Obedience to the White Coat is Not Always What’s Best for Birth

Each culture and country’s challenges around birth vary, but in nearly every pocket of the globe the majority of women are faced with disrespect, coercion, and even abuse during their birthing times. Many families turn to the doctor in the white coat to ensure what has become the only measure of success – a breathing mother and baby – according to the doctor’s schedule and protocol. However, one writer and activist encourages us, as maternal health activists and midwives, to go beyond this measure and protocol. She asks us to break the silence, stand up for humanity in birth, and ensure a powerful, transformative experience for every birthing woman.

Learn to support women in their choice to birth their own way. Become a midwife or become a doula with Birth Institute.

Consistent with reactions to women’s movements of the past, women who have begun to demand humane treatment in pregnancy and birth often hear the “first world problem” quip. In other words, women, stop your whining, realize how “good you’ve got it” and get over yourselves. Those statements aren’t just dismissive, they’re lathered in ignorance. For, to believe that justice issues in birth are only Western women’s problems, reveals a complete lack of understanding of the myriad of issues that women face in birth around the globe. And while each culture and country’s challenges around birth vary, there is a very distinct thread of disrespect and abuse that is rampant – it pierces nearly all cultures and every country.

While it is especially important to understand the specific challenges that women face in the areas that we live in and serve, it is foundational to understand the broadness of the dilemmas that women face across the globe. Western women are most familiar with things like mandatory surgery policies, high cesarean section rates, and non-evidence-based interventions and routines; and women in other regions endure lack of access to trained and skilled birth attendants and clean facilities, separation from loved ones and support people, high episiotomy rates, even higher cesarean rates, and routine Kristeller’s maneuver.

Whether a woman is hiking miles while in labor to get to a clean clinic with trained staff, or another is frantically seeking someone to support her in her choice to birth her baby with her vagina, both have their agency in birth stripped from them. Whether a woman endures her labor with strangers, separated from her husband and loved ones, or another is compelled to undergo unwanted surgery, each claws uphill against systems that don’t allow women to hold ownership over their bodies. When women are forced onto their backs with the weight of another splayed on top them as they push, when their tender vaginas are sliced as routine, when they’re made to do as they’re told under threat of their own, personal liberty, their most basic humanity has been stolen.

Birth is a landscape where violence against women has become a global, societal norm. If a person dons a white coat and sterile gloves, he may hold a woman down, penetrate her, tell her to be quiet, all under the pretense of “ for the good of the baby.” How pervasive this unquestioning obedience to the white coat is may vary somewhat by culture, but this “doctor-as-god” opinion is quite prevalent across the board, allowing for a strangely lit stage for abuse of power and forced submission.

Michel Odent has has been quoted as saying, “…many health professionals involved in antenatal care have not realized that one of their roles should be to protect the emotional state of pregnant women.” It’s true. The universal measure of a successful outcome is a breathing mother and a breathing child. How is it that we have arrived at a place that devalues the pregnant woman to such a degree that a desire to protect her emotional state in birth is tantamount to a “western white woman’s problem?” How is it that a significant component of a woman’s health has been reduced to petty selfishness over lamenting about her “experience?” Why are we okay with ushering more and more women into motherhood through trauma?

Women should not have to rely on their ability and privilege to hire an independent birth worker to provide them with emotional support and advocacy. Every woman, regardless of geographic location and socioeconomic status, has a human right to support and safety in pregnancy and birth. Every person who identifies as a birth worker – whether she is a midwife, nurse, doula, or physician – has a responsibility to protect the birthing space of the women she serves.

That women must prepare for birth with strategic defensive plans, that they must hire specially trained people to navigate the unfriendly terrain with them, reveals an incredibly perverse system whereby women are treated as property. No matter how hard a pregnant woman prepares, no matter how much support she has, she is at risk of abuse. It’s a roll of the dice, because as soon as something veers away from whatever her care provider deems as “normal,” she is subject to force, coercion, and threats to comply. Convenience, routine, and fear of liability should not trump the best interests of the woman and her child, but they do. And, as always, the least privileged within society are at highest risk of abuse.

Pregnancy, with its myriad confining factors, including restrictions, limited options, forced interventions, and the criminalization of certain outcomes or behaviors, has fallen to the bottom of a sort of universal, global caste system. And within that caste, the already-oppressed suffer the worst. Low income women and minorities suffer the greatest level of indignity, violation of rights, and subsequently, the poorest health outcomes. Pregnancy offers us a unique opportunity to examine the complexities of oppression because of these various layers.

One of the most telling signs of oppression is the resistance to calling it out.  The backlash, the eye-rolling, the cognitive dissonance….  It’s hard to have our boundaries pushed; to consider that we’ve been complacent in the process. It’s disturbing to examine our own experiences through this kind of lens. It triggers us and it’s a more than a little uncomfortable to sit with realizations that illuminate our status in such suffocating ways. Healing oppression starts with a willingness to get cozy with speaking truth, no matter how much it chafes.

The time of co-opted birth can end, but vocal and insistent opposition to it needs to grow – both in discourse and in labor rooms. What are you doing to push boundaries? How willing are you to stand up for women with your words and actions; to allow yourself and others to wrestle with concepts of responsibility, complicity, and abuse? Language matters; how boldly we choose to speak, what words we use, how often often we speak them, what platforms we allow ourselves to step onto, make a difference. Pregnant people everywhere are counting on bold truth-speakers and seekers to forge a path of healing and empowered birth for future generations.

Want to make a difference? Study abroad with Birth Institute or become a midwife in your own community.

Kathi is a mother, writer, speaker, and activist. She is the mind and voice behind the blog and facebook page, Birth Anarchy, and is a former birth doula and birth educator. Her decade-long years of bearing witness and listening to women’s stories offer a unique lens into the rampant abuses of women in today’s maternity care system. Kathi has been called “a true artist,” and “one of the brightest minds in this movement.” Her essays have appeared in numerous birth journals including, Squat Birth Journal, and Midwifery Today. Kathi recognizes the continuity of reproductive justice from pre-conception to birth, and is passionate about advancing the security of those rights for all women.