On danger and deliverance

When immediate extraction from our cultural beliefs seems advisable.

A couple of years ago I met up with a fellow midwife for dinner. She and I had become friends while both working in a large midwifery service in a busy public hospital, but after she had been there for some years and become disillusioned with how little mental health support most pregnant clients were getting, she had gone back to school to become a psychiatric nurse practitioner, eventually leaving our full spectrum midwifery service to pursue a perinatal mental health practice full time.

We sat together, nursing drinks and talking about all sorts of things — our relationships, our kids, how things were going for her in her practice and me in mine, as I had also left that public hospital job and opened my homebirth practice by then. And she , poking her fork into the tapas we were eating, a candle twinkling on the table between us, said something that has stuck with me even now, years later:

“I could never go back to L&D because what I realize now is everyone leaves thinking they almost died or their babies almost died.”

Listening to her therapy clients’ stories, she said, it was always clear that no one, in fact, had almost died at all. The births had just been normal, run of the mill Medical Industrial Complex births, with normal, run of the mill Medical Industrial Complex interventions that were either justified by normal, run of the mill Medical Industrial Complex rationales about how they were necessary to avoid catastrophe or themselves caused normal, run of the mill Medical Industrial Complex “emergencies” (scare quotes on purpose).

“I could never just continually and casually traumatize people that way again,” she continued.

Thanks to a client for this beautiful illustration of the kind of two-step birth I discuss below (though it should be noted that in the years since this photo was taken it has become my practice to not even hold my gloved hands out expectantly. 99% of my clients now catch their own babies, which I’d love to talk about more in a future newsletter if it’s of interest)!

I agreed with her, of course, sharing that I, too, with a little distance and perspective from the MIC, had come to believe that the practice of obstetrics (and by extension modern midwifery) too often justified its existence and indispensability by causing the conditions for its indispensability: in other words, by making birth less safe than it could be, and then saving people from the danger of it.

Bring this up with most anyone in our culture, of course, and they will immediately say:

“But back in the day, before modern medicine, women and babies died in childbirth all the time.”

The “back in the day” is always nebulous; are they talking about hunter gatherer societies? The 16th century? the 1800s? 1936? Meanwhile the statistic is always specific and insistent despite also being always inaccurate; people generally throw around grossly conflated numbers like “half” or “a third” with complete conviction. Once a seemingly 20 year old white man on Instagram told me very specifically that “100 years ago 47% of women died in childbirth,” a number that, as far as I can tell, has never existed in any culture or place in any time, and and was sure has hell not true 100 years ago. 100 years ago, in 1920, the maternal mortality rate (MMR) in the US was 900 maternal deaths out of 100,000, which I don’t think you need a particularly robust mathematics background to know is probably not 47%, and the infant mortality rare (IMR) was 98.4 deaths per 1000 babies prior to age 1: also not 47%¹.