Lisa Gould Rubin is a childbirth educator, who has been teaching and doing labor support and postpartum consultation for over twenty years in New York's Westchester County. She, along with Amen Ness and Jackie Frederick Berner, has co-authored The Birth That's Right for You: A Doctor and A Doula Help You Choose and Customize the Best Birth Option to Fit Your Needs (McGraw Hill, 2005).
Sarah Buttenwieser: You've been in the world of childbirth for a long time; tell me what you notice about how the world has changed or stayed the same.
Lisa Gould Rubin: Culturally, we seem to assign value judgments to birth, ascribing words like "normal" or "natural." In Utne Reader, there are a few articles about childbirth, including one called "Drugs, Knives, and Midwives" that looks at the current struggles midwifery faces, and the rise in infant mortality in this country as we head toward more interventions rather than fewer. But what's also striking to me is that through all different movements surrounding birth, we still come up with the same old dilemmas or issues that put a value upon birth as if there's a good or bad, right or wrong way to give birth.
SB: How does this tendency toward judgment affect women?
LGR: Lots of women feel crappy about their births. There was a big survey in 2005 -- Listening to Mothers II -- and it revealed that many women report feeling dissatisfied with their birth experiences. Some are guilty because they didn't have a "natural" birth; others wanted vaginal births and ended up with cesarean sections. To me, guilt shouldn't need to be part of their experience. Guilt is punitive.
SB: Is there a current version of "best" or "right" birth?
LGR: Don't you find that people judge epidurals to be as not as good as medication-free?
SB: Oddly, I know people who just scrunch up their noses at the idea I didn't opt for any medication. But others I know wanted no meds. For those women, taking meds represented some defeat, yes.
LGR: I really challenge the notion that there's a single "best" birth; that's why I wanted to write a book urging each woman to find the option that is best for her. I believe there's not nearly enough support out there right now for women to find their most comfortable choice and settle with that, as opposed to someone else's idea of what she should do. Lamaze, with its taglines, "A normal birth for every woman" and "Advancing normal birth," doesn't help. Again, like "best," who are we to determine what's "normal?" It'd be a little more truthful to say medicated and un-medicated. And, in the Lamaze world at least, there's a value still implicit in medicated and un-medicated.
SB: Lamaze is often the only game in town, depending upon your town.
LGR: I got certified as a Lamaze instructor because it was the method with the most credibility when I was starting out and it still has the most credibility. Some people think of a method like Bradley as a little more "out there." While Lamaze used to be wholly against medication, it has had to soften its stance for commercial reasons. So many women opt for medication that advocating success in terms of going without medication would fault or fail too many of its clients. Lamaze still has a strongly judgmental good/bad paradigm, though, from which I differ.
SB: While I'm not naive about the impact of litigation, it's interesting to me that in a time when so much information is available, the intervention rates in hospitals would rise again and midwives again find themselves fighting to keep a place in the hospital.
LGR: I loved the quote from the Utne Reader that "trying to have an intervention-free hospital birth is like trying to fit a square peg in a round hole." Hospitals and birth centers with midwives have lower intervention rates; with doctors, the intervention rates rise. Those are plain facts. The other thing, though, is that many doctors want the midwives' business and that interventions are expensive, and thus lucrative. Women coming in without insurance through an ER are probably not being induced nearly so fast as affluent women, because inductions are not cost effective, too many interventions tend to follow.
SB: Can you talk about why induction often leads to more interventions?
LGR: An induction with the drug pitocin often brings on very strong contractions. And you aren't as free to move around physically as you'd be without that IV attached, because you have to be more scrupulously monitored to make sure the baby is tolerating the drug induced labor. And because the contractions are so strong and mobility is so limited, it's not quite a given but nearly a given that women on pit will require medication, an epidural, to ease the pain and also to take the edge off of the fatigue that comes from handling those intense contractions. Without the ability to move around, labor -- even with the drugs --often stalls. At a certain point, if labor just won't progress, especially if there are signs of fetal distress, a section becomes the only option; looking back, you might see it as an inevitable outcome coming from that series of interventions.
SB: I definitely know plenty of women who have beaten themselves up over having birth experiences that seemed less than perfect or different from their expectations.
LGR: Part of what bothers me is that there are so many mixed messages. With so much information available -- you're supposed to look up every possible option or scenario on the internet -- women are blamed if they didn't do tons of research, although not every woman wants or needs to. And at the same time, it's very patronizing to judge women for things like their choices about medication, as if their own decisions aren't valid. So, at once we're placing culpability upon women and at the same time acting as if they can't make legitimate, responsible choices for themselves. And what's worse, women judge one another, so we can't miss out on support from one another. If we can't support each other, we're lost.
SB: Personally, the other piece I sometimes find myself miffed by is that notion that birth is necessarily a journey. I'm not saying it can't be, and yet it might not always feel that way.
LGR: For some women, it most definitely is a journey. But not so for all women: for some women, it's a means to an end. To force women to envision this experience as a journey really just places yet another pressure to conform upon them.
SB: Are women competitive about birth?
LGR: One thing is that pregnancy and childrearing are so public. Everyone feels free to weigh in. You're suddenly vulnerable to commentary about everything: how much weight to gain, how and where to give birth, how to feed your baby, where your baby should sleep...
Another thing is that I think women can get pretty competitive around their births; both in the planning of it and afterward, in terms of how successful they feel it turned out. They can even compete for how badly it went as long as the baby was born healthy. The competitive piece isn't distinct to birth and parenting, though. I think it's endemic to our culture and is just the next platform in which it can be played out. Check out Judith Warner's book, Perfect Madness: Motherhood in the age of Anxiety. I also think that in our inherent narcissism -- part of which is organic, part cultural -- that giving birth and mothering are the next big opportunities for us to continue to work on separation from our own mothers and to grow out of the "me". Part of the big work in parenting is not seeing our children as extensions of ourselves, but as individuals separate from us. This work starts as soon as the umbilical cord is cut; we get the opportunity to revisit our own childhoods and ways in which we were parented, including separation from our families of origin. Our children serve as our mirrors.
SB: When you first got involved in childbirth education and support services, what did you aspire to provide for women? What did you hope to experience for yourself?
LGR: From before having kids, I loved being around pregnant women and birth. I had pretty clear ideas about how my births should go. The thing was, the story unfolded differently and through that, I learned a lot. I was organic everything, I spun my own yarn -- in fact, my wedding present from my former mother-in-law was a Shaker spinning wheel -- and in truth, I was very neurotic. I was also dogmatic, so sure my way was the right way. And then, when I was six months pregnant with Indy, I got diagnosed with cancer and had every diagnostic test possible, having refused every routine test or ultrasound offered to me. How could that happen to me, who'd done everything so right?
I had already struggled through infertility. I endured miscarriage. In this arena in which I was so committed, I wasn't experiencing the outcomes I thought were justly mine. And then I ended up with a long Pitocin induction and I refused pain meds. No one said to me that trying an epidural might help, because it'd ease the pain. And as I've said, physically, a pit induction is a very painful, intense experience. As it was, I had no resources left. I ended up with a section after 36 hours. This was a big eye opener. Despite everything, Indy came out this healthy baby. Now, she's graduating from college.
I was very committed to having a VBAC (Vaginal Birth After Cesarean) with my second child. This was counter to the times, especially in the Westchester County in 1989, but I persevered with a homebirth, because I wasn't willing to go back to the hospital. I wasn't as well versed with the risks entailed by not being at a hospital as I am today; in fact, I'm not sure I'd have made the same choice if I were to do it again now. But I do think that over time, I've come to respect the fact that rather than placing our ideas or ideals upon our lives, we have to respect that we need to go with the way the story unfolds. When we don't yield to what's happening, we can't really honor who we are or how our lives are really going. It's taken me a very long time to understand and appreciate that life gets life-y. And although I fought against that, in truth, it's much better that way.
SB: Your personal experiences must have made an impact on how you worked with women ever since.
LGR: I really believe that I became so much better equipped to help women. After experiencing infertility, I bring a bird's eye view into the cost to marriages and to self-esteem for those premium babies. And after my VBAC, I knew I wanted to support other women who wanted to try for VBAC. More than anything, I try to support women to listen to themselves; each woman is her own best expert on what makes her most comfortable. I want to help each woman reach the place of feeling responsible for herself and tolerant of herself.
SB: When women come to you disappointed about a previous birth experience, how do you help them to sort those feelings through?
LGR: One thing I've noticed is that it's hard to have conflicting expectations. Sometimes, although we're disappointed about the outcome -- a section for example -- another part of our response is relief -- relief that it's over or the baby's healthy or the doctors took care of things -- but it's hard to live with those conflicting responses. I try to link those conflicting emotions to help a woman find her truth around her experiences. And I do this conscious of the fact that in trying to help her uncover her own truth, I'm also doing so in a supportive way, not a judgmental one.
SB: You've done childbirth education and labor support, so why a book?
LGR: Through my hands-on work, I can only reach women in my area. I wanted women beyond my immediate region to have access to this information. I didn't see this message out there. I am really urging women to look the components of their lives and to find their tolerances and preferences to make their birth experiences and early parenting experiences suit them best. I do not believe there's a specific "right" way to do birth or early parenthood well. I want every woman to know she already possesses her most important information; she knows herself. Her challenge is to uncover the details that will inform her best choice for herself, from whether to use a midwife or a doctor, or to learn about the hospital's policies or to try keeping a baby in her room or a nursery during the first weeks. If she looks at herself first and then tries on different options with that knowledge in mind, she can really help herself find choices that are most comfortable for her.
mmo : march 2008 |