Birth, BDSM, and safewords

If you'll allow me to venture just a bit off topic here, I want to talk about BDSM. If you don't already know, the acronym stands for Bondage, Domination, Sadism, and Masochism. It encompasses everything from a playful spanking and "you tie me up and I'll tie you up" to cutting and piercing as sexual play. If discussion of sex upsets you, well, read this anyway. It's not going to be too intense, I promise. Also, if you're familiar with BDSM, you can skip the next two paragraphs.

There's a concept in the BDSM world called the safeword. Basically, part of what makes BDSM fun is that you can get to a point where you don't have to think about your reaction. You can cry and get upset and generally make a big fuss, and even say "no," without the other person stopping. It can be a fun fantasy to have someone keep going even after you say "no." But how can you differentiate between a playful "no" and a serious "stop now" no? I'm a firm believer that "no" means "no" always, unless there's a pre-defined agreement, but even with such an agreement, you need something else to mean no.

That's where safewords come in. A safeword is a special phrase or word that you can say that will make any pain infliction come to a complete halt immediately. It's always a word unrelated to "no" -- something that you wouldn't normally say during sex or while in pain -- that you will only say if you need the action to stop right away. Generally, most people in BDSM rarely end up using their safewords: most partners are able to sense when someone is nearing the limits of their pain tolerance, and back off accordingly. A safeword is sacrosanct, it must be followed without hesitation.

When I've heard other women talk about birth, many of them mention that they felt unsupported in their choices, even choices they'd made with the full knowledge of their partner. Why? Because as soon as, say, a woman intending a natural unassisted home birth says "I don't know, this isn't normal, this can't be normal, I want to go to the hospital," it's an unwinnable situation for the partner. If she just needs reassurance that her labor is normal and that she's doing well, his response of "okay, let's go to the hospital right now!" might seem unsupportive or like he doesn't believe she can go through with it. On the other hand, if she's having a genuine moment of intuition that says her labor is developing complications or she truly believes she must go to the hospital immediately, his reassurance that she's doing fine might just make her feel scared and trapped. Sometimes a woman saying to her doula or partner: "dammit, I wish someone would just give me the meds" is a genuine cry for medical attention, and other times, it's just said to let off steam and have an emotional vent. "I want an epidural, fuck this, I want my epidural" could mean "Even with the risks involved, the pain is too bad to cope with and I must have this now," or it could just mean "I wish I could make the pain go away! Tell me that it won't be too much longer."

But it's just like in BDSM. How do you tell apart real requests and emotional vents made in a heated moment? That's why I think the concept of a "birth safeword" should be incorporated into all births, whether they're in a hospital, a birth center, or a home, and regardless of who they're attended by. This way, women can say whatever comes to mind, without fear that their venting will be interpreted as a plea for immediate medical attention, but also have the ability to make their needs known as serious and immediate if necessary.

What are your thoughts? Does a "birth safeword" sound like a good idea to you? Has there ever been a time when you think you might have avoided an unnecessary intervention with this sort of technique?

Superstition

I've talked already about how everything's an early pregnancy symptom. But that's not the only way that trying to conceive creates superstitions.

There's a constant attention paid to Murphy's law, and I think that's because of all the stories of 40 year old women who want children desperately and have money and stable homes but can't conceive, and then 13 year old girls getting pregnant accidentally and having it mess up their lives. There's this idea that if you try, it won't happen. If you hope too much, it won't happen.

So when I saw an Avent Isis breastpump and breastmilk storage supplies to go with it for a total of $12 at a local store that sells brand new dented box merchandise, I should have bought it. But I didn't. Why? Because it would be staring me in the face if I can't get pregnant! We've already bought a couple of things, but somehow the breast pump just seemed like too much to get before even conceiving. In many ways, there's so many things where it'd be really easy to start stocking up now, like cloth diapers, but I shy away.

I hate superstition! I know it's wrong. I do. Especially when I catch myself thinking, oh, great, I forgot to take my prenatal vitamin, now I'll definitely get pregnant because I'm being stupid and unprepared! It's bad. But I don't know how to stop it.

J's IUD came out. It was sort of awesome, but I don't think I ever want one.

So I'm trying to cool my heels this cycle. The first month I tried to conceive, I was charting and driving myself totally nuts. The second month -- last month -- I ended up having a 102 degree fever for the time when I'd have normally ovulated, and had an anovulatory cycle. In order to not keep worrying myself all the time, I am going to temp every OTHER cycle, rather than every cycle. I think this will keep me from being totally nuts and obsessive, while still keeping track of my fertility enough that I can feel confident in my ability to conceive.

I had a nice, ovulatory cycle the first cycle I tracked, so I don't think ovulation is something I need to worry about. But still, the worries are always there. What if I'm infertile? What if my husband is? Yikes! I had what I assume to be a very early miscarriage last fall -- a late period, tender breasts, and then a positive test followed an hour later by heavy bleeding -- but that doesn't stop me from concocting scenarios in which either of us could have BECOME infertile since.

To make matters worse, my periods have been really odd since I stopped hormonal contraceptives. They have, in the past, been heavy but rather short. Now, I bleed lightly for 1-2 hours a day, every day, for about a week. It's hardly a damn period, and even 2 years ago when I stopped hormonal contraceptives for a few months (I wasn't partnered at the time), I didn't have this sort of weirdness. So even though I spent all my periods before wishing they'd be lighter and less crampy, I'm now wishing for the old-style, cramping, tampon-soaking period.

By the way, I will never tell you that I'm about to give you "TMI." You're reading a blog about conception, pregnancy, and birth. These things all involve bodily fluids, physical processes, and sights, sounds, and smells that might not always be pleasant. If you have an aversion to hearing about those, what on EARTH are you doing reading this blog? I always hate in pregnancy communities when women pre-emptively apologize for including too much information about their discharge or periods or mucus plugs. We're all grownups. I want to talk about birth honestly, and I can't be honest without talking about my body and the things it does. I hope no one has an issue with that, but if you do, don't expect me to go changing things for you.

More about choices -- this time, from a fat perspective

I talk a lot in this blog about choices, and how informed choice is what frames my ideas of birth. I also talk about the fact that, for all the rhetoric of choice in this country, if you aren't born with an awful lot of privilege, you may not have all the choices you supposedly have. This isn't just true with economic privilege or abortion rights.

This and this show how fat women are often told that their choices don't matter and are forced to use medical treatment that is against hard medical evidence (being given statins during pregnancy, or getting a vertical incision c-section) and which is often dehumanizing or demeaning. Being told to make funeral arrangements? Pressure to be sterilized? This is disgusting treatment that no one should be forced to go through.

I am strongly drawn to unassisted home birth for reasons that I have talked about in previous entries, but I regret the fact that another component of my decision is grounded in fear. I am deeply afraid of a doctor treating me the way Gina Marie's doctor treated her. I'm afraid of being pressured into doing things against my will at an extremely vulnerable time. At my weight, I would very likely be "risked out" of a great many midwifery practices, and even going to a midwife doesn't guarantee that you'll get good treatment, as the Gina Marie story so clearly illustrates. Over and over, I've seen doctors treat fat people like they were less than human, and asking them to follow courses of treatment that are not medically sound (one example? Having a doctor recommend an 800 calorie starvation diet, a surefire recipe for muscle loss, metabolism slowdown, and eventual weight regain).

Because I believe I would want an unassisted birth regardless of all this, I hate the fact that my choice is also one made because I fear the other options. This is especially bad because, of course, if there is a labor emergency requiring medical attention I would want and need to go to the hospital. I am counting on my labor support people to get my wishes through to any particularly thick skulls in the hospital. Our local hospital, which is so small it doesn't have a full-time OB or most medical specialists, has weight loss surgery seminars and support groups every week, so I'm doubting it's exactly size-positive.

I wish I felt I could trust doctors to do what is right for me. I wish I could trust them not to take advantage of labor's hormones and emotions to push an anti-fat agenda. But I can't. Staying out of the hospital from start to finish is the only way to guarantee that my care won't be severely compromised just because I'm fat.

My mother's births, and why my mother will not be at my birth.

My mother gave birth twice. Both were victories, in their day, in some ways.

Her first child (me) was born by caesarean section. This was something she had always hoped to avoid, but at 8.5 months, I turned transverse and would not budge. There was too little amniotic fluid to attempt version, so a c-section it was (given her second pregnancy, I wonder if I might have turned if I had been left to cook a bit longer, but this was the 80s). My mother was upset about it, but was even more upset that she would have to leave my father behind. At that time, the partners of women getting c-sections were expected to stay out of the operating room, leaving the woman totally without a support network at a time when she really needed one.

My mother successfully argued her way into letting my father come to her birth. My father was the first non-doctor father they'd allowed in to see a c-section birth, and he stayed and took pictures (they didn't turn out too well until I was out, but that's okay). My mother didn't have to be without labor support, something that was very unusual for that time and place.

Four years later, when she was pregnant with my sister, my mother saw no logic to the "once a caesarean, always a caesarean" rule. Her body had been more than capable of birthing, my positioning was just very unlucky (and unusual -- a very, very small percentage of babies stay in the position I did for as long as I did!). She wanted this newfangled thing she'd been hearing about, a VBAC (vaginal birth after caesarean). Her OB/GYN flatly refused, and fired her as a patient when she continued to insist. She went to one who would "allow" her a "trial of labor," and her pregnancy progressed. She and an aunt of mine had an identical due date, and when my aunt gave birth at 36.5 weeks with a very short and precipitous labor, my mother felt more than a pang of jealousy. But she was happy when she passed 38 weeks and my sister was head-down, just like she should be. At 40 weeks, she could see my aunt's nearly month old baby and started wondering when labor would kick into gear. Another week passed, and another. At 42 weeks, many hospitals would force a patient into an induction, but they knew that an induction with a VBAC meant a higher risk of uterine rupture. She went in for tests daily to make sure the baby was okay, which it was. Another week passed as she tried all the usual methods and some unusual ones for getting labor to start: she had a lot of sex, did physical activity, rode a motorcycle. Nothing worked, and another week passed. At 44 weeks, I'm sure she wondered if she'd EVER stop being pregnant.

At 44.5 weeks, she had her successful VBAC after a 48 hour labor. As it turned out, the OB/GYN who had flatly refused the VBAC was the one on call that night, and handled it with professionalism and decency (he is now a big advocate of VBAC!). My father was there at this birth as well, and my mother tried very hard to lobby for me to be present at the birth too. In spite of the fact that they never let children under the age of 8 into the delivery room, I was already into my "I want to be an obstetrician" phase, and wowed the doctors with my high level of verbal interaction. However, because VBACs were so new and there wasn't tons of data on their safety yet, they were worried there could be major issues, and the doctors didn't want to have to worry about what to do with me if my mom had to be whisked off to the OR. So I stayed and waited with my aunts, and only got to meet my sister when she was cleaned up and presentable.

My mother was a fighter against interventions she saw as unnecessary, and fought for labor support and to have her immediate family around her during birth. It should come as no surprise to her that I would be similarly radical in thinking. But upon even testing the waters in discussions of birth with her, my mother has nothing but good things to say about epidurals and medicalized, hospitalized birth. When I've mentioned my plans for a natural birth, she's said "oh, you'll be crying for the epidural in an hour, and remember, it took me 48 hours to have your sister." When I've even mentioned the idea of home birth, she seems to think it's a naive and foolish thing to plan -- again, her idea is that I will automatically want to go to a hospital right away.

That kind of defeatist attitude, the idea that failure is inevitable and that my body won't be strong enough, is exactly the wrong kind of thing to have around at birth. There are many points during labor where going to the hospital or staying home to birth are determined by the level of support and optimism the laboring woman is surrounded by. During the parts of labor where I say "I can't do this, I refuse to do this, the pain is too much," I want someone to be around to say "you're already doing this, this is normal, you are doing great. I worry that if my mother was around, she'd say "well, the pain would go away if you'd just go in to the hospital." I worry that if she was up here, even if she said nothing, I wouldn't let my control lapse. If you can't let your guard down, you can't birth effectively.

The people I will have at my birth are the exact people who live here in the house now. One of those people, my housemate J, whom I've talked about in previous entries, is a doula and knows a whole lot about birth. The other three are men, two of whom I love and couldn't imagine a birth without, the other of whom is J's husband, who will be there for the little logistical things that need to be done, like calling people who need to be called or heating blankets or sterilizing scissors. Four other people. I've seen them all naked and vice versa, so there's no possible body shame issues there, and they will be there the entire birth. How many hospital births can you say that about? Most hospital births involve a small platoon of medical personnel, many of whom are only seen by the laboring woman for a short amount of time.

One of T's jobs -- that's J's husband -- is to call my mother when the pushing stage starts. Even traveling at top speeds with no traffic, it's seven hours from my mother's doorstep to mine. That means that even with a long pushing phase, my mother will get there when the baby's born and not before. If somehow she managed to get up here sooner, the pressure to have an epidural or whatnot is off at that point.

In some ways I sincerely wish I could invite my mother to my labor as well. It would be a culmination of those ways in which she fought for herself, an evolution of the type of birth she wanted. I would have no issue inviting my father, because he would tell me that my choices are my own. But as it stands, I think she would be more of a hindrance than a help and I can't very well invite dad without mom. So, mom, if you find this blog (you've found all the other ones, right?), that entry is for you. If, between now and my birth, you can convince me that my fears are wrong, I would be more than happy to invite you. I could see you being a fantastic help, if only you could get it through your head that sometimes I don't want the same things you want!

One more note, in relation to the post below:

This is why I am pro-CHOICE, not pro-abortion. The fact that doctors would use misinformation to encourage abortion is as deeply disturbing and horrifying as CPCs using misinformation to discourage it.

There are two kinds of birth people...

I generally hate any kind of "there are two kinds of people" discussion. It's polarizing, and it often leaves a lot of people out. But I have to say, when it comes to birth junkies in general, the polarization is already there. In general, women who are very interested in birth and especially natural birth options fall into one of two categories: very liberal, hippie, crunchy, granola types, and extremely conservative Christian types. I fall into the former, but it's a pretty even split between the two groups.

In some ways, this makes sense: extremes often meet up in some areas. Both the hippies and the Christians believe that birth is an event that needs more attention, and that giving birth is an event to be celebrated or even worshipped. The hippies believe it because of a fundamentally pro-women and pro-choice bent, the Christians do because of a fundamentally pro-creation one. This means that in most birth-related things, the two groups converge. When it comes to helping a woman have a safe and happy home birth, or making sure her doctor doesn't get too pushy, or mothering a new mother, it's very easy to be in the same position. But there's one issue where the two groups diverge radically.

That issue is abortion.

My housemate J and I often wish that we lived closer to an abortion clinic. Neither of us has personally had an abortion. However, we have respect for women's bodies and women's choices, and believe that in the absence of coercion women generally make the right choices for their lives and themselves. We would like to help at clinics, by being clinic escorts or even abortion doulas. I'll talk more about the practice of being a birth doula later (which is something I'm intending to start doing this year, exciting!) but essentially it means being a non-medical support person and advocate. Just as in birth, women who are aborting need someone to stand by them and be their representative and advocate during a difficult time. They may need someone to stay with them during the recovery phase, or need someone to run interference with clinic protesters. This is the sort of thing we could and would do if we lived near a clinic, but we don't. Small towns don't generally have an abortion clinic, and ours is no exception.

And on the other side, there are the Christians. They, too, believe very strongly in this issue. While I was at a meeting of doulas recently, several of the women who gravitated more toward the Christian, pro-creation side of this debate were talking rather excitedly about working at a crisis pregnancy center.

If you don't know what a crisis pregnancy center is, they're often listed as "abortion alternatives" in your Yellow Pages. They're also the places that put up those signs reading things like: "Pregnant? Scared? Need someone to talk to? Call us." Their stated purpose is to prevent abortions.

As a stated purpose, I don't think that's too bad. I certainly would like it if there were fewer abortions in this country, which is why I advocate comprehensive sex education and easy access to reliable contraception. No one (except perhaps a few very crazy internet people) wishes for more abortions. I believe many women are essentially forced into aborting because of financial circumstances, and that's a terrible, awful thing. That's why I support paid parental leave policies and more benefits for mothers. I want everyone to be able to make a choice about their childbearing independent of their personal finances (choices which also come into play in the hospital birth/home birth issue, which I'll talk about later). If crisis pregnancy centers worked with women to make sure their finances were adequate and help them with the costs and emotional issues of raising a child, I would support their mission.

But crisis pregnancy centers do not do that. Their goal is specifically preventing abortion at all costs. They lie to women, often telling them the old myth that abortion causes cancer or leads to infertility. They have uncertified ultrasound technicians doing ultrasounds and guilt tripping women who are already in a delicate emotional state. They tell women to come in for additional "counseling" appointments that are specifically to delay abortions -- which, because the cost and risk of abortion goes up every week of a pregnancy, is a good way to make abortion an untenable option for some women. Women are promised support in purchasing baby items, but this often amounts to a few onesies and a used piece of baby furniture. Some crisis pregnancy centers have even used women's personal information to track down their relatives and tell them about the unplanned pregnancy and the woman's intention of aborting, if they believe that the woman will go through with an abortion.

When your goal is preventing abortions at all costs, it makes sense to lie to women. The ends justify the means for the people working at crisis pregnancy centers. But I don't believe that we need to lie to vulnerable people, or force them to make the choice we want them to make. While I understand the point of view of the pro-creationists, I don't endorse it. I actively work against it.

If and when I do become pregnant, one of the things I intend to do is visit local crisis pregnancy centers. Since one of the first things they do is provide a pregnancy test, going in without a pregnancy wouldn't work. I intend to tell them that I am considering all my pregnancy options and even abortion (which, of course, I am not: I do not consider a minor bit of undercover lying to be morally equivalent to repeatedly lying to distraught women). I want to see if the local centers are as morally bankrupt as the ones I've heard about before. I am still open to being pleasantly surprised, but I doubt it'll happen. Of course, I'll need to avoid any centers being worked at by other doulas at the group (who know I'm trying to conceive), but I can't help but wonder: are these women, who other women are relying on as advocates and honest, helpful support during labor, lying to other pregnant women without shame or remorse?

I'd like to say I can't picture it. But I can, all too well. The divide between the two groups is so chilling on that subject. I could not trust a birth doula who also worked for a CPC. Mabe some people could. But I would never want to have anyone in charge of caring for my emotional or physical well-being who didn't respect my own bodily autonomy.

If you work in the birth world, or are otherwise a birth junkie, how do you view the split between these groups? Have you ever encountered it in a particularly nasty form? Have you ever figured out a way to heal that rift?