An article in the most recent edition of Mother Jones calls into question the natural childbirth movement (among other things). Strong reactions to/against the natural birth movement — especially in regard to home births and the use of midwives — are nothing new; however, Kiera Butler’s article isn’t exactly a critique of natural childbirth. Instead, it asks a seemingly simple question with some heavy implications attached: If doctors are required by law to disclose the dangers and side-effects associated with cesarean sections, why shouldn’t they also disclose the potential dangers of vaginal births? Good question. Butler’s ultimate point is that if we are to truly empower women in the process of pregnancy and childbirth, then they need all the information, and that includes information about vaginal birth injuries.
As someone who sustained a very minor, but long-lasting, injury from a vaginal birth, I was kind of in awe to discover the prevalence of these outcomes ranging from a minor tear, like my own, to broken pelvis bones and prolapse (which often doesn’t appear until middle age). According to Butler’s piece, 50 – 80 percent of women who give birth vaginally sustain some kind of injury. My first reaction: wow, I am not/was not alone! Part of the purpose of her piece: women need to talk about these body damaging results of vaginal birth. There is no shame. It’s natural, after all.
As a pretty hard-core natural birth advocate, I did take issue with a number of elements in Butler’s piece. For example, yes, like some of the women she describes in the piece, I labored for 40 hours without meds. Do I tout this like a badge of honor? Um, not on a daily basis or anything, but damn straight that I’m amazed by and proud of my ability to bring a child into this world through a mentally and physically arduous process. It is a badge of honor and should be. As, should be, a six hour labor or a two hour labor or a c-section. As, should be, hospital births and births in cars on the side of the road. All of the different labors in this world (as the name indicates) are hard work and should be recognized as such.
Additionally, some of her points are a bit fast and loose. For example, bringing in numbers about the growing cost of nursing home admissions and the growth of the market for adult incontinence products. It isn’t at all clear what percentage of this is actually the result of vaginal births (and figuring this out might be close to impossible). It’s also never clear to me the exact number of women and/or doctors she interviewed for this article, and she obviously hand-picked the more nightmarish stories. I’m guessing the pool of subjects wasn’t all that large.
Lastly, I have a huge problem with her use of the word scary. In a recent episode of The Longest Shortest Time, Butler is interviewed by the show’s host, Hillary Frank. In the opening, Frank states the title of Butler’s article, “The Scary Truth About Childbirth,” and then says, but Butler doesn’t want us to be scared. Well, if you don’t want to scare people, then don’t use the word “scary” in your title (seems obvious enough). I understand it gets readers, but come on…. This is supposed to be about empowering women through shared information about childbirth; however, I have a friend who is pregnant right now, and she is already a little scared. Would I want her to see the title of this article? Hell, no. Also, I both read the article and listened intently to the interview, and I have to say, if they didn’t want us to be scared, they did little to provide positive reinforcement for the benefits of unmedicated vaginal births. I have already been through childbirth, and I was scared AF! after reading/listening. While I truly believe that women should have access to some of this information, I would hate for them to read it through this particular lens of “scary.”
All that being said, I did listen/read with a truly open mind and great interest. After all is said and done, I still firmly believe that unmedicated vaginal births are far preferable (when and where possible for the mama) to c-sections (this is fairly undisputed in the medical community). I feel that even given the worst case scenarios — things like a broken pelvis and prolapse — the outcomes of vaginal birth are ultimately less risky in a life and death sense than those associated with c-sections. I also believe strongly in all of the research that associates vaginal births with supporting a baby’s microbiome, which impacts their long-term health. I do believe the evidence showing that epidurals potentially interfere with breastfeeding outweighs the evidence showing that they don’t. Even given all of these ways in which I might be seen to disagree with Butler’s article, I still think she offers a valuable perspective and important information. As I said in the beginning of this post, simply knowing how not alone I was is deeply fascinating to me.
I remember feeling almost ashamed when our group of babes and parents would meet up for playdates or other events months after our births (Levi has a small group of friends all born within three months of each other), and I still could hardly stand up and certainly not for an extended period. It hurt to walk and move about. When I did tell other mothers, they seemed shocked. Now, it’s worth noting, that a few of the mothers that I hang out with are younger than myself, so they might have bounced back much more quickly. Although, I also just spoke with a mother in her twenties who is suffering from the same painful, unhealed granulation tissue that I suffered from. It is so important for women to share these stories, and it was truly eye-opening to read the stories of the mamas in Butler’s piece, who are/were far worse off than me. Like Hillary Frank, I too read, Ina May Gaskin’s Guide to Natural Childbirth like a bible while I was pregnant and had been envisioning one of these ecstatic home births for myself. When mine was nothing like that, I struggled for close to two years to feel okay about it.
Lastly, the article did make me think more closely about what exactly I knew about vaginal birth heading into mine. My midwife is a kind of legend in the area and, with thirty-five years of experience, is one of the most knowledgeable, experienced childbirth practitioners one could ever hope to get. She spent countless hours giving us information. Of course many of those hours were spent addressing the more immediate fact of pregnancy — discussing symptoms, taking care of your pregnant body, checking on how the babe is doing, and so on. Many of our hours were also spent weighing the very difficult decision between home and hospital birth. As we got closer to the actual event, we put a birth plan in place. I learned the mechanics of birth — the what would actually happen to my body as the baby made his way out and earthside, but in retrospect I knew very little about what effects all of this would have on my body. I knew from friends who had children that at six weeks you have an exam that tells you whether you can return to life as normal. I had BIG plans for this moment, as, even before baby arrived, I was eager to return to the active lifestyle I was accustomed to. Did I know how long is too long to push? I didn’t. Now, my midwife might even disagree with the ACOG guidelines of no more than three hours of pushing for first time moms, which is fine, and I’d be open to her perspective. The point is that I simply didn’t have that knowledge going into the birthing experience.
(I’ll stop after this, I promise). One more thing that this article points to, but doesn’t mention explicitly, is something that I’ve thought about ever since my own experience: We need to change the expectations around time-to-heal for postpartum women. While many women are cleared for “life as normal” at the six week mark (I just wrote sex week mark there – ha!), some of them have sustained injuries that go undiagnosed and many others just are not ready for that at all. I know that given how healthy and fit I was, I just assumed that at six weeks I would have fully bounced back. I never knew you could be in pain for up to a year, and now hearing some of these other stories, I know the pain could be even longer-lasting. I do agree with Butler in this sense. These stories about injury and long-term healing after birth (vaginal or c-section) need to be told more often and with a bigger spotlight.