A Surge of Pain

Image result for woman in labour

 

I’ve written before about language, birth, and women survivors of child sexual abuse. I’ve mentioned how words matter, and certain words are very upsetting for those of us with a history of child sexual abuse.

Earlier this week, I had the privilege of sitting with a pregnant woman and her husband. As a survivor herself of child sexual abuse and multiple rapes in her teens (sadly, revictimisation is a phenomenon that is not uncommon), she’s doing all she can to prepare herself for her impending birth. Part of that preparation included having a chat with me. We spoke about language and how words matter in labour. She used the word ‘surges’ and I had a reaction to it that I didn’t quite understand. Until now.

‘Surges’ is a word that is used to describe uterine contractions in labour. It was popularised by Ina May Gaskin and adopted by many in the birth community in the past few decades. It is deemed more ‘positive’ than using ‘contractions’, and sold as a reframing of the pain of labour, and it’s never sat comfortably with me. Here’s why:

As abused women, we had our experiences – our lived, physical, experiences – ‘reframed’ by our abusers. They would touch us and say things like ‘That’s nice, isn’t it?’, ‘You like that, don’t you?’, ‘I would never hurt you,’ etc.  Their words were incongruent  with our experiences and that – in and of itself – is damaging and needs work to undo. Telling abused women that calling contractions by another name will make them a more positive experience isn’t helpful. For the vast majority of women, labour hurts. That’s the bald truth of it. The extent to which it hurts, and how we deal with the pain, is individual. Personally, viewing labour pain as ‘pain with a purpose’ helped me. It wasn’t like a migraine (migraines are more painful), where pain doesn’t produce anything except more pain for at least 24 hours.

I think that midwives and doulas working with women who have a history of abuse might want to discuss the merit of using ‘surges’ instead of ‘contractions’ with their clients. Then, the women themselves should use the word that suits them best;that they are most comfortable with.

Labour hurts, and it doesn’t do women who have experienced abuse any good to tell them otherwise. What is helpful is talking about how to get through the pain, how to be present for it, and how the best thing about labour is that it ends. And that it ends with a baby in your arms. The wonderful woman I met with earlier this week also made the point that there is a difference between ‘pain’ and ‘harm’. As abuse survivors, we associate pain in our bodies with (often long-term) harm, yet the pain of contractions is not harmful, and reminding ourselves of that can be hugely helpful in getting through it while still remaining present, grounded, and participative in our own labours.

No Country For Pregnant Women

Yes, yes, I know…..you’re sick of hearing me banging on about pregnancy and the state of maternity “care” in Ireland.

But it’s getting worse, not better.  I heard from Jene Kelly at AIMSI (the Association for Improvements in Maternity Services, Ireland) today. She told me a shocking tale. Alas, I have to report that I am shocked, but not surprised. This is how women are treated in Ireland. We are still second class citizens, we are still treated as though we are incapable of making informed decisions for and about ourselves. We are still subjected to a patronizing, patriarchal maternity system that, crucially, is not evidence-based

This past weekend, as the nation celebrated International Women’s Day and Mother’s Day, an Irish Maternity Hospital initiated an invasive procedure on a pregnant woman against her will. ‘Mother A’ was denied patient autonomy and the right to informed refusal when the drastic and unprecedented measure of an emergency High Court sitting was called in order to compel her to undergo a Caesarian section. The risk of uterine rupture was cited as one of the main reasons for the urgency in this case but this risk is widely reported as being 0.1% or 1/1000. This is what Dr. Michael Turner, Obstetrician at the Coombe Hospital has called: “exaggerated, professional scaremongering…and it must stop” (VBAC Conference, 2012).

State-sanctioned coercion of medical procedures on pregnant women or any other competent adult is not only unacceptable but it is also unlawful in other jurisdictions, such as the USA and the UK (Re AC [1990] & Re S [1998]). ‘Informed consent’ and ‘informed refusal’ abuses are common issues reported to AIMS Ireland by women.

Imagine if ‘Mother A’ was your mother, or your sister, or your cousin, or your daughter, or your friend, or your partner or your wife, or you.

Jene Kelly, of AIMS Ireland, states: “there is an overwhelming acceptance by the public and some maternity service providers in Ireland that a pregnant woman’s right to informed consent, or informed refusal, is not reliable and that women who exert their rights are selfish. It is this mentality that has allowed atrocities such as symphysiotomies, miscarriage misdiagnoses, unnecessary hysterectomies by Dr Neary and all the other reported assaults against women by our maternity system to continue to go unanswered in Ireland for so long. This is no country for pregnant women. ”

 

AIMS Ireland reports that women who are bullied into consenting do not fulfill the principles of informed consent and therefore are entitled to sue the doctors for assault. For example, a woman who was forced to have a caesarean section against her wishes in the UK sued the doctors (Ms S v St George’s NHS Hospital Trust, 1998) and was awarded £36,000 damages. It is time that Irish women did the same. Threatening women, bringing women to the high court, removing women’s rights and choices – these bullyboy tactics do not promote trust between women and their care providers. How can you trust a system that doesn’t acknowledge your rights? Women are choosing to leave the system as a result.

Annette is one of these women. She is lobbying the HSE for a homebirth following a previous Caesarean section. The HSE currently does not recognize informed choice for homebirth for women who fall outside strict exclusion criteria in site of a European Court of Human Rights ruling recognizing a woman’s right to decide how and where she births. Annette does not meet criteria following her previous Caesarean, despite having subsequent successful vaginal births. Annette asks: “Is it HSE policy to use the High Court as a method of intimidation and coercion, when a patient tries to exercise her right to informed decision making, as laid out by the European Court of Human Rights (Ternovsky v Hungary, Under Article 8)? We are humans, with great intellect. We are capable of informed discussion and decisions regarding our pregnancies and births in the best interests of ourselves, our babies and our families. I feel anger, disappointment and bewilderment. Today as a woman and mother, I grieve.”

A Section of Society…..

A fortnight ago, I heard about the latest ESRI report on the fertility of Irish women. It’s taken me a while to address the most disturbing statistic revealed in that document, but I’m finally getting around to it.

 

Caesarean section rates in Ireland have increased. They are steadily creeping up and now stand (or lie!) at almost 25%. Bearing in mind that the WHO recommends that the C-section rate should not be more than 15 percent in any country – least of all a developed one where difficulties associated with vaginal birth, like malnutrition and FGM resulting in damage to the birth canal are virtually non-existent.

 

The day after these figures were released, I heard Peter Boylan of the National Maternity Hospital in Holles Street giving reasons why we are now more than ten percentage points above the recommendations of the WHO.  I was just going to tweet ‘There’s Peter Boylan talking bollocks’, but I decided instead that it might be more useful to deconstruct his argument.

 

Boylan’s main arguments for the rising increase revolved around the following:

1. We now have women who are ‘much older’ giving birth for the first time.

2. There are more IVF babies.

3. Breech presentations lead to more C-sections.

4. Women have a ‘natural tendancy’ to worry about their pregnancies and think that anything that can go wrong will go wrong.

 

Unfortunately, none of these ‘reasons’ is an evidence-based reason for cutting women’s abdomen’s open in order to extract their babies.

 

That Irish women are ‘much older’ giving birth for the first time, is an interesting piece of demographic research – not a reason to insist they undergo major surgery! In a search of scholarly articles, I could not find a single shred of evidence to suggest that being over 35 or even over 40 was in and of itself a contributing factor to risks that would necessitate a C-section. Not one.

 

As to Boylan’s assertion that IVF babies are more likely to ‘need’ to be brought into the world via surgery – there is no evidence to suggest that a pregnancy achieved through IVF does not proceed exactly the same way as every other pregnancy. Therefore, there is no evidence to suggest that any more than 15% of these births should be ending in Caesarean-sections.

 

Breech presentations, as any good midwife knows, are a variation of normal. A breech birth, therefore, is a ‘normal’ birth and should be treated as such. The problem is that the knowledge and skills necessary for attending a breech birth are being lost and ‘normal’ is regarded as ‘dangerous’.

 

I don’t think any of Peter Boylan’s ‘reasons’ for the rise in C-sections is quite as arrogant, condescending, patronising or stems from a more patriarchal place than his assertion that ‘women have a natural tendency to worry about their pregnancies and think that anything that can go wrong, will go wrong’.   Women don’t have a ‘natural tendency’ to assume that their pregnancy is doomed from the outset. We don’t need a doctor to pat our hands and tell us that they’ll take care of everything for us! Women, in fact, don’t worry about anything until it is suggested that there is anything to worry about. And who plants these seeds of doubt and worry? Why, the doctors, of course.

 

If, as Peter Boylan was suggesting, these natural worrying tendencies of women are responsible for the rise in C-sections, I wonder where he feels the responsibilities of doctors lie? Should they not be reassuring women with actual, cold, hard facts on the outcomes of pregnancy and childbirth? Should they not be reassuring women that pregnancy and birth are perfectly normal, everyday occurrences? Should they not be informing women that the outcomes for then and their children are better if they just allow nature to take her course?

 

In her piece in the Irish Times on June 26th, Dr. Jacky Jones reminds us that  ‘Fooling ourselves that the birthing process is safer for women when doctors are in charge is the ultimate example of group-think. The vast majority of women are able to give birth without surgical intervention so doctors are redundant except in about 10 to 15 per cent of cases. Obstetricians spent the 20th century inventing surgical and mechanical ways of interfering with a natural process to ensure they were not redundant.’

 

Unfortunately for women and their babies, Dr. Jones is right. I don’t want to vilify all doctors; they’re not operating from a place of greed many of them genuinely believe that they have women’s best interests at heart; but they forget that they are trained in the ‘abnormal’.  Their expertise is in intervention when things go wrong. As women have increasingly handed over their power to male doctors – and female doctors trained in a medical model that was invented by men – the amount of intervention in normal births has increased.

 

Dr. Marsden Wagner, who was formerly the WHO’s Director of Women’s and Children’s Health, wrote about this phenomenon in his seminal piece ‘Fish Can’t See Water’  which points out that because doctor’s don’t know any better, they can’t do any better.

 

It makes me very, very sad that women are continuing to hand over their power in this, the most feminine of arenas, to men. Until we stand up and wrest our power back from the patriarchal system that Birth is embedded in in this country, we can never truly expect the lot of women and children here to improve. As long as we are happy to be compliant, we will continue to be complicit in our own subjugation.