Feminism – Page 3

The arrogance of doctors and episiotomy without consent

June 24, 2016 By Deena Leave a Comment

Part 2 of my “Dear Diary” series for Giving Birth with Confidence brings us to 1920. You can read the full, historical fiction piece here.

Episiotomy without consent

Episiotomy, (sometimes called a perineotomy) a cut from the vagina towards the anus (midline) or a bit to the side (medio-laterally), was once a routine procedure for obstetricians during the pushing phase of labor. Sounds pleasant, doesn’t it? Ok, no, not really…

So, what’s up with this episiotomy without consent, as mentioned in the “Dear Diary” story? Let me take you back in time, specifically to the Chicago Lying-in Hospital in 1920. Dr. Joseph Bolivar DeLee wrote and published a paper called, “The Prophylactic Forceps Operation”. In it, he takes childbirth from a natural, normal occurrence and makes it something pathological that requires preventative intervention. He wanted to elevate the profession of obstetrics to a higher status among other fields of medicine and he needed a reason to do so.

Labor has been called and still is believed by many to be a normal function. It always strikes physicians as well as laymen as bizarre, to call labor and abnormal function, a disease, and yet it is a decidedly pathologic process. Everything, of course, depends on what we define as normal. If a woman falls on a pitchfork, and drives the handle through her perineum, we call that pathologic, abnormal, but if a large baby is driven through the pelvic floor we say that is natural and therefore normal. If a baby were to have its head caught in a door very lightly, but enough to cause cerebral hemorrhage, we would say that it is decidedly pathologic, but when a baby’s head is crushed against a tight pelvic floor, and a hemorrhage in the brain kills it, we call this normal, at least we say that the function is natural, not pathogenic.

In both cases, the cause of the damage—the fall on the pitchfork and the crushing of the door—is pathogenic—that is, disease-producing, and in the same sense labor is pathogenic—disease-producing, and anything pathogenic is pathologic or abnormal.

See, if birth is normal, then we really only need to catch the baby, which anyone can do. We only need an OB if there is a problem – and then we *really* need one! So, DeLee created a problem that needed solving. (He sounds like a rather expert marketer to me.) One aspect of the problem he created was he wanted women to come out of childbirth looking “virginal” at their perineums. Yes, you read that correctly, “virginal”.

Now, should virginal conditions be restored? Did not nature intend women should be dilated in the first labor so that subsequent children will come easily? Are not the lacerations normal?

I do love The Oatmeal dearly. I play Exploding Kittens with my kids 🙂

Right. Moving on…

DeLee makes a big leap and says,

We can take direct action to save the fascial and muscular structures of the pelvic floor, in addition to practicing the measures just mentioned for preserving the connective tissues of the upper pelvis. By incising the fascia at its most vulnerable point, and reuniting it after delivery, we are almost always, not invariably, able to eliminate all damage to the pelvic floor.

Except that this is not an evidence based statement. He makes a huge assumption to justify this new method of birth which is fully controlled by the doctor while the mother is unconscious during her labor with a “Twilight Sleep” birth. So, the mother is unable to consent to anything being done to her body.

I can’t even begin to tell you how angry that makes me. Informed consent/refusal are one of the core topics of my childbirth classes. We, as women and mothers, need and deserve respect. A lack of informed consent for any medical test, procedure or medication shows a profound lack of respect for the mother from the medical care providers.

DeLee’s writing firmly illustrates the “doctor as god” concept. This is the idea that the doctor knows best in all cases and should not be questioned. His entire paper reads as self-indulgent with an air of superiority. He speaks of how he can “save” mothers and babies with his techniques. His arrogance is profound.

As for the forceps operation—in skillful hands the danger is nil. By means of the head stethoscope we are able to recognize danger to the infant from asphyxia, and since the resistances of the soft parts are gone, there is no compression on the child’s brain. We should not blame the operation for faults made in its performance.

So, where does this leave us? Thankfully, in 2016, where you can affect the outcome of your birth and avoid unnecessary medical interventions. These tips will help.

Mothers need to know their legal rights during childbirth and advocate for them.
Mothers should feel comfortable asking questions of their doctors and midwives.
Partners play an important support role physically, emotionally and intellectually. Their advocacy is of the utmost importance during pregnancy and birth.

I am grateful that we are beyond the days of Twilight Sleep. However, we still have a long road ahead. Some mothers still have episiotomies and other medical procedures done without consent and are treated disrespectfully during labor by some staff members. Hopefully, you and I, dear reader, can make birth better for our daughters when their time comes to be mothers years from now.

Resources

Please support The Silent Mother by becoming a patron through Patreon.

Your generous donation allows me to keep writing.

Do share this article with your friends.

The Dalkon Shield. A story of corporate greed, a lack of medical testing and an ongoing fear of the IUD.

May 4, 2016 By Deena 6 Comments

I think it looks a bit like a horseshoe crab on it's back. — I think it looks a bit like a horseshoe crab on it’s back.

I have a Secret Santa who sent me a rather large box of interesting objects. My Secret Santa included a new-in-the-package Dalkon Shield IUD. As a collector, I was giddy when I saw it. This particular IUD has caused long term fear and loathing of all IUD’s. Yet, most women don’t know the story behind it. They know that IUD’s caused “problems” and that other methods of birth control were “better”. Even now, I hear women say they’d never get an IUD. That is a shame because IUD’s today are the most effective birth control on the market.

Let’s dig in to the story behind the Dalkon Shield and this pervasive fear of IUD’s.

In 1971, the A.H. Robbins company brought the Dalkon Shield to market, billed as a safer alternative to The Pill. The birth control pill, still being relatively new, had some kinks yet to be worked out. Many women were unhappy with it’s side effects and were searching for something that was safe and effective. Given the hole in the market, it was a prime business opportunity for A.H. Robbins and this new style of IUD.

IUDs have been around for a over a thousand years, in various shapes and forms. The Dalkon Shield, however, had something new going for it – a mass marketing campaign. Well, that and a different physical structure and an entirely different kind of string… but we’ll get to that in a minute.

This marketing campaign was so successful that approximately 2.8 million women eventually used the Dalkon Shield. They were, however, unaware of the lack of proper testing on this device and its safety.

Although A.H. Robbins tested the Dalkon Shield for efficacy, they did not test it for safety. At the time, that was not required before putting it out to market. The company also padded it’s efficacy rate to show a 2-3% failure rate, as opposed to the 10% failure rate it actually had.

Dalkon shield IUD, The Silent Mother — The blue stick is the insertion device. The grey, insect looking thing is the IUD itself.

There was a rather large problem with the Dalkon Shield. The string which attaches to the plastic IUD was made of a multi-filament string instead of a mono-filament string. Why is this an issue? Well the multi-filament string allows bacteria to creep up into the uterus whereas a mono-filament string does not. Bacteria, as we know, causes infection. Infection leads to sepsis. Sepsis leads to hospitalization, massive doses of antibiotics, the potential for surgery and so on. The biggest complaint being pelvic inflammatory disease, which beyond it’s discomfort, can lead to infertility.

All of this lead to five deaths, multiple spontaneous abortions and over 300,000 lawsuits against A.H. Robbins. The company folded under the pressure.

So after all that, there is an upside. Women stood up for themselves and for better medical testing. The success came in 1976 when the FDA added the Medical Device Amendments to their policies. Change is often slow. These women, of my mother’s generation, took to the streets, the media and the courts to protest and affect change. It makes me wonder what we could do now, should we rally.

In the meantime, I’ll hang on to this piece in my collection to remind me of how far we’ve come, and how far we still have to go to support women’s rights with regards to access to safe birth control, safe abortion and bodily autonomy.

Please support The Silent Mother by becoming a patron through Patreon.

Your generous donation allows me to keep writing.

Do share this article with your friends.

On Being a Good Girl During Labor

March 21, 2016 By Deena Leave a Comment

“She had such a calm, quiet, beautiful birth!”

There seems to be some sort of ideal out there that birth is done right when we are quiet, calm “good” girls. This gives the impression that those of us who are loud during labor had done something wrong, or at least weren’t as good as our quiet peers.

Good girls are polite, don’t speak out of turn, and are quiet and respectful. They don’t ask for much and they definitely do what they are told. Good girls listen to those who are in charge, and they don’t question the directives delivered from their perceived superiors.

In labor, the good girl is quiet and calm. She stays in bed and doesn’t bother her doctors or nurses. She does exactly as she is told and she isn’t a nuisance to her care providers. She “breathes her baby” out and isn’t sweaty or messy. She is compliant and doesn’t have her hair mussed.

Where did this “good girl” in labor idea come from? We have to take a peek back at history. When birth moved out of the home and into the hospital in the early 1900’s, we see the beginnings of this concept. Hospitals, up through the early 1980’s, had maternity wards, not individual labor rooms. There would be 12, 15 or 20 women laboring in one ward with a small handful of nurses to monitor them. When it came time to push, they were brought to the delivery room. After birth they went to a multi-woman recovery room.

Now, since they were laboring all together, with little or no privacy, they were required to stay in bed and not be too demanding of their nurses. A woman who was loud and out of bed would “disturb” the other women in the ward and be more difficult for the nurses and staff to control. So, the laboring mother needed to be a “good girl” and be quiet, still and not complain. Staff needed a solution to this problem and new medications, combined with effective marketing, afforded them their answer.

Women, feminists, at the turn of the century were clamoring for pain medication. Twilight Sleep was the new thing and it brought them into the hospitals for birth. Pain medication was not only seen as desirable by the mothers, but by the staff as well. A painless birth was the way to go to make birth easier on all involved parties. Oh, but this doesn’t count dad. He wasn’t allowed in for labor and birth.

Digging a bit deeper into history, we get this idea of breathing to stay calm and manage pain, otherwise known as psychoprophylaxis. Lamaze’s original name, by the way, was The American Society of Psychoprophylaxis in Obstetrics (ASPO). This is usually referred to as “that Lamaze breathing thing”. (Which, by the way, most educators don’t teach anymore. It’s still listed in our curriculum, but it’s bumped way down the priority list.)

This technique, psychoprophylaxis, was developed in 1930’s in the Ukraine. There was a need for some pain relief techniques because of the post-WWI depression medication was in short supply.

To make a long story short, psychoprophylaxis was specifically designed to control women and to keep them, calm, quiet and in bed. Those noisy, demanding women who had the audacity to move their bodies in a way that seemed feral while the sounds emanating from their throats reminded staff of bedroom pleasures, needed to be restrained and restricted by either the scopolamine / morphine cocktail or by breathing techniques dictated by her husband. A husband’s job was, quite simply, to keep his wife quiet and well behaved during labor if there were no drugs available to her.

Want to know more? I blogged about this in greater detail a while back on Science & Sensibility.

Let’s move forward in time. Feminism shifted in the 1960’s and 1970’s with regards to childbirth. Our hippie foremothers brought forth the idea that birth can be natural and normal. The idea that women could be moving around in labor; that their husbands or partners could be there with them; that labor didn’t need massive medical intervention in all cases and that women did know a bit about their own bodies.

Yet, we are still confronted with the “good girl” idea. There are other childbirth education organizations out there that sell this idea of being quiet and calm during birth as the “right”, “preferred” or “best” way to go through labor. There are mothers out there who sing the praises of their “calm” births and how “beautiful” they were; which, in turn, sets the expectation that future births should be like that as well as making women feel less-than for not having a quiet, calm birth.

True enough, that some women are naturally quite and calm during labor and true that some women will “breathe the baby out”. However, that should not be the ideal. In fact, there shouldn’t be any ideal way to give birth.

Sometimes labor is loud. Sometimes we swear. Sometimes we puke and we poop. Sometimes we cry and we scream. Sometimes we yell at our partners and then feel guilty about it. Sometimes we make animal sounds and are on our hands and knees. Sometimes there is blood and fluid and it gets all over are legs and the bed and the floor. Sometimes our hair is messy and we are sweaty.

If we fight the process just to be seen as being a “good girl” we increase our pain and complicate birth. The idea that calm and quiet is good or ideal is erroneous. Calm and quiet may be birth for some of us – sure as heck wasn’t for me…

Birth is always beautiful. Laboring women are always beautiful. Mess and noise are normal. Birth is primal and it rocks us to our core and we can come out stronger and more confident because of it. If we permit ourselves to be present in our bodies during labor; if we tune in and pay attention; if we release and let go of the hold our societal conventions have regarding “good” behavior, then we have a much better birthing experience.

Remember, birth is beautiful and you don’t have to be a “good girl”.

Being Badass feels so much better!

Train with me! Become a Lamaze Certified Childbirth Educator

Please support The Silent Mother by becoming a patron through Patreon.

Your generous donation allows me to keep writing.

Do share this article with your friends.