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Giving Birth In Yogaland

in Featured, YD News

Trigger warning: This article addresses birth and birth trauma and includes related images. 

birth-yogalandby Alix Cale

1. Real Birth

Jill, a yoga teacher from Texas, labored for 36 hours before her baby got stuck and had to be delivered by cesarean. “It was the only way he was coming out,” she tells me. She had hoped to have an intervention-free birth, and afterwards found herself grappling with a complex mix of emotion. “Of course I was grateful that my baby and I were both ok,” she says. “My labor and his birth were quite an ordeal. But I did have some feelings of disappointment. I was fit, healthy, I did everything I could to prepare!”

Years later, a colleague suggested that had Jill “stuck it out” she could have had a vaginal birth. And another teacher told her that “women who have cesareans aren’t able to deliver vaginally because they aren’t ready to be mothers.” Jill describes how these intrusions made her feel “stunned.”

“What they said had me reconsidering, rethinking at some level, something I thought I had processed and settled in my mind. It was only after really remembering how my particular birth experience played out did I see how they didn’t really have any authority, at all, to tell me how it could have or should have gone.”

As Jill talks, her eyes widen. Though ten years have passed since these encounters, the shock of them is still very much alive.

Such comments about birth are not uncommon in yoga culture. While plenty of people tell happy stories about the pre and postnatal support they received from their yoga communities, many others harbor memories of feeling let down and judged by fellow practitioners — especially in the aftermath of births involving intervention. Inger (a pseudonym), a yoga teacher based in a Scandinavian city, was alarmed by the “pitying, rude, condescending and nosy comments” she received after her cesarean birth. “The most bizarre aspect of my experience,” she wrote in a Facebook thread, “is that the friends I have outside the ‘yoga world’ are much more accepting and respectful.” Instead, it was other yoga practitioners who implied that her birth experience was lacking. Some wondered whether she could still teach prenatal yoga. One colleague asked if Inger felt like a “real mother” even though she hadn’t had a “real birth.”

This last remark exposes a prevalent split in yoga culture’s current birthing discourse. The “real” birth is vaginal, and intervention-free. It’s a “natural” birth, fueled by inner strength and intuition. In contrast, the “unnatural” birth employs man-made strategies like epidurals and cesareans which (so the story goes) rob us of our power, relegating us to the role of passive bystander. On one side is the birth that transforms, and on the other side is the birth we sleepwalk through, oppressed and unchanged. As a contributor in Yoga Sadhana for Mothers writes, “These days many women are scared to go through [natural birth] and program a C-section without giving themselves the opportunity to grow.”

Such attitudes find their roots in a troubling history. In the 1700s, midwives began to be pushed out of business by medical men who sought to standardize and technologize birth. The medicalization of birth eventually improved maternal and infant mortality rates — particularly for middle and upper class white women — but there was a sense that these improvements had come at a cost. By the 1950s and 60s, many women were feeling alienated from their birthing instincts by the indiscriminate use of heavy anesthesia and unnecessary surgical intervention, and it was out of this sense of alienation that the natural childbirth movement gained momentum.

For those who have been steeped in the empowerment narratives of the natural birth movement, the urge towards “natural” birthing may be rooted in more than a personal desire for a particular somatic experience. It may equally be about participating (consciously or not) in a politicized process that seeks to take birthing back from standardized medicine. Viewed this way, the split between “natural” and “unnatural” becomes even more charged, seeming to express a divide between “feminist” and “patriarchal.” For how has the intervention been made into a symbol of oppression? How does a cesarean birth, or a birth with epidural, make some of us feel as if we’re failing to free ourselves from a paternalistic system? Is this the politicized essence of the “real” birth? Is it what we imagine will take us beyond bondage?

Adrienne Rich writes in Of Woman Born that “no more devastating image could be invented for the bondage of woman” than the birthing woman “sheeted, supine, drugged, her wrists strapped down and her legs in stirrups, at the very moment when she is bringing new life into the world.” It’s a searing image. There is truth in it, too: some of us have been traumatized by a medical system that sometimes puts its own anxieties before the idiosyncratic rhythms of labour. However, Rich’s evocation of a generalized female body replicates the very problem she critiques. As Glosswitch writes in her article “Birth Wars: The Politics of Childbirth”: “Female bodies aren’t real bodies, not even to feminists. They’re the grounds upon which we test out our theories of power. They’re the paper upon which we write our stories. The laboring body — ultimately female, ultimately other — can be used to prove whichever point you want it to.”

So it is with Rich’s nameless woman, who has no voice, no history, and no social context. She is a faceless object pinned down not only by a cool medical gaze, but by the point of Rich’s argument, too.

I have been that woman, pinned down. Twice.

sara-csectionMy first cesarean birth was traumatic: I felt myself caught, specimen-like, under the fluorescent eye of the operating room. My flesh was stunned by death’s nearness. But I recognize now that the physiological trauma was amplified by the narratives which preceded it. Long before giving birth I had internalized Rich’s faceless woman; I had come to believe that interventions were automatic signifiers of subjugation. In other words, once my birth began to look a certain way, my disempowerment became a foregone conclusion. As I began to resemble Rich’s woman, I simply assumed I had become her.

The second birth was a planned C-section. I had weighed my options and I had chosen to be there. That second cesarean counts among the most empowered experiences of my life. From the outside, it may still have looked like subjugation: on the inside it felt like anything but. Later, when I told people that I had had a healing cesarean birth they politely tried to hide their confusion. “Really?” they said. And I knew they were thinking of Rich’s woman, too.

When we consider births in terms of categories, we are privileging abstractions, not real people. On the one side are singular figures, radiant in birthing tubs, and on the other side legions of faceless victims immobilized in hospital beds. But such symbolism erases the specificity of each birth, and of each birthing person.

Ironically, the natural birth movement has replicated a number of the problems that it purports to push back against. According to Sasha Padron, an Ontario-based pre and postnatal yoga educator and doula who has supported women in birth for over twenty years, in many ways we’ve continued to apply goal-oriented attitudes to how we “should” give birth. So while the natural birth movement has “freed” (primarily white and middle class) women from a highly problematic context, Padron describes how it simultaneously “placed them in another confined space, with a very linear way of approaching birth and approaching what women need and want in birth. And we’re discovering how we actually get left in a fairly similar place, where we’re alone and isolated and confused about what happened, and why it happened.”

The natural birth movement has also sought to increase choices in childbirth only to link that sense of “choice” to a birth that looks a certain way. As Jennie Bristow writes in “The Politics of Childbirth”: “[…] choice in childbirth tends to be assumed to run in one direction alone — that is, the choice to have less medical intervention, rather than more.” And there’s a tendency to assume that births in hospital are always over-managed by fear-mongering doctors. Again, this is sometimes true. But according to a 2013 US national survey of women’s childbearing experiences, “Mothers generally rated the quality of the United States maternity care system very positively.” 83 percent of respondents were happy with their care, with 47 percent saying it was “good”, and 36 percent saying it was “excellent.” Such statistics suggest that while there is always work to do in terms of improving medical maternity care, many women are already framing their hospital births in positive terms.

The over-simplified split between categories of birth has made it hard to talk about experiences that don’t fit the mold: joyful births with epidural, or empowered cesareans, or traumatic home-births. Lila (a pseudonym), an Ashtanga yoga practitioner based in Finland, decided to ask for an epidural. This was despite having a fellow yogi tell her point-blank: “You don’t need the pain medication.” But Lila knew her history with anxiety in medical settings and she intuited that pain relief would help her manage that anxiety. “Overall, my birth experience in a hospital with pain relief was an incredibly positive one,” she tells me, “which is not a story I see portrayed in the yoga community very often.”

And then there is Gavriella’s story, as told in Amy Tuteur’s book Push Back. Struggling with postpartum depression (PPD) after a traumatic, intervention-free birth Gavriella called a PPD hotline. She recalls how the midwife who answered “seemed genuinely confused as to how I could have gotten PPD when I had a natural birth, because it goes so against the narrative. She also didn’t get why I was so upset about my birth experience. […] Interventions are the traumatizing stuff, not unmedicated birth!”

Pre-existing ideas about birth are literally obstructing our capacity to listen to each other. I do believe there is another way. But it will mean noticing what automatic associations arise when we hear the word “natural” or “epidural” or “cesarean.” It will mean recognizing how an experience changes when we name it. It will mean understanding that “women” do not make up a single, uniform class with universal needs. And it will mean examining the ways in which an outcome-based, categorical approach to birthing has shaped our assumptions and our stories, hurting many of us along the way.

2. You Make Me Feel Like a Natural Woman

Many of us seem to assume that the way we birth says something decisive about who we are. In modern yoga culture, where what a person’s body can do is regularly confused with who we imagine that person to be, this sense of correlation may be especially hard to shake. As Kundalini teacher Gurmukh writes in her book Bountiful, Beautiful, Blissful: “As a woman lives, so shall she birth.”

In a 2012 interview with New York Times Magazine, pioneering midwife Ina May Gaskin was asked about epidural rates at the Farm (the rural Tennessee commune and birthing centre started in the 1970s by Gaskin and her husband). Gaskin, whose books are featured regularly on the reading lists for prenatal yoga teacher trainings, answered that among the 3000 women who have birthed at the Farm, only one has ever transferred to hospital for an epidural. And the reason for this was clear to Gaskin: that woman was a “princess.” That word, which evokes a lesser, weaker, more childish woman, is a bullying jab in the midst of a subculture that prides itself on its feminism. It’s clear that what’s being privileged is not the power to choose, but Gaskin’s own agenda.

Many of the yoga and birthing resources I’ve come across communicate similar attitudes. The dominant message is that there is a right path to choose through birth. In The Yoga Birth Method, Dorothy Guerra doesn’t use the word “princess”, but she might as well. She urges against becoming “high maintenance” in labor: “When you become high maintenance, you exhaust everyone around you in a negative way. This is considered stealing energy from others. You have to trust your ability to cope. Your support team is there to help you manage pain and create comfort for you. Embrace what they have to offer without being selfish.”

Of course, in this instance, trusting “your ability to cope” means sticking to a natural birth plan. Guerra describes a laboring woman who begins to consider pain medication. But “by choosing truthfulness as their birth intention, her partner is able to remind her that discouraging words are not part of their plan and encourage her to speak in positive words.”

This is a glaring example. But even in more moderate resources, personal identity and birth experience subtly intertwine to communicate a clear preference for “natural” birth. In fact, the premise that natural birth is best seems to be such an accepted norm that there tends to be little, if any, critique of the idea. For instance, Yoga Mama, by veteran yoga teacher Linda Sparrowe, offers many good practices and suggestions for healthy pregnancy and birth. But even so, you can feel Sparrowe shake her head as she describes a group of women touring a local birth centre. Again, there’s an echo of Gaskin’s “princess” comment: “All they wanted to know was whether they could still get pain meds if they chose the birthing center and how quickly they could get them. A couple of women even wondered if they should simply schedule a cesarean birth so they wouldn’t feel a thing.”

“Sadly,” she goes on, “these women aren’t an anomaly.”

In yoga culture, we have so internalized this presumed link between identity and outcome that many of us are left to assume a birth with intervention means something shameful about who we are. “The biggest thing about my C-section was feeling like a failure,” writes Lindsay, a yoga teacher in Hamilton, Ontario.

And Maria, a yoga practitioner in Russia and an editor at the Russian Yoga Journal, tells me that in her community “having a C-section was seen as a sign of failure as a woman and a mother, and actually that’s what I felt. Apart from the pain, grief and guilt, I felt almost shame for messing up a home birth.”


3. “Natural” Privilege

Approaching birth as a means of self-development and self-expression — and expecting that everybody else should be able to too — requires tremendous privilege. As Meghan Murphy writes in her article “Choice Feminism”: “More privileged women always [have] greater access to reproductive choices compared to more marginalized women.”

When it comes to birth, the majority of the world’s women have had — and some continue to have — no illusion of choice: you either get the baby out through your vagina without pain meds or other interventions or you and/or your baby will likely die. In countries where modern obstetrics aren’t readily available, there’s a 1 in 15 chance that a woman will die giving birth during her lifetime, and about 7 percent of babies die at birth. Thus the fetishization of birth as a critical stage in self-evolution rests on the privileged assumption that we, and our babies, will survive the experience. As Alison Phipps writes in The Politics of the Body: “In rejecting a medicalized birth, middle-class activists confirm their elevated social position since only women who know they are able to give birth safely are able to reject the trappings of technology.”

Political scientist Candace Johnson goes further, describing how middle-class women appropriate the aesthetics of birthing in poverty, while assuming none of its risk: “The fantasy of Third World women’s natural experiences of childbirth has become iconic among first world women, even if these experiences are more imagined than real. This created multiple opportunities for exploitation, as the experiences of Third World women are used as a means for first world women to acquire knowledge, experience and perspective on ‘natural’ or ‘traditional’ birthing practices, while denying the importance of medical services that privileged women take for granted.”

The pressure to give birth “naturally” as an act of empowered identity expression is particularly prevalent among white, middle-class women. This privileged demographic has the most faith in its birthing safety, because it is this demographic that can best expect to receive good, timely medical attention should it be required during labor and to more generally feel supported by the dominant social structures. But within a structurally racist, classist, heteoronormative and ableist system, do people of color, LGBTQ people, or people with disabilities share equally in this faith? Is the glorification of ‘natural’ birth in fact a middle-class, white feminist luxury?

As Dianne Bondy, a woman of color and yoga accessibility activist, tells me: “[Birth] is not a singular experience for people, and [the current] view of it is really narrow. Where can you start to look at your privilege, your filter, your lack of diversity?”

It can be a life and death matter. In her article “What It’s Like to Be Black and Pregnant When You Know How Dangerous That Can Be,” Dani McClain writes: “Black women [in the US] are almost four times more likely to die from pregnancy complications than our white counterparts, and black babies are twice as likely as white babies to die before their first birthday.”

Dr. Joia Crear Perry adds depth to this statistic in her article “The Black Maternal Mortality Rate in the US is an International Crisis”: “Black women cannot buy or educate their way out of dying at three to four times the rate of white mothers. Maternal mortality rates persist regardless of our class or education status. Deaths among mothers extend beyond the period of pregnancy or birth. Nine months of prenatal care cannot counter underlying social determinants of health inequities in housing, political participation, education, food, environmental conditions and economic security—all of which have racism as their root cause.”

McClain puts it succinctly: “Research suggests that it’s the stress caused by racial discrimination experienced over a lifetime that leads to black American women’s troubling birth outcomes.”

In other words, the embodied and systemic impact of racism substantially affects pregnancy, birth and postnatal care. But these structural realities are never addressed in prenatal yoga resources or by mainstream natural birthing narratives. And this failure of acknowledgement implies that these resources are really just for white women. In their ignorance of structural inequality, white people are free to reframe privilege as superior moral choice.

McClain points out some of the ways in which birth prep courses often present the middle-class, white experience as the norm. In her white-dominated hypnobirthing class, McClain recounts how, “we were told that the number one reason for pre-term birth is dehydration.” But, she continues, “Thirteen percent of black women deliver babies before they’re full-term—and that’s simply because we’re thirsty?”

And on April 22 2017, at a seminar hosted by the Texas Birth Network, Ina May Gaskin was asked about the impact of systemic racism on the US’s maternal and infant mortality rates. Gaskin answered by suggesting that Black women’s drug use was a primary reason for their higher mortality rates. “Drug overdoses, cause number three—that’s a biggie,” Gaskin said. “And I presume these are illegal drugs. Not prescription drugs, but those are also going to be a problem.” She also suggested, absurdly, that Black women might also look to prayer and home-grown food to remedy higher mortality rates.

Ambreia Meadows-Fernandez sums up the racism of Gaskin’s response like this: “In that moment, Gaskin did two things: She denied the reality that Black mothers are disproportionately affected by poverty, crime, and other causes of stress that undermine infant and maternal health; and she bypassed the fact that not only are Black birth workers competently serving our communities now, but they were also historically responsible for serving Black and White families in the South, delivering and raising White babies as their midwives and caretakers.”

Gaskin also failed to say “I don’t know.” A transcript of her meandering response makes it clear that she’s grasping at straws. But accustomed as she is to her position as lauded teacher, she went ahead and played expert anyway. It’s a mistake that many of us might learn from. Too often we pretend certainty in the face of others’ birth stories, as if we think we know what “women” as a singular class should want and need. But those of us who occupy the privileged position granted to us by middle-class whiteness can get better at making space to witness and learn from experiences that are different from our own.

We can get better at saying “I don’t know.”

4. Eve’s Sin

While the natural birth movement frames itself in terms of woman-centered empowerment narratives, natural birthing as an ideology finds one of its primary sources in the post-war work of Grantly Dick-Read, a white doctor with anti-feminist and racist views. He wrote that “woman fails when she ceases to desire the children for which she was primarily made. Her true emancipation lies in freedom to fulfill her biological purposes.” In “The Misogyny at the Heart of Natural Childbirth” the bloggers at We Are Skeptixx describe how one of Dick-Read’s primary goals was to “convince middle and upper class white women to have more children and abandon their demands for political, economic, and educational equality.” And Amy Tuteur writes in Push Back about how Dick-Read, fearing a decrease in the white birthrate, believed that “women must be socialized to return to the home […] or the white race risked ‘race suicide’.”

In an unpublished manuscript, “Account of visit to USA 1958,” Dick-Read claimed that when “tribal women” died in childbirth it was “without any sadness…realizing if they were not competent to produce children for the spirits of their fathers and for the tribe, they had no place in the tribe.” And he suggested that “primitive women” did not experience pain in childbirth. If white, middle-class women experienced pain it was only because they had committed the sin of becoming “overcivilized”, by pursuing higher education, or working outside the home, or becoming politically active.

But despite these views, Dick-Read’s work continues to be celebrated today. In her 2013 Ted Talk, Ina May Gaskin makes it clear that Dick-Read’s book Childbirth Without Fear was a central resource for her. And in Midwifery Today the book is touted as being “as timely and important as it was forty-five years ago.”

Another key figure in the ideological push towards natural childbirth was French obstetrician Fernand Lamaze. In the 1970s he introduced techniques designed to manage labor pain through psychological conditioning and breath work. These techniques were popular in the 1970s and 80s, and would likely have been well-known to many of the mothers of middle class white women giving birth today. But Lamaze was anti-feminist, too. Tuteur describes how he ranked women’s “performance in childbirth from ‘excellent’ to ‘complete failure’ on the basis of their ‘restlessness and screams’.” He believed that those who “failed” did so because they were under-prepared, or doubtful about their own capacities. According to Lamaze, the more intellectual a woman was the more likely she was to “fail” due to her tendency to ask a lot of questions.

These underlying politics complicate ideas about birth. As it occurs in the context of individual lives, intervention-free birthing may absolutely be an empowering experience for some women. But “natural” birth as a fetishized experience is not inherently more feminist, more empowered, or more progressive than any other kind of birth.

5. Towards a New Paradigm

We are in need of a new birthing paradigm. The current model, though it may work for those whose narratives it serves, is leaving too many people, and experiences, out. And it’s contributing to too much isolation and shame in the aftermath of difficult experiences. As Tiffany Rose, a yoga teacher and trauma sensitivity educator, as well as a former doula and childbirth educator, tells me, “the expectations around having to have a natural birth can cause trauma for women when they can’t do it.”

birth-yogaland-babykissAt the heart of the existing paradigm is the assumption that there’s a “right” kind of birth to have. In yoga culture, books, classes and other birthing resources are often sold on the basis that they will help us “achieve” this correct birth. In The Yoga Birth Method, for example, Dorothy Guerra writes that her method “will make your birth a positive and natural experience.”

Impossible-to-keep promises like this have turned “natural” birth into something we imagine we can control, and even purchase. We are told that with the right preparations, mind-set, techniques and accoutrements we can choose and actualize the optimal experience. More subtly (and seductively) we are also often being sold the transformed future self, which is the supposed by-product of giving birth “as nature intended.” In yoga culture, especially, where a tendency to spiritualize pain often coalesces with the belief that certain kinds of extreme somatic experiences will bring us closer to transcendence, the idea of “natural” birth is equated with the cultivation of a new and better self. As Guerra suggests, “divine empowerment” in birth is only to be accessed by those who do it “naturally”: “By choosing a natural birth and allowing divine energy to guide you there, you surrender to the power of your soul to birth with faith and trust.”

She goes on: “By committing to an enlightened birth experience you embody a strength that encourages you through the natural process. You accomplish enlightenment when your child is born.”

In other places, the new and better self is described in less spiritual (but no less appealing) terms. In one of the online natural birth prep courses that I audited, the facilitator (who is a naturopathic doctor and a yoga teacher) suggested that “natural” birth is like “super glue” for your relationship. The choice to birth without intervention benefits your partner too because “he’s engaged and it makes him feel important. […] It improves his experience of the day as well.”

The facilitator continued, alluding to the more loveable self that will apparently emerge through “natural” birth: “The other beauty about your partner being involved in your natural birth and benefitting from your natural birth is that he can now see how deep you are, how deep you go, how much strength you have, how much grit you have, how hard you’re able to work.”

“It does really prove to him how amazing you are.”

Such sexist (and heteronormative) generalizations have much more to do with selling attractive hopes than with actually supporting individuals in birth. This is perhaps the most troubling part of the current paradigm: it pretends to serve people while actually serving an ideology, turning well-intentioned service providers into mouthpieces for an unconscious anti-feminism. And these ideological pressures can make it hard to cultivate genuine support. Many of my interview subjects describe the ways in which they have felt silenced and shamed by colleagues and community members who subscribe to the idea that “natural” birth is a better kind of birth.

Megan (a pseudonym), a prenatal yoga teacher in a Canadian city, says that “there’s a lot of pressure on giving birth naturally when you’re a spokesperson in the wellness and yoga industry.” She admits to me via Skype that in part due to this pressure she experienced so much shame after her two cesareans that she has sometimes chosen to re-write her story, telling others that she’s had one cesarean and one intervention-free birth: “I felt so ashamed about speaking my truth to women who I knew had just squatted down with their mothers and their sisters all around them, that I made the choice to lie about it.”

Lila says she avoids mentioning her epidural because she knows that her fellow yoga practitioners “see it as ‘unnatural’ and view bearing the pain as a kind of strength.”

And Gabriela wrote to me from Mexico to describe how she is dismayed by the way people in her yoga community automatically psychologize her cesarean birth experience, rather than simply listening to her tell her story. “You will need to do a lot of therapy work with your child since he is a C-section kid,” one colleague told her.

Sara, a yogi in New York City, articulates the biases that she herself felt during her own pregnancy. When a pregnant neighbor expressed the desire to labor with “as many drugs as possible,” Sara recalls her reaction: “I remember thinking, wait, she’s not even going to try to see how it feels? No trial of labor? She’s just going to capitulate to the industry? She’s going to be a pre-subscribed sucker to the belief that women can’t do this without disempowering drugs? So I judged the shit out of her, like it was a sport. She was completely confident in her decision.”

Since then, Sara’s views have changed significantly. “I always knew intellectually, but perhaps not actually, that I had no right to be the arbiter of anyone else’s relationship to pain,” she tells me. “I had hoped I would make it through my birth without drugs or interventions– but left a bookmark for emergencies. And that was exactly what I got. I remember when I was rolled at top speed down to the OR for an emergency C-section. All decisions I had made about the birth became irrelevant. The most powerful moment was when I shouted at the top of my lungs, even though no one was asking, “I give my consent!” I realized that all we have, no matter how we exercise it, is our agency and trust. And this changed how I saw everything.”

The experience also changed how Sara thinks about that word “natural,” which for many of us has become the conceptual source of our preferences and judgments and self-blame. “What exactly are we calling ‘natural’?” she asks. “Is it natural to die in labor, also? Is it natural to panic, to fear death, or to be unable to cope with the pain? Is it natural to want whatever resources are at your disposal to manage the pain enough that you can stay present with your experience?”

When we judge each other’s attitudes about and decisions in birth, we are saying: we should all be the same, and we should all want the same things, and we should all be able to cultivate the same kinds of experiences. We are saying, I know what you need better than you do. In place of the never-completely-known person, we erect an essentialized image of female biology as the primary source of meaning and power in birth.

But we are not all the same. We are not only people with babies inside us; we are also socially constructed beings, with differing histories, attitudes, social contexts, desires, and needs. We each have our own relationships to pain, to our bodies, to gender, to the structural realities of privilege and racism, to the medical system, to the idea of asking for and receiving help, to fear, to trauma, to authority, to safety, to family. Not only that, but our babies are of different sizes and in different positions, our pelvic floors are differently toned, our pelvises are differently shaped, and we are differently healthy and differently abled.

As Gloswitch writes in “Birth Wars: The Politics of Childbirth”: “We have people who will never know what it is like to live in our skin telling us just how much pain our nerves can stand, how much that skin can stretch, how much a woman should bear for the sake of the greater good. It is pure misogyny.”

Because we don’t know how birth is going to go, or how it’s going to feel, for the person who is giving birth. And when we wholeheartedly embrace the reality of that uncertainty we begin to honor the actual person who is giving birth and not a symbolic “individual” onto whom we can project our hopes and beliefs about what is best. Such a shift involves a change in focus from the isolated, neoliberal “individual” of consumerism (who is accustomed to being told how to shape identity through purchasing power) to the relational individual who is always uniquely embedded in the world with others. Such embeddedness generates a sense of a subjective self who does not and cannot conform to pre-formed meanings.


Tynan Rhea, a doula and sex educator in Toronto, frames it this way: “Whether [it’s] a C-section that makes you feel safe, or natural childbirth, or unassisted birth, or homebirth, hospital, birth centre, whatever — we need to try to shed any kind of messages around what any of those choices mean. Because there’s what they mean within a society and culture and then there’s what they mean to me as an individual with my set of experiences. And we need to get better at looking at people, rather than telling them that they’re making a political choice. It’s like, take the politics out of my fucking body, I just want to birth right now in a way that feels safe.”

For doula and birth educator Sasha Padron, this shift means moving away from a one-size-fits-all, goal-oriented approach to birthing: “We’ve been trained to figure out how to reach a goal by following step 1, 2, 3, 4 and 5. And that method can be very effective and useful when the outcome is controllable. Like building a house or writing an essay. But applying it to something as mysterious and unpredictable as birth sets us up for disappointment or feelings of failure because success is attached to getting the birth we wanted rather than the birth we got.”

Canadian birth educator Annyse Balkwill agrees. “We give women a contradictory task. We say create a birth plan, but then be open to it not happening. Perhaps a formal plan is not what we actually need. Maybe we could focus on creating feeling states that aren’t dependent on what the birth looks like? Like, what do you need to feel safe? Who needs to be in the room? What needs to happen when you are starting to feel unsafe? Who needs to know that information?”

Padron continues: “Birth is working with mystery and the unknown. So our power actually comes from letting go of the ‘how am I going to make this happen? How am I going to achieve this goal?’ And going to a place of wonder and curiosity. I actually don’t know what the outcome is going to be. I’m going to discover it as I go. And my power comes from a place of receptivity and a willingness to allow the process to unfold without needing to know how it’s going to go, or to have it go a particular way.”

This receptivity is clearly embodied in Anna’s birth story. A yoga practitioner based in Mexico, she had experienced trauma earlier in her pregnancy. “I could have birthed naturally,” she tells me. “I was physically capable but I was an emotional wreck after being abused and fleeing Guatemala at 7 months pregnant to a country where I had no support at all.” Anna labored for twenty-four hours at home before realizing she needed to choose a different path: “I elected to have a C-section to get out of the emotional darkness that was my birth.”

“I don’t regret it at all,” she says.

It is this kind of moment-to-moment, ideology-free responsiveness which needs to form the heart of a new paradigm. As Padron says, “a slight but profound shift in orientation can open up the full potential for what birthing can offer us. It is the difference between, ‘I want a natural birth’ to ‘I want to stay present, grounded and connected to my innate power while I birth my child’.” And part of staying present means knowing we have a range of tools at our disposal, from sophisticated technology, to clean operating rooms, to safe medications. “Relative to days past,” says Padron. “We can have complex surgery safely, we can get assistance safely, we can birth in our homes safely.”

And those of us who support the birth process as partners, doulas, midwives, doctors, birth educators and friends are there not to help “achieve” a birth that looks a certain way, but to respond to the needs of the person who is giving birth, as those needs emerge and change throughout the process. “The choice,” says Padron, “is actually about us as a community deciding that the woman is right in the centre of the entire thing and that the choice she is making is not so much about which birth option she wants but how she takes her next step [in labor], and how we support her in that.”

But who is this community that gathers around, and what kind of diversity will it be able to support? Will we be able to envision this new paradigm as more than just another lifestyle ideal for a privileged few? This challenge provides yet another opportunity for yoga culture to look at whether real social equity is amongst its core spiritual values.

Padron imagines the new, “ideal” birth like this: “Everyone is coming around the woman, and she’s the one who’s going ‘this is what I need next’.”

She pauses, and for a moment closes her eyes, as if to conjure the voice more clearly, in all of its infinite variability, and how it cuts through both expectation and inequality. She speaks again, slowly, with the fierce emphasis of a new mantra: “This is what I need next.”

Photo credit 1, 3, 4: Cassie Rodgers (www.anandawithin.com); 2, 5 Sara Kleinsmith, used with permission.


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Alix Cale is a writer, mother, psychotherapist-in-training and occasional yogi living in Toronto. She is a life-long student of movement and stories. For awhile it seemed to her as if yoga was the answer, but it turns out that it — like most other things — is only a part of the puzzle. She lives with her partner Matthew Remski and their sons in Toronto. 

87 comments… add one
  • Hello
    Thankyou for this, it is a beautiful article. The judgement around the pregnant, birthing and post natal body in yoga communities is deeply disappointing I often find. Infertility and the yoga community is another area which requires some illumination!

    Equally the practices of the medical community are also equally disappointing with a culture of non evidence based intervention (at least in Australia and America).

    I believe that conscious and empowered birth is one in which the mother feels PART of the experience, as someone with agency. How she gives birth is irrelevant unless her agency is negated in a certain scenario. The research I have done on the Mindfulness Based Childbirth Education pilot I created led me to believe while the Mindfulness and yoga helped, it was actually the role plays, the communication skills and the access to evidence based information which helped women have positive and empowering birth experiences. I respect a woman’s right to choose how she births – yet I will always ask if she would like more information to help with her choices, as often women do not have access to information that would be helpful to their decision making. That said, if she is not interested in that information that is her right also. Having had a drug free birth and an ‘epidural birth’ on my second I honestly can’t say either felt better. However if I had a third I would probably have an epidural …yet that has its own risks too.

    However I did notice that in a private hospital (as compared to birth centre) I did come up against some resistance in terms of what I would wear, how often I would be monitored etc all of which had no evidence to support these practices. Again I simply communicated my preferences and had a dialogue. It all went beautifully.

    Thanks for this article.

  • As a doula and childbirth educator, I found this article to be so affirming! My goal is for my clients to have a “satisfying birth”, whatever the circumstances of their particular birth might be. Doulas and educators who overstate positive results (“If I’m your doula/you take my class, you will have a ___ birth”) do a terrible disservice to their clients and themselves. Birth is unpredictable, and people carry memories and perceptions and preferences with them into that experience that profoundly impact their decision-making. If it’s true that mothers remember their birth experiences for the rest of their lives (and anecdotally, I think they do), the last thing I want is for them to remember a feeling a judgement from me or anyone else on their birth team.

    • Giving birth is such a wonderful experience that mothers remember their birth experience for the rest of their lives

  • Chandrika Gibson

    This is such an important message. I had my children while surrounded by a yoga community that was supportive in many ways, yet definitely conveyed the ‘natural is better’ message. I ‘failed’ to have the blissful, non complaining version of natural birth I was sold, but saved face by defying hospital policies when my first planned home birth required intervention. Five years later I was lauded as some kind of champion goddess (sounds like a juicer brand!) when I birthed my second baby in a birthing pool at home. In the years since I’ve come to understand through witnessing too many times the trauma people feel when they think they have ‘failed’ at having the ideal birth. I’m so grateful to read a more nuanced, woman centred approach, and it gives me pause to examine the terrible arrogance and smugness that I was part of as a privileged middle class white woman in the natural health and yoga paradigm making my all natural choices. Thank you for this thoughtful, beautifully articulated message, it’s really significant and hopefully reaches and reassures many that an empowered birth experience doesn’t look just one way.

  • lots of judgements also happen to the one born cesarean, as I was, non-labor cesarean. I’ve “chased” this topic for 45 years — see my latest take on it at http://www.cesareanvoices.com/SHOW-small.pdf

  • I see this as a woman’s issue, not only a yoga community issue. I am a 64 yo mother or two, grandmother of two and a lifetime yogi . In the 1970’s when Lamaze was the rage, there was birth shaming around accepting pharmacologic assistance during labor as well as having a C-sec.This attitude still continues in many circles today. I wish that those of us(male and female) who are committed to a particular lifestyle (yoga, veganism, etc) can learn that understanding, acceptance and love is at the core of our beliefs. Shaming is a psychologically damaging emotion that I think should not be part of yoga in any form.

  • Phil
  • Hannah Fries

    Hi Alix. Have you encountered the most excellent and deep work by midwife, author and educator Pam England and Birthing from Within? She absolutely addresses this subject and you may find great enjoyment in discovering her work.

  • Mel

    I feel as if the vocabulary of yoga, of liberation, of feminism — has been turned and twisted against itself in this piece. Alix, you are really a talented (and prolix) writer like your partner, and like him you seem to be drawn to use your power to divide and to make me feel like a lesser feminist, even though I know better.

    Anyone who makes someone else feel uncomfortable about their birth choices, unless they are that person’s medical professional, has work to do. That is so obvious, and yet I do completely understand the more-natural-than-thou attitude the author is talking about. Other pieces, also written by those who’ve felt judged, touch on many of the same points. If the movement toward empowering those who are pregnant to make more decisions about their labor is flawed, and it is, by all means let’s talk about it. But come on. Invoking Grantly Dick-Read and calling him out for being fucked up…feels like when anti-choicers talk about how Margaret Sanger was a eugenicist. We are where we are now, it is 2017, Dick-Read is long since dust. Understandably, the author did not even bother to read his book. Ina May Gaskin is surely influential, but she is also a nutty religious hippie out in middle Tennessee, not some mainstream medical professional, and I would hope everyone here has enough sense not to listen to a white Southern elder on the subject of racial inequality.

    Of course, modern hospital birth is an unimaginable improvement over one that lacks the advantages of modern medicine. (Birth is surely risky without modern medicine, but, seriously, so are all stages of life.) Yet how can anyone deny that offering people choices regarding their labor is also better than what our mothers, grandmothers and great-grandmothers went through in the West: on their backs fighting gravity so the male doctor could see, their legs in stirrups, forbidden to walk around or eat, drugged and cut with no agency, their babies whisked away at the moment of birth. There’s a reason we’ve begun to progress beyond that.

    I do agree with the conclusion the author draws. I am a woman who’s chosen not to give birth or have kids, but had I ever given birth, I would of course have wanted to control some of the things I could about the situation, and I wouldn’t have wanted to be judged for those choices. But I also want *everyone* to have those same choices, and they don’t. I have no statistics to back me up here, but I feel certain that for every person in the West who chose a C-section and then was shamed for it, there are ten who unwittingly underwent a medically unnecessary C-section, or were made to feel powerless or stupid in the hospital, or gave birth at home because they were too scared of the hospital or scared of being deported or couldn’t afford it, or had an unnecessary episiotomy, or were given a winking ‘husband stitch,’ or gave birth in the hospital because they had no idea you might be able to do so in the comfort of your own home. Who, in short, did not have freedom of choice, who are stuck in the modern version of stirrups.

    If the movement for birth choice (ie the inclusion of choices like homebirth and less-medicated birth along with standard hospital birth) is lacking because it is most accessible to the white and privileged (I assume this is true), then logically I’d expect this to be an article about ways to make birth choices more accessible to the less white and less privileged, such as outreach, education, or research. But it’s not; it’s an article advocating that those who’ve had or will have birth choices be affirmed in those choices rather than judged. The discussion of race and inequality is just social justice window-dressing on a piece that’s really for and about those with the most privilege. I’m truly sorry about how harsh that sounds because the truth is this piece is in good company, and yet here I am singling it out. That’s the Internet, I guess.

    • Alix Bemrose

      Thank you for your thoughts, Mel. I’m wondering if you can you show me where in this article I have made anyone feel bad about their birthing choices? Because I don’t care if someone gives birth by c-section or in a tree, so long as they felt well-treated and respected throughout the experience. I make it very clear that I am critiquing the idealization of natural birth, not the actual experience of natural birth as it exists in individual lives.

      If there is any charge of lesser feminism in this article it would be against those who talk about empowering women in birth while simultaneously suggesting that there is a better kind of birth to have. And this narrow view of “empowerment” comes directly out of the work of people like Dick-Read and Gaskin. So while you personally may be able to dismiss them, the fact is they are still extremely influential. Plus I’m not sure difficult history should be so easily swept aside.

      And of course people don’t have equal birthing choices yet. The article is about that too: “More privileged women always [have] greater access to reproductive choices compared to more marginalized women.” The problem in yoga culture is that this inequality is rarely — if ever — acknowledged. More than that, one’s birth outcome is too often attributed to some strength (or lack) within the birthing person rather than to a subtle and impersonal web of luck and privilege and circumstance.

      Finally, I agree that the article doesn’t go far enough in terms of offering solutions. But I know that my audience is largely white and middle-class (that’s yoga culture, no?) and that it would be putting the cart before the horse to offer solutions before the problem is described. We have to wake up to our privilege before we can make changes to the system.

      Thank you again for your comments. I appreciate you taking time to engage with this material.

      • Jean Byrne

        Hi Alix,
        Just a question about your comment above. In terms of idealising a natural birth, why do you think this is the case? How would you relate the idealising of natural birth to, for example, the idealising of breastfeeding (‘breast is best’).

        For example while I respect a woman’s right to choose not to breastfeed, I do believe that in most cases breast milk is the best food for an infant. I would rather look to find ways women can be supported to breastfeed so that those that have obstacles to breastfeeding are more able to make that choice to breastfeed if they wish. Then those who decide they don’t want to haven’t had to make this choice due to lack of support.

        Similarly while I respect women’s choices to choose how and where they give birth and do not see c sections as a ‘lesser’ type of birth I also know many women have c sections for reasons which are not evidence based, yet still their doctors recommendation. It is difficult for women to make choices when they don’t have access to sufficient information to make informed choices …

        Interesting to ponder.

        • Alix Bemrose

          Hi Jean,
          I just responded to you but I see my response came up as its own separate comment below. Wanted to point that out in case you don’t get a notification. 🙂


      • Mel

        Sorry, I see where I was unclear. I wasn’t trying to imply that you were judging anyone; rather the opposite: that your article inveighs against those who would be judgmental. I was agreeing with what I saw as your main thesis in order to establish common ground. I see how I phrased that poorly and how that could make my comment pretty confusing. Also you don’t know me but I would never be like, “um, you have work to do,” lol.

        I absolutely think there *is* a better kind of birth to have, but that the distinction is not between, eg, a vaginal birth and a c-section, but between more informed choices vs. fewer informed choices. Did Ina May Gaskin say something racist af? Yes. Is Gaskin racist? Probably. Is ‘Spiritual Midwifery’ magical and has Gaskin done a lot toward empowering some women to have better birth options? Also yes! We don’t have to, uh, throw the baby out with the bathwater. Her faults don’t negate the good that she’s done and we can build upon that good while actively discarding the bad. I’m tired of these purity tests and grateful that that ‘Excommunicate me from the Church of Social Justice’ article is starting to give people a framework for talking about them.

        “And of course people don’t have equal birthing choices yet. The article is about that too” — Yeah but, I don’t think it is, really. That’s what I’m saying, is that it’s, like, lip service. That’s why it really got to me and that’s why I bothered to comment.

        “We have to wake up to our privilege before we can make changes to the system.” I don’t agree. I learned in Psych 101 that you change someone’s mind by changing their behavior and not the other way around. It’s stuck with me!

        • Alix Bemrose

          Hi Mel,

          I understand: I read that second paragraph differently now. Thanks for clarifying. Though I think my original reading was skewed by the last sentence of your previous paragraph, in which you suggest that I’m using my writing to “divide and to make [you] feel like a lesser feminist.” 😉

          I’m not sure the psych 101 maxim applies here. For instance, who exactly (in the unregulated landscape of yoga culture) would be responsible for legislating the new behaviours that would then change people’s minds regarding problematic birthing attitudes and inequalities? IMO nothing will change (because there will be no pressure or reason to alter current behaviours) if people remain oblivious to the privilege underpinning the idealization of natural birth. Activism requires seeing a problem first and then working to correct it.

          To my knowledge no one has published an intersectional critique of modern yoga culture’s dominant birthing attitudes and so that is what I wanted to do. It occurs to me that there is some confusion in our discussion here around the scope of this article. It is written about yoga culture and its intent is to show how the capacity to idealize “natural” birth in fact rests on tremendous privilege and unacknowledged inequities. I am not a policy maker nor do I have the ear of people who are. What I can do is speak to a subculture that is generally blind to its privileges and continue to talk about the ways in which our ideas about birth (and our prenatal spaces and courses) are actively excluding whole segments of the population. I think the article more or less does that, and it feels like a good first step. The next step would definitely need to be solution-based. Like, can we start using more gender neutral language in prenatal yoga classes so that queer, non-binary and trans pregnant people don’t feel alienated by problematic gender essentialism? Can we offer a sliding scale for prenatal classes so that more people of various socioeconomic statuses can access them? Can we acknowledge the ways in which our yoga spaces are dominated by slender, white bodies and ableist attitudes and then work to make those spaces way more inclusive?

          Anyway, thanks again for the conversation. I appreciate you engaging with me in these ideas.

  • Alix Bemrose

    Hi Jean. Thanks so much for your thoughts and for contributing to this conversation.

    IMO wellness has to be about context and relationship. Breastfeeding may be considered somewhat “healthier” on paper (though how much healthier is currently a matter of debate and research). But if the struggle to breastfeed generates stress and feelings of failure in a new parent (and this is very common), it is clearly not the healthier path. Also, as I’m sure you’d agree, parents need to feel free to choose the feeding method that works best for their families. Again, concepts of family health need to be oriented towards a bigger picture.

    I agree absolutely that as a society we need to provide better (and publicly funded) postpartum support to new parents. This would include help with breastfeeding (if breastfeeding was the chosen feeding method). In many places, the majority of postpartum support is still only available to those who can pay for it. Here is a great article about the (often invisible) privileges that underly an ability to breastfeed: https://www.todaysparent.com/baby/breastfeeding/breastfeeding-may-be-free-but-its-still-a-luxury/

    Finally, there are many things to be improved upon within modern obstetrics. I think the vision put forward in the last section of the article could be easily applied to hospital birthing as well: big parts of that community could certainly learn to pay much better attention to the moment-to-moment needs and desires of the people who are actually giving birth. As for the c-section rate — it could definitely be lower. MUCH lower in some countries. I know people sometimes feel pushed (even bullied) into surgery and this is horrific and absolutely needs to change. At the same time, I’d love to see a study that break-downs the numbers behind the cesarean rate. How many of those cesarean births felt unnecessary to the actual birthing person involved? How many of those people were left with residual feelings of uncertainty — was that procedure really necessary? And how many birthing people would report the opposite, that they were on board with the procedure, that perhaps they even chose it and were grateful for it? As long as we’re dealing with lump sums it will be hard to fully know what the number means.

    Anyway, I don’t think we change the problems with broader birthing culture by generating backlash idealizations which in turn can cause their own kind of harm. The way forward definitely needs to be over middle-ground.

    • Jean

      Hi Alix
      This is a great discussion, thanks for initiating it. I couldn’t agree more that mental health is central to birth and parenting decisions. For example while something like controlled crying horrifies me personally I also see it’s necessity for women and families and their overall happiness and have actively supported my friends who needed to make this choice for the wellbeing do their home.

      The bigger picture is always key to decision make at any stage of life and the benefits of breastfeeding for example are certainly undermined if women are stressed and families are under pressure due to attempts to breastfeed.

      I am not aware of any research questioning how healthy breastfeeding is – I would love to read that!

      As you mentioned earlier activism does involve seeing a problem first then acting. Research is a wonderful way to help with this clear seeing. The risks on c sections are clear as are the fact that the rates are very, very high and given that c section has many associated risks it is a procedure which needs to be used in an evidenced based manner. The research has helped people begin to enquire more deeply into what is occurring which is wonderful.

      I think the ‘natural’ is radically over emphasised as ‘better’ in the yoga community and it is a somewhat anti science attitude which is embraced as part of this.

      Funnily enough my first ‘natural’ birth was wonderful. Yet to be honest I preferred my supposed ‘non natural’ birth with an epidural. I wasn’t as exhausted when I welcomed my son into the world. But I was thankful to have been able to make an evidence based choice and felt informed to make the decisions I made.

      A good example of anti science in yoga land is the reluctance of many Yoga and meditation practitioners to take, for example, anti depressants. For many people drugs are a key way alongside lifestyle and yoga for example to manage their wellbeing. And over emphasis on ‘natural’ has people not using chemical supports which they dearly need.

      It is interesting I am not sure what it is like in Cananda – but here the best pregnancy and birth services are 100% free in public hospitals. Obviously there are still many economic and situational / access barriers to something like breastfeeding. But while we do still have have huge problems here, women in public hospitals receive access to pre natal care, post natal care via midwives in their own home. Free access to hydrotherapy, OBGYNs, midwives, psychologists, physiotherapists, subsidised childcare and have a legal right to 12 months maternity leave.

      There is a lot lacking, but it’s a decent start.

      I would love to hear your thoughts on infertility in yoga land. Having struggles with secondary infertility for five years I was met with many cruel and painful remarks and analysis about my situation.

      Great discussion.

  • Hi everyone
    Thanks for this article! I think it’s a much needed area to explore and discuss. As a midwife and childbirth educator, I can certainly relate to many of the concepts addressed in this article. As a parent who had 2 kids out-of-hospital (one at a birth center and one at home) I am intimately connected with the “natural birth” community and understand the pressure that’s often placed on people to give birth “naturally.” I totally get it. I do have some food for thought, though. I think it’s incredibly important for people to be informed about their options and to give true informed consent for interventions or procedures. In an ideal world, pregnant people will fully understand the benefits and risks all of labor and birth interventions and make choices that are appropriate for their physical, emotional, and social needs. Whatever those choices are, they would be honored, respected, and carried out with compassion and clinical competence. BUT, we don’t live in an ideal world, and many pregnant and laboring people are coerced, bullied, and pressured to get interventions that they don’t need and/or want. Many people don’t understand the concept of the “cascade of interventions” and don’t understand how getting one intervention, such as an induction or epidural, can lead to others that may culminate in a cesarean birth. If they understand this from the get go, and make the decision to get an intervention with full knowledge of the benefits, risks, alternatives, and potential consequences, then all is well with the world and they are truly implementing informed consent. But we know that this is not the case, and many pregnant and laboring people find themselves in a situation that they had no forewarning of, not being given correct or complete information, and not understanding the impact of interventions both short-term and long-term. So I think it’s important to change the culture of birth to one of respect for all the choices that people can make COMBINED WITH full and transparent disclosure of the potential benefits and risks of all interventions (for example, do all people know that long-term risks of cesarean birth include increased risk of placental complications in future pregnancies, formation of painful scar tissue on internal organs that can cause problems for years after birth, and increased risk of ectopic pregnancy in future pregnancies?) Would people make the same choices knowing these increased risks? Maybe so, maybe not. But they must know this info in order to give full informed consent. So, I applaud and respect your attention to this very important matter, but I think the conversation needs to go further and we need to do more to make sure that pregnant and birthing people fully understand their options.

  • This is such a thoughtful and thorough article, it was a pleasure to be a part of it!

  • Giving birth is one of the memorable experience in the lives of every mom but it could also be one of the traumatic events that a woman could undergo. With few supports and knowledge in child delivery, a woman could find herself feeling terrified, pained and depressed during the process but with adequate support, one could feel courageous during the risky times of child delivery. This post is a good read for pregnant women to keep them encouraged.

  • Any birth is “natural,” as nature takes its course bringing the baby into the world. When I teach prenatal yoga (and train teachers to teach pregnant mamas), using inclusive language is key so that no woman feels judged about her decisions. Don’t we as women suffer enough criticism as it is? Seriously. Women are hardest on each other, it seems, when it comes to birth and parenting choices. What we really need is support — and we should offer it to each other. That’s part of what yoga is, isn’t it? Unity, community, joining together.

  • K Saphir

    I had a lot of thoughts and feelings about how disappointing the author’s yoga community was in supporting women and their birth choices. In prenatal yoga teacher training, there should be more sensitivity discussed on ways not to share our personal opinions or judgements on women’s birth choices or experiences. Instead we should support women in whatever they choose. Going through labor, delivering a baby, and taking on motherhood are hard enough to handle without having to deal with negative viewpoints about “natural birth”. I feel very lucky that I did not encounter this during my prenatal yoga classes in Seattle. There was a lot of discussion on how to cope with the pain and sensations during labor using yoga techniques but no dogma was preached. A few women in the circle sharing time did voice disappointment if they had to change their planned birth location or ended up having a scheduled C-section but they were respected and supported.
    I also think that saying that a vaginal, non-medicated birth is the only natural way to give birth is extremely misguided and detrimental to moms who choose a different path. I think if mom’s seek out a medicated birth, they need to know all the risk factors and possible side effects that come along with medical interventions during labor but shouldn’t be judged. The cascade of interventions from an epidural and being tethered to the bed may be a slippery slope to getting a birth far from the one the mom imagined.
    Along these lines, any birth in a hospital setting does not seem “natural”. I gave birth unmedicated and vaginally but there is nothing natural about the process (other than my body knowing what to do in multiple strange situations). To start, you have to leave your home where you were comfortably laboring to get in a car (and possibly get through a contraction on all 4’s on the sidewalk which is what happened to me). From the car you enter the hospital lobby (and possibly get through a contraction on all 4’s on the lobby floor which is what happened to me) and head to triage where you may have to labor in a tiny bed for what seems like hours until your midwife or OB arrives to the hospital. Then when you finally get into your delivery suite, you’re hooked up to some kind of EFM, you have a IV tap in your hand with a needle constantly pressing in if you’re on hands and knees, and there are all kinds of people you don’t know around you making the environment anything but natural. While I was laboring and pushing with the guidance of my midwife, there was a shift change and all the nurses and midwife rotated and had different ideas of how I should push. I was told to hold my breath for 10 seconds and squeeze which felt like I might pop an anuerysm in my brain. One nurse was adamant about me getting on my back with my legs up and holding a towel over the birth bar. I refused for a while thinking that being on your back was the worst place to push, but of course in the end that’s what worked and I tore pretty badly. Overall, it was not an ideal or natural setting to be in when you need to be relaxed in order to get through an unmedicated “natural” birth. When I finally got my baby girl out, she had some breathing complications and was taken to the NICU after I only got to spend about a minute with her (and in turn had to stay 4 more days in the hospital). My natural birth never seemed natural while I was moving through the places and stages of a hospital birth.
    All this being said, I think the discussion should be less about women and their failings if they choose a medicated hospital birth or surgical birth, but should shift to be more about preparing and supporting women to birth outside of the hospital industrial complex. This is where our focus as birth advocates need to be. If a mom is healthy and baby is doing well, mom should be allowed a home birth with a midwife rather than be forced into a highly unnatural setting where she isn’t told her body can handle a natural birth. Birthing with an OB means that they are looking for problems to solve in a set time rather than allowing moms to take the time they need and to birth as their body sees fit.
    This also touches on was the mass influence that hospitals and insurance have over women and their choices. Depending on where you live and what type of insurance you have, many women don’t have much of a choice. When I was pregnant and deciding on care providers in Seattle, I had a wide array of choices of birth centers, home births, hospital births with either a midwife or OB. On top of birth location choices, I had great insurance through my husbands job which allowed me flexibility and lots of coverage of where I wanted to birth. I know that this is a huge privilege I have as a white middle class woman and many other women aren’t afforded these options, even in Seattle.
    Since we’ve moved to Columbia SC there are fewer options for me and I imagine even less for women without good insurance. There are no birthing centers and only one all female OB group with no midwives in the city of Columbia. I did find two home birth midwives online but neither gets reimbursed by insurance companies. These midwives seem to be the exception to the rule of how birth works in Columbia and if you can’t pay out of pocket you don’t even have them as an option. If you don’t like your OB or their practice you have limited other choices. Or if you have a certain insurance that doesn’t cover home births, if that’s what you desire, then you’re at the mercy of the hospital and OBs. Disrupting the hospital systems hold over women, should birth need to be where people’s energy is focused, not on mom’s and their choices. Using mass media outlets to promote women’s birthing abilities as being capable and amazingly designed to deliver a baby can help shift the hospital/OB birth paradigm and move it back towards midwives and home births like in many other countries.

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