Pushing in captivity

In which she resists making even one single Salt-N-Pepa pun.

Whenever I talk or write about my time working in the Medical Industrial Complex (MIC), one of major themes that comes up is how much I had to learn, unlearn, or relearn when I left, because there’s so much you can’t know when you work in a setting where both birth and your role in it is so overdetermined. Some of these things were things were paradigmatic (i.e. how to let labor unfold without treating time as the enemy). Some were actual skills or knowledges I had been taught as part of my midwifery school curriculum, but had never had the opportunity to actually use in the MIC: for example, how to assess and care for newborns, whom I barely looked at beyond assigning an Apgar,¹ or how to provide true informed consent, complete with actual evidence, without being influenced by fear of liability or how much trouble I’d get into if someone refused to “comply.”² In those early days of my homebirth practice, I felt like my brain was constantly on fire, and it became apparent to me how dampened my intellectual curiosity had become in an environment where the work had become, despite the insistence of most providers in the MIC, mostly predictable.

The longer I’ve practiced in a community setting, though, the more I’ve realized that many of the assumptions I had internalized (and needed to actively divest from) didn’t just come from the Medical Industrial Complex, but from midwifery generally – not only because midwifery itself has been colonized by obstetrics³, but because midwifery exists and reflects a culture of paternalism, hierarchy, and white supremacy generally. Yes, midwives might be more patient than obstetricians when it came to labor curves. But they still seemed to accept the assumption that length indicates pathology, that most birthers want to be “put out of their misery” sooner than later, and that a midwife’s role was often to move that process along with the tools and skills their “expertise” provided. Yes, midwives might use the word “catch” instead of “deliver,” but they still rarely seemed to ask why their hands needed to be there in the first place (they usually don’t; birthers are typically capable of “catching” their babies themselves).

I had muddled along in my homebirth practice without actively engaging a lot of these assumptions myself, too busy learning how to be midwife and nurse and pediatrician and sanitation and admin and lactation consultant all at once, after the fragmentation of care I had experienced in the hospital, too enamored with how beautiful birth looked outside of the draconian policies and violent practices of the MIC to question much of anything at all. I felt only relief at being able to provide care that felt so much more robust and so much more humane. But slowly, as my comfort increased, and I had the space and time (and, oh, how much space and time you have to stare at the wall and daydream when you’re sitting at the feet of someone whose labor you are not actively trying to shorten), I realized my body was often feeling something, some slight tinge of inadequacy, some wistful confusion, every time I attended a first time birther (“primip,” as it is often called by birthworkers⁴) who didn’t push very long – which was, increasingly, most of them.

Why, that little voice would ask, was pushing so hard for me my first time around? Why are all of my clients so much better at pushing than I was?

My first birth had been a transformative miracle, had radically changed my relationship to my body and the world, had challenged everything I ever knew about myself, and had by any measure been shockingly fast for a first-time birth, a mere 7.5 hours from start to finish. But 2.5 of those hours had been spent pushing. That amount of time wasn’t itself an issue (as a midwife now, knowing that my baby was birthed with both hands by her mouth – something I’ve never witnessed in any of my clients since – the overall shortness of my labor, let alone a pushing stage of only 2.5 hours, feels miraculous) so much so as the fact that I spent much of that time frustrated. I had felt “bad at pushing” the whole time I was pushing, confused by why it felt so unintuitive after a labor that progressed so swiftly. I had needed a lot of support and guidance from my midwife’s hands and voice, and those feelings of dejection every time I attempted to push and my midwife didn’t give me encouraging feedback still lived in body, lingering and stirring in my cells every time I attended a birth with a primip who was “good” at it.

And then, one day, it clicked for me: pushing hadn’t felt intuitive to me because I hadn’t been pushing intuitively. 

Put another way, I suddenly realized that "not knowing how to push" or "needing help with pushing" is a function of pushing when it is not actually time to push.

It actually hadn’t been about me at all.⁵

Okay, wait, so let’s back up.

Most of us, birthworkers or not, are groomed to believe that people need a lot of “coaching” while pushing. Lived experience with birth throughout one’s life span has been replaced by media-depicted birth, and whether it’s presented as a laughingstock or a terrifying, life-threatening (or life-taking) emergency, one part of the representation that is more or less universal is a bunch of people screaming “PUSH!” at a woman who is on her back looking terrified and exerting herself so hard her eyes appear to be in danger of popping out of her sockets.  These scenes are replicated again and again, even in children’s programming; watching an episode of Anne with an E with my preteen daughter I was forced to endure the indignity that is watching a teenage boy encounter a women in labor alone in a barn and declaring “I must see if her body is prepared!” before then directing her in her pushing efforts (which of course happen with her on her back).⁶

Many thanks to my teenaged daughter for creating this .gif for me, even if we disagree on the way .gif is pronounced

And truly, though there is legitimately no way a woman in labor alone in a barn in the 1890s would push on her back (or, I hope, let a random white boy digitally penetrate her and take over her labor!), when it comes to the twenty-first century United States, this representation is not wrong, exactly, because it is its own kind of self- fulfilling prophecy.  For a lot of people it’s the only framework they go into labor with, and what they expect is generally reinforced by the MIC, where most people push while anesthetized, or are told when to push, or push in positions that aren’t instinctive, or push with other people who have also only seen pushing look this way (because their only training and experience has been in the MIC), or all of the above.

But if you step back, it's a pretty fascinating assumption: that people wouldn’t instinctively know how to push, that the sensation of an entire human descending through one’s pelvis and putting pressure on one’s pelvic floor wouldn’t be all the guidance one would need. Why does it prevail?