Is Empowerment Really What We're Doing Here?

Redefining Maternity care Within the Natural Birth Movement

It’s tempting for midwives, in a world where anesthetized and often surgical childbirth is the norm, to promise mothers an empowering birth experience.  Midwives would love to ensure that all their clients’ needs and wants, both physical and emotional, will be met, and that their sweet babies will slide out of their bodies and blink up at them as choirs of angels sing and their partners tear up in wonder at their strength, power, and pure beauty.  We want to say that natural childbirth is going to be incredibly empowering.  It’s so very tempting. 
 
Why?  Because midwives see all the brutal things that happen to women within the high-tech, high-volume medical model, and we know that it rarely needs to be that way.  We want women to know that they can mitigate the risk of what writer Sarah Blackwood calls a monstrous birth (“Monstrous Births: Pushing back against empowerment in childbirth,” The Hairpin, Aug. 10. https://thehairpin.com/monstrous-births-3d666cda5030#.chdyb2a2o) by carefully choosing their birth setting and attendants.  We want them to know that their bodies are actually miraculous, and that birth can be transformative.  But the promise of a transformative experience does not guarantee any particular or expected outcome.  Transformative means that it will change you, not necessarily that it will bring you any kind of heightened sense of power over your experience.
 
Here’s the truth.  Childbirth is grueling.  No matter how many times you read Orgasmic Birth (by Elizabeth Davis – I recommend it!) and visualize giving birth in an outdoor hot tub beside a rustic mountain chalet while the sunrise peeks over a distant, pastoral meadow and unicorns frolic in the yard, childbirth is going to take everything you’ve got. 
 
Normal, perfect childbirth, which occurs on its own in a large majority of healthy low-risk women, is intensely challenging, both physically and otherwise.  And once in a while, things go sideways and everything in the birth plan slips through your fingers like sand.  Hospital transfers happen, emergency C-sections happen, and birth can be “monstrous.”  Even at its best, it is gritty, messy, and exhausting.
 
I don’t say this to scare pregnant women, but rather to prepare us all for the wide array of possibilities.  In life, and perhaps especially at the beginning of life, there are no guarantees.  Midwives cannot make your birth go the way you want.  We so much wish that we could, but that is not the way of nature. 
 
However, here’s what we can do.  We can help you prepare for whatever might come.  We can listen to you, and hear you, and respect your informed choices.  We can show you through our words and actions that you are wondrous and powerful (in the way of perseverance, not in the way of controlling the outcome) regardless of how things play out.  We can encourage you to make healthful choices that will increase your likelihood of having - dare I say it - an empowering birth experience.  But what does that really mean?

​Blackwood cautions us to beware of the moralizing nature of words like “empowering.”  When we equate the natural, mountaintop birth with empowerment, we put a judgement on births that don’t turn out that way.  The ones that need an epidural, or “worse”, surgery, are treated as births gone bad.  But are these situations really failed experiences at the least, if not failed bodies and failed mothers?  When we moralize birth by assuming everyone should try for a natural birth, we assume that there is a right or wrong way to do it, and that if you do it the wrong way, or your birth turns out “bad”, you are perhaps less of a mother, or less of a woman.  
 
Every birth is intensely important and potentially transformative for the mother and those close to her, and the range of experiences is wide.  It is possible to accept them all with wonder and awe and appreciation, without judgment.  Birth just is, and a large part of its transformative nature is purely the act of letting go of our uniquely human desire to control it.
 
Of course we can and should be strong, as healthy as possible, and armed with a positive attitude, and if we are going for a natural birth, an arsenal of labor coping techniques.  This is one of the places midwives can positively affect the outcome.  But we cannot ultimately wield much power over how birth unfolds.  Often it’s sweet and lovely, even within the gritty, messy part of it, and once in a while it is a monstrous, injurious thing.  When birth is grisly, we should be free enough of notions like “empowerment” to be able to carry our scars like Olympic gold medals.
 
So I am going to try to steer clear of words that put a positive or negative judgment on birth or the women who give birth.  Birth will come, and women are strong enough and brave enough to experience it, whatever it might be.  Birth, even mountaintop birth, takes you down to your core, and it likely transforms you into someone you didn’t know before.  Someone stronger, wiser, maybe more jaded, depending on how it went down, and hopefully someone more confident and ready for all the trials and joys of motherhood. 
 
I don’t know in advance which births will be a wild ride and which births will be a float down the lazy river.  But I believe in women.  And I believe that if we embrace the unknowns and make our informed choices with intention and acceptance, we will gain something precious in the process.  Your midwife cannot guarantee any particular course for your labor.  But she can look into your eyes and know that how you are treated during this journey matters.  She can employ her knowledge and skills to make course corrections along the way that will probably decrease the need for interventions.  She can respect your informed choices and stay with you as the outcomes of those choices and the mysteries of your birth unfold.
 
What are your thoughts on empowerment in childbirth?  I welcome your comments!