Considering my recent thoughts and posts on these topics, check out the great timing on the posting of the list of The Best and Worst Places to be a Mother by Save the Children. It's already been all over the news this morning that America places pretty low for a wealthy developed nation (28th), and this is largely due to the high maternal mortality rate and our lack of support (like maternity leave) for mothers. And this is precisely my point.
It is a fact that choices can be curtailed in multiple ways. You can give all kinds of lipservice to the benefits of breastfeeding, but as long as medical professionals don't give real help to new mothers trying to get into a good nursing routine, and women are expected to carry most of the domestic labor burden within the home, and pumping is frowned upon in the workplace, and maternity leave is short, and people continue to think of breastfeeding as some repulsive thing that ought not to be done in public, and women experience serious career limitations for altering their work schedules to accommodate breastfeeding and pumping, and formula is pushed as the nutritional equivalent to breastmilk ......we can't really view breastfeeding as a viable option for most mothers. It's not that anyone is explicitly telling them that they can't or shouldn't breastfeed. But there are other ways to constrain a person's choices other than through legal or social prohibitions and physical constraints. And this is a really important distinction we overlook.
When there are multiple barriers to your success in a particular endeavor, then we cannot view that as a choice that one can freely choose in the same way they can choose the options without similar barriers. Take abortion, for example. In my state, abortion is legal. Nobody can legally stop you from terminating a pregnancy. But you can't get an abortion here. There simply are no providers. You can come up with about $500 and drive several hours (depending on where you live) to get to clinics in neighboring states that provide abortions. And then a week or two later you'll need to arrange for transportation to drive back to that clinic for follow up. So if a teenage girl or an unemployed woman or any woman who is financially (and/or transportationally) dependent gets pregnant, it makes no sense to talk about her choices. Unless she can find someone to drive her to an out-of-state clinic and pay for it, she's gonna have that baby. And this is true in more geographical locations than most people realize.
And what of natural childbirth? In some places homebirths are an option. In some places there are birthing centers that are woman-centric and support mothers in whatever informed decisions they make. But most women will give birth in a hospital, either because these choices aren't available where they live or because they aren't covered by their insurance. And new guidelines for midwifery have even further restricted these options in some places. So that leaves most women who desire a natural birth with the sole option of making it work in a hospital setting.
And let me tell you about how that generally goes. From the minute you step through the doors you will be fighting off medical interventions. It will be you against a doctor and several nurses, or possibly you and your midwife and/or doula against a doctor and several nurses. Although you've clearly written in your birthplan that you do not want an epidural, nurses will breeze in all cheerfully right when you're in the middle of a contraction and ask you if you're ready for your epidural yet. Repeatedly. Instead of supporting you in your goals and talking you through the hard stuff, they hit you when you're down, when you're most likely to give in. I'm not the only one with this experience. When you start comparing notes with other women it's astonishing to realize the similarities. It's as if they're working from a script. So women who attempt natural childbirth will not only be dealing with the stress and pain of childbirth, but they will often also be fighting a constant battle to fend off the medical interventions that they have already clearly communicated a desire to avoid in their birth plan. And this is frequently true even in a fairly uncomplicated, quick birth.
In my experience, it took slightly less than an hour from the time I started pushing until my daughter was born. She was in a great position. She was not a particularly big baby. Her heart rate was good. There were no indications whatsoever of any danger. And yet, just as she was crowning the doctor (my midwife was out of town when I went into labor early) decided that I needed an episiotomy. This seems to be prompted by the fact that, when the pressure suddenly ratcheted up, I said "Oh fuck" and then to my partner "I'm not sure this is such a good idea." I was joking in a grim sort of way, because that's how I handle these things. But it said very clearly in my birth plan that I didn't want an episiotomy. In addition, it's generally accepted in the medical community that the vast majority of episiotomies are not only unnecessary, but harmful to women. You heal slower and are more likely to sustain permanent damage to surrounding tissue. But none of this mattered. My consent didn't matter. And let me tell you that seeing someone come at your genitals with a knife that big would be somewhat traumatizing no matter what the context was. But when you're struggling to manage the pain, and ignore the nurses who are cheerleading and babytalking you in spite of your repeated requests that they not do this, and to think your way through this tough process, it's even worse. It's like one of those days when everything is going wrong, and then truly ridiculous shit starts happening, and you're like "what's next, the locusts?" Because having to fight this shit off when you're already handling so much and feeling pretty damn vulnerable is really too much, and they know it. They've dealt with lots of women in labor. They understand the psychology of it. They know that saying no and standing up for yourself is really damn hard in that moment. And sometimes even saying no isn't enough. At first I just looked at the knife and said "I don't want an episiotomy. Is that what that is?" She still held the knife. Then my partner said "absolutely not - she wrote that in her birth plan." She still held the knife. Finally I sat all the way up and looked her squarely in the eye and said "I do not consent. If you cut me I will sue your ass." Then another contraction hit me and I felt that urge to push that kind of drowns out everything else and so I leaned back on my elbows and started pushing again. She made an exasperated "hmmph" sound and set the knife down hard on the table. About 10 minutes and 3 or 4 pushes later my daughter was born. My partner thought she had scared/angered the baby right out of me with that knife. It could have been that the additional adrenaline rush sped things up. I don't know. But I remember how ironic it was when she cheerfully told me after the fact that I had only had a very minimal amount of surface level tearing, and that I didn't need any stitches and it would be all healed up in a day or two. And it was. But I remember thinking, "well, if I had just tried to cut you with a giant knife against your will I would certainly not be talking about how you clearly didn't need to be cut at all in a totally pleased tone of voice." You'd think you would be sort of embarrassed and apologetic.
But if you put my experience in context, it seems pretty minor. So I had to fight off an unnecessary episiotomy and the minor damage that would have accompanied it. But think of all the women who are told they have to have a c-section, and they don't want one, and wonder if it's really necessary, but are bullied into shutting up and getting it over with already. And finding out later that it probably wasn't necessary, and wondering if there was anything more you could have done to prevent it, has got to be a hurty thing. And so the overwhelming feeling you take away from your childbirth experience is impotence and a complete loss of control, because in your vulnerable moment, there was nobody there to support you and take your side and argue your case. Of course your friends and family can try, but their voices get drowned out very quickly in the context of the medical juggernaut, which is backed by our cultural attitudes toward doctors and childbirth.
So that's why I keep yammering on about supported choices. Live options. Robust agency. Because merely having the choice to do something (technically, legally, whatever) doesn't mean shit if it's not viable for you due to the lack of support and the cultural forces against it. And this applies to all of the "choices" women make concerning mothering. If you're clearly going to experience setbacks in your career by choosing to have children while your male counterparts will be unfazed by it, then the choice to have children is not a free one. If it's going to be a constant struggle everyday to breastfeed and deal with social negativity and pay the price for arranging your schedule to accommodate it, then breast vs. bottle is not a free choice. And this, my friends, is why America scores so low when it comes to mothering.