Fear & Control; a World Perspective on Birth

It is obvious that the birthing practices of any particular society have a far reaching effect on the outcomes for mothers and their children. Depending on birthing location and access to important things like adequate medical attention, food, money, and support one could have a successful and rewarding experience with birth or a horrifying one.

Clearly people of different environments experience vastly different outcomes based on location and development of that environment. It is true that mothers in a place like Liberia might experience more complications that mothers in the United States or the Netherlands, just because of economic resources and technology. However, this is not to say that women in these “developed” nations do not have the potential to suffer from the same downfalls in birthing practices that mothers in places like Mozambique and Liberia might.

When reading Zola’s piece on medicine as an institution of social control as well as Lori and Boyle’s study on childbirth practices in Liberia there were some crucial factors that came to mind when thinking about the issues with childbirth plaguing the world. The biggest aspect that became apparent was the lack of women’s control over their own health experiences. Certainly this lack of control manifested in different ways for women in the U.S. vs. Liberia, but the common factor was still the same. Women suffer from a lack of control when it comes to their own health outcomes.

Much of this is due to the context in which women in the U.S. and Liberia live. Zola wrote about the pervasive nature of health in the United States, noting that pregnancy is one of the many instances in life in which the not-so-invisible hand of medicine sneaks it’s way into the lives of women. By viewing pregnancy as an illness in the U.S., women are swindled into giving up control of their own pregnancy because they fear they can’t make the right decisions. This was also a factor that Liberian women experience. Because they are taught from a young age that they are simply too “little” to make decisions for themselves, they often leave medical decisions in pregnancy up to their husbands, but only when things have gotten out of hand. Instead of learning to trust our instincts and bodies, we are taught that another person, whether it is a man or a doctor, knows better than we do. This often leads to mistakes in treatment that lead to huge issues down the line, and sometimes (too often, in my opinion) death in mothers and infants. For instance, Women in the U.S. give up control to medical professionals who treat patients in a methodical, by-the-book way. Without an individual approach where women can safely identify their concerns and needs so that an optimal birthing and prenatal plan, women lack the autonomy to voice discomforts. This silence can lead to anxiety, fear, and a lack of real knowledge about what their bodies are going through. Liberian women, on the other hand, cannot make decisions to be taken to the hospital if necessary, or how many prenatal check-ups they can go to, without a man or elder’s approval. Even though a woman might feel she needs help or medical attention, she is discouraged from including the man until it is absolutely necessary. Waiting until this threshold is met is so damaging, which is clear in the amount of deaths upon arrival to hospitals that were observed by Lori and Boyle. I don’t think it is unreasonable to say that each of us has at least some knowledge of our own bodies. Autonomy is such an important aspect of health because when we lose control of our own bodies, we lose control of so many aspects of our lives.

Another huge factor in pregnancy shown through the readings was the presence of fear. Even in situations where pregnancy is viewed as a natural process rather than an illness or condition, there is still some element of fear around the subject. Certainly an woman would be more than justified in feeling afraid throughout pregnancy. With the pain and discomfort that tends to come along with giving birth and carrying a child, fear seems natural. However, fear for cultural reasons seems like an added stress that is unneeded. Even in the case of Foua in Laos, a woman who exerted much control over the birth of her children, she still experienced much fear around pregnancy. The fear of spirits harming her unborn children, the fear of her husband seeing her give birth, the fear of not eating the proper foods during pregnancy that will yield the best spiritual chance of survival. There’s just so much fear of messing up, and if you do, there’s no coming back from it. Women in Liberia experienced this same fear of people finding out they were pregnant and casting spells on their unborn children. This fear plays out differently in the U.S., but it is still very prominent. We are inundated daily with magazines, articles, and daytime T.V. specials about what is best for pregnancy. From diet, exercise, prenatal practices, and even delivery options, there are so many ways to mess up. Pregnant women are presented with so much conflicting opinion that there is no way to know what is the right option., and if you don’t do the “right thing,” the consequence falls on the most important person…the child.

With this lack of control and this overwhelming placement of fear on Women throughout the world, no wonder birth outcomes in many places are suffering. I believe better birth outcomes are possible, but it starts with these cultural influences that have fundamental influences on pregnancy and birth. If the world stopped viewing women as weak and unable to make their own choices, we might be closer to being able to make more informed decisions. Johnson’s study on birth in the Netherlands shows us that autonomy and comfort are possible. It is true that only 30% of women take advantage of home births in the Netherlands, but the benefits seem undeniable. Not only do these women have the opportunity to get to know a midwife in a comfortable, personalized way, they have more of an opportunity to educate themselves on pregnancy and prenatal care. This allows women to be more confident and in control when it comes to their own health. Letting go of the fear is a more complicated problem. Cultural ideologies have such a huge influence on our behaviors, especially when it comes to women and health. In the U.S. especially, women’s reproductive health is something that is cringe worthy and all too personal. If societies around the world could move toward an orientation that is more open and honest about women’s health, then maybe we’d be more comfortable with talking about it.

In an ideal world, women would be able to have whatever kind of health care they wanted when it comes to birth. The idea of having an encouraging midwife in the comfort of one’s own home, who has the knowledge and personal connection needed to help you make decisions about your pregnancy seems like a panacea to this whole issue. But this is unrealistic in most economic and cultural situations. Many people don’t have the access to this sort of birthing strategy because of lack of insurance or availability. It is also likely that many women desire hospital births as well (maybe not the impersonal, rushed births that tend to happen in the U.S.). However, with the world moving toward a more open and empowering view of pregnancy, the prevalence and necessity of trained midwives and birthing coaches as well as more comfortable hospital practices may become more of a widely-accepted thing. In countries where midwives and hospitals are not the cultural norm or desire, there could be much benefit to a more open social view of pregnancy as well as more adequate education.