Friday, December 07, 2007

Disciplining the faithful

We know that for a small but significant number of women, a vaginal delivery is literally impossible. Either the baby will not fit, the mother suffers severe pregnancy complications or the baby is in obvious danger. Homebirth studies show C-section rates in the range of 3-4%, and even that is not high enough to prevent an increased rate of neonatal mortality. Intellectually, even homebirth and natural childbirth advocates know that a certain minimum proportion of C-sections is absolutely necessary.

Nonetheless, the homebirth and natural childbirth communities demand confession and expiation from members who fail to have a vaginal delivery. Like many subcultures, they insist on conformity and when members fail to conform, they must publically apologize and seek the forgiveness and approval of the group. There is an accepted public ceremony for seeking forgiveness: it is the birth story that you must tell if you "failed".

Like all birth stories, these must have a title. There are two generally accepted titles: "Need feedback on my birth story" and "Unresolved feelings about the birth". the titles signal that the writer recognizes that she has trangressed the rules of the subculture, is throwing herself on the mercy of the community and is humbly begging forgiveness.

There is a generally accepted form for these public declarations of error. First, a very detailed description of the birth is required in order to demonstrate the multiple attempts the supplicant made to have the ideal birth. This includes describing the really long labor, or the really long second stages, the interventions explicitly refused, and the cultural trappings employed (using a birthing pool, squatting, etc). The purpose: to demonstrate that it was not the supplicant's "fault" that she "failed" to achieve a vaginal delivery.

Second, there are the ritual denunciations of support persons. If only my ____ (fill in the blank: husband, doula, midwife, nurse, doctor) had been more supportive, this wouldn't have happened.

Third, anything else that is not perfect is blamed on the transgression (demonstating that you are being punished and you recongize and accept it). Whether it's failure of the baby to latch, long term breastfeeding difficulties, postpartum depression, you name it, it is the result of failure to have an unmedicated vaginal delivery.

Fourth, there must be a declaration of suffering and remorse: "I am so angry with myself", "my body failed", "I am having trouble bonding to my baby".

Finally, there must be a renewed public commitment to the ideals of the subculture. Generally this takes the form of pledging to have a VBAC, or, better yet, an HBAC.

The subculture of homebirth and natural childbirth advocacy demands a public confession in order for the member to restored to full (or almost full) standing. She must humbly petition the group, confess her errors, display her suffering and promise to do better next time.

Here's what she cannot do; she cannot be honest. She can't say: "You know, you guys are living in a dream world. Not everyone can have a vaginal delivery and we shouldn't be setting women up to believe that this is some sort of ideal that they should aspire to. It makes no difference whether a woman has a vaginal delivery or a C-section. It makes no difference whether a woman has a pain-wracked or a painless delivery. The only thing that counts is supporting all women in doing what works for them, not insisting that every woman does what works for us."


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