Birth by Tina Cassidy

Full Title: Birth: The Surprising History of How We Are Born
Tina Cassidy
Publisher: Atlantic Monthly Press (2006)
Number of Pages: 254
How long it took me to read: 4 days
Where I got this book: I’m borrowing it from my favorite midwife.
ISBN: 978-0-87113-938-2

Like a Moth to a Flame

It’s not like me to pick up a book on history, but I’ve been curious about modern obstetrics for a while. How did it get to this point? I know about midwives and the smear campaign doctors ran against them, and I’ve heard stories about Twilight sleep, but what else? What happened in emergency situations before there were surgeons, for instance? Where did the forceps extractor get its start? Exactly how has mankind made it this far? I lifted this title from my midwife’s shelf and put off reading it for months, equally worried that it might frighten me as a work of horror or bore me as a work of history.

Favorite Five

Whittling 13 down to 5…I propose that the top 5 quotes from this book are:

5. “Birth hurts because women don’t have roomy pelvises. It hurts because women expect it to. And it hurts because women have been physically and emotionally restricted by societal norms and conventions from doing what might make them feel better, whether it’s shouting, squatting, or having company there to support them.” (p.83)

4. “But after all these years, despite the growing body of evidence that they provide excellent birth outcomes, midwives are still fighting the same battles for respect and market share. In the past, arguments against midwives have always focused on safety, an issue central to every mother’s mind. By withholding the proper licensing and education of midwives, governments paradoxically made a woman’s decision about who would attend her birth more complicated and potentially even lethal. It took the power of the counterculture revolution and the force of the women’s movement to push back on the outdated stereotypes, to call for reform, and to help some women understand why midwives are better than doctors for attending low-risk births.” (p.48)

3. “There is no doubt that modern medicine has made astounding advances in the area of birth: infertile women become mothers, sick women deliver healthy babies, and infirm newborns grow into happy kids. But, it must also be said that, for many women, over the years, this supposedly beneficial medical help has often meant isolating babies in nurseries, receiving an unnecessary episiotomy, having a breast dipped in iodine before every feeding—whatever the latest trend. If only we’d known how skeptical we should have been. And should still be. The shot of scopolamine my mother received when I was born was not enough to erase her fear of laboring alone. Those ineffective X-rays she received to check the size of my brother in utero have since been found to cause leukemia. And as for those hee-hee-huuuh breathing exercises she learned, well, my birth instructor told our class not to make such silly noises because they cause hyperventilation.” (pp.252-3)

2. “The busy nurse on a twelve-hour shift smiles, calls in the anesthesiologist, and moves on to the next patient. Soon the laboring woman reclines comfortably in bed, talks on the phone, watches a movie, and waits for the baby to come. She is not screaming for the nurse, pacing up and down the hall. She is not cursing, grunting, or moaning. She is quiet. She is a good patient. And she’s happy. As is the nurse.” (p.102)

…and my pick for the No.1 quote is…

1. “But even in places where fathers were recognized as procreators, they were banned from the birth for other reasons. A woman’s modesty was sacrosanct. Men were thought to be unclean and dangerous. Having a male witness birth was considered immoral, repugnant, and, frankly, stupid. What, women wondered, could men know that a female midwife didn’t? And why would males want to be there? In 1522, believing it important that he witness a birth, a Dr. Wertt of Hamburg snuck from confinement to confinement dressed as a woman until a midwife realized he was a man and raised the alarm. His deception did not go over well, and he was burned to death, with other physicians watching, no doubt reinforcing for them that birth had been, and should always be, the exclusive realm of females.” (p.200)

Conversation with the Reader

While I read, I write, and as I write, I read. Here’s some of what I wrote while I read this book:

“Cassidy begins the story of her decision to research the history of birth by asking a series of questions: if birth was nature’s plan, why was it so difficult for her? Why didn’t she enjoy the experience as much as other women? Was her son too big? Was she too small? Too sensitive? Too modern and spoiled? Many of her questions are familiar and painful, her final one in particular: should she not have given in to the epidural?

“The guilt of motherhood is overwhelming. There are so many mistakes to be made! As science advances, we’re enlightened each day, whether it’s about vaccines or car seats, and we know enough to know that we don’t know everything. The pressure to be Super-Mom, to act like we have it all together when we really don’t, to do everything exactly right, cracks so many of us. A trip to Facebook or any number of mommy blogs or forums can send me spiraling as it seems all other mothers are handling things perfectly and can back it up with photographic evidence. I have to take myself back to the early months of my first pregnancy and remember my friend Elaine telling me, ‘I’m not the perfect mother. But I am the perfect mother for my child.’ When I feel overwhelmed by everyone else’s successes and opinions, I let that encourage me. Everyone is just doing the best they can for their own children. I’m the perfect mother for my boys.”

“Even as I digest my midwife’s books, I feel this subject devouring me. Over and over I wonder how women, though we are drawn to one another and many of us are drawn to motherhood, set ourselves up against each other and against our own bodies. How has this happened? While the history of modern childbirth has had many male players, it’s had even more women. The tragedy is in the stories of nurses pinning together a woman’s legs to keep her from delivering before the doctor gets there, in the stories of female doctors using guilt to coerce an emotionally vulnerable woman into a choice that isn’t really a choice after all. Even more, it’s in our dishonesty with each other, in the lies we tell about what’s normal, in the insistence that things are okay when they aren’t, and it’s in our willingness to tell a woman in grief after an ugly labor, ‘At least the baby got here and that’s all that matters,’ when that isn’t the point at all. How can we say that to a woman whose soul has been ripped to shreds? As I read, there’s certainly a part of me that’s angry at the number of men who have poked their heads in where I feel they don’t belong, but I find myself being disappointed in my fellow women more than anything. Men can’t fully understand a woman’s grief over her body. We women should understand and protect each other.”

“I’ve read elsewhere that all human babies are born ‘prematurely,’ in that they have no control over their bodies and aren’t able to take care of themselves in any way. Unlike most mammals, human babies are in need of our constant love, care, and protection. I think this is an intentional design: it forms our bonds so strongly by making us, as parents, stop and consider the immense weight of responsibility intermixed with overpowering blessing of raising our children. I think one of the things that scares people about parenting is that frightening responsibility, that fear of doing something wrong, but you overcome that fear each day and when you go to sleep, you do it knowing an even greater love, and finding yourself capable of so much more than you could have imagined. Having someone’s life in your hands each day, being the center of someone’s world, is a terrifying reward in itself.”

“I find myself getting emotional as Cassidy’s focus turns to midwives. My own midwife, Bettie, is a beautiful woman with a real passion for her work. She made me feel so confident in my abilities, encouraging me to listen to my body. Beyond that, she was able to create a peaceful environment for me as I labored, not through any means in particular, but by being whom and what I needed at the time. Birth is an intimate experience, something I didn’t enjoy with an audience the first time and something that connected me to everyone in the room the second time. In the hospital, I felt stripped of my humanity, as though I were expected to leave it with my underwear, balled up in the middle of my clothes where I hoped no one noticed it as my husband carried it for me while I was carted from room to room in a borrowed gown. At home, my guard lowered bit by bit with each contraction. Bettie didn’t ask too many questions or demand anything from me. She remained calm and waited for me. I wasn’t rushed or stalled, but allowed to blossom slowly, to ride out each contraction like a wave. Bettie is forever a part of my story, and her work is woven in with centuries of beautiful, passionate, wise women, selflessly guiding birthing mothers to a new purpose, with or without gratitude—but oh, how could anyone lack a love for the woman who provided the support needed? The woman who knew what you were capable of from the start.”

“Having a baby at home seemed like the brave, powerful thing to do. But I wish someone would ask me if I was, or even accuse me of being brave. I’m not. In the thick of it, I was grasping for my husband, my pain intensifying if he was out of reach. I was calling out to God, I was crying, ‘I can’t do this,’ until I remembered I needed to do it and corrected myself out loud, ‘I can do it,’ because I had to.

“If I became brave, it was out of necessity rather than something I was born with or even an option I had considered. If I’m ever brave, it’s only because my children have needed me to be. I look back on my mere two years of motherhood and know I’m only fearless by the grace of God and out of love for my boys. And still, I never stop battling my own doubts about myself. Am I doing this right? Am I ruining their lives in some small way without realizing it?

“But like so many mothers, I fight the battles every day, no matter how large or small. My baby needed to be born, and with the realization that his shoulder was caught, my husband guided me to my knees.

Your baby needs you, Bettie told me.

“Pushing in frustration, I told myself God didn’t bring me this far to let me down. Face-to-face with myself, I knew my needs didn’t matter, and not my fear, the pain, even my own body—what mattered was my baby. I would’ve split in two if it meant my baby was out, alive, and healthy. In that moment, what my baby needed was a lioness on all fours to expel him with a roar, so that’s what I was, on the floor of my bedroom, with Justin steadying me and Bettie guiding my child out of me.

“I’m not brave. I’m a mother. If you have life in your womb, you already have the means to bravery. You do what you must and the reward is great.”

“I’ve read pages and pages outlining the terrible history of male obstetricians’ effect on laboring mothers: women becoming infected and dying because their attendants didn’t know—or worse, did know and yet refused—to wash their hands, women being strapped down and shaved, forbidden to see the people they wanted to see. There have been centuries of torture, yet that which I feel is possibly the worst thing to happen to childbirth, Twilight sleep, while yes, invented by a man, was popularized and demanded by American women. It was feminists who demanded this treatment, despite the wariness of American doctors. This growing group of feminists didn’t believe women should suffer the pain of childbirth because, after all, men don’t. They didn’t want to feel anything. But instead of a posh and pain-free experience, women were essentially rufied with a combination of scopamine and morphine. Their inhibitions were lowered and afterwards, they didn’t remember the tortures they went through. Doors were padded to muffle the noise of their terrified screams. Laboring mothers were strapped and blindfolded; even their ears were stuffed with cotton so their own screams wouldn’t disturb them.

“It angers me to think that women did this to themselves and to one another. It seems so backwards to want to deny other women a healthy birthing experience. But as a culture, don’t we still? We talk up epidurals, scoff at the women who want to labor and deliver without interference, calling them superstitious in their distrust of hospitals, painting them either as cartoonish hippies or religious zealots. Is it our own guilt, coming out of a hospital and feeling we did something wrong, that makes us want to encourage other women to make bad decisions?”

“A woman should be allowed to control her birthing situation so she can feel safe to be out of control as her body takes over. When I had my first child, my doctor tried to tell me not to push as I felt contractions urging me otherwise! It sounds almost silly to spell it out, but the truth is that you need control to be able to lose it, you need less distractions so you can focus on not focusing, you need, in the end, to think of nothing and no one, not over-thinking your primal urges, or worse, having someone try to direct you.”

“It surprises me when healthy women are afraid to give birth naturally. These women—who want to be knocked out or cut open, stripped of control in the name of fear—what are they afraid of? Experiencing the primal instincts written in our DNA? Birth is a miraculous event that separates us from men wholly and completely. We’re born with a profound ability that I wonder if they envy on some level. After all, a man’s natural instinct is to provide, and we women are able to sustain a human life within us and then become the child’s sole nourishment for months, or even years, afterwards. What makes a woman afraid to access this part of herself?”

“There are heroes and villains in this fascinating history of birth, and it continues to amaze me that there are so many male players. Grantly Dick-Read, for example, was a founder of the natural birth movement in the early 1900’s who believed that many of the regularly accepted practices of the time actually slowed the process of labor, and he spread the idea that if a woman could relax, she was far less likely to feel pain. Still, for every champion, there are several more doctors like Joseph B. DeLee, who created a bed with stirrups to keep the woman on her back and spread the notion that birth is a disease. He delivered babies by means of unnecessary episiotomies and forceps extraction, damaging hundreds of infant skulls, racing against time to keep the woman from even pushing. Thanks to his teachings, obstetricians were so in the habit of episiotomies that no one noticed until the 1980’s that those incisions weaken the perineum and make it more likely for the anus to tear.

“As I read, the old nagging question of why there are male obstetricians in the first place comes back to the forefront of my mind. What inspires men to pursue a career of gynecological exploration? Fortunately for my curiosity, Cassidy includes the story of how the infamous Dr. Lamaze was encouraged into the field. An older male doctor tells him that one day, on his own in the hospital ward and with no experience, he had to deliver the baby of a frail laboring women. He described it as one of the most meaningful experiences of his life, insisting that the intense bond between the woman and himself lead him to feel like a creator giving life. I can understand the desire for that feeling, a feeling that I carried throughout both pregnancies. I have a distinct memory of missing that feeling in the first few months after my first pregnancy. My womb felt sad, hollow. While the doctor’s words ring as overbearing and a little frightening, I can relate to the desire to be near that new life again. I even feel a little sad for him because there wasn’t really any other way for him to be close to that electrifying feeling of bringing another soul into the world.”

“While I was familiar with the stories of my mother’s many deliveries (two of them with a midwife), for some reason, the clearest image in my head when I found out I was pregnant the first time was of Lucy and Ricky Ricardo rushing to the hospital. While I’d always said I’d have a baby at home, I somehow ended up at my gynecologist’s office with them showing me payment plan options, and when I asked whether they ever worked in conjunction with a midwife, they said no and that I needed to make up my mind fast if I wanted to start making payments. While I had one friend who’d had a home birth, far more were going the hospital route. And I could picture that. I couldn’t picture giving birth at home. I asked Justin for his thoughts, but I was so scared to make a false move that I knew our choice had already been made when we walked into that office. A hospital wasn’t the only choice, but it was the easiest choice: everyone else was doing it.

“You may have heard this story about a newlywed couple where the wife is excited to cook a ham for her husband for the first time. Before she puts it in the baking pan, she cuts the end off. Her husband asks her why and she insists that’s just how it’s done. They argue until she calls her mother to ask why it was necessary to cut the end off of the ham. She says it was the way her mother prepared the ham. Curious and determined, the young wife calls her grandmother to ask her about it and her grandmother tells her, ‘Oh, my pan was too small to hold a whole ham so I had to cut the end off.’

“Reading the history of child-birthing practices, I think of this story because we get caught in cycles that have no relevance to our own needs. During the industrial revolution, for instance, women who lived and worked indoors developed bodies dangerous for pregnancy and birth. The lack of sunshine caused a vitamin D deficiency that lead to rickets, softening and disfiguring bones. Forceps were a useful tool for getting a baby past a warped pelvis. Somehow, though, forceps became standard practice even in otherwise healthy deliveries! Episiotomies, too, which can also be damaging, were simply what had to be done in some cases. But not in every case. The practice of keeping a woman on her back really began because it was easier for the doctor, and now it continues, no questions asked. It’s just what you do because it’s what’s always been done.”

“A man named Robert W. Goldfarb wrote possibly the most romantic thing I’ve ever read and sent it in to the Ladies’ Home Journal in 1958. This new father got to witness his wife giving birth, something that was very uncommon for a husband to do at the time. He fielded questions from friends and family about whether his feelings towards her changed after seeing her in such a raw and unattractive setting. He answered by saying that those moments made her even more beautiful to him and that afterwards, he loved her more than he ever had.

“I can say with certainty that I was afraid knowing that Justin would watch me give birth, at least the first time. I knew it would be messy. I thought I might swear (it turns out I was fairly polite), or hit him (like in the movies), or make embarrassing animal sounds. I made Justin promise in advance to keep his head up by mine, no peeking. I remember, though, in both labors, that once I caught his eyes, the excitement and pure love and devotion shining through made me realize I was capable of more than I imagined. No, he doesn’t look at me the same way any more. And I like it that way.”

“I had a quiet freak-out when my body began developing colostrum during my first pregnancy. I thought there was something wrong with me. I wasn’t surprised that my breasts were producing, but I wasn’t expecting something so yellow and unhealthy-looking to be leaking out of me. Fortunately, my friend Elaine had just gone through her first pregnancy and delivery about a year earlier. She reassured me, explaining that it’s like a pre-milk, a special milk, for newborns; something to get them started. Reading this history, I learned that it’s only fairly recently that women learned what this strange liquid is and started to feel okay about producing colostrum. People used to think it was pus and wouldn’t feed it to their babies for fear of making them sick. They would pump it all out until the ‘real milk’ came in. I’m glad we’ve gotten past it. I’m hopeful for generations of babies with mothers who know to nurse immediately to promote bonding. I know some hospitals will allow for immediate skin-to-skin contact, which helps jumpstart the process, but I know too that there are other hospitals with staff members anxious to weigh and measure an infant immediately. The longer it takes a mother to get to it, the harder it becomes to nurse, and the more mothers there are heartbroken, thinking their biology is wrong.”

“All things considered, I think we live in the safest time to give birth. High-risk women have access to the medical care they need, and professionals are able to catch high-risk women early on. It’s been proven over and over that hospitals aren’t necessary for the average healthy birth. We’ve been taught that birth is dangerous, but now, new information floods us every day, and it’s no longer necessary for us to plan our births in fear. Women are safe to labor in freedom—beautiful, brave, unrestricted, messy, noisy freedom! I’m happy to have been one of the women to take advantage of that.”

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