Living as we do in the midst of contemporary maternity culture, it’s difficult to recognize that that the beliefs and priorities that drive US childbirth care are not universal; indeed they are hardly more than a generation old. Our beliefs and priorities in regard to maternity care are particular to this time and place. Sadly they are more likely to reflect the needs of the natural childbirth industry and the hospital industry than the needs of women.
For most of human existence childbirth was recognized as arduous and life threatening. Although we’ve all heard apocryphal stories of indigenous women giving birth in the fields and going right back to work, cultural anthropology tells a different story. Most cultures consider new motherhood a special time that should be spent isolated from the larger society and nurtured by other women.
The natural childbirth and breastfeeding industries insist that childbirth is not an ordeal; women should room-in with their babies 24/7 since they need no rest at all.
Many cultures and religions specify a period of “confinement,” weeks in which new mothers are relieved of their daily duties and allowed to concentrate on caring for a newborn. They don’t even have to take care of themselves; mothers, mothers-in-law and other women take care of them. Today women may not live near family members, but in some societies they can avail themselves of “baby hotels” to rest and recuperate after leaving the hospital.
Our own culture mothered new mothers until a little more than a generation ago. My mother spent 5 days in the hospital after each birth, and could send her babies to the nursery whenever she wanted to rest. By the time I started my obstetric residency, that period of nurturing had dropped to three days and by the time I finished my residency, “drive-through” deliveries (staying in the hospital for only one day after birth) were being promoted.
Why did we suddenly stop mothering new mothers?
It happened because of an unholy alliance between the natural childbirth industry, which sought to “normalize” birth, and the hospital industry, which relentlessly searches for new ways to save money.
Contemporary natural childbirth advocacy is to a distressingly large extent about wresting back economic control of childbirth from obstetricians. Midwives, doulas and childbirth educators have woven a convenient fantasy about how obstetricians “stole” childbirth (and the money it represents) from midwives. That fantasy rests on a profound unwillingness to acknowledge both historical and scientific fact.
It is a historical fact that women came to prefer obstetrician hospital care because of its safety and increased comfort. So the natural childbirth industry/midwifery has fought back by deriding both the safety and the comfort of obstetrician led hospital birth. The natural childbirth/midwifery plan to wrest childbirth back from obstetricians is predicated on the following:
If obstetricians and hospitals medicalized childbirth to make it safer, then midwives would de-medicalize it to make it more enjoyable, and, for added impact, would declare that childbirth was safe before obstetricians got involved.
If obstetricians offered pain relief, midwives would proclaim that feeling the pain improved the experience, tested one’s mettle and made childbirth safer.
If hospitals nurtured new mothers allowing them to recover from the physical ordeal of childbirth, the natural childbirth industry/midwifery would insist that childbirth was not an ordeal and that women should have their babies room in with them 24/7 so they could get no rest at all.
Obstetricians have resisted these efforts and in the beginning hospitals resisted them, too. But hospitals now receive global maternity fees from insurance companies instead of itemized fees based on services supplied. The only way for many hospitals to continue to operate is to cut services. The natural childbirth industry and breastfeeding industries have given them moral and intellectual cover. If childbirth is “normal,” why shouldn’t they force new mothers out of the hospital ever earlier? If the breastfeeding industry insists based on no evidence at all that mandatory rooming in increases breastfeeding rates, why shouldn’t they close well baby nurseries and recoup the savings for themselves?
The natural childbirth and breastfeeding industries benefit in other ways, too. Being forced out of the hospital early makes a postpartum doula and her fee more attractive. Being pressured to breastfeed makes a lactation consultant and her fee seem less like a luxury than a necessity.
So the hospital wins and the natural childbirth/breastfeeding industry wins and mothers lose!
We have stopped mothering new mothers NOT because they no longer need nurturing. In an age where many live far from family and where mothers are likely to return to work only a few weeks after birth, new mothers need nurturing more than ever. But no one cares about women’s needs, least of all the natural childbirth industry and the hospital industry.
The bottom line is that we stopped mothering new mothers in order to increase the profits for both the natural childbirth/breastfeeding industries and for the hospital industry.
I have no hope that the hospital industry could be brought to care about taking services away from new mothers, but the natural childbirth/breastfeeding industries are built nearly entirely on discretionary income and are therefore vulnerable to consumer pressure.
It’s time to push back against the natural childbirth/breastfeeding industries’ insistence that new mothers should be forced to begin the work of motherhood the moment the placenta detaches. We must demand that well baby nurseries remain open, that breastfeeding is treated as optional, and that women be allowed to rest after birth.
Simple human compassion mandates that we do at least that.
