I once sat with a fellow midwife in a vacant Labor & Delivery room on a relatively sleepy Sunday afternoon shift, eating the lunch we had spread out on an overbed table while the sun streamed from the large windows on one side of the room. We were chatting amiably, and though I don’t remember what exactly it was we were chatting about, it must have been about a recent patient, her’s or mine, because she turned to me and suddenly said, waving her fork for emphasis, “You know, I’m just over people making such a big fuss about birth. Honey, you’re not that special. It’s just biology, the most universal thing on the planet. You don’t have to get so goddamn precious about it.”
It might seem like “objectionable things MIC1 providers said to me when I worked there” is a running theme of this newsletter, but let’s be clear: I loved this midwife. I looked up to her and respected her. She was compassionate and caring with her patients, and they loved her for it. She told it like it was and took no shit, was unabashed and hilarious at fuck, but she was also genuinely affectionate and nurturing to me, and I only had affection for her in return. She never went out of her way to bully a member of the team, or haze a student, or fuel the endless rumor mill of the floor, and these seemed to me to be rare and precious qualities in my colleagues that I did not take for granted.
And so, in that moment, I was taken off guard by the cynicism of her statement, at how out of character it seemed, and I wasn’t sure what to say. In fact, I don’t actually remember how I responded, but I assume it was probably with a nervous laugh, my answer to so many things in the MIC. With some distance, though, I realize that what she was saying wasn’t wrong, exactly; actually, it was a statement that told a very real truth, even if not a literal one. What she was giving voice to was the inherent tensions of working in a system that treats gestation and birth as a model T — a product whose production must be standardized and optimized — while caring for people for whom it is anything but. For those giving birth, birth is singular and precious, one of the most formative and individual moments of their singular and precious lives. But for the MIC it is a rote procedure, one undergone many times a day, one made efficient and generalizable to the many people it cares for at once. In order to justify its existence, and its practices, the conceit of the MIC is that the human body can be treated as a machine that can be improved by obstetrics’ specialized knowledge and technology. But to treat a body as machine, you must do exactly that. And machines don’t have personalities and histories and dreams and wishes and stories of their own. Machines don’t have the most important day of their life. The sacredness, the unknowability and magic of birth that people desire and expect, is exactly at odds with the project of industrializing it.
So what that midwife was giving voice to was that trying to meet expectations for magic and sacredness, in the tsunami of standardization and protocols, is a surefire way for a provider to drown. There is only so much compassion fatigue one can withstand and still work in such a setting, after all2; better to convince oneself that the expectations are wrong to begin with. Better to be frustrated by patients who had unreasonable hopes for what we could not deliver than to reckon with how dehumanizing the whole damn thing was to begin with.
I’m someone who is told a lot of birth stories, for better and for worse: I hear about the prior births of everyone I’ve cared for, of course, and I’m friends with an awful lot of birth workers. But I also hear a great deal of stories from perfect strangers. The minute anyone hears I’m a midwife — and sometimes even when they don’t, as if I have some kind of neon sign pulsating above me making it clear I’m an easy target — I’m told birth stories. In line at the grocery store, at the playground, stuck on a stalled and wall-to-wall packed DC metro train on the way to the Women’s March in 2017, where multiple women joined in as if in a Greek chorus? You betcha. Everywhere I go, birth stories follow. And as anyone who hears a lot of birth stories, especially MIC birth stories, can tell you, these stories are invariably linked by one theme:
It never seems to go the way the person hoped it would.
My experience is corroborated somewhat by evidence (though the evidence is limited for reasons I’ll discuss below); in the 2016 Listening to Mothers survey, for example, nine out of ten polled women agreed with the statement “Birth is a process that should not be interfered with unless medically necessary” — but nearly half of them experienced five or more interventions during birth and only one in twenty had a birth that was not interfered with at all.
The MIC will tell you, well, of course it didn’t go the way you expected, birth is unpredictable!
(And yet, if birth is never going the way in which people expect, and it’s almost always going off script from those expectations in the exact same way, then isn’t that precisely the definition of predictable?)
But people have come to accept this narrative, and when they share their stories, and share the way the stories diverged from what they’d expected or hoped, they almost always take on responsibility for these divergences themselves. It is the fault of the individual that birth went it did, not that of the system.
“Oh, I didn’t know any better, so I agreed to that intervention.”
“I wasn’t strong enough to give birth unmedicated like I wanted to.”
“I pushed too hard so it stressed out the baby.”
“I never went into labor myself.”
And so on.
What’s so interesting, and heartbreaking, about these stories to me is that they all rely on the belief that the person telling them is the exception; that there are other women and birthing people who “know better,” are “strong enough,” whose bodies don’t betray them by stressing out their babies or failing to go into labor.
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