Saturday, September 7, 2013

decisions, decisions

36 weeks and counting...
Yesterday, I finished work and began my parental leave. 
Today, I started bleeding and ended up in hospital, wondering if I was about to go into labour four weeks early.
Now, having been monitored and checked for a couple of hours and given the all-clear, I am back at home.
Today's experience has brought a few things into focus, not least of which is that I should probably wash some baby clothes and pack a bag for the hospital ... just in case.
Mostly, however, it has forced me to think even more about the end-game of this pregnancy: labour and birth. 
This week, I went to visit a specialist to discuss what happened last time and what my options for the delivery would be this time around i.e. would it be OK to labour naturally? What precautions could be taken to try and ensure that what happened last time wouldn’t happen this time? Was a planned caesarean an option and, if so, was it a good option? What were the risks in each of these scenarios? There were a lot more questions too, which the doctor patiently answered. His conclusion? That I am more ‘high risk’ because of what happened last time, and they’d take some extra precautionary measures to actively manage the immediate post-natal period. In his view, however, there was no reason that I couldn’t let nature take it’s course if that’s what I wanted to do. Equally, if I felt that a planned caesarean was the best (‘least worst’?) option then they would be happy to arrange that too. So I have some thinking to do - fairly speedily - about what I would ideally like to happen.  
It’s kind of funny to be contemplating a caesarean this time around, when I was adamant last time that I wanted to avoid one if at all possible. When they offered forceps as a first alternative when the baby wouldn’t come out, my first thought was ‘at least it’s not a caesarean’. In the event, I would’ve had a better recovery first-time around if I had had a caesarean. 
During this pregnancy, up until fairly recently, I’ve been in a bit of denial about the birth. If I thought about it all, I was picturing a straightforward labour and birth without follow-up surgery that would be a much more positive experience than the first one. And, maybe, somewhere at the very back of my mind, it would enable me some time in the future to tell my daughter that birth can be a positive experience. But as that mental image is getting much much closer to becoming - or not becoming - a reality, I’m starting to wonder if that really is the best option after all.
I have yet to make my final decision - although today when I thought I might be going into labour early, I was, let me tell you, much much much less excited at the prospect than last time - but time is getting short now and I need to make up mind.
While in the process of making it up, one thing the doctor said keeps resonating: ‘a straightforward labour and birth after a traumatic one can be an incredibly empowering experience ... but a labour and birth that doesn’t go too well again probably won’t be.‘ It got me thinking, somewhat digressively, about the idea of birth as empowerment, some of the ideas circulating around how best to give birth, and how they may set up women to feel like failures if their experiences don’t match that ideal.
‘Empowerment’ is part of the vocabulary of feminism (and other movements aimed at achieving liberation or greater equality), but I’m not sure it’s entirely being deployed in a feminist way in this case. Certainly, the reclamation of routinely medicalised and highly interventionist births by midwives and expectant mothers is, at least in this country, viewed as one of the gains for women made via second-wave feminism. I’m not knocking that by any means, particularly after the reading I have done about the kinds of births women were subjected to in the post-war period, and still are in some countries. I agree that pregnancy is a state of health and that in the roughly 80% of births that are straightforward (not easy) probably minimal intervention is required. While the ideal of natural, drug-free birth is still contested - some doctors, for example, argue that pain management is also an advance and advantage that women should be entitled to in labour and birth - it is nonetheless mainstream in a way that it wasn’t in the 1950s-1970s. 
There is, however, a sense that a natural birth without drugs is the ideal to be aimed for and that opting for an epidural and/or caesarean or other intervention that is not medically necessary is ‘the easy way out’. It can also be the case that women who have interventions that are medically necessary can feel ‘cheated’ out of the birth experience they wanted, or feel as if they have somehow ‘failed’. It’s interesting that both these terms - cheating and failure - are also used when it comes to tests, exams, sports and other competitive events. When did how a woman ‘performed’ during childbirth become a measure of womanhood and so tied up with her identity as a new mother?
I can’t say for sure, but I think what began as a liberationist approach to highly medicalised births that really disempowered women has been co-opted from its feminist origins to prop up the the ideology of intensive mothering. In this ideology, a woman commits herself totally to motherhood (which, in sociologist Sharon Hays’ terms is ‘child-centered, expert-guided, emotionally absorbing, labour-intensive and financially expensive’). But I think this ideology takes root even before birth, not only in the surveillance of expectant mothers’ habits, but also in whether they ‘achieve’ an ideal birth (giving a whole new meaning to the phrase ‘labour-intensive’). Furthermore, the ideology of intensive mothering is pro-natalist: it defines all women primarily through their reproductive capabilities and, in doing so, props up heterosexual, cisgendered womanhood as the norm by which all women are measured. That doesn’t seem like feminism to me. 
I wonder, then, if the language of childbirth should be less about ideals and ‘achievement’ - and, the flipside, ‘cheating’ and ‘failure‘- and more on genuine empowerment. This means having the structures and resources in place to ensure that women can make fully informed decisions about what might be best in their own particular circumstances so that their birth experience, however that experience plays out, is as positive as possible. 
How might that help me with the decisions I have to make?
If I opt for nature to take its course and have a natural labour and birth, I may well achieve that ideal birth I can see in my mind’s eye, the one that would likely mean the quickest recovery time for me and positive outcomes for my baby. But I may not. Neither me, my midwife, nor the specialist can say for sure whether that ideal birth will become a reality. If I choose to let nature take its course I need to go into it fully aware of the potential risks, and the possibility, admittedly not huge, that what happened last time might happen again. I need to ask myself whether I’m prepared to risk that. And I need to make the best possible choice with my eyes wide open rather than dwelling on ideals and ideologies.
Because, whatever I choose about how I want to give birth this time, I have nothing to prove to anyone about what it takes to be a woman.