Читать книгу Give Birth Like a Feminist - Милли Хилл - Страница 8

Indeed, ‘laminated’ birth plans (which, in reality, I am yet to come across) seem to stand as a metaphor for a really organised and strong-minded woman who misguidedly thinks she can have any power in the birth room. In his bestselling memoir, This is Going to Hurt,[4] former obstetrician Adam Kay recollects a woman with a ‘nine page birth plan, in full colour and laminated’, who has abandoned it – ‘hypnotherapy has given way to gas and air has given way to an epidural’ – and is now headed for surgery due to ‘failure to progress’. This, he says, does not surprise him: ‘Two centuries of obstetricians have found no way of predicting the course of a labour, but a certain denomination of floaty-dressed mother seems to think she can manage it easily’, is his summary.

Such attitudes pervade modern maternity care. I hear them embedded in women’s birth stories daily, but if you don’t believe me, you only need to look at the media reaction to celebrity births to find more of the same. My first ever paid gig as a journalist was to write about how the press were bullying Kate Middleton about her plans for a natural labour and hypnobirthing, and we’ve seen similar mockery of Meghan Markle in the run-up to the birth of her first baby. ‘A doula and a willow tree,’ a leading obstetrician apparently joked, ‘let’s see how that goes!’[5] The willow tree, like the floaty dress, is an attempt to poke fun at ‘earth mothers’ who want everything to be ‘natural’, and neatly portrays Meghan as demanding enough to want a particular kind of tree at her birth. It’s all intended as humour, but underneath the surface is the rather chilling idea that a kind of satisfaction or sense of triumph might be gained from seeing a woman’s ideal hopes for her birth go to the wall.

In Ireland, the Eighth Amendment – which gives the pregnant woman and the fetus equal rights in law–has recently been repealed, but the legacy of hundreds of years of blurred lines between Church and State mean that women’s rights in birth still have a long way to go. Here, midwives in Dublin reliably inform me, a woman with a birth plan and strong ideas about what she wants is commonly referred to as ‘a difficult woman’ by her care team. Indeed, in early 2018 an obstetrician from a Dublin maternity unit, Dr Aoife O’Malley, described women who make birth plans as ‘middle-class birthzillas’, adding that her audience of fellow birth workers would ‘know the women because we’ve all had them’ who ‘think they are the only woman who’s ever given birth and they certainly think they are the only woman giving birth in the labour ward that day’[6].

Selfish, opinionated, controlling and difficult: women can often be treated like wayward children when they try to create this grown-up document. Lawyer and board member of Human Rights in Childbirth, Bashi Hazard, has described the birth plan as ‘the closest expression of informed consent that a woman can offer her caregiver prior to commencing labour’. Hazard also reminds us that the medical institutions where we birth will always have a birth plan themselves; ‘one driven purely by care providers and hospital protocols without discussion with the woman’.[7] An intelligent consideration of birth plans reveals that they are a fantastic opportunity for women to consider their many birth options and open a meaningful dialogue with their care providers about their choices. Why would anyone find this problematic? one wonders.

There is even controversy about the label ‘birth plan’ itself, with some birth professionals arguing that they shouldn’t be called ‘plans’ at all, because this gives them too rigid a feel in a situation where it is important always to be flexible. ‘Women need to go with the flow in labour’, we are often told, as if we have the mindset of 5-year-olds. ‘Preferences’ is the most oft-suggested alternative, but it’s interesting to consider why the word ‘plan’ is the source of such anxiety, in a world where women can make plans in other areas of their lives and be considered perfectly capable of adaptability, contingency or, indeed, dealing with the emotional fallout of disappointment itself. Why must we present our needs and wishes in childbirth in the style of Oliver Twist, holding out our empty bowl tentatively and apologetically, when in fact we have the legal and moral entitlement to take the lead in every single one of our childbirth choices? Imagine if business people or our politicians spoke about their ‘shortand long-term preferences’ – we would quickly lose confidence in their strength and leadership. Indeed, the very hospitals we give birth in have ‘policies’ and ‘protocols’, and nobody is asking them to tone that language down.

Regardless of what a woman decides to call her birth plan, she can expect to receive subtle discouragement at every turn, because birth is ‘unpredictable’, and you ‘can’t really plan for it anyway’. She will be urged to ‘go with the flow’, rather than try to ‘control’ what happens to her in labour: but whose ‘flow’? As midwife and academic Dr Elizabeth Newnham puts it, ‘Going with the flow is fine, as long as it’s the physiological flow, not the institutional flow.’[8] Debby Gould and Melissa Bruijn, founders of the Australian birth trauma organisation BirthTalk agree: ‘Most women’s interpretation of “going with the flow” is “to put ourselves in the hands of our health carers, and accept the interventions they suggest as inevitable, unquestionable and in our best interests”. Every week we talk with women whose birth plan was to “go with the flow”. And now they are contacting us for support after a traumatic birth.’[9]

Encouragement to take a passive role in birth is everywhere, but if a woman does push ahead and make a birth plan she may find the cultural prediction that it’s ‘pointless’ coming true: in a 2016 survey from Positive Birth Movement and Channel Mum, nearly 75 per cent of respondents said that they made a birth plan, but only half of this group said that their birth plan was read by professionals, and 42 per cent said that their plan was not adhered to.[10] In some cases, plans simply have to change: you cannot have a home water birth if you develop placenta praevia, for example, but women understand these situations and when they complain about their birth plans being disregarded, this is not the kind of example they are giving. Rather, they talk about plans not being read due to a hospital shift change or because they are ‘too long’, or aspects of their plan which could have held in almost any situation, such as optimal clamping, minimal talking in their birth space, or keeping their placenta, not being observed, or being told at the last minute that what they are requesting is not possible, or even not allowed.