“The Theft of Childbirth”

I just read a beautiful essay the other day – Adrienne Rich’s The Theft of Childbirth. It was published in 1975, so kinda dated, I know, but after doing a bit of research, though some of her statistics are dated, it’s a little horrifying how little has changed when it comes to obstetrics.

The first piece of information I want to tackle is this: “Of sixteen developed countries, in 1971 and 1972, the United States had the highest infant mortality rate” (159). [Page numbers refer to the anthology I read her essay in, Seizing Our Bodies.] As of 2006, CNN.com reported that the United States has the second-highest infant mortality rate of developed countries, tied with Hungary, Malta, Poland and Slovakia. Only Latvia has a higher infant mortality rate than we do, though the article quotes the Annual State of the world’s Mothers report for pointing out that “The United States has more neonatologists and neonatal intensive care beds per person than Australia, Canada and the United Kingdom, but its newborn [mortality] rate is higher than any of those countries.” In 35 years, the United States has gone from last place to second-to-last place. Progress?

Childbirth is (and has always been) a process that is unique to every
woman that experiences it. The medicalization of this process has
resulted in a system that treats childbirth less like an experience and
more like an illness, something that a woman must go to a hospital to
“treat,” until she can leave, being “cured.” Never having given birth, I
can only speculate on the experience, or read others accounts, but when
my sister went through childbirth two years ago it gave me a different
look into the industry.
My sister has always had a low tolerance for pain, and she would much
rather take medicine for pain than “deal with it,” but early into her
pregnancy she was determined to have a water birth without benefit of
pain medication. Fortunately, her partner was on board for whatever she
decided to do, but her doctor wasn’t. My sister doesn’t have health
insurance, so as soon as she found out she was pregnant, she signed up
for the state-sponsored health plan, which directed her to what is
considered one of the best (and most expensive) hospitals in the area.
Her OB/GYN, a female doctor, bluntly told my sister that she has never
met a woman that didn’t regret her decision to not use pain medicine –
specifically an epidural. My sister was terrified, as her doctor painted
a picture of women permanently traumatized by the “horrors” of
childbirth. Not only was my sisters pregnancy induced, (an act I’m not
convinced was even necessary) as soon as she arrived at the hospital,
her doctor “firmly recommended” that she be injected with the epidural –
through a large needle in her spine. My sister relented, already tired
and scared of giving birth for the first time, and she stayed in the
hospital for two days before her water even broke, unable to walk around
or eat, growing more and more agitated and stressed. As soon as her son
was born she was hurried out of the hospital so the state wouldn’t have
to pay more than it had to.

This was two years ago. In Childbirth,
Rich succinctly sums up my sisters experience: “It is a question of the
mother’s right to decide what
she wants…the medical establishment continues to claim pregnancy and parturition as a
form of disease” (161). She also tackles the issue of position in
giving birth; supine (on the back) versus standing up, squatting, on
hands and knees, and other positions used by doctors around the world.
Rich quotes a doctor practicing in Argentina as saying, “Except for
being hanged by the feet…the supine position is the worst conceivable
position for labor and delivery” (156). In 2006, a study done by
the Journal of the Osteopathic Association concluded that “Nonsupine
positions during labor and delivery were found to have clinical
advantages without risk to mother or infant. Enhanced maternal outcomes
included improved perineal integrity, less vulvar edema, and less blood
loss.” This clinical trial studying 198 women, half giving birth in
supine positions and half not, come to the same conclusion that Rich did
in 1975. Yet unless a woman uses a midwife or some other
non-conventional method to give birth, she will be lying flat on her
back with her feet in stirrups. Why? According to Rich, “Obstetricians
believe [non-supine positions] would be inconvenient for them in
attending births” (156). In the Journal of Obstetric, Gynecologic, and
Neonatal Nursing, a
2006 article titled “Reevaluating Positions for Labor,” comes to an
identical conclusion, using almost the same language: “Yet much too
often, the supine position is forced on patients solely for the
convenience the OB team.”

I don’t want to suggest that there has been no progress in the health
care industry since the seventies, because that would not be correct.
But the health industry devoted to women is sadly lacking; how could we
have made such advances in cancer research and prevention yet treat
pregnant women exactly the same as we did 35 years ago? It could be due
to lack of funding, lack of research or just lack of women in the field.
But what it comes down to is the devaluation of women in general. Until
that changes, women will continue to have substandard health care.