birth activist who was exhorting women to repeat “I do not consent.” in the face of threatened, or actual, obstetric violence. If you’ve been raped, you are probably aware that your words had no effect on your rapist or you wouldn’t have been raped. Most of us answer the threat
of rape with a clear, no thanks, after all. If you have been fortunate enough to avoid rape while physically fighting or talking to the rapist, then you know it was because the rapist decided not to rape you not because your words held magic powers. The same words would not work on every would be rapist and it was the decision of the rapist to cease, not the charm you uttered. Would Hermione avoid rape more easily than the rest of us?

I could name without difficulty many women I know who have uttered something similar to “I do not consent” in a birthing suite. I said, “Get out of my body.” to the obstetrician with her hand in my vagina. She didn’t. When a police chief in Toronto said women had to stop dressing in provocative ways in order to avoid rape, women worldwide answered with a cry of “Are you serious?!” and embarked on marches against sexual violence.

When we exhort women to say no, or curb their own behaviour, we tell women that rape is our fault and stopping it is our responsibility.

As I frequently write, birth culture is just a reflection of the wider culture in which women birth. The rights extended to women in birth can only be as great as the rights extended to us in the culture within which we birth. Equally, the degree to which women recognise the denial of their rights, can only be on a par with the degree to which women recognise their own worth. Women who are used to being paid less, sexually harassed, violated, passively
consuming body myths and products will not walk into a birth suite and suddenly go all Xena on hospital staff. That women be aware of their legal right of refusal is essential but when we tie to it the idea that this will prevent obstetric violence, we begin to tell women, again, that it is their own fault when assaults occur. Knowing burglary to be illegal does not prevent burglary, but may encourage victims to seek justice and not blame themselves for the actions of others.

The dominant discourse around birth is that only selfish women care about how their babies are born. Good mothers inhabit the normal space of perpetual feminine consent, allowing all hospital staff access to their bodies at all times regardless of their own feelings. Bad mothers are women who consider themselves to have a stake in birth, that their own health and wellbeing are important to themselves and their families, that they are capable of making decisions about their baby/ies, and who believe that birth is normal and thus preferable when performed by them, not that technological delivery systems be the default.* In reality, there is no good or bad mother, there are simply women, each deeply invested in the health and survival of her offspring. What is unequal is the quality of information and the degree to which obstetric disinformation has informed a
woman’s decision making process and the capacity of those who love her to provide support.

So if, as a society, we are committed to quelling violence against women, and we consider obstetric violence, what can we do?

Who really needs to hear the right of women to refuse interventions?
Those who perform the interventions.

Who needs to realise that no means no, however we dress, wherever we go?
Those who ignore the no.

Who needs to see the effect of obstetric violence years down the track when women are still unable to drive past the hospital where it occurred?
The people perpetrating the violence.

Who can stop obstetric violence?
Those performing it.

Obstetric violence, unlike most rapes, is carried out equally by men and women because obstetrics is a culture which affects men and women equally. It is not a form of male violence against women but it is a creation of, and reflection of, a wider culture of patriarchy in which most men are privileged above most women. It is, in many ways, an interesting reflection of kyriarchy where intersections of race, sex and class meet. But we cannot get away from the reality that 100% of those on the receiving end of its physical expression, are women in the process of pregnancy or birth and that is a striking fact.

So in case you’re wondering, here are my top ten tips for stopping obstetric violence:

1 Don’t touch pregnant or labouring women without an express invitation or without consent obtained in the absence of duress or coercion.

2 Don’t administer drugs or other interventions to pregnant or labouring women without an express invitation or consent obtained in the absence of duress or coercion.

3 Don’t ask the partners of pregnant or labouring women to aid you in administering drugs or other interventions without an express invitation or consent obtained from the woman in the absence of duress or coercion.

4 Don’t perform vaginal examinations or administer drugs or interventions to unconscious women without a prior express invitation or consent obtained in the absence of duress or coercion.

5 If you can’t stop yourself from acting without an express invitation or consent obtained in the absence of duress or coercion, ask a colleague to stay with you and alert others who can remove you from the room if you behave inappropriately and consider a change of employment.

6 Don’t administer artificial baby milk, dummies, drugs or tests to babies, touch babies or remove them from their mother, without an express invitation or consent obtained in the absence of duress or coercion from their parents.

7 Don’t attempt to coerce pregnant or labouring women and their partners by telling them things you know to be untrue, or with which you intend to manipulate them into consent. This is not consent.

8 Do act with integrity and love in every situation where you are faced with a pregnant or labouring woman just because it’s right.

9 Refuse to be a party to the administration of drugs and/or interventions when you can see that your colleague has attempted to gain consent via coercion or duress or when consent has not been sought at all.

10 Point out to women and to your colleagues when this occurs and report it to your supervisor or NUM.

If you have worked in maternity care and you feel traumatised by what you have participated in, and witnessed, I urge you to seek professional help. And I urge you to consider speaking up because women alone cannot end this violence. If you wish to apologise and take responsibility for your actions in maternity care, please know that
this would be welcomed by me and I would be honoured to support you and publish it on my blog. Someone has to start the process of reconciliation, why not you? When we treat others with scant regard for their humanity, we show ourselves to be equally disconnected from self and this is always a painful place for a person to find themselves. I wish you peace and love.

Women who have experienced obstetric violence are not a tiny minority of birthing women. We are a large portion of unrecognised survivors on whose bodies is written the politics of obstetrics and in whose suicides can be read the depths of the system’s failings. Every woman who finds herself in the space of being able to speak up, is providing
more than she can ever know for those around her, as yet unable to speak. May each of us do what we can to end this pandemic of modern violence against women, babies, families and communities.

What will you contribute this year?

*And we are tired of always having to add “unless it’s warranted” because frankly, duh. The notion that advocates of a normal physiological process are offended en masse and per se by technological support is a derailing tactic to draw attention away from the massive overuse and abuse of that technology on a population whose compliance has been manufactured and should be exposed as such.

Belinda will have her next baby at home

My name is Belinda and I live in a town in the Southern Highlands of NSW.

I have only had one child, and she was born via emergency c section at my local hospital. I had always wanted a very natural, very calm birth and when I was pregnant with my daughter asked my husband about home birthing, but he brushed off my thoughts with a simple “the hospital is the place to be, what if something goes wrong?”

My birth story is one that I have since heard repeatedly. I was late, my daughter was in the right birthing position, was induced, daughter turned a little, nasty midwife, waters broken, put on the drip, told to stay laying down, labour stalled, drip turned up, gets to lunchtime on a friday, doctor (who hadnt seen me at all) declares I need an emergency c section due to failure to progress. (I was told afterwards by a doula I met that the failure to progress was simply the doctor deciding he wanted to go home early on a friday)… After my emergency c section I didnt get a chance to hold my baby, and she was taken away by the nurses to be checked over, where later I learnt that before I got my cuddles she had already been held by nurses, the midwife, her father, my mum and my in laws.. This broke my heart, with feelings of guilt over the way the labour had gone, and the fact that I should have been the one to hold my daughter first..
My stay in hospital was long (over a week) and was treated horribly. I was upset, (which they thought was depression and brought in a psychologist), I couldnt feed, and was forced to shove my screaming daughter onto my breast, and no one would listen to me.

I still feel guilt, and sadness over my birthing experience, and it has taken me a while to realise that I cant do anything to change what happened, but I can learn from it.

I know that next time will be different, I want to have the choice to birth at home, with caring professionals who are responsive to my needs. I know the Government wants to take this choice away from high risk mothers like myself and that makes me mad! I dont care about the cost, I want to birth like it should be, no induction, no drugs, no drip, just me, my support team, in a comfy environment where I am relaxed and the baby is too.

Jade was born at home in the bath

My name is Jade Farmer, I am 26, and was born at home in the bath in Eudlo Queensland (Australia) with midwife, Jane Ferguson.  My sisters were born in Brisbane with midwives Jane Ferguson, Judy Thompson and Vicki Chan.  One of my mother’s births was in hospital after 63 hours labour but Vicki still delivered her 9lb 6oz baby.  I was in attendance at part or all of 3 of these births.

At 19, I delivered my first child in the Royal Brisbane Hospital, It was a 26 hour labour, with a posterior bub who was approx 3 weeks early (apparently).  I dilated very slowly to begin with but refused all pain relief other than gas.  A nurse attempted to catheterise me part way through my birth but “missed” 3 times at which point she was told in no uncertain terms to go away.  I found it very frustrating to be able to look at tubs but be told that they were not qualified to use them.  My mother and my husband were in attendance.  I was spoken down to, intimidated and taken advantage of, in the middle of a particularly painful contraction a nurse gave me a pethidine injection (which i had not agreed to) stating that it would be a long time and it would be fine as I was only 5 cm dilated and my membranes were intact.  Approximately 40 minutes later i told my mum that i needed to push, so just to be sure she asked me to try not to push through one….this was impossible! So by now, mum and I both know that it is nearly time to have this baby.  Upon telling the nurse this she told me that i wasn’t! so mum told the nurse that she had been there done this and would be more than happy to deliver it herself.  A short time later my membranes ruptured.  After about 20 minutes, of pushing (on my back at hospitals insistence) i delivered my son.  He was not breathing, the hospital then proceeded to make sure it was emergency by cutting his cord. bad move.  His apgar scores were 7 and 9 and he weighed 6lbs 7oz. I was then discharged from hospital 2 days later, unable to yet feed my baby.  Overall this was a horrible and scary experience

I fell pregnant again at 21, feeling like i had no choice i attended hospital appointments until 30 weeks.  My mother then told me that she was terrified of coming to the hospital again with me and that she would pay for me to deliver at home.  I jumped at this chance, although it took a little more to convince my partner, he was pretty much told what was happening :). So at 32 weeks, I met Dee.  Went into labour at 35 weeks, but that was quickly solved with some prompt zinc drinking at Dee’s advice.  I made it to 40 weeks, and 41 and 42….. So at 41.5 weeks Dee did a little stretch and sweep but it had little effect, i also started attending acupuncture every 2 days and went to the naturopath to get some serious labour herbs happening.  I finally went into labour at 1 day short of 43 weeks (again, apparently)  Again she was posterior.  this labour lasted about 13 hours.  I was not dilating evenly so i was walking up stairs sideways so shift bubby’s head, mum was cooking soup for after the birth, my partner was watching the world cup soccer.  At one point i was getting pushing contractions but was not ready to push yet, so we told Steve (my hubby) to go have  a lie down and we would do it, so mum breathed through the most painful contractions I have ever experienced with me.  i was finally able to push.  we called Steve in, he sat on the edge of the bed with me standing facing him, he supported my weight while i semi squatted.  my membranes ruptured all over his lap.  he asked to go wash but i said no :D.  Johanna was born with the cord loosely around her neck (the midwife and my mum had known this the whole time and was monitoring it, I did not know)  her shoulder also got somewhat stuck but Dee fixed it fairly easily.  Her apgars were 6 and 10  but unlike with Alex, I was never scared for her.  Johanna weighed in at a healthy 9lb 3oz.  She took to breastfeeding wonderfully although we did need some help with getting a good position for large breasts, this was no problem for my midwife of course.

In addition to having to convince my husband to birth at home, we then faced an additional challenge.  Our chosen midwife got deregistered for attending homebirths when I was about 37 weeks.  Dee did give us the option to continue with our planned homebirth with her in attendance or to transfer to hospital care.  Although it concerned neither my mother or I, we were very worried about how Steve would react to this news.  He took it in his stride, announcing “but you still know how to deliver babies!”.  We continued on our homebirth journey with an unregistered midwife.  So although we birthed with a midwife, if we had needed to transfer, Dee would have had to be our doula or friend.  We also had to tell Births Deaths and Marriages that we had in fact had an intentional unassisted childbirth and hence had to get statutory declarations from everyone who was in attendance (ie just me, Steve and my mum)  as well as my GP who had seen me shortly before the birth and also examined me within 24 hours of birthing.

Katie just wanted a vaginal birth

Where do you live? Perth
How many homebirths have you had? 1 

Why did you birth at home? Because I wanted a vaginal birth and I wanted it done safely without fear or pressure. I wanted to feel like I had given birth. I felt like with the changes in legislation on the horizon, that this could be my only chance to birth at home with a qualified midwife.Did you homebirth your first baby or subsequent babies? My first was a caesarean, my second was a HBAC. I didn’t know that Homebirth was an option. I thought everyone went to hospital and have a baby. I felt Homebirth was something people did elsewhere in the world whom didn’t have access to hospital facilities.

Have you used a publicly funded homebirth scheme in any country in the world? No. I am ineligible for the CMP here in WA because of a scarred uterus. 

Have you experienced hospital or birth centre birth? Hospital birth (supposedly Team Midwifery Care)

Have you experienced trauma around birth? Having a baby surgically removed. I felt like I didn’t give birth. I felt disconnected from my baby. The process was painful and unpleasant. I was recovering from surgery and had a newborn. My partner was looking after me and the baby, totally different notion to how our start to parenthood was supposed to be.

How old were you when you were birthing at home? 29
With what ethnicity do you identify? Australian (caucasian australian?)
Have you had a caesarean? More than one? 1
Have you had a breech home birth? no
Do you identify as disabled/temporarily able-bodied? no
Have you had a midwife-attended home birth? yes
Are you in a relationship? yes
Are you single? no

How did you pay for your home birth? I paid from my wages at the intervals set out in writing by the midwife

Do you work at home or in the paid workforce?  paid workforce
Does your family have a history of home birthing? no

Andrea had her third baby at home

Where do you live? Geelong, Victoria
How many homebirths have you had? 1, my 3rd son. My first two boys were hospital births.
Why did you birth at home? Because my rights and wishes weren’t being respected by the hospital, because I didn’t feel SAFE there anymore, because I was lied to several times and because I was treated like a child. Because I wanted a waterbirth which the hospital denied to me.
These are some other things to consider:
Did you homebirth your first baby or subsequent babies? I had hospital births with my first two and my third was my home birth.
Have you used a publicly funded homebirth scheme in any country in the world? No
Have you experienced trauma around birth? Yes. My first birth was horrific and it wasn’t the pain from the 53 hours of labour that i found to be horrific, it was the way i was treated by the staff throughout my labour and afterwards. There was so much wrong doing that I wouldn’t even know where to start. With my second child, I was denied a water birth because he was measuring big and because I refused the GT test. I was told that if I had the test done and it came back clear, that I would be ‘allowed’ to go back to midwifery care (I was told that until I had the test done, I was going to be seen by the GD obstetrician). I had the test done, it came back clear and I was still denied my water birth and I was ‘allowed’ to have a vaginal birth only if an OB was present.
With my 3rd child, I started off in the hospital system and I was shocked at how disrespectful they were, yet again with my very well informed choices only because they did not meet hospital policy. I was again denied a waterbirth despite the fact that I was measuring ‘on track’ and I birthed my previous 10lb2 child with no issues at all. After my assigned midwife rang me at home and yelled at me like a child for refusing to have the GT test and refusing my water birth, I looked into my options. At 28 weeks pregnant, I pulled out of the hospital system and met with my midwife whom I continued my pregnancy with and had my perfect home birth with.
How old were you when you were birthing at home? I was 27 years old.
With what ethnicity do you identify? Caucasian
Have you had a caesarean? More than one? None, thankfully although I ticked several boxes with all three of my birth for ‘needing’ one.
Have you had a breech homebirth? No
Do you identify as disabled/temporarily ablebodied? No
Have you had a midwife-attended homebirth? Yes
Are you in a relationship? Yes, married
How did you pay for your homebirth? Tax return
Do you work at home or in the paid workforce? No but i do study full-time
Does your family have a history of homebirthing? No

To the woman at the shops with the weeping babe

I saw you today, at the shops, my sister. I saw you pushing a pram, perusing scarves, unable to respond to the bleating, hiccupping cries and jagged breaths of your newborn. I heard the babe cry out over and over, “Help me. Hold me close. Comfort me. Show me I’m not alone.” and yet in your aloneness, you were kept from responding. Was I seeing the trauma of your babe’s birth in action? The fragmented care of a brutal maternity system which prizes compliance above wellness? The ugly effects of industrialised parenting and the mould into which we are all shoved in this 21st century Sparta? I saw your babe’s face as she shut down and stared blankly at you from the pram and I felt my heart break for you both.

I hid weeping behind the clothing racks, pained for you and for your babe that this is the normal of parenting now; the bereft mother who struggles to relate to her baby. I feel the more keenly for you because I too have been that mother, savagely denied my birthright of connection with my first child and because the babe who would be in my sling right now is missing from my arms, never to return. I wish I could nurture you a little, mama, so you could connect with your earthside babe as I cannot mine.

If you are like most women, your pregnancy has been punctuated by testing, by scaremongering, by the slow whittling away of your instincts and connection to Self and Other within. Your babe has experienced the onslaught of ultrasound, almost definitely twice but most likely more. A sugary drink was probably fed to you after a day’s starvation and your belly babe struggled to regain equilibrium in an environment now hostile, with a beating heart and who knows what else? By the time gestation was nearly finished, as your babe’s body began to prepare for life earthside, harsh drugs were probably used to evict her from that perfect dwelling place, and make a once safe place dangerous. Did strangers ram a painful screw into your scalp, little one? I am sorry. Did someone puncture the cushion on which your head rested, while the drugs denied you oxygen with each mechanised wave of pain that wracked your mama? Was your beautiful birth cocktail of love hormones ripped from you and your brain changed? I am sorry. This is how birth is done to babies now in my world and in your prehistoric innocence you journey earthside unwittingly, to wrestle with a system which does not recognise your intrinsic humanity, or capacity to dance from your mother’s body.

Mama, did you feel fear as you submitted to induction? Did you try curries, walking, sex despite your unwieldy body, or even castor oil, in an effort to have some control over inducing yourself before giving in to the people you trusted to care for you? Did you feel relief when the drugs entered your body and took the agony of chemically induced labour away even though you didn’t realise just how much it was going to do damage to your babe and you? I am sorry. We should be doing better for you. Was your babe cut from your body, wrapped up, wiped, injected and removed from your sight, for who knows how long? I am sorry. I wish you could give birth in your own way, without drugs to dull the keenest experience of your life. Held in love, nurtured, in bliss, walking that hard path to a new you, a woman who knows what she can manage and feels her own strength in the world.

But all is not lost because your human brain can find ways through even this most terrible pain and injury. What can you do? Buy a soft, cotton sling, hold your babe near your heart and your breast as you move through the world. Take to your shared bed, sleep together, dream together and in that dreaming, weave again a cocoon for you both, from the untouched remnants of your primal self who still remembers how to parent these helpless, pink, hairless babes. Offer your breast without timetables, or rationing, revel in the hormone rush of oxytocin and show her the world is predictable and safe. Bathe together and marvel as your tiny one remembers the giant sea of her gestation, close your eyes and remember back to the bliss of feeling those tiny limbs as they swam in your body. Share the joy of unfettered mammalian parenting with the world so other women may awaken their memories of parenting without recourse to punishment or the casual brutality demanded of us today.

I wish that through this pain you may birth yourself and find the woman in you who seeks only that which nurtures, and casts aside in future, that which does you harm. I wish that your next birth will be eye opening, life changing and that the first hands to touch your babe will be yours.

Tami was only having a second babe if she had a homebirth

My name is Tami White. I live in central Victoria. I’ve had one homebirth. I am a 30 year old Caucasian woman. I am self-employed as a psychologist. At the time of my son’s homebirth I was employed part-time as a counsellor by another psychologist.

When I homebirthed, I was a woman in my mid-20s. I had one 2-year-old girl child who was born in a hospital, and my condition for my husband of having a second child was that it would be a homebirth. My daughter’s hospital birth had left me shattered mentally with no faith left in my body, and fragile mentally with no faith in my abilities as a parent. I didn’t ever want to go back there again. Given that Einstein defined insanity as doing the same thing over and over again but expecting a different outcome, I was determined to not behave as though I were insane.

I have hypermobility syndrome, a ligament disorder that means my ligaments are too lax at the best of times. During pregnancy, the increased levels of the hormone Relaxin render my ligaments non-functional. By the end of both of my pregnancies, I could not walk more than 10 meters without assistance. I needed full time care from my husband, who is supportive but could not earn an income due to my needs. My pregnancies are technically classified moderately dangerous. I was offered a caesarean section at 38 weeks with my first pregnancy due to my condition, although I went on to ‘successfully’ birth vaginally (if a vaginal birth is the measure of success, and not the health and wellbeing of the infant and mother).

I hired a midwife when I was 10 weeks pregnant with my 2nd baby. I knew from interaction with some homebirthing women online that my midwife was reasonably priced at $3000, inclusive of pre-, ante- and post-natal care from 10 weeks pregnancy to 6 weeks post-partum, which I paid for at approximately 10 weeks post-partum with the ‘proceeds’ of the Baby Bonus. I could not think of a better investment than ensuring that my baby had an un-traumatised mother.

I did not know much about hiring a midwife, so hired the first midwife who was willing and with whom I was able to forge a connection. Unfortunately as much as I came to adore my midwife, she had a great deal of self-doubt and brought her insecurities into my pregnancy space and later to my birth space. I believe she is a hospital-at-home midwife. Whilst I have a great deal of respect for her, I wouldn’t hire her again. However, having said that, she and I were able to work together (with a few hiccough) to get me the birth that I wanted.

In the end my son was born on his own terms and in his own time frame. I had a very long pre-labour ‘warm-up’ – approximately a week of gentle warm-up contractions, culminating in a home water birth after 12 hours of established labour. My son was ‘big’ by mainstream standards at 9lb 10oz and was born into my arms just before dawn on a Saturday morning. It was the most empowering day of my life, the day that I learned what true strength and endurance means to me.

Up ’til that point, I had thought of myself as being fairly mainstream. I still do to a large extent. The rest of the world views me as something quite different – but funnily enough I still feel like ‘just’ me, just so much more self-aware.

A 3rd baby is still a possibility, although somewhat remote. If that baby became a reality, homebirth would just be a no-brainer for my family. It’s just normal here now, as is breastfeeding, baby wearing, and co-sleeping. Those are just the cornerstones of a healthy mother/baby dyad. One that, thankfully, my family now understands if only for *my* wellbeing and not in a larger sense for all women.

So that’s my story – one of a mainstream woman who had no interest in being butchered again, or having my baby hurt again. Homebirth was not a radical choice for me, not a ‘brave’ choice, not something done to make a political statement, nor yet to prove a point. Only one made out of the best interests of my baby and my family – and myself. One I’m so glad I came to have faith in. One that changed my life, and changed the one people judge me, but one that, having had the strength to make has lent me strength when I’ve needed it.

Giving and receiving the gift of birth

Judy Chicago, Hatching the Universal Egg

 

Giving and receiving the gift of birth.

It is no accident that we call the act of bringing babies earthside a gift. The first gift we can give to our children is the manner of their birthing, so we “give” birth to them. I gave loving, bloody, long birth to my daughter. She was wrapped in my body until she released herself and swam down through me and into the world. Welcome earthside, wee woman, your first gift from life was from me. A birth where loving hands receive us at the end, and no one breaks the sacred space should be the first gift for each child.

I did not give that gift to my son. He was pulled from my womb by uncaring strangers who were painted with my blood not knowing how I blessed them. He was not given birth, he had a deformed version of it forced upon him. Oddly it was ultimately a gift to me though as it changed and altered my life immeasurably and I hope that the sacrifice of his birthright gift will be made up to him in other ways.

I could not parent him as he deserved in his early life because the gift of his birth was too painful to bear. I could only stay afloat, nourishing him with my body but with my soul sometimes absent. I even felt driven to killing myself but came back from the edge realising he did not deserve such a gift from me as that. Although I was a broken mother, I was his mother and in my own way a gift to him as I struggled to put myself back together again. I can hold him more strongly than I would have been able to now, knowing as I do the price of life and the cost of the gift.

When he is old enough to know that we are separate and that our birth journeys were separate, I should like to thank him for coming through my body and helping bring me that gift. While it nearly killed me, it only broke the back of my spirit instead and then brought me back, whole and infused with more pain and thus also with more joy than before. I celebrate my scars, I love them more deeply for their impact and how they force me to concentrate on living above all else.

Beware the birthing Trojan horses

Are you looking out for Trojan horses in your birth space?

Did you hear the tale of the defeat of the Trojans by the Greeks? Roughly speaking, the Greeks left a giant wooden horse in Troy and pretended to go away. The Trojans took the gift horse into their city, then at night the hidden Greek soldiers popped out and slaughtered the city’s inhabitants. Stories were good in those days.

It made me think of the Trojan horses we take unwittingly into our birth spaces. Have you found yours?

Sometimes they’re careproviders who promise one thing and deliver another in the heat of birth. Always listen to your gut and let her guide you through avoiding those. What have you asked your careprovider? Did you ask their rates of the birth you want? Do you want to birth after previous surgery? What’s their rate of vbac and what kind of vbac happens? Trojan horses can look beautiful, look like everything you wanted has walked into the room but when you’re labouring, they can turn out the hidden entrails and start to sabotage that birth you’ve planned so hard to achieve.

Sometimes they’re beliefs in ourselves about our bodies or birth which have lurked, unlocated, for the whole of pregnancy and only emerge when night falls and our defences are low like the Trojans’. Work on finding those by whatever means necessary in pregnancy.

Sometimes they’re family members we trusted to be in our birth space or thought would come through for us once labour started even though they’d been nervous or difficult through pregnancy. People who aren’t totally upfront and supportive of your plans are not people to invite to your birth.

If birth was as simple as it should be (Notice labour occurring, birth baby, go to bed.) none of this would be necessary but we live in a world which is full of birth traps, booby traps, myths, lies, superstitions and violence in our birthing spaces. Keeping the Trojan horses at bay and embracing the genuine gifts of support and awareness offered to us by the right supporters is really crucial.

What did you do to find and remove the Trojan horses from your birth space? Or from your breastfeeding space? Is there a woman around who hasn’t had some kind of Torjan horse experience in pregnancy and birth? I doubt it!

Maternal mortality in Australia – 30% under-reported?

Maternal deaths in Australia compared with England and Wales from 1967 to 1969

The MMR for Aboriginal and Torres Strait Islander women remains three times higher than the MMR for non-Indigenous women.

Monitoring maternal mortality and morbidity in Australia

We need first to ask, how good are the data? There is a concern about under-ascertainment. As distinct from a stillbirth or a neonatal death, there is no mandatory notification of maternal mortality, although some States and Territories have a ‘tick box’ for notification that the deceased has been pregnant within the preceding 12 months. It is generally held that in the absence of coordinated efforts to maximise ascertainment, maternal deaths are underestimated by as much as 30 per cent. Some States undertake such efforts, but as is so often the case in public health surveys in Australia, there is variation between States and Territories in the approach to ascertainment. Failure to notify might be more likely for deaths in early pregnancy and when the death occurs remotely in time and/or place from the birth or termination of the pregnancy.

There is also variation and inconsistency in the way in which maternal mortality committees function in Australia, with respect to consideration, classification and reporting of maternal deaths. For example, in the compilation of the most recent report on maternal deaths in Australia, it appeared that there was no functioning maternal mortality committee in Queensland, which was the State with the highest MMR in Australia (over the previous twelve years).Only some States consider and report on preventability. Other States refrain because of privacy or other concerns. There are also variations in referrals of these deaths for coronial investigation. From 2003 to 2005, only 47 of 65 deaths were reported to the coroner, and only 19 of the 29 direct deaths were referred to the coroner.

There are also concerns about the quality of data indicating Indigenous status. In the 2003 to 2005 report, data on Indigenous status was missing in eight per cent of maternal deaths. This deficiency is of special importance because the MMR for Indigenous women was 21.5, compared with 7.9 per 100,000 for non-Indigenous women, reflecting their health disadvantage, in pregnancy and childbirth, as it is in all areas of health of Indigenous
groups.

It is estimated that for every maternal death, there are approximately 80 instances of severe maternal morbidity, in which the woman experiences a life-threatening complication from which she survives (completely, or sometimes with residual injury).

A concerning aspect of maternal mortality monitoring in Australia is the lack of recurrent funding or a permanent auspicing agency. The last national maternal mortality report carried a foreword signed by the Director of the Australian Institute of Health and Welfare (AIHW), which auspiced and authorised the report that contained this statement:

‘..the (Australian) Commission (on Safety and Quality in Health Care)
is not able to provide ongoing funding (for regular reporting of
maternal deaths in Australia) and it is concerning that no resources
have been identified to sustain and improve this reporting in the future.’

An options paper to obtain a firm footing for the national maternal mortality survey has been prepared by the AIHW and submitted to the Commission on Safety and Quality in Health Care, but no response had been received at the time of preparing this article.

Maternal mortality in Australia 1964-72

Maternal mortality in Australia, 1973–1996

Maternal deaths in Australia 1997-1999

Maternal deaths in Australia 2003-2005

Maternal deaths in Australia compared with England and Wales 1967-1969