“If we provide an environment that is fearful, anxiety provoking, and deeply suspicious of nature, one that we aim to command and control, rather than to trust, then an inability to birth naturally becomes a self-fulfilling outcome in many of those who actually have the inherent ability to give birth.”
Dr. Amali Lokugamage
Modern obstetric care is not wellness oriented, but rather problem oriented, always on the lookout for complications or potential problems, which doctors must stay a step ahead of in order to avoid, and or alleviate. Imposing this risk reduction/defensive medicine strategy on expectant mothers tends to objectify and dehumanize the mother and her childbirth experience. She is no longer an individual, unique and precious in her own right, and her pregnancy and impending birth is not sacred, or miraculous, but instead, she is a risk to be restrained, dominated,controlled,and contained. Rather than a unique, individual, expectant mother who is to be nurtured, nourished, and cared for, defensive medicine transforms her into a hornet’s nest, or a Gordian Knot of lurking medical complications and possible litigation. Once cast into the realm of aesculapian quagmire, providing her care is no longer an honor, but rather a bother, a struggle, and her questions and desires for her birth merely an irritation or annoyance. Encouraging her to become educated, prepare and practice, and follow her intuition, would be folly then, as this would interfere with the effective, active management of her care, by the doctor who must be in complete control in order to avoid any chance of deviation from his rigid idea of how the course of her labor will procede, and of course, avoidance of potential litigation.
Removing all sense of control and cooperation from expectant mothers, serves to undermine her sense of safety and need fulfillment, which inhibits her ability to relax , surrender to the process, and allow labor to progress easily and naturally. It sets her up for ineffective, unproductive, and prolonged labor, and opens the door to the very complications the doctors were so worried about avoiding. This translates too into the idea that her female body is inadequate, she is incapable of birthing on her own, and subjects her to constant needless pressure and anxiety over what could potentially go wrong, and a self- fulfilling prophecy of labor complications. If in her anxious and fearful state something does go wrong, she is then put on the treadmill of self- blame, self- doubt, and weighted down with the label of “bad mother”. All of this further undermines her confidence in her ability to labor and give birth, and to mother her child.
This model of risk reductive medicine and actively managed care, begins and ends with causing anxiety for the mother, and then dehumanizes and berates her for her very real human emotions, needs, and responses. It negates the existence of her emotional and psychosocial needs, reducing her to mere physicality. It overlays her with a suffocating blanket of guilt, shame, and power struggle, that she has no choice but to rail against, if she is to retain her self- esteem, her autonomy, and her ability to do what she needs to do in order to birth her baby in a gentle, loving, peaceful fashion.
Conversely, when a laboring mother receives what she perceives as disrespectful, manipulative, emotionally abusive, and bullying treatment from the very medical caregivers she depends on for the need fulfillment and safety of she and her unborn child, at a time of intense vulnerability, she may feel such extreme cognitive dissonance concerning this type of care versus her birth visions, intentions, goals, and expectations, that in order to justify this ill treatment, and to continue trusting the people she needs to be in charge of her very life and that of her baby, she may feel forced to cave in and acquiesce to their orders, demands, and a suggested cavalcade of unnecessary interventions. While the bullying caregiver may feel this is the more acceptable choice, and that he has gotten his way, foolishly believing all will end up ok anyway, with healthy mother and healthy baby, research shows that this is not only not enough, but not true. After her birth, all mothers look back on, and seek to process their birth experience. If she has been the recipient of actively managed, defensive care that dehumanized her, she will realize that she caved in to the betraying caregiver she counted on to help her to have a peaceful, joyous, gentle, and loving birth. She will know that she did so due to an overwhelming sense of fear, anxiety, powerlessness, and guilt they forced her to feel, and her deep need to understand and resolve these feelings in order to safely give birth to her child. She will also feel that not only was she let down by her doctor and or the medical staff, but that she let herself and her baby down by not standing up and demanding what she knew to be right. The problem is that standing up in the face of medical caregivers who are not being honest, who are making suggestions and decisions based on their own convenience and defensive medicine practices that may help to head off any potential litigious events, at a time when she is in pain, utterly helpless, vulnerable, and being forced to feel she is a bad mother for supposedly risking her child’s safety and life if she does not do what they suggest, is hard, if not impossible to do. How many women have been cast aside in the wake of such insensitive, dehumanizing, and injurious medical care, and then guilted even further for feeling confused and depressed about it afterwards? If her depression then negatively affects her ability to mother her new baby, she is the recipient of even more guilt heaped upon her as she is accused of being selfish, and a bad mother. This is in no way her fault. Managed, defensive medicine, obstetrical care sets up an adversarial relationship between mother and caregiver, and then complains in exasperation and disgust that the patient seems to need to fight with their doctor, never realizing they are the very ones who created this damning interplay to begin with.
We cannot change the lack of sensitivity and deep human caring that some doctors possess. We cannot suddenly force them to understand and practice heart centered, compassionate, and loving patient care. We cannot make them listen to and respect us and our needs, desires, and wishes for our birth. We can though make the informed, thoughtful, and actively aware choice of our medical caregivers, the number one most important priority toward ensuring the gentle, loving, peaceful birth and welcome into this world that our precious baby will receive. We can make a list of questions and priorities that are most important to us, and schedule to meet with various caregivers to understand their philosophy, and whether or not it matches with our own. We can cross those doctors off our list who are not willing to work in cooperation with us to have the birth we desire. If our chosen doctor does not show his or her true colors until the eleventh hour, when our birth is drawing near, we can change physicians, knowing that there will not be a second opportunity to redo our birth if it all goes south.
You interview birth doulas, and ask a myriad of questions about our philosophy and how we will offer support before, during, and after your birth. Why do you not do the same with your prospective doctor or midwife? Do you not understand that your doula is a guide who walks beside you, and does all she can to support and love you through into motherhood, but she cannot experience birth sensations for you, she cannot make decisions for you, she cannot take away pain or make up for your lack of practice and preparation for your birth, and she cannot force your medical caregivers to change their chosen plan of care and action during your birth. You are the ones who must begin by choosing the right caregiver, and then by setting your birth goals and intentions, following through with whatever education, practice, and action is needed to bring your intention and goals to fruition, and actively taking part in your health care and your birth.
Going with the flow, not identifying intentions and goals, and not working prior to your birth to be as prepared as you can be, will not result in the birth you dream of. Pregnancy and birth are not merely a physical act that ends with the entrance into life of a baby. They are an enormous transition in the lives of mother, father, and family, and they must be carefully, mindfully, and actively considered and prepared for. This is the first time in your life that your every intention, goal, thought, emotion, and action will not only affect you as a single person, but will also affect the life of your precious child, for years to come. You gave up the right to avoid or abdicate this responsibility when you became pregnant, and now you must rise to be the advocate and parent that your baby needs you to be, to ensure his safety, his happiness, his very life. Don’t make the mistake of thinking that someone else, who is not anywhere near as invested in your birth, you’re transition into motherhood, the life of your child, or the happy, healthy beginning of your life as a family, will do the right thing and work it all out the way you want it to go. If you read every blog post on this website, and even forget them all, hear this loud and clear, write it on your heart where your birth vision is held, on the palms of your hands that will take action to bring your peaceful birth into life, and upon your spirit which you will listen to as you enter into labor, birth, and motherhood:
Your pregnancy and the course of your birth are the beginnings of the life of your most precious treasure and gift, your beautiful baby. How these unfold will impact his/her life forever, in a myriad ways. Love your baby enough, no, love him so fiercely and with such unyielding devotion, that you will commit to begin now to make his entrance into the world your number one priority, and your education and preparation for it, held above all other priorities you will make from here on out. Who cares if you choose just the right new kitchen counter tops, start that remodeling job, buy a new house, shop for all the latest baby equipment, stress out to wipe all those piles of work off your desk, finish your never ending to-do list, if preparation and practice for your birth is either last on the list, or not on the list at all. What do all these material things matter if you end up coming home to that newly remodeled or completely new house, feeling as if you were robbed of the birth you desired, or overcome with guilt or depression about how your birth unfolded?
Choosing your medical caregiver, reading, education, taking classes, hiring and working with a birth doula, practice, and active efforts to get ready for your labor and new motherhood, are the most important things you can do, and are essential if you want to have a gentle, loving, peaceful, birth experience. Your birth doula can put her whole heart and soul into loving you through your pregnancy, labor, and birth, but she cannot be the Oracle who will divine and direct their course or outcome. You are the one who must set the intention, actively work to bring it to life, and surround yourself with a birthing team who is on the same page. I write this, and every blog post on this site because you and your baby, your growing family are precious, worthy, sacred, and important, and it is my fervent desire to see you recognized and treated as such throughout your pregnancy, and during your labor and birth, and to encourage you to surround yourself with only those who realize what an honor it is to serve and support you during this time, and to take part in this miracle. Please, please, open your eyes and see yourself, your baby, and your family this way as well, and in so doing, you will be unable to do anything other than working to honor this sacred act of birth, sacred and important transition, and precious mother, father, and new baby, with whatever it takes to ensure the highest good and most beautiful birth outcome. I wish you all a birth overflowing with compassion, laughter, joy, peace, and love, and bow to the strong, courageous, beautiful, and capable mothers and fathers I know you are, and can be. Om Shanti dear ones.