Tuesday, June 02, 2009

Management, or, Choosing your choice

I've been thinking about birth choices a lot lately. A good friend of mine - friends, in fact, as I first met the husband, goodness! fourteen years ago, while his wife and I met nearly ten years ago when we began undergrad together - is 30 weeks pregnant, having walked a long and hard road to get here. After two excruciating miscarriages, one of which was shockingly late, she and her husband want not only a healthy baby, but a healthy and natural birth experience.

I've been counselling her - over facebook, no less - as to ways she may accomplish this feat. Because a feat it is, when presented with a society that views birth as a medical event, and a medical system designed to take the mother and father out of the equation. What she would like is a homebirth, attended by a midwife and a doula. What she will have, as a result of her small-town location, will be a hospital birth, attended by an obstetrician she will likely not have met previously, and an army of nurses on rotating shifts.

She fears unnecessary interventions. Monitoring, pain "management", epidurals, pitocin, episiotomy, Caesarean section. But it is not a fear of needles or a fear of incisions: it is a fear that she will be denied the opportunity to birth her child, to allow her body to the work for which it was designed and built, to inform her life, including her motherhood, with the profoundly affecting experience of birth. Moreover, she is afraid of being denied choice.

It can be argued that some choices are entirely personal, and others which could be considered far more public. Choices which affect the wellbeing of others are, in a very strong sense, public choices, though they are elementally personal. When we make our personal choices for our lives, we should, generally speaking, make our choices for ourselves, and usually not, I think it is fair to say, as a means of some sort of political activism. Activism is all well and good, and I've certainly done some (*ahem* check out my new banner) but when it comes down to making choices as to how to birth your child, in that regard, all bets are off. We need to make our choices personally, not publicly, if you understand me.

That said, I wonder how the choices made by other mothers in the days, weeks, months preceding my friend's birth will affect her and her husband's experience in that hospital. Will the willingness of other mothers to lay still, semi-reclined, for convenient - and largely unnecessary, though no nurse would ever admit to it - monitoring of the fetus increase the likelihood that my friend will be pressured to do the same? Will the success of nurses pressing the use of pain management and labour management drugs, such as pitocin, on other mothers serve to bolster those same nurses in their almost inevitable fight with my friends? Will enough mothers agree - willingly or not - to these interventions only to have labour "fail to progress" resulting in "necessary" c-sections contribute to the already existent cloud of doubt surrounding natural birth in a hospital environment?

What fights will my two dear friends be forced to fight, while at the same time labouring? How will the choices made by other mothers, by other fathers, affect the establishment or denial of my friends' right to choose for themselves and for their child? I don't believe, truly, that we should be considering others when making deeply personal choices, and goodness knows the choices made regarding pregnancy and birth are deeply personal, but I can't help but wonder these things, and wish to heaven that there were some way to arrange to be in the maritimes when she goes into labour. Because I foresee a fight for them to experience birth the way they are meant to experience it, the way they have set out to experience it, and wish I could stand with them in their battle.

While these deeply personal decisions are just that - personal - I do wonder at what point we must admit that there may be larger societal implications because of them. And, if so, what personal changes must we endeavour to make, in an effort to positively affect the public good.

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