The Silent Mother

Esoteric & Historical Gravidity & Parturition

On the Failures of SCOTUS, the fall of Roe, and the Silence of Childbirth Education Organizations and Doula Organizations with Regards to Abortion Rights

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I’ll preface this by saying that SCOTUS’s decision on Dobbs vs. Jackson, to strike down Roe vs. Wade and ending almost 50 years of abortion access in the US, is an affront to human rights. Restricting access to abortion will only result in harm to both the pregnant person and to the baby they are forced to carry to term. I will add to this that I write using multiple terms (women, pregnant person, person with a uterus, etc.), depending on context.

That said, this will become a broader series of blog posts because there is too much to unpack for one post. Really, this series started a while back with my series on Dr. Grantly Dick-Read and his pronatalist, eugenicist, Christian beliefs about women, birth, and the “right” kind of babies. I’d encourage you to go back in this blog and read more.

My trigger for writing was not the Dobbs decision, per se. You all already know my feelings about abortion and the right to make decisions over one’s own body. My trigger was the absolutely deafening silence of both the childbirth education and the doula organizations in the wake of Dobbs. Yet, while I am severely dissapointed, I am wholly unsurprised. The sheer hypocrisy of the organizations that claim to support women’s choices in pregnancy and birth, yet who say nothing in support of the first choice a pregnant person must make – the decision to terminate or continue the pregnancy, is distressing.

If we are to say we support choice, then we must, support all choices, not just the ones we like or the ones that suit our biases. Staying neutral and trying not to offend anyone is being complicit.

A failure of this kind, from all of the childbirth education organizations and doula organizations, is a failure to support human rights, women's rights, public health, and evidence-based medicine.

Let’s talk first about who does support choice, bodily autonomy, and evidence-based healthcare. That’s at least 75 professional organizations, and counting. The link has the list of organizations and the full statement.

ACOG released a statement on the day of the SCOTUS decision.

“While the Supreme Court’s decision today is a significant and destructive setback, ACOG’s resolve is unwavering: we will continue to support our members, our community partners, and all people in the ongoing struggle against laws and regulations that violate and interfere with the patient–physician relationship and block access to essential, evidence-based health care.”

ACOG

ACNM released a statement as well.

“ACNM maintains the right to access to abortion care as an essential right of those capable of pregnancy. ACNM affirms that everyone has the right to decide what is best for their health, bodies, lives, and families. As such, we adamantly oppose all legal opinions and legislative policy that blatantly or surreptitiously seek to restrict or ban the provision of abortion care, as well as any efforts at any level to render it less accessible. ACNM will continue to support efforts to increase access to midwives as abortion providers and engage with stakeholders to make abortion care accessible to the people and communities midwives serve.”

ACNM statement
PA chapter of ACNM’s statement

Childbirth Education and Doula Organizations did NOT release public statements about the Dobbs Decision.

At the time of writing (7/11/2022), no childbirth education organization or doula certifying body has released a public statement regarding the Dobbs decision. These organizations include Lamaze International, ICEA, CAPPA, and DONA. No public statement from any of them appears on their websites or social media. Their silence speaks volumes.

Lamaze did send a letter to the membership (i.e. the certified childbirth educators) via email on July 7, 2022. This was internal only and not designed for the general public. A fellow educator called the letter, “wishy washy,” which I think is a kindness Lamaze does not deserve for it’s failure to support it’s stated mission. The letter, in the image below, falls intentionally short of supporting abortion and human rights. While it acknowledges that a lack of abortion access will cause harm, it does not even use the word abortion in it’s letter. Noting that an issue is “highly politically charged and polarizing” directly shows that Lamaze intentionally will not take a stand to support pregnant people. By not taking a stand, like almost every other maternal-child health organization in the country, Lamaze lays their cards on the table. They chose not to advocate for women, not to support bodily autonomy, not to support evidence-based medicine, and not to support normal healthcare.

Letter from Lamaze International to the membership 7/7/2022

For as long as I’ve been teaching Lamaze classes, since late 2010, I have been told by the organization that they support women’s birthing choices. I’ve been told that they support evidence-based medicine. I’ve been told they support women’s autonomy in decision making regarding their bodies and their births. I’ve been to DC to lobby lawmakers with Lamaze for laws to improve maternal health, reduce maternal mortality, and support breastfeeding initiatives.

As a Lamaze educator, I have taught the people with whom I’ve worked that their choices about their bodies matter and they they should advocate not only for themselves, but also for the next pregnant person to improve the quality and accessibility of healthcare.

A failure of this kind, from all of the childbirth education organizations and doula organizations, is a failure to support human rights, women’s rights, public health, and evidence-based medicine.

I am so disappointed in my organization. Even though I no longer teach childbirth classes or attend births as a doula, I still have an affinity for the group that shaped my life for 12 years. I feel somewhat like a child, who has learned that their parent is flawed and not what they had believed. Let’s explore the details of Lamaze’s failure and the failure of the other organizations in not joining the other 75+ maternal health organizations in condemning Dobbs and supporting the right to abortion.

Breaking Down the Failures of the Childbirth Education and Doula Organizations

  • These organizations say they support evidence-based medicine and information.
  • These organizations say they want to reduce maternal mortality and morbidity
  • These organizations say they support women’s choices and autonomy in all things pregnancy, birth, and parenthood.
    • Except, apparently, for the first choice, to continue or to terminate the pregnancy. If this first choice is not supported, then are women’s other choices truly supported or is it dogma? How can you claim to support women’s choices, but not for abortion? Simple, you don’t support women’s choices.
  • These organizations say they support shared decision making with a medical provider.
    • When the law disallows abortion, shared decision making with a medical provider is squashed.
    • How can a person even have the conversation with their doctor or midwife in a state where abortion is outlawed and it becomes a crime to even help a person by driving them to have an abortion or telling them how to order medication online? Women many skip the doctor entirely and choose online resources that may cause her harm or be ineffective because abortion isn’t legal in their state.
    • Abortion must be legal and accessible for shared decision making to take place.
  • These organizations say they have a mission to advance safe and healthy pregnancy.
    • Safe and healthy pregnancies are had when abortions are accessible. Safe and healthy includes mental and emotional wellbeing in addition to physical. Without abortion, many unhealthy (for adult or fetus) pregnancies will be forced to continue.
    • Pregnancy is a huge drain on the body’s resources, and can cause permanent harm or death. The risks of pregnancy on the body must be entered into with open eyes, evidence-based information, and proper prenatal care which includes access to abortion.
    • Emotional wellbeing is essential to being a successful parent. Not everyone is emotionally ready, nor is everyone financially ready, nor do they have proper social and familial support.
    • Poverty and the social determinants of health play a huge role in how safe an healthy a pregnancy will be.
  • Advocacy
    • This is a rough one for me. I’ve been to DC to lobby with Lamaze. I’ve written letters, I’ve spoken with local, state, and federal legislators on maternal health issues.
    • Abortion is the one topic Lamaze and the other organizations won’t touch with their advocacy.
  • These organizations have chosen the feelings of some of the membership over the reality facing pregnant people. (note: I haven’t seen a poll as to whether or not doulas and childbirth educators support abortion rights. Do we have data on that?)
    • By Lamaze choosing not to make a public statement to pregnant people and those outside of the organization, Lamaze ignores those who matter most. The people we serve.
    • Noting that this is a controversial issue sidesteps the real, direct issue of human rights and women’s health.
    • Taking a firm and direct stance like the 75+ other maternal-child health organizations would send a direct message in support of all people who have the ability to become pregnant. It would support human rights, women’s rights, public health, and most importantly, it supports the health, wellbeing, and autonomy of those people who own a uterus.
    • Noncommittal responses are the same as supporting anti-abortion legislation. It’s like voting 3rd party and therefore helping a reasonable candidate lose because your vote didn’t count.
    • Being “wishy washy,” staying out of politics, trying not to hurt someone’s feelings is doing direct, irreparable harm.
    • Silence is doing direct irreparable harm.

Our local Midwife Center for Birth and Women’s Health also released a statement. So did Healthy Start.

“This includes the belief that our clients are the experts in their health care choices, social environment, and influences, including when and if they choose to become parents. In the United States, the maternal mortality rates and economic disparities currently affecting women and families of color, especially Black women and birthing people, are already at a crisis level, which means that access to comprehensive reproductive services is more critical than ever.”

Midwife Center for Birth and Women’s Health

“As a community that is focused on public health, health equity and centering the lived experiences of marginalized people—in particular Black women—this decision presents an affront to our safety, security and bodily autonomy. What is at stake is bigger than the perceived morality of a personal decision about pregnancy; but the duality of a society where women, children, poor people, people of color, people who are disabled and people of nonconforming gender and sexual identities are oppressed through policy and legislated hatred. In particular, this ruling will have a disproportionate impact on Black women.”

Heathy Start

Ok, but why are these organizations silent?

I’ll give you a hint.

The two major flavors of childbirth education, Lamaze and ICEA, have their historical origins firmly planted in eugenics, pronatalism, politics, and Christianity.

I’ll leave off on today’s post with this: While on one hand, I expected better of the childbirth education and doula organizations, on the other hand, I’ve been in this world of birth professionals long enough to be a realist. There was never any way they could come our and possibly offend someone by speaking out against the Dobbs decision and in support of the human right of abortion access. Their silence is enough to make them complicit.

Expect the first post digging into the history of why in the coming days. In the meantime, go back and read the dozen posts on Dr. Grantly Dick-Read. You’ll find them a good foundation for what’s to come.

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Chloroform, Childbed Fever and Historical Fiction

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http://www.marycassatt.org/Mother-and-Child,-1900.html
http://www.marycassatt.org/Mother-and-Child,-1900.html

I am writing a new historical fiction series for Lamaze‘s blog, Giving Birth With Confidence, entitled, “Dear Diary”. The people are fictitious, but their experiences reflect common ones for their time period. The series will continue monthly until we reach the end of the 20th century. What you find below are some expanded details from the story which I have written.

You can read the first “Dear Diary” post here. “Dear Diary” – Birth Stories of the Past: Albert Jr., Born May 12, 1900

Chloroform

Chloroform’s first known usage during childbirth was in 1847 by a Scottish physician, Dr. James Young Simpson. Queen Victoria used the drug during her labor with Prince Leopold in 1853 and 1857. It was administered with a cloth over a wire framed mask. A few drops were sprinkled onto the cloth and the mother would breathe it is, feeling it’s effects shortly thereafter. There were no dosages or limits, or testing, for that matter. Some maternal fatalities with use of chloroform did occur. Chloroform and Ether were the earliest form of medical pain management.

Childbed fever

http://www.abpischools.org.uk/res/coResourceImport/modules/infectiousdiseases_timeline/en-images/Semmelweiss.jpg

Childbed fever was the common term for puerperal fever. It’s a fever caused by uterine infection after childbirth.

Although the germ theory of disease was proposed in 1546 by Girolamo Fracastoro, and Louis Pasteur and Robert Koch working in 1850’s – 1880 provided strong evidence to support germ theory, the theory wasn’t widely adopted by physicians.

Ignaz Semmelweis, in 1847 was the first to link puerperal fever to physicians. Physicians would go from performing autopsies, gloveless and without washing their hands, to delivering babies in a ward, one woman after another. Thus spreading germs and disease not only from corpse to mother, but also from mother to mother.

Semmelweis’s pleas to his colleagues to wash their hands, were ignored, even though Semmelweis’s students, having washed their hands, reduced their cases of childbed fever from 18% to 1%. Joseph Lister continued working on aseptic medical practices in the late 19th century. Physicians were slow to adopt these new antiseptic practices until the early 20th century.

The births in the inaugural “Dear Diary” post take place before the era of aseptic medicine. As we move forward in time, we’ll explore new advances and maybe a setback or two.

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On Being a Good Girl During Labor

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“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.

Good birth, Silent Mother, Deena BlumenfeldWhere 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

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