The great feminist Gloria Steinem once said,
Democracy begins with owning our bodies. By that measure, women have rarely lived in a democracy
When I think about birth, and more specifically, the politics of the modern, mechanised birth factories, that quote often comes to mind. Recently, I’ve been thinking about what birth practices have changed in my lifetime and what has stayed the same. I wonder – has democracy and dominion over our own bodies improved or worsened in the last 50 years?
In 1969 my mother was 20, innocent, unmarried and “in trouble” but thankfully, the boy was standing by her and offering to marry her. There were a few major differences in her antenatal care. For a start, they’d figured out x-rays were rather dangerous but did not yet have another window into the womb. So my mum didn’t know whether I was a boy or a girl. Other information, like my size, or how I was lying in the womb, was gleaned purely from the hands of the midwife. My mother is no longer with us, and the story of my birth has as many holes as a colander, but what I do know highlights some rather massive changes and some worrying similarities to our current system.
Firstly, my mother saw the same midwife throughout. That midwife got a good sense of how I was growing because she gently felt my growing body each time she saw my mum. She asked her commonsense questions, too, like ‘are your clothes feeling tighter?’
She was told I would be due ‘some time later November, early December’ so no one was obsessing over due dates and no one bothered my mother with intrusive phone calls asking ‘is the baby here yet?’. (They wouldn’t have been able to anyway – my parent’s phone was the red phonebox at the bottom of the street).
Induction was reserved for the few mothers whose babies really needed to be born, right now. Everyone, including my mum’s GP and midwife, reassured her that babies are born when they are ready.
Whilst my mum and her two older brothers had all been born at home, by 1969, more and more babies were being born in hospital and, by 1974 when my brother came along, homebirth was pretty much a thing of the past. ‘Home confinement’ had become seen as something dangerous. By 2003, when I became a doula, homebirth rates were 6% in Cambridge and in parts of the city as high as 20%.
Searching for records of induction rates for 1969 reveals little of what was going on at the time, but I did find some statistics for 1976, which state that induction rates were around 24%. During the Covid pandemic, many hospitals have been recording induction rates of between 35 and 45% – a large proportion of which are made up of mothers being induced for being over 41 weeks or with a ‘big baby’ on board. The 1976 article states that hospital induction rates varied between 14% and 27%. Some small maternity homes were inducing as few as 6% of pregnant people.
If being induced is necessary, I have some questions: if it’s safest for someone to go into labour soon, and knowing that all the hormones that facilitate that process are ones of calm and connection, why is it that the system so often achieves precisely the opposite; creating anxiety and adrenaline? Why do we seem to set up an environment that lessens the chances of the pregnant person labouring spontaneously or effectively?
In 1976 the majority of mothers interviewed after their induced birth said they were not given enough information about the induction process. My perception as a doula is that not much has changed.
If we ARE going to induce more pregnant people, we urgently need better resources, including outpatient inductions, comfortable homelike private induction suites, more staff and all the other resources necessary to make sure people are not waiting DAYS for induction to begin. Because you can’t talk RISKS, leaving parents petrified and convinced their baby is in imminent danger, and then leave them moldering on a ward FOR DAYS. It’s actual torture.
My mother knew nothing about birth – as little as she’d known about falling pregnant with me, outside wedlock, to the immense horror of my grandmother. And that’s another difference between that era and our own – the plethora of information available to modern parents. In fact there is so much it can feel overwhelming! Whilst my mother had nowhere to turn for empowering and informative birth education, today’s parents have to know how to sort the informational wheat from the chaff. And if I were to give one tip to all expectant parents right now, it would be to gather information about the risks and benefits of induction. Ask lots of questions and don’t stop asking til you have satisfying answers. Because in spite of all the information our there, not much of it seems to come from the staff caring for us. Just like 1976, parents today routinely tell us that they wish they’d known more about the process of induction before consenting to it.
Something else that hasn’t changed much since 1969 is how women and birthing people are routinely treated on busy wards. My mother felt frightened and invisible. On the 11th December 1969 I was an ‘almost BBA’ in Queen Charlotte’s hospital. My mother was on a trolley in the corridor, waiting for a bed in the ward. Busy midwives, rushing by, would respond to my mother’s complaints about “the pains” by reassuring her that she had “hours to go, Mrs Roach”. My head was out by the time a pupil midwife actually stopped to listen to her, lifted the sheet and raised the alarm. I wish I could say the story of my birth is a historical blip. However, unfortunately parents are being ignored, misled, coerced and emotionally manipulated into induction on a daily basis, then not listened to when they say the baby is coming or pain relief is needed.
I for one would like to see hospitals being made to publish the number of babies born on induction wards, in toilets and hospital corridors en route to the labour ward. Not many other statistics would give us as stark a reminder of how short staffed and under resourced our maternity hospitals really are.
And it’s about time we started auditing hospitals on outcomes that are more subtle and informative than just alive babies and mothers. What are the breastfeeding rates in dyads that were induced? Postnatal depression rates? Secure attachment at 6 weeks? Sexual pleasure at one year? Positive feelings and memories of birth 5 years later? Birth trauma and PTSD rates? Because you can as much force birth without possible side effects as force a rose to bloom before its time.
Now is the time for us to stand up together, shoulder to shoulder, and demand answers and demand better care. Because, to quote the glorious Gloria again,
“Revolutions like trees, grow from the bottom up”