On Birth and Life and the World

The second workshop I attended at CLPP was Empowering Birth, with a panel of three inspiring birth workers: Cara Page from the Black Women Birthing Resistance and the Kindred Southern Healing Justice Collective, Nechama Wildanah, a Certified Professional Midwife and midwifery educator, and Marianne Bullock, a childbirth educator and birth doula with the Prison Birth Project. They covered a wide breadth of topics covering the history of midwifery, reconnecting to midwifery traditions, and expanding the option of choice in birth to under-served populations. It was really wonderful, and helped me hone in on my own midwifery credo.

In my last post, I used the phrase “re-popularization of natural birth,” quotations marks and all. I have some issues with this phrase and this workshop really hit them home for me.  First, the term “natural birth.” I understand why people use the term to describe birth without interventions such as pain medication, pharmaceutical labor induction, or surgery. I use it too. It makes sense. My conjectural issue with the adjective natural is that it tells us that anything else is unnatural. Birth is birth, a natural event, regardless of intervention. And interventions are not new or necessarily unnatural! Women have been finding ways to naturally relieve pain in childbirth for ages. Cesarean sections were performed in ancient times, with references to cesareans showing up in the writing and artwork of ancient Hindus, Chinese, Egyptians, Grecians, Romans and other ancient societies. Jennifer Block puts the debate over “natural birth” terminology well in her book Pushed, which I highly recommend:

“The old debate over “natural childbirth” seems quaint at this point. I don’t have much use for the term, which has become synonymous with vaginal birth. What’s happened to normal birth—what is normal birth? Not simply nonsurgical birth… Not simply unmedicated, either. It is natural, after all, to want to alleviate pain. The term I find most useful to describe normal birth is physiological birth: labor begins and progresses spontaneously, the woman is free to move about for the duration, and she pushes in advantageous, intuitive positions.“

While it may not be the most accessible term for the public, I think using the term physiological birth could have positive results in the training of obstetricians. Obstetricians are trained as surgeons, not as supporter of birth, they way nature intended. They are an invaluable part of our birth culture, but only when a mother is high risk, or real problems develop in labor. A very large majority of women have normal births, and yet very few obstetricians are even given the chance to witness a physiological birth during their training. Every other field of medicine focuses on finding a way for the body to resume its normal, physiological functions. Perhaps by calling “natural” births physiological, we can remind the obstetricians of the future that most mothers don’t need to be “fixed,” they just need to be supported.

My second problem with the “re-popularization of natural birth” is the idea that midwifery, “natural birth,” homebirth, doulas and related people, practices and experiences are new, or that they’re experiencing a second wave of popularity. These people and practices haven’t only been recently developed, nor did the hippies develop them in the 1960s. These are ancient practices, and their popularity has remained high in most parts of the world for most of time. It is only in the United States that we see such significant trends in birth. To most women worldwide, these have always been the trends in birth, because these are the only options.

Public representations of midwifery, like The Business of Being Born, can do both good and harm to the midwifery profession. While it is fantastic that physiological birth is being promoted in mainstream media, films that show women giving birth in their penthouses can also be very polarizing. While Ricki Lake’s primary audience of educated, white women of some means, may be enticed to try homebirth, women who don’t fit that bill may get the message that it is not for them. Nechama said during the panel that she is concerned that the perception of homebirth being for this specific class of women keeps the clients she would really like to help, those who feel they don’t have many options, from seeking her assistance. Homebirths can happen in a trailer just as well as they can in a mansion, and there are doulas, like me, who are willing to work for free, but the media rarely portrays homebirth, physiological birth or labor support as being for classes and races other than upper and white.

And just as with the women who choose physiological births, it is vital to remember that midwives and birth workers are not all white women from the same background. Midwifery is ancient, and it is everywhere! Women have been birthing babies since babies came to be. Black and indigenous women have spent centuries practicing midwifery in America, and by ignoring their stories, we are losing the traditions and collective knowledge that they offer us. I love Ina May Gaskin dearly, just as many other birth workers do, but we all need to remember that many of the methods that we say are hers, she actually observed from indigenous Central American midwives. I think it is important to honor the full history of the midwifery profession, and to take away important lessons from the births midwives have witnessed over thousands of years.

There are two types of certified midwives in the United States: Certified Nurse Midwives (CNMs) and Certified Professional Midwives (CPMs). CNMs are registered nurses, trained at a Master’s level. They are able to prescribe medications, often work in hospitals, but are still supporters of physiological birth. CPMs are usually not nurses. They are trained at accredited midwifery schools, and apprentice with midwives before developing their own practice. CPMs are not able to work in hospitals, and only cover homebirths. I have wavered over which kind of midwife I hope to be for a while now. I usually lean towards CNM programs. I feel like to have the confidence I need to be the midwife I want to be, I would like to have more medically oriented preparation. But this workshop really made me question that thought. There is honor in learning a practice from people who have had the secrets of birth handed down to them over millennia. It is part of something larger, and I love that idea. I’ve got some thinking to do, I guess…