Open Letter to Dr. Amy

Recently on The Unnecesarean blog, you have participated in many discussions, saying lots of different things, occasionally including some things I agree with. However, one thing that stuck out most to me was your insistence that natural childbirth (i.e., not receiving pain medications) made no difference in a woman’s birth experience — basically, that the stories of countless women who have told stories of how wonderful and empowered they felt after having given birth drug-free were bunk and hokum. Your proof of that? Just your own experience. Really? — That’s it? — “I did it, so your experience will be exactly like mine”? What else would you apply this narrow-minded view to?

I recently had a miscarriage, and the experience was shockingly normal — that is, it was neither dramatic nor traumatic for me, and was not even terribly emotional nor upsetting. I was a little sad, but would not say that I “mourned” or “grieved” unless those terms could be used in a mild form. But I would never tell someone who had a different reaction to a miscarriage that she shouldn’t feel the way she does — that she should feel the way I do/did, and handle things exactly like I did. Some of my friends have mourned their early miscarriage the way others have mourned a mid-pregnancy loss, a stillbirth, or an even later loss. I didn’t. Some of my friends have had D&Cs. It wasn’t necessary in my case. One of my friends experienced such heavy blood loss that she was air-lifted to the hospital (it was rush hour in a big city plus there was road construction — otherwise an ambulance would have sufficed, or her family may have even been able to drive her). Nothing like that happened to me. One size does not fit all.

Some might think that women who are pro-life will experience more grief than those who are pro-choice. [I’ve heard many pro-choicers say that the fetus isn’t really a baby until birth, so it is not too big of a stretch that a woman would feel more grief over losing a “real” baby than a “potential” baby.] Yet that is not necessarily the case. I believe that life begins at conception; yet I know of two women for sure who are both pro-choice (one of whom actually had a prior abortion), who both mourned more for their miscarried babies than I did. Perhaps the length of gestation may have something to do with it; yet I know of women who mourned more for their early-pregnancy loss, than others did for later losses. Some women may feel deep grief if they see the fetal or embryonic remains; others may get a sense of closure, and find it to be a healing experience. Some women may feel more loss for a planned and/or wanted baby than for an unplanned baby — yet that is not necessarily the case. When I was pregnant the first time (unplanned and certainly not the best timing, in my estimation), I had a miscarriage scare due to a negative pregnancy test after a prior positive one. Although I had not wanted to be pregnant, I immediately felt a strong maternal protectiveness for the baby I was carrying. Some women may even grieve or mourn more for a miscarried baby they had not planned on conceiving, because of the initial negative reaction they had to finding out that they were pregnant. They may have guilt added on to grief.

There is also a wide variety of reactions when it comes to natural childbirth. There are a lot of women who intend on giving birth drug-free, but end up taking drugs. Some of these women decide that natural childbirth is “for the birds,” and plan on having an epidural as quickly as possible in subsequent births; other women approach their next birth more determined to go natural, even taking steps like planning a home birth to make it more difficult for them to be offered and/or to acquiesce to drugs. Not every woman who gives birth drug-free will feel empowered; but many will. Some women feel empowered from choosing a C-section. Some women who have drug-free births go on to have epidurals with subsequent births — some of these may regret the decision, but others may regret not having had an epidural during previous births. To each her own.

But, the bottom line is, do you not see how preposterous it is for you give your one, single anecdotal experience as if it were a gold standard? — and thereby to completely dismiss all other women and their birth stories who have a different tale to tell? In future, it would behoove you to say, “I’ve given birth both with and without drugs, and could not tell any difference, except that it was more comfortable to have the drugs; but other women may have difference experiences.” That’s a much more credible response, especially when said amongst hundreds of women who would strongly beg to differ about whether or not drugs affected them during their birth!

6 Responses

  1. Hear, Hear! Thanks for posting this. I have discussed with my friends the differences in our experience of birth–and the fact that variation is normal. We expect to respond to things differently in life. Some of my friends have come out of natural childbirth feeling like it is something they simply endured and would never do again. Others, including myself, have found it to be absolutely the most empowering, incredible experiences of our lives. I was on such a euphoric high after my first birth, I felt I could do anything at all. Climb Mt. Everest? No problem. Run for president? Sure thing, and win too! If I can do THIS, I can do anything.
    I strongly suspect some of the difference is moderated by differences in the way women’s bodies handle the pain and exertions of childbirth–biochemical differences. My body apparently really ratchets up its natural pain relief mechanisms, and I experience a huge surge of, I am guessing, endorphins. But not everyone’s body will respond the same way. I think the differences are real and physiological, not just a matter of attitude etc. And so the experience is different for different people, and we will make different choices for future births. And aren’t different choices also an important and necessary part of being human?

  2. “your insistence that natural childbirth (i.e., not receiving pain medications) made no difference in a woman’s birth experience”

    I didn’t say that. Why don’t you find the quote that you are referring to? I suspect that when you look for it, you will find I said something different.

  3. Primarily this comment: “Well, then, I AM in a position to say otherwise. I have given birth to four children, two with epidurals and two without and I can tell you that it is no more of an achievement than digesting food, and it is no more deserving of pride or praise than breathing.” from this page, about 3/4 of the way down.

    But to round out more of your philosophy, I will quote some more:

    “And, furthermore, I’m not sure what you think is so wonderful about giving birth unmedicated. It’s not safer, healthier or better in any way than giving birth with pain medication. It’s not some sort of achievement either. Most of the mothers who have ever lived have given birth without pain medication (or died trying) and the mothers around the world give birth without pain medication each and every day (or die trying). Only Western, white women have decided to pretend to themselves that unmedicated birth is something special. It’s no more of an achievement than having root canal without pain medication.”

    and

    The idea that pain of childbirth is “rewarding” is one of Dick-Read’s fabrications. There is nothing inherently rewarding about pain of any kind, but demeaning, discounting and rationalizing the pain that women experience is an old story. Dick-Read embraced the idea that women’s pain in childbirth was so meaningless that he could pretend it didn’t exist, and convince women that they too should pretend it didn’t exist or at least convince themselves that it was “rewardng.”

    It is hardly a coincidence that the only pain that is supposed to be “rewarding” is pain that only women can experience. That attitude is not surprising coming from a man who evinced racist and sexist ideas. It is surprising that the claim is still embraced today by a small group of Western, white relatively well off women.

    Ina May Gaskin and other proponents of the big lie known as “orgasmic” birth are the intellectual descendants of Grantly Dick-Read. He lied and said childbirth in nature is painless if you do it “right.” They lie and say that it is orgasmic if you do it “right.” Both are products of an ideology that treats the pain of women as something that is supposed to be “rewarding” or even “pleasurable.” It is nothing more than brainwashing. Grantly Dick-Read, at least, was honest about the fact that he was trying to brainwash women. I don’t know what Gaskin’s excuse is for her ridiculous fabrications.

    and

    Please do not put words into my mouth. Many women have unmedicated childbirth. I’ve done it myself. They choose not have medication because they don’t feel they need it, because it isn’t available or because it is too late to get it. That’s very different from a philosophy that insists that unmedicated birth is “better” than childbirth with pain relief. If you don’t want an epidural, don’t get one, but don’t pretend that it’s some sort of achievement or somehow better or safer to experience the pain. That’s the part that “natural” childbirth advocates made up.

    and

    Despite all the prattling by “natural’ childbirth advocates about science based medicine; it has nothing to do with science. Its a way for some women to feel superior to other women by elevating their personal preferences (their “beliefs”) to the level of standards to which other women are supposed to aspire.

    Grantly Dick-Read deliberately tried to trick white women of the “better classes” to have my children by telling them that giving birth to children was the ultimate achievement for a woman. The remarkable thing is not merely that women are still being duped into pretending that it is an “achievement”; the remarkable thing is that some women are so gullible that they are proud of the fact that they have been duped.

    and

    We have made vaginal birth, unmedicated birth, breastfeeding, attachment parenting, etc. into a set of standards that all women are supposed to meet in order to be considered “good mothers.” I think that this comes in part from our anxiety over motherhood and our anxiety over achievement. Motherhood brings very little in the way of awards and kudos. Your kids don’t often turn to you and say, “Mom, thanks for not letting me have that candy I want. I know you are only thinking of my well being.” But many of us are used to getting good grades, and awards, and praise and we have created these artificial “goals” of mothering so we can tell ourselves that we have met them and feel superior to those who have not.

    My philosophical views about childbirth are, of course, informed by my years of practicing obstetrics. I spent way too much time trying to prepare women to be realistic about the pain of labor after others had encouraged them to be unrealistic, and way too much time trying to comfort them when they felt that “failed” by “giving into the pain.”

  4. Right, and no where did I say that “natural childbirth (i.e., not receiving pain medications) made no difference in a woman’s birth experience”

    • The comment you were replying to, will help to set the context:

      “I have to tell you, Dr. Amy, that most women who have unmedicated and fully natural births do not expect them to be painless, and in fact are very accepting of the pain. I will also tell you that to give birth like that is a huge achievement, absolutely worthy of praise, and until you do it yourself, you are in no position to say otherwise…”

      To which you replied: “Well, then, I AM in a position to say otherwise. I have given birth to four children, two with epidurals and two without and I can tell you that it is no more of an achievement than digesting food, and it is no more deserving of pride or praise than breathing.”

      Your births were like digestion, whether you had an epidural or not. All your statements above, taken together, each one expounding on the others, formed the basis for my post. I did not pretend to quote you, but to give the implication of your attitude, a summation of your thoughts on the matter.

      Besides, if I were you, I wouldn’t get too cranky about this whole thing — you who are the queen of taking things out of context, pulling phrases out of sentences, and sentences out of paragraphs, and twisting and perverting statements to pretend the authors [including me on many occasions] have said something they haven’t, shouldn’t be too testy about my drawing these conclusions from your above statements. You said repeatedly that natural childbirth was not an achievement, was nothing special, is akin to having a root canal without medication — and you based this on your personal experience of having two births each with and without drugs. Oh, and on trying to comfort women when they felt like they had “failed” by “giving into the pain.”

      Did you ever have any opportunity to take doula courses, or labor-sit, and try to help these women manage their contractions with non-medical means? Did you have anything to offer them, other than drugs, when they couldn’t take the pain of lying on their back in bed while the contractions washed over them, unable to move lest they dislodge the fetal monitors? Did you ever see anybody with a doula? Did you ever see anyone apply counter-pressure? How many of these women who felt like they had “failed” had been induced or augmented and couldn’t handle the artificial contractions? How many of these women were allowed freedom of movement? How many of these women had one-to-one support from you, a nurse, a doula, or a supportive and knowledgeable family member for the duration (or even the bulk) of labor? How many of these women were allowed into a labor tub, or to be on a birth ball? Looking back at your career, do you think you could have spent your time better in learning how to support a woman who is wanting a drug-free birth, rather than spending “way too much time trying to prepare women to be realistic”? Have you ever contemplated why so few women planning a home birth transfer to the hospital for pain relief, yet so many women (by your own accounting) planning a natural birth in the hospital end up needing drugs?

      Since you take exception to my inference from your multitude of thoughts on the subject, you have the floor to clear up any misunderstanding — do you think that natural childbirth makes any difference in a woman’s birth experience; and if so, in what way?

  5. So Dr. Amy~ pain medication for birth poses no risk to mother and child?

    Hmmm you might want to tell that to my client who was paralyzed for 5 wk after her first birth due to the epidural.

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