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| Book cover for "Give Birth Like a Feminist" |
I recently read the book Give Birth Like a Feminist by Milli Hill. It's about the rights of pregnant people to make choices during the process of laboring and giving birth to their babies, rather than just being pushed along by doctors telling them what's going to happen. You may recall I've written before about how I'm interested in what consent should look like in a medical context- so obviously I'm interested in this book. Also I've given birth twice so yes I have some opinions on that.
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People say "A healthy baby is all that matters"
This is something I've heard many times- when a woman tells the story of how she gave birth, and there are always some things that went wrong or didn't go the way she would have preferred, and then someone says it's okay, all that matters is that the mom and baby are alive and healthy.
I don't like when people say that. Very much disagree. The writer of this book, Milli Hill, also very much disagrees.
I guess when people say all that matters is that the baby's healthy, there are 2 different ways you could understand that:
- Some things didn't go the way the pregnant person expected/wanted- for example, medical issues meant that the baby had to be born early, so you're rushing around in a panic, texting your manager on the way to the hospital to tell them you have to start maternity leave right now, you didn't even have time to buy things for the baby yet, all you have is a bunch of newborn clothes somebody gave you, and you thought they looked kinda old and ugly and didn't want to use them, but now that's all you have for your baby to wear. And whenever you look at your kid's newborn photos, the kid is wearing those ugly clothes.
The sorts of things that are like, at the time, they're really stressful, but later you look back on them and you can kinda laugh because they're not really a big deal in the grand scheme of things, and everything turned out fine. - You feel you were pressured or coerced into doing things that you didn't want. (For example, getting an epidural or not getting an epidural, getting induced, C-section, not having skin-to-skin time right after the baby is born, etc.) You wanted your birth experience to go a certain way, but other people disregarded what you wanted and pushed you into things that you didn't want- and you were vulnerable and in pain and weren't able to stand up for yourself. You feel violated. You have trauma from that. The birth of your child is a very important moment in your life, and it could have gone so much better, but that was taken from you.
And then you hear people say "all that matters is that the baby is healthy" like they think you should just ignore your trauma and pretend it doesn't exist.
And maybe in between these 2 things, there's a whole range of experiences that a pregnant person may have had, where they didn't get the kind of birth experience they wanted, and for some cases it's best to just conclude that it's not a big deal and move on, and for some cases, there is real trauma there, and it can only heal when you acknowledge it and believe that you did deserve better.
(And there can also be trauma from genuine medical issues, but that's kind of a different thing than what we're talking about here.)
The point of this book is, it's NOT true that as long as the mom and baby are healthy, everything is fine. Pregnant people deserve better than that- we deserve to be listened to and respected. We deserve to have choices. If doctors do things to you which feel traumatic and violating, and then people say it's fine because at least no one died, well, that's NOT COOL.
(Also, I've often heard moms talking about what they wish had gone differently with giving birth, from a sort of "mommy wars" perspective- ie, if you're a good mom, you should give birth without an epidural, etc. The idea that your birth experience is supposed to go a certain way, or else society will judge you and say you're a failure as a mom/ as a woman. And it can be good and healthy to just ignore society's judgment, and say "just because my experience didn't fit this 'ideal' image, doesn't mean it was bad." Yes, I agree with this advice. But this aspect of it wasn't really what was discussed in the book. It wasn't about judging one's birth experience from a "mommy wars" perspective. It was about being able to make your own choices. It was about consent.)
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Is your doctor actually working in your best interest?
In an ideal world, of course the doctors and medical staff are working in the patients' best interest. But, here in reality, sometimes patients have concerns, and doctors don't listen to them, and this leads to worse problems. Or sometimes doctors perform various medical interventions during the process of labor and giving birth (induction, C-section, forceps delivery, episiotomy, etc), and these interventions actually do more harm than good. Because of problems like this, maternal mortality rates are higher than they should be- especially for certain marginalized groups like Black women.
Why do doctors do these kinds of interventions, if the patient doesn't need it? Why not just let the patient labor by themself and give birth vaginally, and only intervene if you run into serious problems? Well, I can think of a few reasons:
- Interventions mean the doctor is the one in control. If you're trying to have a natural delivery, who knows how long you'll be in labor? Could be hours and hours. The doctor has to wait around that whole time- this is very inconvenient for the doctor. But if you get a C-section, well, the doctor knows exactly what to do and when and exactly how long it will take. This is much better for the doctor's schedule. Rather than having a timetable that's out of their control.
- Sometimes patients feel like nothing is happening, and it would make them feel better if the doctor would just *do something*. I think the issue there is when pregnant people are not well-informed about what labor and birth actually look like. If you have only seen it on tv, you probably expect that it all happens very fast and exciting- but actually, the reality is you'll probably be experiencing contractions for 24 hours or so, before the baby is finally born. When you're all excited and you get to the hospital and get changed into your hospital gown and they hook you up to the fetal monitoring and it's all very exciting, and then, okay, and then pretty much nothing happens. You have to just wait around, experiencing contractions for hours and hours. It's kinda boring. Sometimes patients will be unhappy with this, and will want to know, isn't there anything the doctor can do to make this faster??? And, yes, there are things the doctor can do to make it faster. But it's not a good idea to do that, if there's no actual medical reason for it. But if you're there in that situation, and you expected it to go a certain way, because you aren't well-informed about what labor actually looks like, it might make you feel better for the doctor to do things (that aren't actually necessary and might do more harm than good).
- Doctors are afraid of getting sued. It's much more likely that they'll get sued for "you should have done something, but you did nothing"' than for doing something that maybe was not necessary and resulted in additional complications. So it's not really about what's in the patient's best interest, it's about what the doctor is more likely to get sued for.
I'm in China, and I've heard that Chinese hospitals serve such a huge number of patients, so they don't want you taking up a spot in the labor room if you're taking forever and nothing seems to be happening. After a certain amount of time, they would want to do a C-section. I gave birth at an international hospital in China so I wasn't in that kind of environment though.
And another thing that happens is, doctors tell you that there's some serious problem, and they have to do some medical procedure on you right away, or else there is a risk that your baby might die. They act like it's very urgent, and there's no time to actually understand the situation or what your options are, DO YOU WANT YOUR BABY TO DIE???? This is a very difficult situation to be in, as a patient, because you're not an expert in pregnancy complications- how do you know if it's really as serious as what the doctor is saying? Or is it just a small risk that they are blowing out of proportion? Or do they have other reasons, not related to your health or the baby's health, that they want to push you into some medical intervention? It can be really coercive.
It can help a lot, in this situation, to have a midwife or doula who is "on your side." The midwife or doula will be knowledgeable enough to know if the risk is really as great as what the doctor is saying.
Honestly, though, my opinion is, you should talk to the doctor during the pregnancy, and make sure you find a doctor you can trust. During your prenatal appointments, talk to them about what kind of birth you want to have, and see what their perspective is. Find information about what percentage of births at their hospital are vaginal vs C-section, and other statistics like that. You find a doctor you can trust, who supports the kind of birth experience you want to have, and then if they tell you there's some kind of urgent reason they need to do something that wasn't in the plan, you can trust that it's because there really is a medical reason, not because they just don't care about your plan. You don't have to be in a situation where you're second-guessing them and have no idea if your baby is actually at risk or not. (And then afterward, you always wonder if you should be grateful to the doctor for saving your baby's life, or if everything would have been fine if they had just done nothing, and they violated you and disregarded your wishes for no good reason.)
For example: When my second child was born, we had discussed with the doctor beforehand that my husband was going to cut the umbilical cord. This is apparently a thing that a lot of dads find meaningful. I don't think my husband really had a strong opinion about it though. But then, my baby came out, and the doctor was immediately saying "cut it" in Chinese, and the doctor and nurses cut the cord right away. Turns out this was because the cord was around the baby's neck, and she wasn't breathing. The doctor cut the cord and immediately handed the baby over to the other medical staff there who know how to get the baby to start breathing. (Don't worry, they got the baby to breathe.) So, the doctor didn't follow the plan, but there was a good reason for it- you don't want to be in the middle of a situation like that, and be arguing with the doctor because you don't trust that they actually cared about your plan.
It is a privilege, though, to be able to have access to a doctor you can trust like that. In some places, there are not any good options, or they are too expensive. This is so wrong- everyone should have a doctor who listens to them and is supportive.
This book talked about how women are often told they are "not allowed" to do something. That it's the hospital policy. They're "not allowed" to do skin-to-skin with the baby immediately after birth. They're "not allowed" to do delayed cord clamping. They're "not allowed" to continue laboring after a certain number of hours. They're "not allowed" to continue being pregnant past 41 weeks, they have to get induced.
How can you be "not allowed" to do these very simple things? It's your body!
Why do we have this concept that hospitals are in charge, and they tell you what you are or aren't allowed to do with your own body? It should be that the hospital's services are a resource that pregnant people choose to use, as they make their own health care decisions.
The book makes the connection between birth trauma and sexual assault and the #metoo movement. Between the concepts of consent as it relates to sex, and consent as it relates to giving birth. Here is a quote from page 177:
Just as women were once told, 'sex is for procreation and nothing more,' they are now told, 'childbirth is for procreation and nothing more'. In either act, what matters is the production of a healthy baby, and the woman is merely a means to that end. The experience of childbirth is dismissed as meaningless and unimportant to a woman's body, heart or soul, just as the experience of sex used to be.
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Birth plans
The book said that society mocks women who make detailed birth plans- saying they are too high-maintenance, too controlling, need to be more realistic, need to learn to "go with the flow," their expectations are not reasonable, etc.
What is a birth plan? It's a document that the pregnant person writes, to communicate their preferences for how they want labor and birth to go. When I was pregnant, I read online that I should write one, so I did, and I brought it to a prenatal appointment to show the doctor. He read it and basically said yeah all of it is fine, it's all consistent with hospital policy. Then we didn't really discuss the birth plan again, and then during the actual birth, a bunch of things did not go according to plan, but I was okay with that because I did trust the doctors and nurses to respect me and my choices.
You should do this if you are pregnant. You should write a birth plan and discuss it with your doctor, well before the actual birth. Milli Hill also thinks so, and says it is not cool how women get mocked for expecting doctors to care about their birth plans. There's this caricature of a pregnant woman being really unrealistic about her birth plan- don't you know that sometimes things go wrong? Don't you know that birth isn't really something that can be planned down to the last detail?
Okay, people who mock birth plans are really misrepresenting the whole thing. Making a birth plan doesn't mean you're in denial of the fact that things don't always go according to plan. It's about communicating what you want. There are plenty of things that are extremely reasonable, that it's best to communicate with the hospital beforehand. Who do you want to be with you when you give birth? Do you want to bounce on a yoga ball during labor? Ask the hospital whether they provide a yoga ball.
Making a birth plan isn't like, you actually believe it's going to happen that way, just because you wrote it down. It's about communicating with the medical staff about your preferences and your choices. Yes, you absolutely should have a birth plan.
Here's a quote from page 53 about women feeling bad for "getting their hopes up":
Interestingly, and also in common with other forms of violence against women, it is often the woman who is left carrying the blame and shame in the aftermath. Just as the woman who has been attacked may feel that the clothes she wore or the route she took home at the end of the night may have contributed to her violation, women traumatised by birth will spend the days, weeks or even years afterwards going over the events in fine detail and asking, 'What could I have done differently?' And, just as men are rarely asked to reflect on what they could do to reduce violence against women there is similarly considerably less postnatal analysis - and often none at all - done by the individuals, institutions and systems that inflict birth trauma. Women are left with the shameful reflection that they 'should not have got their hopes up', 'should not have made a birth plan', or 'should have just gone with the flow' and those messages are consistently reinforced in popular culture. Those who try to take control of their births, and antenatal courses and teachers who encourage them to believe they can do so, are consistently derided and mocked. 'Yes,' the woman thinks to herself, 'I was totally unrealistic to think I could have a positive experience of birth, and that is why I now feel so awful. It is my fault I feel this way.' This is victim-blaming, pure and simple.
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She is more of a "hippie" than me
It's very clear that the author, Hill, personally believes home birth is better than hospital birth. There are statistics in the book about how only a very low percentage of women are having home births, and this is presented as a bad thing. Also, the book talks about how many medical professionals have only experienced birth in a hospital setting, isn't it sad that they don't even know what their patients are missing out on.
Also, there's a lot of language in here about pregnant women being naked and roaring and powerful. I'm not really... that's not really my thing. I'm not into the idea of feeling powerful and "trusting my body" while giving birth. I already grew the whole baby during the pregnancy, that's already impressive and "powerful" enough, I don't also need the birth to be like that. I want to be with doctors and nurses who know what they're doing. Make it easy for me.
I mean, if I was stranded at a truck stop and had to give birth there, I would encourage myself with talk of my powerful feminine energy, but thank goodness I never had to do that. Let's avoid that if possible.
My opinion is, I don't really believe in this talk about "trust your body" and "women's bodies are made to do this" (the book uses language like, hospital birth is based on the belief that "women's bodies don't really work"). Because, yes, sure, giving birth is natural and the body has processes that handle it- but from an evolutionary perspective, that only has to "work" at a rate high enough so humanity as a species can continue. It's not something that I as an individual woman can rely on. Giving birth is natural, but dying in childbirth is also natural. I don't want to take my chances on that; I want a doctor who knows what they're doing.
Note, though, that actually studies have shown that home birth is just as safe as hospital birth- if there is a midwife present at the home birth who knows how to recognize when you need professional help, and you have a backup plan about how to get to the hospital if necessary. So, sure, okay, I guess it makes sense that some pregnant people would want to do it that way, but I very much do not.
Even though the author clearly has a preference for home birth (and being naked and roaring, etc), the book repeatedly emphasizes that this is about supporting all women's choices in childbirth. It's NOT about saying one type of birth is "better." The book says we should support women along the whole entire spectrum of options- from home birth to elective C-section.
Here's a quote from page 13:
We also need to talk about those women who don't want or cannot have straightforward vaginal births. There is literally not one single birth scenario in which increasing empathy for the woman, listening to her voice, respecting her decisions, and honouring that this is an extraordinary day in her life will not be valid. There is literally not one single type of birth that we cannot improve upon. The best way to find out more about this is again to listen to women. I learned so much about what women want in birth from talking to those those have experienced caesarean, and in particular, caesarean under general anesthetic - often the most difficult birth experience to process and recover from. From them I learned that the smallest of gestures can make the biggest and most life-changing differences. Taking a few moments to photograph the newborn on their mother's chest, for example, even if she is still unconscious, will create something she will treasure for a lifetime, a tangible antidote to her trauma. Women repeat again and again how much it means to them to know that their hands were among the first to touch their baby, even if they were not 'there' to experience it. Every small gesture matters, and we can always do better.
Yes! Totally agree with this! It is absolutely NOT true that if some kind of emergency comes up and you can't have a birth according to your birth plan, then you have no choices or consent at all and the doctors take over everything. This example of the C-section under general anesthesia- this would happen only in very rare cases, when there's such an extreme emergency and the baby has to be born right away, and there's not even time to do an epidural; the only way to give the pregnant person anesthesia fast enough is to use general anesthesia. Being asleep while your baby is born, yeah, that would be traumatic. I definitely see how it can help, to take a photo of the baby on the mother's chest, and other little gestures like that.
Don't view it like the "home birth" end of the spectrum is the "respecting women's choices and consent" end, and the "hospitalized birth" end of the spectrum is less so. No, at every point along the spectrum, no matter what kind of birth you end up having, even if legitimate medical problems mean it ends up having more interventions than you originally wanted- every birth can be improved by doctors respecting the pregnant person and caring about their choices.
So yes, the book says sometimes there are circumstances where you really do need a doctor. Doctors are experts in medical interventions for pregnancy complications- which are sometimes necessary to save lives- and midwives are experts in how pregnant people's bodies are meant to naturally give birth, and how to support them in that. Doctors and midwives both have important expertise, and they should learn from each other.
Yeah, throughout human history, the midwife role has been very important. And women knew about how childbirth worked because they were there to support the other women in their family who gave birth. But that knowledge is not really being passed down any more. It's really common for women to not really have any idea about the reality of what childbirth looks like, until they're actually pregnant themselves. It's very common to feel like it's unbelievable that a whole entire baby can come out of a vagina- how on earth would that even work? Doesn't feel realistic, does it?
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What about doctors not being comfortable with participating in scenarios they feel are too risky?
The idea that pregnant people should have doctors or midwives supporting them in whatever choice they make for the birth- I'm wondering about the details for how that would work.
For example, suppose an unborn baby is in the breech position (ie, the baby's head is not pointing down). Now, this would make vaginal birth more risky- and as far as I know, most doctors would be unwilling to try for a vaginal birth in this case. They would say you have to have a C-section. But if the pregnant person wants to have a vaginal birth- well, what should happen? Doctors refuse to try for a vaginal birth not because they are being mean and not supporting women, but because they know that vaginal breech birth is more difficult and risky, and they feel that they don't have enough experience and knowledge about this specific situation to be confident that they would do a good job. Seriously, if you're pregnant and your baby is breech and you want to have a vaginal birth, I don't think you should try to talk *your* doctor into it, I think you should *find* a doctor who is experienced and confident with vaginal breech births.
I wonder about this... and the book didn't talk about it, so I don't really know whether my speculation matches reality or not, but, don't you think it would be traumatic for a doctor, if the patient insists on something the doctor believes is a serious risk to the baby's life- how can you force the doctor to participate in that? I mean, I guess to some extent that *is* their job, they can give recommendations but at the end of the day they provide the medical service that the patient chooses, not necessarily the one that the doctor thinks is best. But for something like vaginal breech birth, I wonder if doctors feel they don't have the training to do a good job with it- and the pregnant person and baby deserve to have a doctor who is trained enough to do a good job.
So it can't be like, you force doctors to participate in something they think is a bad idea. It should be like, even if most doctors don't want to be involved, there at least exists *somebody* who says "yes, I will support the patient in this" and society should allow pregnant people to use their services. (The book had examples of midwife organizations being shut down for shaky reasons- so, don't do that, allow the midwives to continue doing their work.)
But wait, what if that "somebody"- who says yes to whatever choice a pregnant person makes- is a quack? Shouldn't society require some kind of certification for these people? You can't let quacks and "influencers" give pregnant people misinformation about how this or that serious pregnancy complication is not actually a problem and you just have to trust in your feminine energy or whatever.
I agree with the idea that pregnant people should be supported along the whole entire spectrum of choices- but how can you make sure it's really an informed choice? Like, yes, if you want to have a home birth, or other things I personally think are a bad idea, because you are well-informed about it and you know what you're doing, I totally support that. But if you want to have a home birth because somebody in a facebook group said that pregnancy and childbirth carry no risks at all, well, yikes.
Like, how would this 'making sure all pregnant people's choices are supported' work? Who do you give midwife certification to? There has to be some kind of vetting. And I think the answer is, the standards for midwife certification should be created by experienced midwives who know what's what. So it's not that 'it's impossible to draw a line, so don't even try'- it should be that a line is drawn by people who know what they're doing.
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This is a feminist issue- but it's difficult
The book emphasizes that this is a feminist issue. Yes! I agree! Birth trauma is a feminist issue, and we should talk about it more. On pages 88-89, Hill speculates that maybe this is difficult to talk about because people who have bad experiences during birth tell themselves that there were reasons that it had to be that way- and to find out that actually it didn't have to be that way, and they deserved better, can be traumatic:
To say that we are not powerless in birth can be extremely triggering for those women who feel that they absolutely were, and this alone could explain the lack of feminist attention to the birth experience. Such a large percentage of women have had utterly dreadful birth experiences in the past few decades, and they're been given these experiences in a well-rehearsed cultural package bound up neatly with the ribbon of unwavering faith in medical science to rescue them from their inadequate bodies. And the bow on top is the repeated mantra that a healthy baby is all that matters, setting them up for a lifetime of reluctance to question whether their experience could have been less traumatic, could have been different, could even have been glorious.
Anyone who talks about birth in positive terms, therefore, can face a huge backlash, which often seems to me to come from a very hurt place, a wound in women that is often both personal and cultural. I felt the pain of it myself, when, after my first hospital forceps birth, a friend, who had been pregnant at the same time, had the easy home birth that I had been hoping for. I can still remember where I was when I heard the news, and it floored me. I felt gutted - and yes I know that some people will try to tell me that this was simply because I had been set up to view one kind of birth as somehow 'better' than the other, that I felt I had failed the test somehow, and my home birth friend had passed it. But I was not gutted because I had had my silly head filled with unrealistic ideas of the perfect birth - far from it. I was gutted because I was traumatised. I hated to think about her birth because it brought up so many 'what if' questions about mine. I was so deeply wounded by my own birth that it was almost unbearable to think that it could have been different for me.
But also, to me it feels sort of more difficult and complicated than other issues. Because, doesn't it feel like there is an argument to be made that pregnant people *shouldn't* be allowed to do things which put their unborn baby in serious danger?
Or, to put it another way, as far as reasons go for restricting women's choices/ telling them what they're "allowed" to do with their own bodies, saving a baby's life seems like a really good reason. Childbirth truly is risky. Before the era of modern medicine, people were dying in childbirth all the time.
But, maybe every feminist issue used to feel complicated. Maybe people used to feel like "well there are plenty of good reasons for not letting women [vote/ have a bank account/ get divorced/ etc]," and now that feminists have been talking about these issues for so long, they no longer feel "complicated." They feel obvious.
The book said that there's a big connection between "pro-life" ideology and controlling women's choices during childbirth. I feel like, superficially this seems surprising- isn't "pro-life" about wanting to have a baby, and "pro-choice" is about wanting to kill one's unborn baby- and so women who are giving birth are on the "wanting to have a baby" side of that, ie, the "pro-life" side. That's how I would have thought about it, years ago when I was evangelical and "pro-life."
But the way I see it now is more like this: "Pro-choice" is about supporting people's choices related to their own health and their own bodies. If they want to be pregnant, we support that, and if they want to have an abortion, we support that. But "pro-life" is based on the idea that women can't be trusted to make their own choices, so we need the government to make laws to force them.
Page 36 says:
Some may feel that a pregnant woman should not have the right to make a decision that puts her baby 'at risk', but, unfortunately, as unpleasant as it may sound, the unborn child can never and should never be considered to have any rights - and as soon as we put so much as a toe in this water, we begin to stray into a place in which a woman can be taken from her house by the police and compelled to undergo major surgery against her wishes. [Earlier in this chapter, there was an account of a Brazilian woman who was taken by police and given a C-section because of a court order.] There is a creeping nature to such a mindset - once we begin to make provision for the occasions when doctors or the state may overrule a pregnant woman with full mental capacity, we are on a very slippery slope indeed. Instead, the point needs to be made clear, often over and over again, that we have to trust women to be the ultimate decision maker in birth, no matter what.
I think... I think it's difficult, and this is something you should really think through rather than just agreeing with it because it's the "pro-choice" or "feminist" opinion on it. But basically yeah I do agree with what the book is saying there. It has to be the pregnant person who is making the decisions.
Even though pregnant people might sometimes do a bad job of making decisions, there's nobody else you could pick who would do better. Sure, we can think of hypotheticals where a pregnant person decides to do something which is a really bad idea, and they or their baby might die as a result- but there are also plenty of cases where the government makes bad decisions for pregnant people- and that would happen far more frequently.
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It's such a scam that they've got us believing women are weaker
Can I just say, it's such a scam that society has us believing that women are weaker than men. Seriously! Women/ people with a uterus are the ones who make new people. We create life! And we have to deal with menstruation, pregnancy, and childbirth. Even a healthy pregnancy is extremely difficult, very hard to go through. Cis men don't have any kind of equivalent difficulty that their bodies go through. If cis men are healthy, their reproductive organs never give them any trouble. IMAGINE. Blew my mind when I realized that. Can you believe patriarchy has really tricked us into thinking women are weaker than men?
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It's hard for me to get my head around the idea that these unpleasant but normal medical procedures violate patients' rights
When you are in labor, you might have all manner of people sticking their fingers in your vagina to check how dilated your cervix is. (This is called a vaginal exam.) *I* personally did not have "all manner of people", just 1 doctor, but yeah it is common that women report having all manner of people sticking their fingers in the woman's vagina.
Here's the purpose of the vaginal exam: During the process of labor, the cervix opens in order to let the baby come out. This could take hours and hours. Doctors feel that it's useful to do a vaginal exam to check how far the cervix has opened- this gives you a sense of how far along you are in the process. But it's not *necessary* to do it. You could just labor without knowing how dilated your cervix is, and then when you have a feeling like you want to push the baby out, that's how you know it's time to push the baby out. (Note that when the pregnant person has an epidural, they might not be able to feel this feeling of knowing it's time to push.)
So the vaginal exams are not medically necessary. But patients often like to know their progress, so they want to do them. But some patients do not want to do vaginal exams- and they should absolutely be allowed to say no. It's your vagina! You're not *required* to let people stick their fingers in there, wtf.
Page 38-39 says:
The interesting thing about VEs is that they are completely optional - but not a lot of people know this. You would think it would be obvious - of course nobody can put their fingers inside your vagina if you don't want them to, right? But the majority of women are unaware that they are perfectly entitled to decline. Furthermore, some women report a nagging sense that they are entitled to decline, but are unable to voice their refusal, whereas others do manage to decline but are then either directly or indirectly coerced, for example by being told they cannot be admitted to the ward or use the birth pool unless they comply, or by simply being told they 'have to' - which is of course incorrect, as you don't 'have to' allow anything to happen to your body against your wishes. Still others consent to the VE but are told afterwards that their midwife or doctor gave them a 'sweep' or broke their waters 'while they were in there'. Women to whom this happens report finding it extremely violating and yet rarely complain formally about it, perhaps because there is a widespread and unspoken acceptance that maternity care requires you to 'leave your dignity at the door' and can at times be violating by its very nature.
And I also want to put a few quotes here about doctors respecting patients and how that can come across as unusual. From page 276-277:
What is also at risk of happening is women who, for whatever reason, can no longer have the straightforward birth they really wanted, feeling like they no longer have any rights or choices. As some put it, 'the birth plan went out the window'. On the contrary, when those situations that truly do require medical help arise, respectful care means continuing to keep women and their feelings at the heart of every action. Nothing illustrates this better than the many examples of clinicians trying to raise levels of empathy in highly medicalised settings. In Nottingham, obstetrician Andy Sim has been one of the pioneers of 'woman-centered caesarean,' which shifts the focus of surgical birth away from clinicians 'doing their job' and towards the woman as the pivotal character in the drama. ... One of Andy's 'small' changes - which of course any woman may ask to be part of her caesarean - is that, while the catheter is being inserted, theatre staff who are not needed for that procedure go and stand at the woman's head. When I've told people about this option, many will look a bit baffled and ask - why? Perhaps their first assumption is that there is a complex medical reason for the doctor's actions, but in fact the answer is simple - it's entirely about the woman's dignity. This seemingly small act of kindness says: 'We, the medical team, are thinking about what this is like for you, the person giving birth.' It's a sudden flash of empathy for how a woman, on the threshold of becoming a mother, may feel at that moment as an area of her body that is usually kept private is exposed. And it's an acknowledgement that in birth, everything is remembered, and everything 'matters'. Perhaps people are initially baffled by this because we're simply not used to the concept of building the activity in the birth room around the needs of the woman.
And this one from page 267:
As Hermine Hayes-Klein put it to me: 'How much would it change in the birth room if everybody in that room really understood that the woman could not be touched without her permission - this would be transformative. And the fact that it would be transformative tells you everything you need to know about how informed consent is routinely ignored in current maternity care systems.'
Yeah... I feel like, for me, it's hard to get my head around the idea that... like... it is right to limit how much medical staff look at patients' "private parts" and/or touch patients in intimate, invasive ways. Because, isn't that how it always is with doctors? Like, of course I don't want strangers looking at me or touching me like that- but if it's a doctor, then you have to, that's just how it is with doctors.
I don't really know how to put my thoughts into words on this... I really like what these sections of the book were saying, but I just can't see how to fit in into my understanding of what medical care even is.
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I pay the big bucks for the international hospital
In China, I always go to international hospitals for my medical care, because they have standards for bedside manner, patient privacy, etc, which match what I'm used to from the US. I have had bad experiences in Chinese hospitals. Chinese hospitals are very good at giving you the medical treatment you need, but don't do anything about caring for your emotions surrounding it.
This was especially important to me when I was pregnant, because I've heard things about Chinese hospitals- like they will push you into having a C-section if they think you're taking too long, male partners aren't allowed in the labor rooms, you get treated as just an object in a system instead of a person- that kind of stuff. (In some cases, the reason they don't allow your partner to come to the labor room is that it's not just you- there will be other women also laboring in the same room. You don't want *other people's* male partners in the labor room with you. In some cases, though, it's a private room, and I have no idea what the justification is there.)
These things won't be true of all Chinese hospitals- there is a huge range. (And there are public hospitals, private hospitals, international hospitals, VIP departments in public hospitals- all of which will give you a different kind of experience.) And sure, plenty of people report having good experiences at Chinese public hospitals too.
Anyway MY POINT IS, I pay the big bucks to go to the international hospital.
Yes, it is much more expensive. Not everyone has access to that kind of medical care. And that's the problem.
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This book is not trans-inclusive
I have to put a warning here, for readers who are trans/nonbinary/queer, that the language used in this book is not inclusive of trans people. The book constantly refers to people who give birth as women, constantly talks about how this is a women's issue, etc- and yes, that is true, this is a women's issue- but *not* all people who give birth are women. Trans and nonbinary people exist. I think it's better to use language like "women and/or people who give birth" but this book doesn't do that, it's always just "women."
... Oh, oh dear, I just did a little googling and found the author's substack and it's, ahem, not really trans-friendly. Oh wow, I'm actually really shocked to see that- because trans rights are all about trans people being allowed to make their own decisions about their medical care, rather than having the government/ gatekeepers/ conservative politicians/ etc decide what kind of medical care they're "allowed" to have. And isn't that the exact same thing that "Give Birth Like a Feminist" is about?
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Conclusion
The topic of what consent should look like in a medical context is extremely important to me. And giving birth is one area where a lot of people have trauma due to disrespect and lack of consent. The message of "Give Birth Like a Feminist" is that women deserve better than that. Yes! You have choices! It's your body! But society and the medical system treat women like they are being unreasonable for "getting their hopes up" and expecting that their choices will be respected during childbirth. This definitely is a feminist issue that we should be talking about.
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Related:
A Comprehensive Pro-Choice Ethic
"Expecting Better": Asking the Right Questions About Pregnancy
"Queer Conception" (book review)
"Afraid of the Doctor" (I read this book because I have medical trauma)
I Don't Want My Baby To Be "Brave"
Doctors (part 3 of Autism & Teaching Kids to Protect Themselves)
