I was sent the link to your discussion by Heddy Vernon, the woman who produced my play in Gainsville and who brought you the short excerpt last week in class. Heddy encouraged me to engage with you all on this blog – which I’m delighted to do.

I’ve read with great interest all of your postings and wanted to thank you all for expressing your opinions and feeling passionate about this topic. Obviously it’s a topic that I feel passionate about too!

I’m not writing to convince you to have any other reaction than the one you’ve expressed. In fact, I see how the play can be interpreted as anti-medical. What’s ironic to me is that since the play has been performed when I’ve surveyed the medical community with their reactions about half think the play unjustifiably trashes the medical model of care and half think it’s a completely accurate portrayl of childbirth inside the medical system today. (like the head of Obstetrics of a hospital in New York City who sat on a talkback panel after the play and said “this is exactly what’s happening in labor and delivery rooms and it needs to stop”).

What’s even more interesting to me is that when midwives are surveyed I’ve received pretty much the same feedback: about 40 percent of midwives feel the play unjustifiably trashes midwives and 60 percent think it’s accurate. When mothers are surveyed whether they think this play represents birth today the numbers swell to over 80 percent.

What this tells me is that there is no doubt childbirth is in crisis in America and that this “picture” of birth is hard to accept. It’s hard to believe our institutions (hospitals, doctors, insurance companies) are not listening to mothers? It’s hard to believe a pregnant woman can walk into a hospital today and the only first method of induction available to her is cytotech, a drug that is not FDA approved for obstetrics and has a track record of maternal death. Cytotech is cheaper and induces women faster than its counterpart, cervadil, but what about the risks to mother and babies? When are mothers going to come first when it comes to giving birth? That’s what this play is asking you to think about, that’s what this play is showing you in the eight stories.

I was recently at a performance of the play in Philadelphia and a person stood up and gave a similar critique of the play to what I’ve read on this blog – that the play is anti-medical – and my reaction was yes, the play is a critique of the medical system. When you see in the play a woman who has the potential to have a wonderful birth experience (Natalie’s story) and she is violated by being given an episiotomy without her consent instead of getting mad at the play for criticizing the medical system how about getting inspired to change the system that led to this oppression?

And let me be clear, I don’t feel it’s the obstetricians who are the only “bad guys.” Oppression is never that simple. It’s a complex cocktail of power.

Have any of you seen Michael Moore’s film SICKO? I’d encourage you to see it because if you understand the fundamental problems of healthcare today it would be easier to swallow the pill of why maternity care is not working for many women. Not all women, but in general the atmosphere today for a low-risk woman to have a safe, gentle birth in a hospital is tough.

YET…there are women taking back birth and having wonderful birth experiences in birth centers and at home and even at some groovy hospitals where the labor and delivery nurses are allowed to let women’s labors unfold without unnecessary interventions. It can and does happen. We just need it to happen more and for all low-risk women.

Notice I say low-risk women. My play is about how low-risk women are giving birth. If a woman is truly high risk then she is always best served seeing a high risk doctor and having appropriate interventions. Interventions aren’t wrong – women just need to be educated about them and use them appropriately.

Well, I’ve probably said enough for now!

Again, thank you all for your comments. Keep ‘em coming!

Karen

I mean, am I alone on this? My mother suffered less because a Caesarean let both of us live through a difficult breach birth. Granted, Caesareans are a considerable risk and I’m not doubting that some mothers are having their precious “birthing experience” (much like the “losing your virginity” experience: biology being overhyped by culture) ruined by pushy doctors, but demonizing them seems not only outright silly, but ultimately sexist (reinforcing “traditional” gender roles in any context seems to end up on that path more often than not, no?).

I had my baby in a bathtub at the Birth Centre of Gainesville. And while I personally would never *choose* to have a baby another way, you have no choice but to go with the flow when it comes to the birthing process–wherever it may take you. I do know MANY women who have had really rewarding experiences in the hospital. However, I have also met many, many women who had second and third births at home or at birth centers because the hospital experience wasn’t very good.
And while I haven’t met any women who had bad experiences in a birth center or home birth, I’m sure they’re out there. Ultimately, every woman’s experience is unique regardless of where or how the birth takes place.

I do not think the comment of ‘having a baby in the safest way possible’ and therefore being in the hospital has much weight, only because many of the technological interventions that are standard in hospitals cause the very complications that put mothers and babies at risk (for example, chances for a c-section are much greater if epidurals and pitocin are introduced during the labor stage, and the use of fetal monitors immobilizes the woman, making the labor much more difficult and often creating the need for medical intervention). That being said, hospitals have their place, and I know many women planned midwife-assisted births and ended up in hospitals, and things would have turned out very badly had they not had hospital care available. And they were satisfied with their experience, and grateful.

It’s hard to know what you will do until you’re in the situation. But I really think it’s important to consider where people feel most comfortable to give birth, because that is key. If the technology and expertise of the hospital gives you more comfort than the technology and expertise of a midwife, that’s probably where you should be. The number one thing that bothered me while pregnant and after giving birth was how many people had opinions about what I’d decided to do, and they felt perfectly justified in sharing them. The whole process is hard enough without having random strangers, let alone your friends and family, expressing their opinions about what is wrong with the decisions you’re making. It’s a very personal decision, and not one that I think anyone else has any business judging. The hope is that families-to-be do the research and make the decision that is right for them. And we should respect that, knowing that there are good experts available both for home births/birth centers, and in hospitals.

After Monday’s class, I was upset by the presentation’s negativity and anti-medical sentiment. This concern was echoed by other TAs and students. Thus, we agreed that more must be said to balance the material.

The performance on Monday was indeed an artistic expression and should be considered as such. However, based on the literature advertising it, this performance was meant as a tool to increase awareness about the dangerous rate of C-sections performed in the US. partly due to the medicalization of birthing. However, this message, if it was there at all, was lost in the stories. Instead the message seemed to be birth=pain and hospitals=evil. This is irresponsible, in my opinion, on the part of the artist when the piece is presented as a tool for learning.

The supposed message is important. C-sections are increasing partly due to medicalization. Induction of births is increasing, often for the convenience of the mom or doctor, which can cause fetal distress and increase the need of a C-section delivery. Epidurals are also now common because birth has been taken out of a natural context and this too increases the risk of a C-section. When an epidural is given, the baby is affected as well and is less able to help maneuver him/herself through the birth canal (yes, the baby has an active role in birth). There is much to be said about this medicalization and many points we can improve upon to increase the safety of women and babies.

To be fair, however, this is not the sole cause of the maternal health problems in the US. What we tried to relay yesterday is that there is an important role for the hospital in childbirth. Other issues affect the outcomes of birth and the risk of C-section delivery, such as obesity and diabetes (which cause babies to be larger).

We could spend a whole semester on this topic. Ultimately, the goal is education so that women may know their options and feel confident in deciding what is best for them. This is truly how to empower women in childbirth. Additionally, we must increase awareness that the messages of birth shown in the media of yelling women (i.e. the delivery in Knocked Up), is not necessary. Birth is a natural process for which our bodies are designed. I agree, V, that we need to readjust our thinking. At the same time, we must also acknowledge the role of medicine in improving maternal and infant health. Finding a balance here is the hard part I suppose.

If we were unsuccessful in the panel in providing alternate views, or came off as negative in a different direction, then I apologize as that was not our intent. This debate is incredibly important for everyone, as most of you will become parents at some point. Please continue expressing your thoughts and asking questions.

When I said that it had an overly anti-medical tone I only meant that it seemed to portray the arguably negative aspects of medicines influence on the birthing process. While of course there are negatives, there are also immense benefits that one could argue outweigh these negative aspects. A primary argument being the differences in highly medical nations infant-mortality rates in high risk pregnancies versus those in low medical nations (I apologize for the awkward phrasing).

This being said, of course there for some women are significant psychological and emotional benefits to the practice of uninduced/non-cesarean/non-epidural etc. birth.

I think ultimately that the message of ‘having a birth-plan, but not being unwilling to alter it should it be necessary for a woman’s own survival and the survival on the child’ is what should really be taken to heart.

I don’t think anyone will try to argue that no mother should engage in the ‘natural birthing’ process, but that for many the ‘medical birth’ provides needed care and security.

The views in this play are shared with a lot of European countries as well. I think the play was trying to introduce this generation to the benefits of having a baby more naturally. We’ve grown up with a precenption of what birth is suppose to be like and it doesn’t necesarily have to be that way.

Lastly, I just want to point out that the play was…well a play. An artistic expression. Hillary (TA on the left) was the only person that touched upon that fact. I think once the majority of people realize that, the whole “the play was too negative” falls apart. As an artists, I’ve certainly overemphasized one aspect of an issue and hoped people understood that certain things where implied without me saying them.