I let my new client know what would happen when I arrived at her home when she was in labour. We talked about sanitation measures, spending time in the kitchen, setting up the pool, and where I could take a nap if she needed some privacy. I said I would not be doing any vaginal exams as I think they’re rude, and she wept with relief.

I specialise in trauma and the majority of my clients are refugees from the medical system, running from ritual abuse and routines that protect the industry. They want someone to mentor them through to a healthy birth without the traps and trappings of the industry that removed their choice, and violated their autonomy and their dignity.

As a traditional birth attendant, I don’t do vaginal exams.

Postpartum haemorrhage is a complication that can happen in any birth setting, although it’s more likely in a hospital. Despite the universal application of “active management” as a prevention, the rate of haemorrhage due to uterine atony has been steadily climbing in developed nations.

“Active management of the 3rd stage”, is an intervention for the birth of the placenta, the time when women are most likely to lose a significant amount of blood. It involves injecting the mother with a uterotonic (something to make the uterus contract), usually synthetic oxytocin, as soon as the baby is born, and it may include some other steps like early cord clamping or pulling on the umbilical cord depending on the protocol used. This intervention is applied to all birthing women in all hospitals, birth centres, and homes with few exceptions.

You’d think if every mother everywhere gets this injection, then it must be a good thing. Well, that’s the thing about obstetrics. It tends to take an intervention that might be suitable for some clients in certain situations and applies it to everyone. And the results are increasingly worrisome.

One third of birthing parents has a traumatic birth.

“The system is broken.”

One in 8 new parents enters parenthood with postpartum PTSD from the experience.

“The system is broken.”

Depending on where you live, one third, one half, or almost everyone has a surgical birth.

“The system is broken.”

One in 6 women are abused during their births.

“The system is broken.” 

If we say it enough, we might believe it. However, the “system” is decidedly NOT broken. It is doing exactly what it was set up to do by any means available to it.

Everyone has an intellectual/mental/emotional operating system – a personal paradigm that serves as a frame of reference containing basic assumptions and ways of thinking. This personal paradigm is the means by which we make sense of the world around us. It helps us to filter, understand, and categorise information and experiences. It helps us to know what is “true” and what isn’t; it guides our responses and our actions.

Humans are designed to be in connection with each other. We operate mostly unconsciously through hormones, synapses, and other magical pathways. Our primary operating system is our para-sympathetic nervous system – our “calm and connected” system. This part of our autonomic nervous system keeps our hearts beating, our lungs breathing, and our food digesting. The main hormone of this system is oxytocin – the hormone of love, trust, bonding, and connection. This is why isolation is so effective at crushing and changing people, and why friends and loved ones can heal and nurture new ideas.

Personal paradigms, once settled and serving us reasonably well are most likely to be changed by 2 things: Great Suffering or Great Love.

It’s frustrating for care providers when their client comes armed with a 10-page birth plan, an army of doulas, and a mistrustful and hostile attitude. Care providers exist for the sole purpose of providing medical or midwifery services for pregnant, birthing, and postpartum clients and their goal is to help them emerge healthy and whole. Unfortunately, this creates friction before the relationship begins. 

A mistrustful client has probably already had her trust broken by someone else long before they come armed with the minute details of how they need things to unfold. They may have already experienced abuse, neglect, sexual assault, victimisation, and trauma. Their trauma might have been the result of an abusive childhood, racial adversity, marginalisation, being the victim of a crime, or it might have been the result of a previous traumatic birth experience.

I received yet another phone call from someone who was trying to sort out the risks of staying pregnant versus the risks of being induced. From what the client could share, it was hard to know if the practitioner wasn’t fully informed on placental calcification at term, or wasn’t fully forthcoming about the non-clinical indications of that particular development in a healthy pregnancy.

To be sure, there are times when the benefits of an induction to rescue a compromised baby far outweigh the short and long-term risks of an induction.

Unfortunately, when trying to make an informed decision, clients often need to learn what their practitioners don’t know or won’t tell them.

In an epic sleight of hand, the US obstetrical industry has managed to produce a study that affirms the “benefits” of universal elective induction of labour at 39 weeks. Headlines have trumpeted this remarkable accomplishment! Inducing labour early “prevents” c-sections!

The conclusion of the much anticipated ARRIVE study are presented in their abstract:  

“IOL (induction of labour) in low-risk nulliparous women (first-time mothers) results in a lower frequency of CD (caesarean delivery) without a statistically significant change in the frequency of a composite of adverse perinatal outcomes.”

Obstetricians now have the much-desired go-ahead to routinely induce healthy first-time mothers prior to reaching 40 weeks under the guise that it will reduce c-sections with no additional negative outcomes to the mother or baby.

This is the same outrageous chicanery that brought us the ridiculously executed Term Breech Trial that changed obstetrical practices around the world. It was the excuse the industry was looking for to do what they already wanted to do: surgery.  

Recently, #metoo went viral as hundreds of thousands of women, and some men, said “me, too, I’ve been sexually harassed, assaulted or violated”. There were stories told for the first time. There were experiences re-told through a stronger voice. And in private forums, women told of rapes, childhood molestation, being drugged, and more. Some couldn’t post “me too” on their social media stories because they didn’t want their parents to know, believed they were partly to blame, or felt it was too exposing. One woman said she didn’t want the world to know she was “weak”. When asked, she said she wasn’t strong enough to fight off her attacker and she felt ashamed for it.

There were waves of trauma as some survivors found it too overwhelming to see the hundreds of #metoo’s across their news feeds and had to disconnect until it passed. It was not comforting to know they were not alone. It was horrifying.

And this isn’t just an issue of female looking or female identifying individuals being sexually violated. Men and boys are also sexually assaulted. Yet, from a cultural perspective, the response is different. Males are not told that “boys will be boys” or "girls will be girls" and they just normally like to grope and grab and hump and fondle males. Males are rarely depicted being sexually assaulted in music videos as a form of entertainment. They are not routinely asked what they were wearing, if they were out alone, if they went to a party, or if they were drinking. As a culture, we don’t victim blame males to the same extent that we victim blame females.

“All procedures offered to a mother should be researched by herself so she can make an informed decision.”  
(posted on Facebook on a thread about routine interventions)

 “Make sure you hire a doula.”
(said by everyone)

Why are mothers being told to do their own research, find out more about their provider and their hospital, check out the alternatives, and make sure they can make an informed decision?

The pipe on my hot water tank sprung a leak and I called a plumber. Not once was I admonished to check into the possible things he might do to fix it and to decide if it was evidence based or if I should switch plumbers. He did a good job because if he didn’t, it would get around, and no one would hire him again.

And yet, mothers are urged to make sure they find out for themselves the risks of ultrasounds, what the science says about postdates, the risks of synthetic oxytocin (Pitocin/syntocinon), whether an epidural can cause problems, whether Friedman’s curve is actually useful for deciding on a “failure to progress” or if it’s a tool for the hospital to manage their time and resources, whether an induction for a big baby is evidence based, or if their provider supports a VBAC and what the risks are between VBAC and a repeat c-section. And if nothing else, hire a doula. And on it goes.

What’s behind this push for families to do their own research into the routines and interventions of birth? I think it’s been the epic failure of the evidence-based movement.

We were sitting across her kitchen table. A tissue was being nervously mangled in her trembling hands.

“I just can’t do it again,” she said.  “Can you tell me about your daughter’s birth,” I asked her?

She explained that everyone told her it was a good birth. Her doctor said it was textbook perfect. Her mother was there and repeated her version of her granddaughter’s birth to everyone who would listen. It was natural. It was quick. It was the best day ever.

And as the story unfolded, tears welled up in my eyes, finally spilling down my own cheeks. It was an awful experience. And my heart broke into pieces again.

She described a birth where she was tortured with screamingly painful vaginal exams, weeping for them to stop, thrashing to escape the confines of the hospital bed where she was tethered to the monitoring machine for policy’s sake, begging to stand up, move, sway, anything to cope with her rapidly advancing labour. Her voice buried under a gentle shush so as not to scare the other mothers.