Birth, bodies, and chronic illness.
Prescript: @Vikkiage wrote an amazing post a bit back about the problems with a lot of body positive slogans, especially for trans people. Cabell added her own thoughts about how these slogans relate to her own medical issues, and that definitely spurred this post. I felt that adding what’s below as a reblog would be derailing, as I’m taking it in a different direction, but I also wanted to give full credit for the inspiration here.
The evolution of childbirth in the last few decades has generally been in a positive direction. Home birth, the presence of midwives and doulas, and a decrease in the medicalization of labor and delivery have become, if not mainstream issues, at least openly discussed topics. There’s still a lot of ground yet to be gained: the Cesarean rate in the United States is still far higher than it should be, for starters, and there is a real gap between science and practice in obstetrics. But we’ve come a long way from the twilight sleep era, and for that I’m very grateful.
But we’ve also come to the point where a lot of talk surrounding pregnancy and delivery can be very difficult and even actively unhelpful for many parents. The natural childbirth community, like the body positivity movement, centers a great deal of its talk around the idea that birth is a normal, natural process. So far, so good. But its slogans focus on the concept of bodies as fully functional, fully abled, and working according to its design.
- Your body knows what it’s doing
- You need to trust your body and the process of pregnancy and labor
- Your body was designed to do this.
- Women have done this for millions of years
For many, this is empowering, and I want to honor how important and valuable many people have found these words. As a counter to the medicalization, to the idea that doctors knew better than women in labor and that the body’s natural process was something to be managed and controlled, words like this were revolutionary.
But for many others, they’re deeply problematic. I suffer from an auto-immune disorder, most likely rheumatoid arthritis. So here’s what that means to me:
- My body does not, in fact, know what it’s doing a lot of the time.
- My body is trying to destroy parts of itself, so trust is a tricky question.
- My body does not do what it was designed to do in many ways.
As a Survivor, the birth of my daughter was incredibly healing, and mothering her has been even more so. But it was a complicated and difficult birth, and the medical problems I have had since then have only made my relationship with my body more difficult. As I approach my second birth, I often feel disconnected from the birthing community because the rhetoric surrounding alternative (as opposed to conventional) birthing excludes me. It is essential that we talk about birth, and birthing bodies, in ways that are inclusive and can nourish all.
This may be a somewhat different direction, but a lot of it still applies to me. While my condition is not autoimmune, it is one that is specifically dangerous in pregnancy. A degree of medical management is necessary for my safety in pregnancy, childbirth, and the immediate post-partum period.
It makes me INCREDIBLY angry when I mention anxiety about getting to the hospital in February and people respond with blithe assertions of “well, you don’t REALLY need to be in a hospital to give birth,” because actually, yes, I do. My clotting history is extensive enough that giving birth without a heparin IV is dangerous—and of course, being on heparin, giving birth without immediate access to the medications that can reverse its effects if necessary is ALSO dangerous.
Like you, my body does not do what it was designed to do, and that causes me anxiety even in cases where my clotting condition is not directly relevant. I don’t trust my body, because I feel like I have plenty of reason not to.
At the same time, I have to fight against being subjected to interventions that are totally unnecessary and, in fact, are an especially bad idea given the particulars of my situation. When I was interviewing OBs before I got pregnant, I had to go through four of them to find one who didn’t insist that any pregnant person on blood thinners would HAVE to be induced, because that is the “standard of care.” It’s the standard of care because anti-coagulants preclude an epidural, which I didn’t want in the first place, but none of them cared when I pointed that out.
Furthermore, although most pregnant people on anti-coagulants are being treated prophylactically rather than therapeutically, which means that the goal is to stop anti-coagulation entirely before labor, that is not my situation. Given my especially clotty history, the hematologist’s recommendation is for continued anti-coagulation up to transition, which means that labor cannot be timed such that an epidural could be administered anyway (you have to be off heparin for at least six hours). And that means that induction is an especially bad idea for me, since my pain management options are limited and induced labor tends to be excruciatingly painful. The US obstetric “standard of care” also means that I will not have access to nitrous oxide during labor, despite the fact that it’s safe and effective and widely used for pain management during labor in Europe.
For me, the biggest issue in how people tend to talk about birth is the huge divide between evidence-based medicine and the obstetric “standard of care,” which frequently has fuck all to do with any actual research or evidence. That sometimes comes out in natural childbirth discussions, but not always. One thing that we all have in common, I think, is that we often have to fight for the right to make our own medical choices, and that’s bullshit. There needs to be better information available, and more agency for pregnant people along with it.
