Birth Shame and Blame: A Response to An Epidemic

For twelve solid years I pioneered the natural birth industry as a childbirth educator, doula, student of ‘traditional’ midwifery, and advocate. This included a strong focus on instinctive and physiological labor and birth.

The motivation to teach about the power of birth, from this lens, was supported by scientific evidence in the fields of physiology, endocrinology, neuroscience, personal experience and a belief that the mammalian female body was created to give birth instinctively.

Deeper yet, I became a spokesperson for natural birth after the birth of my first child because I saw birth as a women’s rights issue; I wanted to stop violence against women in birth. Naturally, I saw the medical institution as the culprit (and those who worked within it) and Midwifery as the solution.

I believe that all passion is motivated initially from a place of heart and soul; a desire to ‘do good’ and ‘help’. However, although the initial motivation stemmed from a place to ‘do no harm’, it is hard to maintain that place of pure motivation without developing an ideology.

I want to talk about how the ‘natural’ birth ideology can be contributing to the concerning rise in childbirth shame and postpartum depression. Including my personal and professional mental battle, as I wrestle with this paradox and help mothers find healing.

Fifteen years deep I am still grappling with the question: If birth is physiological and instinctive than why is it not the experience for so many labouring mothers?

What stands in the way of accessing this mammalian birth right? And why does it matter?

For years I believed that if care givers would just support birth physiology and get out of the way with all of their protocols and interventions, then women would birth instinctively and uncomplicated most of the time. This led to a belief that the reason why there is a high rate of complicated births, followed by unwanted c-sections and interventions, was/is the caregivers ‘fault’ for not applying physiological evidence based care.

From this vantage point the ‘cure’ was/is simple: Care givers need to change their practices to be supportive of physiological and instinctive birth.

THE FIRST LAYER OF BLAME

This mindset led towards what I would consider to be the first layer of blame: If childbirth did not turn out the way the mother had hoped, someone is to be blamed, and that someone is the caregiver!

For a few years I was stuck in this mindset and could not see beyond it. Care givers of birth (Obgyn, Midwives, Nurses) were at fault; the system was at fault; and the education was at fault. Mothers could scapegoat their authentically painful feelings by adopting this mindset. Instead of authentic grief being expressed in response to their unwanted birthing experience, mothers could project anger towards the institution of birth and make them ‘wrong’.

This anger has fuelled many movements within childbirth: Freebirth/unassisted birthing; Cesarean prevention and awareness; Mainstreaming midwifery; Childbirth rights; Thousands of blogs and videos; Documentaries about the politics in childbirth; and Lawsuits against mistreatment in labor.

These movements have opened up the conversation about childbirth in that, giving birth is no longer a private affair but a public topic of conversation.

Within a decade I have personally witnessed the business of birth BOOM! Doula is no longer a puzzling sounding word with no context; but rather a necessity for pregnant families to have by their side. We have experienced an explosion within the Doula industry: There are more courses and instructors now, more Doulas, online programs, extra ‘workshops’, birth bag supplies to be purchased, and even postpartum doulas.

If you are pregnant you are bombarded with more than a handful of different childbirth classes to take, all of which are most often focused on helping you have a ‘natural’ childbirth experience; some even focusing on hypnotherapy to help you train your brain to ‘let go’ in labor so you can have a pain-free physiological labor.

Midwifery has become mainstream (for the most part) and more and more people are hearing the word and choosing a Midwife as their primary care giver. And, for pregnant families within my home city of Edmonton, many are denied access to care because there are not enough midwives to serve the demand. Met with outraged citizens, many of these women who are denied access of care are afraid to give birth with an Obgyn in attendance (I was one of these women who feared OB care).

THE SECOND LAYER OF BLAME

This feeds what I believe to be the second layer of blame: The system has denied women access to caregiver of choice; it is therefore the systems fault for a unwanted birth outcome.

Again, outrage in regards to ‘lack of choice’ has motivated a movement to draw awareness to the fact that this lack of choice is a violation of birth rights. This has led to what I would call the second wave of unassisted birthers. The first wave was motivated by a desire to have autonomy and ownership over the birth experience, the second wave is in response to a denial of care. Two different starting points.

In all of this, the natural birth movement is still very much at the forefront of all of these movements. From what I have gathered over the years, more women are desiring a natural birth because of a belief that this is the best way to give birth. A belief that I have fostered and fuelled. And although part of me believes that this is true, I cannot know that it is the absolute truth – especially if it is causing much emotional pain amongst todays mothers. Birth empowerment and informed choice are high up on the ‘needs’ list for pregnant women.

And throughout my career as an advocate and educator, I taught exactly this: If you just get the right caregiver (or no caregiver), who supports birth physiology and altered states, and who listens to you and supports your needs, you will feel safe enough to let birth happen to you.

All you need is the right environment that supports your hormonal needs in labor, and you need to be undisturbed and left alone so you can find your way. Albeit, all of this was/is supported by science and what we know about instinctive physiological labor, I still found myself perplexed when I attended or was told about a ‘birth that didn’t work out’.

What went wrong? Who interrupted the labor? Who was to blame?

Underneath these initial responses were thoughts that something got in the way: It must have been due to hidden unprocessed trauma; discomfort with letting go; psychological challenges; unhappy relationship; discomfort with sexuality; discomfort with losing control; low pain tolerance; unsupportive environment etc.

As you can see, there are thousands of possibilities. Some of which may be true; they may have contributed to the outcome. However, what is the benefit in figuring it out and focusing on all the reasons why birth ‘didn’t happen’ the way a mother had hoped it would? What if how a mother gave birth didn’t matter, as long as she was supported in a kind, considerate, humane way?

THE THIRD LAYER OF BLAME

This leads to a third layer of blame: I, the mother, must be at fault. My body failed me because I didn’t have the outcome I wanted…the outcome that society is suggesting I have. Anything ‘less’ is unforgivable and someone needs to be ‘blamed’.

WHEN THERE IS BLAME THERE IS SHAME.

Each of these three layers of blame foster shame and worse, distrust in the self (and body for future births) and the other (care givers). This is cultivating the very thing that I, as an advocate of natural birth, was trying to eradicate from the very beginning: violence against women in childbirth. I can’t believe it has taken me this long to realize this and see through the cracks.

WHAT IS WORSE: OVERT EXTERNALIZED VIOLENCE OR INTERNALIZED SELF-PERPETUATED VIOLENCE?

Violence is violence and they both feed disempowerment and oppression. Internalized shame is a violent act that disempowers every mother; diminishes her life force; keeps her from feeling joy in her children; feeds the belief that the female body is defective; and separates mothers from each other (natural birth camp versus medicalized birth camp).

We want to foster a society that empowers mothers and families

It is ironic and beautiful that my path has led me towards a counselling profession in which I help mothers heal from childbirth trauma. I am honoured to hold the stories of shame and guilt, as I sit on the receiving end and see the damage that can be caused by a birth ideology: all women must give birth physiologically, naturally, and instinctively.

I am humbled as I sit in sessions and hold raw grief, grief that is behind the anger and the blame, grief that comes from relief and release from these binding mindsets. Grief that happens when a mother realizes she doesn’t have to hold onto the blame.

Although I still believe in the science that supports birth physiology, I have stopped my need to blame: blame caregivers, lack of choice, or women. Rather, as a holder of stories I recognize that it is far more than this. It is about transcending this mindset and discovering a new mindset that fosters kindness towards self and other.

From this kind inner place true joy can flourish regardless of one’s birth experience.

NOTE: I am not suggesting that we turn a blind eye and ignore overt abuse that does occur in childbirth. This type of childbirth trauma needs addressing and consequences. There is no room for violence period. Also, I chose to use the words: she and women. I acknowledge that not all pregnant people identify with these labels and that the language around birth is changing. Please know my intention is to be inclusive to all peoples.