Thoughts on supporting young or vulnerable mothers and mothers-to-be

Young, unmarried or otherwise unprepared woman gets pregnant, family has conniptions about 'irresponsible behaviour', family accepts the situation and steps in to help, family ends up taking over and mom lets them, confirming family's perception of mom as irresponsible.

I see variations of this story reasonably often in my line of work.

The young mom carries the stigma of 'irresponsible' pregnancy, very visibly for the term of her pregnancy; partner / sperm donor / rapist is usually unscathed by such societal strictures. Well meaning family steps in to save the day - which is all good and well, except that the help usually comes at a price, and that price is often compliance.

It is truly a challenge to be strong and make good choices when you have been labelled as 'irresponsible' and you feel like you have become everyone's problem, which is often how these young moms feel.

'How are you going to look after this child?' 

'What about your studies?'

'What were you thinking?' 

'I told you he wasn't good for you.'

Once everyone is done asking questions, completely overwhelming the young mom to be, breaking down every last shred of confidence she has, then the moment comes for her own mom and dad to step and and fix it all. As if her 'failure' becomes their 'failure' and they have to do their utmost to 'fix it.'

She hands over more and more power as she feels less and less capable.

I'm sure that the delight in being the rescuer, the rock, the provider, isn't a conscious thing, but I sometimes feel that sense of power that comes with being the rescuer ends up causing disempowering situations for the mom to be.

I've seen moms given absolutely no choice about the circumstances of the birth, not because of the actual costs of her choices, but purely because mom's choices didn't line up with the choices of the financier. Mother's options are not even a point of discussion, because the perception is that she has already proven herself incapable of making good decisions so decision-making needs to be taken out of her hands. To be honest, it's not only the young or otherwise unprepared moms who experience this. Moms who are experiencing domestic abuse or marital difficulties or financial strain get similar treatment.

Often these moms are left with little to no autonomy,  as implicit or explicit threats of withdrawal of finance and / or accommodation and / or acceptance are enough to keep her toeing the line. Her parents speak on her behalf, pay on her behalf and decide on her behalf. 

I have yet to see a grandmother-to-be present her daughter with options, encourage her to research those options for herself and find a solution that makes the best of the situation, with the resources at hand, and most importantly, accepts and supports those decisions even if they weren't necessarily the decisions she would make.

I understand that a young mom may choose options that add extra strain to a family, but I'm suggesting that those who are willing to help be honest about the degree of help they are willing to provide, be it financial or otherwise, and then allow the mom to decide how to use the resources that have been made available to her.

Stepping in and fixing everything often seems to end up paralysing the mom-to-be. She may be overwhelmed at the task ahead of her and steps back, confirming the prevailing perception of her as irresponsible and not up to the task of parenting. This then requires family to step in even more, creating a cycle of disempowerment and resentment.

Rather, family should give resources as they are willing and able, and thereafter empower and equip the young mom to make the best plan she can with those resources. She is, after all, about to be a parent, and that is, after all, what good parents do. They do the best they can with what they have.

And it's not just about the birth, often these young moms are kept in check or subdued for many years with the 'Remember how much you owe me because I saved you' line.

Which brings me to the party we haven't yet considered - the baby. That baby will be the one living with the consequences of the mother's choices, as a baby, and into its future as an adult. Surely a dynamic of rescue and disempowerment is not the example one would want to set, as I have seen where the grandmother continually criticised the mother's parenting in front of the child. How is that helpful for this little person who ends up cscond guessing their mother's every move? In one particular case the child became horribly confused and acted out in the most impossible ways, never sure who to listen to or who to be loyal to, and grandmother's perception of her own daughter as a lousy mom was confirmed, thus justifying her intervention in her own mind.

Rather than disempowering moms, let's remind them that as mothers they have the most powerful influence over that child's life, equaled only perhaps by the father's influence if he is around. Let's show them the power they have and support them in exercising that power to make the decisions that will carry them and their children into the future as responsible individuals, confident in the knowledge that they are equipped to deal with whatever life gives them.

Obviously this isn't the situation for every vulnerable mom, but I do see it quite often. Congratulations to all the families and grandparents who have made the effort to encourage and support vulnerable or single moms rather than 'rescuing' them!

Have you experienced something like this?
Share your thoughts below...

Just 'cos he looked at your cookie...

'Just 'cos he looked at your cookie doesn't mean he's the one!'

I wish I had actually said that out loud. 

A pregnant mom was telling me about how she was considering a midwife-assisted birth but was leaning towards staying with her gynae, even though she knew his shocking C-section stats, because, you know, he had done her pap smears for the last 7 years. 

What is it with us that we don't want to disappoint people? We don't want our gynaes to feel rejected? Is that it? Because really, I don't think it's mutual. 

That a woman will stick with a gynae she is unsure of, because he has poked around 'down there' a bit, because he wrote a script for some Clomid, because he did the job that she paid him to do, even though she knows his C-Section rate is over 80%, I can't understand.

Like every abused woman contemplating whether or not she should leave, she believes him when he says, 'Natural birth is Plan A,' (even though the numbers say otherwise) and she believes that this time it will be different. 'I'm not like those other girls,' she says. 

I love gynaes, I really do. I especially love it when they do what they are good at - and it's not a stretch of the imagination to think they also enjoy doing what they are good at. What they are good at is dealing with situations when something is not quite as it should be, where there is a problem, or an emergency, or a real risk. To be honest, they are not trained to deal with plain old physiology. It is unfair to expect them to recognise it.

Like the teller at the bank who can recognise a counterfeit because of years of experience with authentic bank notes, so a provider with experience in physiology can recognise a problem before it becomes a problem.

Everything looks like a nail...

If you want surgery, you hire a surgeon. 

Otherwise, find someone who understands the difference between dealing with disease or trauma and supporting a physiological function.

Everything looks like a nail if you have a hammer in your hand.

But this is not the point I want to make. Where should your loyalty lie? With your care provider? I'm not so sure. Like I said, I'm not convinced the feeling is always mutual. You are one of many. In short:

The axe forgets, the trees remembers.

Should it lie with your family, your community, society at large? Again, I'm not so sure. Will they have to deal with the fallout of any problems? Probably not as acutely as you would have to. As the parent/s, you alone are held accountable in the end. If you leave the decisions up to others without knowing the facts for yourself, you are not making a free choice, but you will have to deal with the consequences of that choice.

This may come as a shock to many, but primarily you need to be loyal to your baby, and yourself. You, plural, are the priority here. A doctor's busy schedule or fear of litigation, or your mother-in-law's fear issues, the friend who referred you to that doctor to start with, the fact that the gynae saw your vagina already so what the hell - these do not deserve your loyalty. 

What is best for you, the motherbaby unit? Are you being treated as an individual or a number? A person or a potential litigator? An rational being or an irritation? Are you a participant or a patient?

Do whatever it takes to find someone who will treat you as a person, an autonomous individual capable of making good decisions. Someone who will give you all the relevant information - the pros and cons of every procedure, who takes your concerns seriously and is not threatened when you volunteer information that may be contrary to the current suggestion. Are your fears treated flippantly and your desires with disdain?  It is never too late to change providers.

If you need a second opinion, get one. Don't stall for fear of offending.

Do what it takes to get the options and opportunities that you and your family deserve. 

Whatever you do, remember that just because he looked at your cookie, it doesn't mean he's the one!

(In case you thought I was totally anti-gynae, I have some thoughts to share in an upcoming post. In short, I sometimes think our gynaes and obstetric nurses are the most disempowered of all...)

But until then, How did you find your care provider for your birth? Were you happy? Would you rather have changed? What advice would you give to moms who are having doubts about the person they've chosen to assist in the birth of their baby? Let us know below...

Obstetrics - Bastion of misogyny

Miso-what?

by Barbara Kruger

Misogyny (miss-odge-a-knee) literally means 'hatred of women' - but just as we understand that a paedophile doesn't really 'love' children, so the term misogyny has come to refer to having an inherent prejudice towards women, usually to their detriment.

I get that referring to obstetrics as a bastion of misogyny is a strong statement to make - Didn't huge numbers of women die in childbirth before maternity wards and hospitals and operating theatres? What is wrong with that? You don't become a gynaecologist or obstetric nurse unless you want to help women, right? How is that missy-, misod... hating women?

This has been a very difficult post to write. It is a real challenge to get the balance between describing the misogyny, if not outright abuse that women are experiencing under obstetric care, whilst acknowledging that there are many care providers who do not intend to practice in this way. I would like to put forward the idea that it is not every individual in the obstetrics industry that is consciously misogynistic (although some are), but that the institution of obstetrics itself utilizes deeply entrenched misogyny as its foundation. For one example, see here.

Therefore even those who are not personally invested in the practice of misogyny feel stuck in a system that cannot function without it.

If you are still a wary, let's try something. I found this site (among others) containing a list of the characteristics of a misogynist. If we personify the obstetrics industry, how many of the characteristics of a misogynist does it fulfill?
Before you read the list below - please remember this is not about doctors vs midwives or men vs women - I have seen internalised misogyny practiced and perpetuated by midwives and doctors, male and female. I believe we are dealing with a system that is inherently misogynistic, but is allowed to continue as such because women are told that the misogyny is for their own good. 

Characteristics of a misogynist:

•  Controls women by destroying their self-confidence
• 'Are you sure you don't need an epidural?' (x10)
• *checks dilation* 'You are only 3cm dilated.'
• 'Failure to Progress.'

•  Needs to ensure that women are always less powerful than he is
• Stirrups
• Lithotomy position
• 'My gynae said he/she will/won't let me...'

• Intimidates women by constantly finding fault with them
• 'Let's see if this naughty cervix is behaving.'
• 'This perineum is far too small - we'll need to do an episiotomy.' *head not even visible*
• 'Be quiet - You're making too much noise!'
• 'What size shoe are you?'

• Humiliates women in public and devalues their opinions
• *Calls the doula over to show her why the episiotomy will be necessary and why more time won't help by demonstrating how 'small' the mother's vagina is with his two fingers while she has full sensation and without her consent.* (Mother is on her back. Ends up cutting three times.)

• Must ALWAYS win in a discussion with or about women – all encounters with or about women are seen as a battle to be won.
• 'Well if you want to have a doula you'll have to find another gynae...'
• 'Well, you can either listen to me or you can have a dead baby.' - otherwise known as playing the 'Dead Baby Card'
• 'You know you can't trust Dr Google,' when a mother tries to present a peer-reviewed journal article on how delayed cord clamping may be beneficial.

• Blames women for failings that are in no way related to them
• 'Failure to Progress' is often more a case of 'Failure to Wait'. When a mom is strapped to monitors and not allowed to stand up and eat and be normal it is no wonder that labour stalls!
• 'We'll have to give formula because your milk hasn't come in yet.' *Less than 24 hours after birth.* Anyone who knows the least bit about breastfeeding knows milk only comes in at around three days after birth. 
• 'It seems your pelvis is too small to deliver this baby.' Said by the same person requiring the mother to be on her back in the position most likely to restrict opening of the pelvis.

• Blame women for his own failings and shortcomings
• 'The Caesarian rate is so high because women's pelves (pelvises) are getting smaller.'

•  Denies women's feelings and makes them wrong for feeling them
• 'It wasn't that bad. At least you have a healthy baby!'

• Makes jokes or derogatory comments about women and then ridicules any woman who gets offended or upset

• Belittles or ignores women's accomplishments
• 'It must have been the atarax.' *After mother reached 8cm from 3cm dilation in 3 hours through some Rebozo sifting, moving around and changing positions.*

• Has no remorse or guilt for the pain he causes women
• 'But I saved you!'

• Tries to keep women from doing things they are qualified to do
• Like being able to make decisions about what they do with their own bodies.

•  Selectively quotes authorities to substantiate his views and positions on women
• 'Cochrane Review? Pfft! I only trust the British Medical Journal on these matters.' i.e. the extent of his research is on how to do better surgery, not on how to avoid surgery to begin with.

• Will confuse issues by changing the subject, denial, word jugglery, lying, twisting the facts or acting as if nothing happened
• 'If you tear, it will be jagged and we will have to cut the jagged edges off and then sew it together.'
• 'Your baby will drown if you give birth in the water.'

• Is preoccupied with sex and is sexually controlling
• Ever heard of the 'husband stitch'?
• 'Don't you think your husband would rather you had a Caesarean?'

• He has problems with authority figures in general and women in authority in particular.
• Outspoken and experienced midwives (as opposed to obstetric nurses) in general and private midwives in particular are often seen as the enemy and are accused of giving women all sorts of crazy ideas.

• Has a Jekyll and Hyde personality - Nice to you in public, but cuts you down in private
• 'My gynae is very pro-natural.' *When I know his CS rate is over 85%*
• 'My gynae is very happy for me to try for a vbac.' *When I know the success rate of VBACs in that hospital is less than 5%*
• 'My gynae said I can have a water birth.' *When the midwife on duty says she's never seen this doctor allow a first time mom to deliver in the water.* 

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So before you start roaring at me in ALL CAPS saying that birth attendants aren't all like that, I totally agree. I know some truly incredible birth attendants and caregivers who have utmost respect for the birth process and birthing women. But they struggle in a system that does not represent these ideals. Read Dr Gauri Lowe's account of her obstetric training as a GP here: Thoughts on expecting natural birth service from your doctor...

Even though all the quotes above are actual quotes or situations I have heard / experienced / read, I understand that they do represent extremes, and yes, I understand that many individuals do not consciously perpetuate these misogynistic language and behaviour patterns, but until someone calls them out, the abuse will continue. A woman should feel safe and secure and supported no matter what her race or social class or education or risk category. 

Edited to add:
In describing obstetrics as the last outpost of misogyny, I don't intend to minimise other expressions of misogyny, both explicit and implicit, but I do feel that obstetrics is a particularly well guarded bastion of the ideology, because it is one of the most widely accepted and widely justified areas of misogyny. In short, 'It's for their own good.'

Further reading: 

Birth: A surprising history of how we are born by Tina Cassidy (On Takealot)
Dr Robbie Davis-Floyd (Anthropologist) - Articles on Childbirth and Obstetrics

The doula as a witness

I love that I learn from every single birth I have the privilege to attend. Each family and each birth requires different things from me - different words, different actions, different energies. Part of the skill in being a doula is knowing when to use which words, actions and energies. 

At times I stand by as a quiet presence, at other times I am in constant contact. Some moms prefer silence, while others want distraction. I rub feet, hands, hips, legs, backs and shoulders, I stroke hair,  I whisper encouragement, I turn down the lights, I turn up the heat, I fill the pool, I bring cool washcloths, I hold the space, I keep everyone fed and watered - doing my best to remove any hindrances to the birthing mother. 

I do all these things, but I feel they are all secondary to my role as a witness.   Of anyone involved in the birth process this one is almost unique to doulas. Partners are present but the birth is their own birth experience too. The midwife, the nurse, the doctor - they have their own responsibilities that often involve papers, numbers and tools - they have additional concerns that I don't have to carry. I am able to be there - truly present - with all my energy and attention focused on the birthing mom. I know midwives who choose to be fully present with the birthing mother, but these are rare.

And so I often get to see the things that others don't. I witness a birthing mother glowing serenely through yet another wave; the gentle interactions between a mom and her partner; the dad's face as he marvels at what he and his partner accomplished. I witness the mother's triumph as her dreams and expectations are clothed in flesh.

I am there for the disappointments too. I witness the moment when the gynae orders a second caesarean section after a long battle for a VBAC. I am there when her wishes are disregarded and her body violated with impunity by those with greater authority than me. 

In those moments something in the depth of me rages.  I don't dispute the medical justification for their actions, but too often there is little to no acknowledgement of her desires, her struggles, her strength, her autonomy, her personhood. 

Something in me rebels at the idea of being complicit in a system that routinely disregards evidence-based care in favour of convenience, that favours policy over personhood.

While this system rolls on, someone has to mop up the emotional fallout after institution has done its work. While there is little I can do on my own to improve the care women get while giving birth in our birthing institutions, I can bring empathy - the ability to sense, understand and share the feelings of another - because I was there.  

So to all my doula moms, thank you for the privilege of allowing me to witness your journey...

I was there when you believed you couldn't go any further but you did anyway. I was there when you felt your body would split itself apart but you kept it together. I was there when you found and accessed that primal power deep inside. I was there when you pushed past exhaustion. I was there when your hopes were shattered, when your deepest healing was won, when your darkest moments were met, and overcome. 

I saw what you did. 

Your triumph. Your power. Your vulnerability. Your pain. 

I saw it all.

And I want you to know: you are magnificent, you are fierce, you are breathtaking. 

I know because I was there, and I remember. 

Keep Calm and use your BRAIN!

This little acronym - BRAIN - is a powerful tool to increase your chances of getting evidence based care. So here goes - your care provider suggests a procedure, such as a stretch and sweep, or an induction, or even an internal exam at 38 weeks, or an episiotomy, or even a Cesarean birth - what do you do?

Sometimes medical decisions are based on outdated policy, financial or convenience factors rather than on what is best for mom and baby. Many parents are not sure how to question their care providers in a way that opens doors of communication rather than slamming them shut. The BRAIN acronym facilitates discussion in a non-threatening way.

What this really all boils down to is making sure that you are making informed choices and giving informed consent. This is a tricky field legally, and particularly in the area of labour and birth where there is a huge emotional component involved and families feel particularly vulnerable. 

Just remember, no one is allowed to do an internal exam or 'adjust' your cervix without your consent - if your care provider asks to do an internal exam and you give permission, and are informed afterwards that your cervix was manipulated or your membranes stripped - that is not informed consent and that is a violation of your patient autonomy. 

Furthermore, no one can inject you with anything or put anything in your drip, or cut into your flesh at any point without your informed consent - and if someone is busy doing something, an internal exam for example, and you say - STOP - you have withdrawn your consent and that person is required to stop what they are doing and withdraw their hand. 

You may be asked to sign a blanket consent when you are admitted to hospital (if you are birthing in hospital) - please read through it and discuss whatever you are concerned about. Perhaps you could get a copy before the time. It really is worth it! I have heard too many stories of women lying in bed for the duration of their labour because they believed that was just how it's done and didn't know they could request otherwise. Or women coerced into unnecessary inductions because of the doctor's leave schedule. For a first time mom, inducing labour drastically increases chances of having a Cesarean birth. If women truly knew the risks of the procedures they are apparently consenting to I think our phenomenally high Cesarean birth rate in our private hospitals would be a thing of the past.

There is much more I could say about this, but you get the idea. When in doubt, use your BRAIN!

Just so you know, I actually have a website dedicated to helping parents make informed choices along their birthing journey. Click here: http://www.giving-birth-naturally.net

When have you used the BRAIN acronym before? Please tell us!

Alternatively, was there a time you would have used the BRAIN acronym had you known about it? Tell us your story!