Saturday, February 20, 2016

Doulas and Dontlas: Promoting Justice for All Birthing People

I had an incredible experience doing my intensive birth doula training workshop last week. Being close friends with a doula, and having an ex-lamaze instructor for a mom (and two little sisters born when I was 11 and 13), I thought I knew a lot about birth, and the needs of birthing people, but we receive so many messages that are based on one specific type of birth that it's almost impossible not to internalize it to some degree.

That type of birth is a highly medicalized one where interventions are used on a 'routine', or 'just in case' basis more so than on an 'as needed' basis.

One important role of a doula is to encourage their clients to research the process of giving birth, and the interventions that might be used, and why,  so that they can make informed decisions.

Another important role is to do everything within the doula's scope of care to make sure those preferences are upheld, unless a deviation becomes medically necessary. Which might seem sort of obvious: like, who needs a doula to make sure a doctor doesn't do something that isn't medically necessary? Except as I already explained, your typical birth in America is full of interventions that are being used on a routine or 'just in case' basis.

Some examples of these include: iv fluids, restriction of movement in labor, augmentation of labor with artificial oxytocin, restriction of movement to supine position during second stage (after the cervix is dilated, when the birthing person is actually pushing out the baby), even episiotomy (enlarging a birthing person's vaginal opening by cutting toward their anus). Sometimes these things are medically indicated, but in the majority of births they are not, but some or all of them are still used routinely by various labor and deliver practices.

Some are falling out of fashion faster than others: I remember reading my mom's Erma Bombeck books when I was a kid, and being confused by her references to sitting on a donut pillow after giving birth. That pillow can provide relief for any person after birth, as their tissues are likely to be tender, or they may still be dealing with hemorrhoids, but the pillow was a potent symbol of the immediate post-partum period for people of a certain age because for a while, episiotomies were a routine procedure to 'prevent tearing' of the perineum. By cutting it. It is exactly as crazy as it sounds. Studies showed that episiotomies did not prevent severe tears, and the practice is quickly falling out of favor, but it's still done if second stage is taking 'too long'.

Other practices, like routine iv fluids, or at least a saline lock to keep a vein open, are still widely practiced, even though studies don't show them to lead to better outcomes for birthing people or babies, and constant iv fluids can actually slow labor by diluting hormone levels in the laboring person's bloodstream.

The connection between the way people are (mis)treated throughout labor and birth, and centuries of misogyny, and misplaced priorities (money over human life) are all too clear to me. Birth is ground zero in the fight for a more just and peaceful world, and I'm honored and proud to be on the front lines, bringing love, advocacy, and support to people during this vulnerable time.

This is all very familiar information to my doula/birth worker/birth advocate audience, but I'm about to switch gears to something you may not have thought about much before, so stick with me.

Depending on how sensitive you are to the vagaries of language, you may or may not have noticed that though I've spent the last eight paragraphs talking about childbirth, I haven't used the words 'mother' or 'woman', or the pronouns, 'she', or 'her' once (except in that first paragraph). That was done intentionally. Very intentionally. I'm still fighting old habits, and that means a lot of typing, backspacing, and retyping, and rereading to catch missed uses of those words.

Both as someone who sees birth work as a way to bring justice into the world, and as someone who tries to be a decent human being, it's important to me to remember, and remind others, that not all women give birth (hey guys, child-free-by-choice Doula here! That will need to be its own blog post, though), and not all those who give birth are women. Trans men, gender queer, gender fluid, a-gender folks, and anyone else with the biologically relevant body parts can all choose to bear children, and because the same system that oppresses women also oppresses these populations, I'm proud to support them as well by avoiding referring to all people who give birth as 'women', or 'mothers', and by using the pronoun 'they' to refer to birthing people (both singular, and plural), as opposed to 'she' and 'her'.

It's impossible to learn about the history (herstory) of giving birth without having opinions about present day interventions in the process, and without having a lot of anger about the oppression of birthing people throughout the process. Many advocates, in their admirable efforts to speak up and move into an era where women, and birthing people are not oppressed, unintentionally oppress trans people (trans encompasses all people who don't identify with the gender they were assigned at birth, so it applies equally to trans men, trans women, a-gender, gender fluid, and gender queer people) by conflating 'women' with 'birthing' people. This implies that only women are oppressed through our modern institution of childbirth, effectively erasing trans people completely from the picture.

That is a really hurtful and unhelpful thing to do when you're fighting for justice. It's not that we can't talk about how cis-women are hurt by modern institutions of childbirth. It's that we need to specify if we're talking about cis-women vs. the entire population of people who give birth. And that we need to recognize how trans people are being hurt in the same way birthing cis-women are, but they are suffering from additional layers of oppression on top of it every time a nurse comes into the room and misgenders them based on the fact that they are giving birth. Cis-women have a level of privilege in that they are not subject to that extra level of erasure and dehumanization.  It's equally hurtful when a birth worker/birth advocate/doula misgenders them in a post or article meant to support and advocate for birthing people.

Historically of course, trans people weren't acknowledged, so you may think that if you're talking in the past tense, referring to all birthing people as women is fair game, but erasing trans history is no better than erasing trans people in the present. Though there weren't structures in place to allow trans people to be empowered to embrace their identities and come out in most cases, they still existed.

Just to be clear, individual people have preferred pronouns and words they want to be referred to by. There's nothing transphobic about referring to yourself as a woman, a 'she' or 'her', or as a mother, or using those terms to refer to a person or group of people who clearly identify with those terms. It's always wise to ask someone what they're preferred pronouns and words are, even if it seems obvious. It will feel awkward at first, but it's an important step toward a kinder, more just world.

If you have questions about this issue, I welcome them, but I ask that you reach out to me privately, instead of in the comments, because I don't want those questions to make trans people reading this post as a sign of growing support uncomfortable. You can go to the contact form on my website, to ask those questions, and as long as your question is thoughtful and genuine, you'll receive a thoughtful and genuine response.

As you can see, I take my role as an advocate for birthing people very seriously, but the role of advocate for oppressed populations in childbirth, and the role of a doula, a one-on-one support role, are quite different. My opinions have no place in the time spent with my clients. Just as I support a person who wants a planned induction of labor or cesarian with the same loving care as I do a person hoping for an intervention-free home birth, I know that labor is not the time to discuss, suggest, or correct pronoun or word usage.

Thank you loving and awesome doulas, birth workers, and birth advocates for all that you do! Please take a long, hard look at your habitual language around birthing people, so that you can be even more powerful promoters of love, acceptance, and justice.

Live, and Birth, Omily,

P.S. In the next five to ten years trans women who were assigned male at birth may have the opportunity to bear children as well as the experimental procedure of womb transplants becomes more widely available. Five pregnancies and four live births have already resulted from this exciting technology. You can read more about it here.

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