Recently, my family attended a meeting hosting by friends of ours to explore the idea of intentional community. We wrongly assumed that this meeting was also organized by them, as we’ve casually discussed these shared ideas and values and visions for our future. Turns out, we didn’t know the people who had organized it, and we walked away feeling like the conversation wasn’t for us. Not because we’re not invested in communal living – my partner actually co-founded one of our city’s flourishing housing cooperatives, and I spent many years investing in this conversation prior to meeting him. In fact, it was the housing collective that led me to the city where we met and to the house that I chose to live in, and ultimately, it was what facilitated the meeting between my him and I.
What I realized often happens in these conversations, though, is that idealism reigns supreme. There are special buzz-words thrown around that most resonate with, but that aren’t always practical or as black and white as one would like for them to be. What stood out to me was the nature of the conversation. Pulling people together in a room and dancing awkwardly around a utopian ideal with the expectation to enact some sort of sterile change. As though intentions, alone, have the capacity to collapse a dysfunctional system. Or for that matter, that we all agree on every aspect of what is dysfunctional at all.
I hear these same kinds of conversations happening around the systems of birth.
“The U.S. has a dysfunctional maternity care system because we don’t have an integrated system or respectful continuity of care; Canada, on the other hand – now they’ve got it figured out!”
Tell that to the Canadian woman I talked to last week, who’s planning an unassisted birth because she can’t find support for a VBAC at home or in hospital. Tell that to the woman who dares not even mention her pregnancy or her plans for fear that protective services will investigate and deem her unfit for her irrational desire to birth her baby with dignity, safety, and respect.
Assuming a less than, equal to, or better than mentality about states of maternity care around the globe misses the point. It sets up a dynamic whereby we assume that particular policies and routines are the crux of the problem; that the System, in and of itself, is responsible for and capable of resolving these problems if they would just make the choice to change them. While policies and routines ARE a huge part of the problem, the real issue lies with something much bigger – that is, the routine and systematic disrobing of women’s autonomy in any aspect of her healthcare, especially concerning issues of reproductive health. When we focus on specific issues and assign our own agendas to them, we almost never have the space to address the real root – in this case, the cultural devaluation of women and the assumption that women are sacrificial beings, by nature and by choice.
About ten years ago, my family was exploring the intentional community conversation with a small group of families. One time, we were planning a breakfast together. We were hosting and planned to make eggs. One of the guys actually said, “The eggs need to be organic and free range and local. Will they be? Otherwise we’ll bring them.” It so happens that local, free range eggs are a staple in our diet, but I’ll tell you, nothing made me want to go purchase shitty, factory-farmed eggs for that breakfast like that comment did. I mean, was this meal important because of the quality of food we were going to consume, or because it represented something way bigger? Were we gathering to flaunt our foodie elitism – to show off why we didn’t participate in the food factory system – or to meaningfully discuss where our systems were failing us and how we could engage, together, to heal our communities, relationships, and the earth?
How are we similarly missing the point in our ongoing conversations about birth systems? Utopian views don’t really do much to serve any agenda. There almost never is a completely realized utopian ideal. Each region and culture has their own unique experience around birth – some countries are fighting against the use of Kristeller’s maneuver, and others are dealing with a 70% cesarean section rate; some are sacrificing women under religious regulations that value a fetus’ life over that of a woman, and others, still, are losing women to lack of access to skilled birth attendants and clean facilities. In any case, what this all boils down to isn’t as much about the specificities of the atrocities, as much as it is a reflection of the lack of humanity afforded to a woman during her most vulnerable and powerful time in her life.
It is women’s access to primal knowledge and primal power that is undermined in nearly all birth systems in all parts of the world. Until women are granted the right to be the final authority on every single choice about their bodies, we will have an unjust system. A system does not become suddenly just because midwives attain licensure, or all pregnant women have access to healthcare, or because ACOG released a position statement that addresses the cesarean epidemic.
We deserve better. We deserve a conversation that is centered around the birthing woman, rather than the system. Yes, the system must change; yes, there are many specifics within the system that need to be examined, modified, and discarded. But all of this needs to happen under the framework of its relationship to the autonomy of the birthing woman. This framework removes the system from the foundation of the pyramid and places it at the smallest position at the top. What would happen if we framed every conversation, and every effort for change under a model that automatically assumes that the woman is the largest part in this dialogue – that she is the foundation; that her experience, her authority, her ownership make or break whether this tower stands or crumbles?
If autonomy were cemented as the foundation, it would force the conversation to exist around a justice framework. And that is the piece that’s struggling to come to the surface.
I hope you’ll join me in committing to pull hard to bring justice to the surface; to check yourself as you talk about these issues; to confirm that you are holding women and their rights to autonomy, firmly, at the base of this discussion.