We should question medical opinion!

Submitted by AWL on 15 July, 2010 - 9:41 Author: Rosie Woods, Rachael Ferguson

I would like to respond to Melissa White’s criticism of my article. Firstly, I am not anti-medical. I am a paediatric nurse, currently working as a health visitor.

  • The wrong kind of feminism, Solidarity 3/176
  • Pregnancy is not an illness!, Solidarity 3/175

    I worked on a heart and lung ward and I know how modern medicine transforms the lives of children who, even 30 years ago, would not have survived. I am well aware that women and children used to die in childbirth, something which is now (in this country) a rare occurrence. I am glad that we have an accumulation of knowledge and skills to make pregnancy and birth safer.

    However, the point of my article was that medical intervention has become routine, even when it is not necessary, and can start a chain of interventions that result in a more uncomfortable labour for the woman, assisted delivery, or (in about 15% of births in the UK) an emergency c-section. I think there are problems in the medicalisation of childbirth that can make birth more difficult and traumatic than it needs to be.

    Women are not treated as equal or senior partners in discussions and decisions regarding their health, but are treated paternalistically and are expected to follow the instructions or advice they are given. This mirrors treatment of women in society in general.

    I was attempting to look at why women make the choices that they do. Women go into the process of having children carrying their own accumulated life experiences, which affect how each woman handles being in such a vulnerable position. Choices we make are not made in a vacuum. They are influenced by our surroundings, the information we are provided with, the support we have and the way we are treated. This is true of many choices we make, including whether we “choose” to have an induction or an epidural etc.

    A lot of women prior to labour intend not to have any interventions, but end up having them, and have very negative feelings about their experience afterwards. It is not enough to say “suck it up, at least you and your baby are alive”.

    I value medical opinion, but it is just that, an opinion. I reserve the right to have my own opinion, do my own research and make my own decisions. Medical staff and midwives are not infallible, and many common practices carried out on labour wards are highly questionable.

    Epidurals are becoming routine. In some cases women really need a break from the pain of a long labour, but they are offered too casually. I do not want to make a virtue of the pain of labour, but all research suggests that epidural use carries risks, including greater risk of assisted delivery and caesarean. If a woman decides to have an epidural that is her choice, but it should be an informed one. She should have other options such as a birthing pool. Lack of funding dictates there are not enough of these and therefore fewer choices for women.

    Induction of labour is also now routinely offered — women are booked in for an induction about 10 days post due date without real discussion about alternatives, i.e. waiting for labour to start naturally. Yet, again, research and evidence shows that labour is more painful, progresses more slowly and is more likely to end in medical intervention if labour is induced — i.e. there are (again) risks to the wellbeing of the woman and baby.

    Also, I feel obliged to say that episiotomy does not “afford easier repair” than a natural tear, in most cases. This is broadly accepted by most midwives, yet doctors continue to carry it out, usually to aid them in managing a delivery.

    And yes, this is done without knowledge and consent. It happened to my mum in the seventies and my sister three years ago, neither under anaesthesia and both against the advice of the attending midwife. The rate of episiotomies in England is 15%, USA 50% and Eastern Europe 99% (NCT 2001).

    Melissa’s assertion about episiotomy highlights my point — it is presented as fact that episiotomy affords an easier repair, when it is an opinion.

    Modern medical advances are not infallible. Look at the use of incubators for low birth weight or pre-term babies. Great advances have been made in caring for premature babies in neonatal units. Yet the way they are set up has resulted in the forced separation of mother and baby after birth. Common sense would seem to indicate that this was just an unfortunate necessity.

    However, in South Africa, due to lack of funds for incubators, they discovered that low birth weight and premature babies do better than those in incubators if they are kept in skin-to-skin contact with their mother (Kangaroo Mother Care). Babies can be cared for this way even while being ventilated. The evidence for this approach to care is very convincing, yet in this country mothers and babies are separated after birth if the baby needs to go to special or intensive care.

    My point here is that modern medicine doesn’t always have the right, or rather the whole, answer. It is not being anti-medical to question things and pose alternatives, and the natural way isn’t just some hippie pre-occupation.

    I am not some woolly-headed herbalist who thinks that petals can cure cancer. If I am seriously ill, then damn right I want good quality medical advice and all the treatments available. But I don’t think this means I have to surrender the right to question and have knowledge and control over my body and health, in pregnancy or at any other time. The question of a woman’s right to have knowledge of and control over her own body is central to feminism.

    Finally I think there is a problem with the knowledge that is generated through research and practice. Firstly, conclusions cannot always be trusted; medical research can be funded by various organisations with profit motives. Secondly, medicine is very elitist. I am for the “democratisation” of healthcare — we should seek to level up awareness of health issues, treatments, drugs etc. We should aspire to a situation in which health care is rooted in communities, and more people in general should possess medical and health care skills.

    Rosie Woods, west London

    This is a feminist issue

    I was appalled by “The wrong kind of feminism”. The author slated a valuable critique on modern medical practices surrounding childbirth. It shows a worrying naivety at best.

    I am in my final year of training as a midwife and have a wealth of first hand experience of obstetrics in the UK (and have read plenty of research from Australia).

    Modern medicine is not a benign or neutral technological advance, as the writer of this letter appears to believe. And the field of obstetrics is highly contentious, probably more so than psychiatry.

    Archie Cochrane’s 1970 critique, which sparked the move toward the so called “evidence based practice” that dominates nursing and medicine today, singled out obstetricians as those most likely to be utilising practices that were not supported by any evidence. Throughout the last 50 years this has included such practices as shaving women’s genitals, administering Thalidomide, starving women in labour, and worst of all, routine unnecessary episiotomy.

    Episiotomy, for anyone who doesn’t know, is the cutting open of a women’s perineum (the tissue between the vagina and anus) with scissors, as the baby delivers, causing significant pain as it heals and scarring. If that isn’t physical assault, then I don’t know what is. To say “hospital obstetrics is geared up for worst case scenarios and the intervention that flows from that”, demonstrates a complete lack of understanding of how hospital maternity care works. It is the other way round — unnecessary intervention flows from being geared up for the worst case scenarios! Hence the caesarean section rate in this country being double that of the World Health Organisation recommended level, in many hospitals.

    Women taking childbirth in to their own hands, applying their own knowledge and making choices about their own bodies for themselves, were being cast as irrational and irresponsible. This reinforces an hierarchical and sexist medical model, in which the experts are not to be questioned, because they’ve seen “when it goes wrong”. Using your medical knowledge to scare women and coerce them into making the choices that doctors or midwives see as the “right” choices — well it’s no choice at all. Women have suffered at the hands of poor maternity care, in this country and internationally, for too long — this is a feminist and socialist issue.

    Rachael Ferguson, north London


Submitted by cathy n on Tue, 20/07/2010 - 14:47

I broadly agree with both Rosie and Rachel on how high-tech, hospital-based medical intervention can often play a negative and oppressive role in childbirth for women and their babies. Believe me I have the scar to prove it! And I also share their passionate belief that childbirth is an important issue and should remain so if socialists want to create a more humanistic society. However, (please get ready to groan), I wouldn't throw the baby out with the bathwater on this!

Recent feminists have criticised the "natural" childbirth's movement's description of women as essentialist and their demand for a "natural" way of birth as sometimes moralistic (impossibly high standards). Before I go on to describe the reasons why let me clear two things out of the way.

First I do not put Rosie and Rachel in the camp of essentialism or moralism — they put women's own (complicated) choices and collective self-organisation central to creating better maternity services, and I agree with that approach.

Secondly two of the criticisms I am about to describe come from the "third wave," post-modernist camp of feminism. As such they are based on experiential relativism — one woman's cesarean is scarring for life, is another woman's liberation, get over it! Such a view might down play any kind of universal experience for women, and would make it difficult, if not impossible, to campaign for any kind of positive demands.

But with that "health warning" I think some criticisms are sensible enough and made me question some of my own assumptions. I think they highlight the fact that even giving women the choice of home birth, which is the more specific argument under discussion, won't necessarily help all, or even very many women.

There are two criticisms worth thinking about.

1. Stressing childbirth as joyful and/or natural, and joyful because it is natural limits a woman's definition of her experience during labour. What about women who are planning to "give up" a child for adoption, or have been through a surrogate pregnancy it is said.

That is too extreme an example, but there are of course many others to think about. The experience of one I knew a woman certainly made me stop and think. When other mothers were writing "only gas and air" in their birth plans, she was writing "epidural 24 minutes after the onset of labour". She wasn't afraid of childbirth. She certainly wouldn't have been afraid of arguing with a health professional. She did have a very firm plan of her own. She was having one child and this was how she was doing it. No doubt at all it was in informed choice. On balance she thought the drugs were too good to refuse. She got her epidural, and she described the experience as.... joyful.

My point would be that though my friend is an unusual person, her experience is not so odd. The drugs are here to stay and as such, even in a more democratic world, where women are better informed etc, would be very many women's "informed choice". Either we come up with a good reason for banning the drugs (and there isn't one as far as I can see) or we have to build some continuing perceived "need" for drugs into the way we look at things.

2. Having a home birth assumes you have a home fit to give birth into. But "home" may not (even assuming everything goes well) safe, comfortable, big enough, empty enough for giving birth in. This is especially so for many working-class women.

In the bio-pic of Ian Dury — Sex and Drugs and Rock and Roll — Dury's first wife is seen giving birth to her son upstairs in bed while her husband rehearses (very loudly) with his band downstairs. Out pops the baby, downstairs she comes (minutes later) with the boy, to tell the band to shut the f*** up. Her husband hand over his fag to her to inhale on, while he kisses the boy on the head. Such horrible depictions of "home life" remind me that "home" isn't part of our vision here. Giving women autonomy and control over how she gives birth is.

When it comes to practical campaigning perhaps we should be prioritising the demand for more birthing centres inside health centres or hospital maternity units, and more so than facilitating home births.

That's the extent of the relevance of post-modern feminist critique as far as I can see. But I'd like to bring in another issue to the discussion.

In a better, fully-funded, health services medical professionals would be able if not necessarily willing to approach people they help more holistically. Pregnancy and childbirth demands this approach as much, and more, than any situation. If we agree that holistic care is what we want then you have to allow for those women who, despite good support from midwives (which in general many women even in the NHS do get!) find themselves simply unable or unwilling to manage childbirth "naturally". Who may, despite support to be in control etc, expressly say that they want to be "looked after", who even want e.g. an elective cesarean because they are so scared of giving birth. It is very unfashionable to let "patients" hand over control to doctors but is it "wrong"? At one level one may wish to call this "false consciousness" — don't they know they can do this better? I would say, precisely because, as Rosie argues, women bring their entire life experience to childbirth, I think you have to accommodate such needs, because that's what they are — "needs" — and should be respected as such.

Cathy Nugent

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