Monday, June 23, 2014

an empowered birth?

Sources of empowerment for women seem to be everywhere these days, not least when it comes to birthing babies. I think I heard the word ‘empowerment’ more often while pregnant than at any other time in my life.

You’d think that would be a good thing, right? More empowered women should mean more women in charge of their lives, taking it to the man, building a feminist utopia of equality at home and work.  Only, wait ... that doesn’t seem to be at all what’s happening.

So is the constant goal of empowerment actually empowering?  

A few years ago the satirical newspaper the Onion published an article entitled ‘Women Now Empowered by Everything a Woman Does’. Here’s a sample:

“From midnight cheesecake noshers to moms who don't fool around with pain, feminist achievement covers a broad spectrum," said Bradley in her acceptance speech. "It is great to be a female athlete, senator, or physician. But we must not overlook the homemaker who uses a mop equipped with convenient, throwaway towelettes, the college co-ed who chooses to abstain from sex, and the college co-ed who chooses to have a lot of sex. Only by lauding every single thing a woman does, no matter how ordinary, can you truly go, girls."
At times, the article treads a pretty fine line between satire and (ironic) sexism, but it also has a point. These days ‘empowerment’ for women seems to be a confused and ambiguous term, used from everything from a conventional political understanding of ‘empowerment’ - meaning to challenge the norms and values of patriarchal culture (as, say the ‘female athlete, senator or physician’) - to what I would say is a capitalist deployment of the language of revolution to sell shampoo and stuff - think Pantene’s new Shine Strong campaign which draws attention to women’s over-apologising, Dove’s ‘campaign for real beauty’  or the perennial L’Oreal ‘because I’m / you’re /we’re worth it’ strategy. 
The language of ‘empowerment’ seems to particularly saturate everything when you get pregnant. It sounds great: taking control of your own birth experience, banishing the drugs as unnatural and - if you don’t choose to stay at home - going home from the hospital within hours of giving birth. For an empowered mother, having a baby need not even interrupt your week.
Only that’s not always what happens. And not everyone feels empowered by their birth experience.
Nurse-academic Ruth deSouza, for example, has critiqued the monocultural understanding of empowerment through birthing that dominates New Zealand’s midwife-led maternity services. In her 2014 analysis of the experience of new Korean mothers in New Zealand, she illustrates how the Korean mothers she interviewed felt profoundly dis-empowered by the care that they received. Where they wanted more tests and ultrasounds to ease their concerns about their babies’ development - what they would’ve expected as routine in Korea - they were told ‘not to worry’ and ‘everything was fine’, increasing rather than lessening their anxiety. Where they wanted hands-on assistance and more nurturing in their early days as mothers, they were instead expected to become independent immediately post-partum.  De Souza concluded that both their medical and cultural requirements were not met. This, in turn, left the women feeling incredibly anxious and vulnerable.
I found de Souza’s study interesting for a number of reasons. First of all, because I think it strongly highlights that a uniform and universal maternity philosophy practice does not suit everyone. Second, that, while maternity services may be empowering for the maternity providers and for mothers who thrive under it, it is not empowering for all women. Finally, I think de Souza’s work gestures towards the question of whether ‘empowerment’ is really the best or most helpful way to conceptualise birth. If we mean by ‘empowered’ feeling supported and cared for, and having your body and decisions respected, then it is helpful. But so-called ‘empowerment’ often means leaving women to fend for themselves, with minimal intervention or guidance, when they don’t really know what they’re letting themselves in for. I think this says more about over-stretched maternity services with fewer and fewer resources than it does about appropriate maternity care.
And, while I agree that pregnancy and birth are natural processes, I don’t think that means we must be expected to act as if everything will return to ‘normal’ straightaway. I think this expectation is unrealistic and profoundly disempowering for many women, not least the Korean migrant women in de Souza’s study. I have heard many women express shock and surprise at just how physically weak and vulnerable that pregnancy and birth made them, about how long it took them to recover, about the agonies of establishing breastfeeding and so on. Pregnancy and birth may be natural processes, but they are also profound physiological, psychological and emotional experiences. For much of human history, my guess is the concept that would’ve best described birth and early motherhood is ‘survival’ not ‘empowerment’.
The law changes in New Zealand - driven by both midwives and what the health system describes as ‘consumers’ (hmm, spider senses tingling there - what about ‘patients’ or, dare I say it, ‘prospective mothers’?) - were a legacy of second-wave feminism. Women wanted to wrest back control of their bodies from predominantly male physicians  who routinely cut and drugged healthy women who may not have needed such interventions. That history is certainly empowering. I am in no way arguing for a return to women having zero say in birth and being treated as little more than objects.
But with the decentralisation of healthcare, the continuing cuts to maternity services - as well as increased workloads - what may once have been empowering is now dressed up in the language of ‘choice’: choose your midwife or other Lead Maternity Carer, choose how and where you want to give birth, choose to have an epidural or not. Such choice, without the support and care to make informed decisions, is not empowering for everyone - for many, it is overwhelming and alienating.
Speaking personally, I did not feel empowered by my first birth experience. I felt shocked, violated and incredibly weak. I also felt like I never wanted to go through that experience again. And even before that, I felt a lot of uncertainty about the process, and was dismayed at how difficult the system was to navigate. 
For most of my second pregnancy, it’s fair to say I was in almost total denial about the forthcoming birth. It wasn’t until the last few weeks, and a conversation with one of the consultants at the hospital, that I actually started facing what I was about to go through. 
During that conversation, the doctor said:
‘A positive birth experience this time round could be incredibly empowering’. 
That word again. 
‘But,’ he added, ‘Another difficult one won’t be.’ 
I was then asked what I wanted from the birth. Um, I guess that meant apart from a healthy baby? 
Without thinking, I blurted out, what I thought was half seriously, to the other four people in the room, ‘I want to survive it.’ 
Nobody laughed.
I guess not everyone prepares to give birth by mentally composing their wills. But my thoughts about the birth had nothing to do with empowerment, or challenging the system, or making a political statement of any kind.
After a bit more discussion, we agreed that it was up to me to make a choice and they would support me in whatever I wanted.  As I have blogged about previously, I decided to do what was - for me - the least worst option. Ironically, this time, as well as feeling physically weak and groggy and all the lovely things that new mothers experience in the first few days after birth, I did feel somewhat empowered: by the  fact that I had faced my fears and made some practical decisions that enabled me to take some control back.
Genuine maternal empowerment is not about conforming to someone else’s notion of what your birth should be like, no matter how well-intentioned they may be. It is about being supported to make the best decisions that you are able to in the particular circumstances in which you find yourself in order to receive the care you feel is necessary. For the Korean women in de Souza’s study, that meant more tests and ultrasounds and more nurturing in the postpartum period. For me, my ‘empowerment’ was incidental to, not the goal, of my second birth experience; it was a by-product of first feeling profound dis-empowerment and a subsequent quest for survival. 
Maybe we’d be better off trying not to find empowerment in everything from birth to beauty bars and feeling like failures when it doesn’t materialise. Perhaps a better concept to guide maternity care is neither ‘empowerment’ nor ‘survival’ - both of which focus almost exclusively on the individual - but on ‘support’. Different women will need different kinds and levels of support both before, during and after birth. Focussing on providing ‘support’ rather than ‘empowerment’ also ensures mothers remain at the centre of birthing experiences, but not in isolation.  
For my birth experiences, I would much rather have been able to say ‘I was supported’ than ‘I was empowered’. Though being able to say ‘I survived’ is pretty good too.