It was Friday, my fifth day of labor. Unable to keep food down or get more than a half hour of continuous sleep since Monday evening, I was relieved when my midwives decided to speed things up by admitting me to the birth center and rupturing the membranes of my placental sac. And still more relieved when one of their more experienced midwives sat with me, coaxing me to relax and let my body do the work.
But soon after, I was left in the care of the one midwife in the practice I didn’t feel a connection with. It was this new midwife who, in our first meeting at my 40-week visit, had immediately started talking about how they would induce me at 42 weeks, even though I was confident that wouldn’t be necessary. And it was this midwife who, on Monday, had told me over the phone that my contractions weren’t strong enough or regular enough to warrant coming in to the birth center, even though I’d been tracking them all day and they had been 5 minutes apart for over an hour. I sensed she didn’t want to take the trouble to come in to the center and monitor my labor in person.
That conversation affected my labor profoundly. I had been en route to the birth center – with all the certainty a first-time mother could have that I wasn’t imagining actual labor. When she said – no, go back home, wait until it’s been two hours – I suddenly felt even more powerless over the forces that had taken over my body. In a surge of frustration and anger, I began to sob. When my husband and I reached our home and I stepped through the front door, a violent contraction trembled through me, and a fit of nausea sent me running to the bathroom. I couldn’t keep food down the rest of the week.
In the thirteen years since, part of me has remained baffled by the helplessness I demonstrated during those five days. In my personal and professional life, I work daily on behalf of gender equality. I experience the privileges that U.S. society gives to white, upper middle class women, particularly those above the age of 30. I was not, in short, the kind of woman who regularly experiences discrimination at the hands of health providers.
And I planned my birth precisely to avoid an imbalanced power dynamic. Wary of the lack of control that I often felt interacting with doctors during my life, I had long known that I wanted midwives to assist me in childbirth.
Yet never once did I express my discomfort with the new midwife, never once spoke up with a strong opinion about my care, never once even questioned the dose of castor oil they gave me on Friday to speed up labor (as if that would stay down when the Haagen Dazs milkshake a couple days before hadn’t). I didn’t ask the comforting midwife to stay, and I didn’t say I wanted someone other than the new midwife to attend my labor. Against my better judgment, in my exhaustion, I even accepted the lithotomy (flat on the back) position for the seemingly endless pushing stage when the midwife insisted that was what the baby’s position required.
The truth is I wasn’t powerless – I’m sure if I had asserted myself at the outset, I could have had a smoother birth. But I was focused – getting that baby out of my body was my only goal, and anything else felt like a distraction, a waste of precious energy. I made myself powerless, because that’s what I needed to do at the time. Powerless in the face of strong contractions, and powerless in the face of the threat that I would be transferred to a hospital if my labor didn’t speed up. Powerless to even make the midwifery practice aware of my complaints afterwards, because after all, I ended up with a healthy baby.
If I felt powerless, as someone who knows and defends women’s rights on a daily basis, as someone who had the ability to seek out providers who would listen to me, as someone who benefits from so many privileges, what must women around the world feel?
I have since learned a great deal about what women around the world are experiencing. Thanks to the diligent efforts of global advocates, and the women who have bravely spoken up, we know that feelings of powerlessness are all too common during childbirth – in the face of verbal and sometimes physical abuse. We also know that layers of discrimination – due to race, age, religion, poverty, HIV status – add to these experiences of disrespect and abuse.
Reading birth stories of women who have experienced disrespect and abuse in childbirth, I know how lucky I am. Being turned away, not listened to, not respected, left alone, denied information, not consulted – women experience this kind of treatment daily around the world, and it drives them away from skilled care, causes critical delays in their care – and violates their human rights. I was never physically in danger from the disrespect I experienced. Unfortunately, many women are. For example, the maternal mortality rate in the United States for women of color is shocking – almost four times higher for black women than white women.
Today is the International Day for Maternal Health and Rights. It’s an opportunity to push forward the structural changes necessary to end the silence and power imbalances that all too often accompany childbirth. We can give women the information they need to understand their pregnancies and how powerful they really are. But most importantly, we can create cultures that honor and respect women’s voices, most critically when they are engaged in the amazing, precarious, painful, heartbreaking, earth-shattering process of creating life.
To add your name to the petition to get official United Nations recognition of the International Day for Maternal Health and Rights, see this page
To learn more about the movement to end disrespect and abuse in childbirth, see this brief I wrote for White Ribbon Alliance.