Susana L. Gallardo
“YOU KNOW, have you checked with Faculty Affairs about maternity leave?” asked my colleague María. It was late September, and we were four weeks into the fall semester. I was somewhat successfully juggling three classes despite losing sleep, breastfeeding my two-month-old daughter, and breast-pumping my leaky boobs in the faculty office I shared with María and another colleague.
“Not Faculty Affairs,” I responded, “but I’ve gone over the contract online, and there are only references to paid leaves for full-time professors.” I had spent several hours doing that the previous spring at her suggestion and had promptly forgotten about it.
“Are you sure? It might be worth checking again. I had the impression there were some benefits for part-timers, too,” she said.
“OK,” I said doubtfully. “I’ll have to do that.”
It was another week or two later that I finally made the call to Faculty Affairs to ask tentatively if there were indeed any maternity benefits for part-time lecturers. I had grown up in a working-class suburban family where working any less than fifty hours a week was considered slacking. I have worked since I was twelve and my mom monogrammed my name onto a blue jumpsuit for me to wear Saturdays at the family auto repair shop, where I inventoried parts and filed customer invoices. I had absolutely no expectations of an unpaid leave, much less a paid one. My daughter was born August 3, and I had returned to work August 23 for the fall semester. If anything, I considered myself fortunate that I was working only part-time, officially 60 percent time, so that I could still spend plenty of time at home with my new daughter.
The call to the Faculty Affairs office was short. An administrator asked me when I was expecting (“last month”) and asked me to come in the next day for an appointment. Thoroughly confused, I showed up the next day for a one-hour appointment that changed my life forever. It’s still a blur how she presented paperwork that counted my years of service, accumulated sick days, and maternity leave and calculated that I could take the next three months off. Combined with the winter break, it meant I would be able to spend the next four months at home with my new daughter and receive full pay.
I was absolutely floored. I stumbled around in a cloud the rest of the day, and on the next day my department chair and I agreed that I would continue working another two weeks while he found substitutes for my classes. Maternity leave had to be taken within eighty days of birth—if I had waited any longer, I would have forfeited my benefits.
As I told my classes of the situation in the following days, I nearly broke down in tears, realizing the enormity of the situation. I was profoundly grateful for the union contract that guaranteed part-timers the same benefit package as full-time faculty. I was particularly grateful to my colleague María, who had insisted that I “check again.” Ever since then, my partner and I have only somewhat jokingly referred to her as “Tía María de la Maternity Leave.”
I open with this story against my better judgment because it reminds me of the complicated social location from which I speak. I am a Harvard-and Stanford-educated professional. I am a Chicana (Mexican American) and the daughter of a mechanic. I am also an adjunct instructor of social science and women’s studies, an older than forty, first-time mother, and an unmarried mother by choice. I share my background not because I am necessarily representative of any of these group identities, but because I think they are relevant and crucial in my approach to researching birth experiences. Birth for me was a physically empowering experience that changed the way I thought of and related to my body. In particular, learning about “natural birth” and its inherent critique of modern ob/gyn medicine drew me into a convoluted web of associations about middle-class privilege, midwifery traditions, the practicality of pain and body issues, and global maternal mortality. Birth and motherhood have deepened my academic research and pedagogy in ways I could not have predicted yet are remarkably consistent with my long-term interests in Chicana studies, religion, and feminist studies. In this essay, I briefly outline my experience with natural birth and then address some of the interlinked issues of what I call the “feminist politics of birth.”
FACING THE FEAR
Giving birth remains the most amazing thing that I have ever done. I was so terrified and skeptical of birth itself. I had always hated those women who smiled beatifically, saying, “Oh yes, it’s hours of the most horrible pain, but it’s all worth it.” I don’t like pain. Even though I was pregnant, I couldn’t bear to think about what the actual birth would be like. I was horrified about where the baby would come out from my body.
I eventually faced facts, picked up an armload of books from the library, and started confronting my fear. A former student, Allana, worked as a doula—essentially a maternity labor coach—and had made presentations to my classes about birthing practices and feminist critiques of the medical establishment. She was the first to introduce me to the idea that there were multiple birth options for women to consider. She also made me realize how strange it felt to think about maternity and motherhood from a feminist perspective. I had been working in feminist and Chicana studies for more than twenty years, and I realized I had a huge blind spot, if not bias, against motherhood. I had been encouraging my women students toward college and economic independence for years, so I had little time to think about maternity and motherhood. That would also probably explain why it never occurred to me to become a mother until I was forty years old.
FAST FORWARD
Several months of research in birth guides, medical journals, feminist journals, and mommy memoirs found me at a very different place as I encountered
two distinctly different approaches to birth. The first and most common is standard Western medical care, called “the active approach” and characterized by minimizing a woman’s pain and accomplishing delivery “within a defined number of hours, usually twelve” (Feinbloom 2000, 182). Performed by an obstetric gynecologist in a hospital setting, the active approach routinely uses a series of medical interventions that work to facilitate or accelerate the birth process—such as labor induction, pitocin, epidural for pain, electronic fetal monitoring, episiotomy, and cesarean surgery. Indeed, these procedures were covered in the hospital childbirth class I attended in my sixth month of pregnancy.
Whereas the active approach foregrounds reduction of pain and timely delivery, a second model is “the unhurried approach” of natural childbirth, which is characterized by “the absence of an expectation for how long or in what way a woman should labor or give birth, and the presence of an expectation (call it confidence) that a woman has the capacity to handle the pain of labor without being traumatized in the process” (Feinbloom 2000, 182). This approach is best articulated by midwife Ina May Gaskin, one of the nation’s most experienced midwives who has “caught” more than 2,200 babies in her lifetime: “The way I see it, the most trustworthy knowledge about women’s bodies combines the best of what medical science has offered over the past century or two with what women have always been able to learn about themselves before birth moved into hospitals” (2003, xi).
This second approach implies a critique of the active approach at the same time that it assumes a reliance on the basic tools of modern medicine. Yet it gives priority to a woman’s own body and unique experience in the birth process; a midwife assists as the woman herself delivers her baby. The difference is more than just language; midwives prioritize education and pain control through body position, environment, massage, acupuncture, and various other strategies.
Over the past twenty years, a significant body of national and global research on birth has called into question the U.S. overreliance on the Western model. With the best of intentions and despite cautionary guidelines by national medical bodies, the “option” of medical interventions has become the norm: one-half to two-thirds of all labors are artificially induced either by having the water broken or with synthetic oxytocin. Epidurals are given to more than 60 percent of birthing women (Osterman 2011) and episiotomies to almost 30 percent (Hartmann et al. 2005).
In addition, the rate of Cesarean surgery in the United States reached 31 percent in 2007, which signified a 50 percent increase from 1996 (Hamilton, Martin, and Ventura 2009). Cesareans are major surgeries that carry risks of infection, scar tissue, and complications, so that the World Health Organization (WHO) recommends that no more than 10 to 15 percent of normal births should require a surgical cesarean delivery (Gibbons et al. 2010). Cesareans are linked to lower rates of breastfeeding due to maternal pain from the surgical scar, delayed access to the baby, and complications due to anemia or certain types of anesthesia (Dewey 2001; Zanardo et al. 2010).
American obstetric gynecologists are performing more procedures, earlier, and more often than ever before (Hartmann et al. 2005; Epstein 2007; Hamilton, Martin, and Ventura 2009; Osterman and Martin 2011). This practice might be acceptable if it meant that U.S. women and their babies were better off. Unfortunately, the United States is currently ranked second to last among thirty-three industrialized nations in maternal mortality, with a rate of eleven maternal deaths for every one hundred thousand live births (WHO 2007). We rank thirtieth in infant mortality, which has been steadily rising over the past twenty years. Journalist Jennifer Block notes that “[a]lthough we are superior in saving the lives of infants born severely premature, women are 70% more likely to die in childbirth in the United States than in Europe” (2007, xxi). Ireland’s system of midwifery tops the list when it comes to reducing maternal mortality, with a rate of one maternal death for every one hundred thousand live births.
At the same time, some of the basic indicators of newborn well-being have been steadily dropping. Babies are arriving sooner, smaller, and less healthy. The rate of preterm birth (babies arriving at 32 to 36 weeks) was 12.7 percent in 2007 and has steadily risen since 1990 so that the average pregnancy length is now 38.7 weeks rather than the traditional 40 weeks (Center for Disease Control and Prevention 2005). The incidence of low birth weight has risen from 6.7 percent in 1984 to 8.2 percent in 2007 (Hamilton, Martin, and Ventura 2009). The National Center for Health Statistics notes: “It is becoming increasingly recognized that infants born late preterm are … more likely to suffer complications at birth such as respiratory distress, to require intensive and prolonged hospitalization; to incur higher medical costs; to die within the first year of life; and to suffer brain injury” (Kirmeyer et al. 2009, 1)
And even these overall numbers mask the inequalities of race and class. African American women are nearly four times more likely to die of pregnancy-related complications than white women (Amnesty International 2010). A New York study found that African American women are seven times more likely to die of complications. Women of color in general are less likely to be insured and to have regular access to good prenatal care.
The pattern of unequal access is replicated at the global level as well. Without dependable access to prenatal care and basic health care, women in developing counties are a hundred to a thousand times more likely to die from birth-related causes. Less than two-thirds of women in developing countries have assistance from any kind of skilled birth attendant (WHO 2008). Lack of access to health care means birthing women will die of hemorrhage, infections, eclampsia, obstructed labor, abortion, and other complications, at least half of which are preventable. Local community midwives in certain areas are making progress in some areas, but this progress only highlights the fact that good midwifery needs to happen in concert with good basic medical care; the relationship is crucial for women’s birthing well-being. A midwife is not enough in an area that does not have minimal standards of hygiene, access to water, nutrition, and medical care.
Natural-birth advocates have documented the cascading effects of medical interventions—an induced labor is often stronger and more sudden than natural labor, so a woman is more likely to request an epidural, which in turn is more likely to lead to a cesarean (Block 2007; Epstein 2007), which increases risks to the mother and makes it more difficult for her to breastfeed her newborn. Women who can afford to hire a doula to help them understand this process will do better; they tend to remain at home longer and are less likely to need medical interventions and less likely to end up with a cesarean.
As for myself, privileged as an educated professional, I chose a doula and an ob/gyn to help me give birth in a hospital setting. I spent hours, days, trying to locate a midwife via my insurance provider before finally giving up in frustration and choosing an ob-gyn. She was wonderful but made it clear she did not appreciate my birth plan or my insistence on “questioning her judgment” when I refused to induce labor until I reached forty-one and a half weeks.
I became an avid natural-birth enthusiast and began incorporating the topic into my introductory women’s studies courses. Yet as I continued to participate in discussions and sharing of natural-birth resources, I remained disappointed at the limited reach of the natural-birth community. Despite the best of intentions, an empowering natural birth seemed within reach mostly for educated, white, Internet-savvy, professional women. There is a too-small network of individualist “choice” discourse circulating within birthing communities that support women in this path. The excellent recent film Business of Being Born (2008), produced by Hollywood mom Ricki Lake and Abby Epstein, broaches many of these issues and follows a series of relatively affluent women as they deliver their babies at home with midwife Cara Muhlhahn. Less than one percent of babies are born at home in the United States. The follow-up book by Lake and Epstein, titled Your Best Birth (2009), also an excellent resource, still further signifies natural birth as an individual consumer product, to be chosen by those lucky enough to be able to “interview your ob/gyn.” Professional doula Miriam Pérez comments, “Upwardly-mobile moms in New York City may finally be catching on to the benefits of midwifery and homebirth, but low-income women are still firmly planted in the hospital most often with medicalized births overseen by doctors” (2009).
Most every other industrialized country in the world bases its maternity care on the midwifery model, with ob/gyns reserved for only the 10 to 15 percent of cases with complications. Evidence from U.S. and international studies overwhelmingly shows that the midwifery model is the safest method of birth for mother and child—good for mom, good for baby, good for the nation (Büscher, Sivertsen, and White 2010). And yet we’re not doing it.
The uneven access of women to adequate medical care in a world of inequality and the paradoxical results of access continue to be the greatest lesson I learned as a mother in academe. The obscene contrast between dangerously high levels of overmedicalized cesarean births among more privileged women and a basic lack of prenatal care among women of color in the United States continues to confound me. A WHO report starkly concludes that, at the global level, 3.18 million cesarean sections were needed in undeveloped countries in 2008, but “6.20 million unnecessary sections were performed elsewhere,” a disparity with “negative implications for health equity both within and across countries” (Gibbons et al. 2010, 3).
Alison Bartlett, a feminist scholar who writes about the maternal body and breastfeeding, reminds me that the work of feminist academics is “still one of the few modes of employment which allows us to think subversively and to encourage others to contest dominant regimes of thought” (2006, 22). Groups such as the U.S. Sistersong Women of Color Reproductive Health Collective have begun to use the term birth(ing) justice to reflect work “for a better culture of birth and reproduction within an intersectional politics” (M. Pérez 2011). The First Environment Collaborative founded by Mohawk midwife Katsi Cook, for example, trains Native midwives in a project that reconfigures birth at the intersection of Native, environmental, and reproductive rights.
I initially wrote this article out of an incredible feeling of empowerment in motherhood and in my own physical body. I wanted to communicate that feeling to other mothers-to-be. Like a paid maternity leave, the natural-birth experience surprised me as an amazing luxury, something to which I had no idea I was entitled. I remain frustrated as I see birth being commoditized into an individual “choice,” limited by access to privilege and at times discursively represented in language that plays on maternal guilt and control issues. We need new language such as birth(ing) justice that moves beyond “individual” consumer birth choices to productively engage dominant medical discourse and global patterns of medical access.
