Motherless birthing, and the one-way street of obstetric “choice”

In another case of the disappearing agent, Australian newspapers have been breathlessly reporting the amazing case of an intrepid Australian doctor “performing” the delivery of a healthy baby with nothing but a first aid kit and an oxygen mask – high in the air between Auckland and Santiago.

Aussie doctor delivers baby mid-flight

An Australian obstetrician has taken her professional skills to new heights by helping a Brazilian woman – who didn’t even known she was pregnant – give birth in a plane flying high above the Pacific Ocean during a flight from Auckland to Santiago.
Luckily for the baby and her mum, Dr Jenny Cook from Adelaide’s Flinders Medical Centre was on board the flight, and managed to deliver the baby girl with only a basic first-aid kit and an emergency oxygen mask on hand.
Dr Cook, 37, confirmed the baby was in the breech position, which often requires a caesarean delivery.

“I didn’t know what was going to happen – if the baby was going to breathe, if the mother was going to bleed. And if I had to make any cuts to get the baby out, were they going to give me a plastic knife?” Dr Cook told News Limited.

She had to perform the delivery next to the toilets and meal preparation area, where blankets were spread on the ground and the curtains were drawn.

As the other passengers slept, oblivious to what was going on, four stunned crew members watched as Dr Cook guided baby – who Aline named Barbara – into the world in minutes.

The mother is nearly invisible in this story – reduced to a silly stereotype of the oblivious woman who didn’t even know she was pregnant. This stereotype is usually associated with classist disparagement, but I think this time there’s more than a whiff of racism in the mix. After the first paragraph, however, she fades into the background, replaced by the superhero doctor who “performed” the delivery and “guided” the baby into the world single-handed. The papers made much of the doctor being thanked with bottles of French champagne and a smooch from an airline pilot. (Ew.)

Headlines from other papers included these gems:

Mid-air delivery for Australian doctor

First class reward for doctor

Baby delivered a mile-high

Stork class to first class for flying doctor

Aussie doctor helps mid-air birth

This reporting was also poorly informed, in that breech birth doesn’t “often require a caesarean delivery”. Even in the Term Breech Trial, with the selection criteria ignored and the bases loaded against competent assistance with non-interventionist birthing, a re-analyses of the data show that routine caesarean section for breech presentations doesn’t make a difference to neonatal mortality – IF the baby is normal and the obstetricians keep their hands off, refraining from induction and augmentation of labour. Yet this study has been used all over the world to justify the routine coercion of women into major abdominal surgery with the “dead baby threat”. A group in Canada even made a case for routinely cutting babies out of their mothers on economic rationalist grounds.

And now, obstetricians who advocate “vaginal bypass surgery” for completely normal pregnancies are no longer considered the lunatic fringe. The undisputed risks to mothers as well as to babies from this approach are being glossed over. Even routine, supposedly “safe” caesarian section entail a higher maternal mortality, and future pregnancies carry a higher risk of severe complications such as ectopic pregnancy, stillbirth, placenta accreta, and emergency hysterectomy. Because the mothers are invisible, the importance of maternal consequences from surgery recede. Birthing is becoming a compulsorily technologised, mediated procedure, an event between obstetrician and baby; the ideal mother, in this model, is a still, supine, anaesthetised body.

The “dead baby” coercion card is played before birth to quell questions, and after birth, women’s voices are silenced with the “live baby” card: “You left hospital with a healthy baby, didn’t you? How dare you complain about your horrendous birthing trauma!”

This led me to a bit of reflection on obstetrics teaching over the past half century.

My Dad was taught obstetrics by a tutor who would kick back in tutorial discussions and say “But, Dr H, you’re out under the banyan tree with this woman. What do you do NOW?” He used the “banyan tree” as a non-technologised hypothetical location to get medical students to think about birthing without a scalpel in their hands and an anaesthetist at their shoulders.

Moving on to the 1980s, I was taught undergraduate obstetrics by a tutor who emphasised the joys of assisting with “low risk” pregnancies and births, the wonders of normal birthing, and how to be as hands-off as humanly possible. “Masterly inactivity”, they called it, even in classfuls of women. I guess we were about to get our Bachelors degrees and our Fellowships, we might as well be obstetric Masters also.

By the time I got to an OB residency, things were changing. The Dublin protocols of rigid intrapartum management were enforced, with partograms (graphs of cervical dilation over time) and scheduled vaginal examinations and artificial membrane rupture procedures and early augmentation with oxytocin being the norm, not the exception. The labor ward had to be efficiently managed, not just supportive and there for emergencies. On the partogram, a woman became a disembodied cervix, classified into acceptable and unacceptable dilated rates, judged on the basis of numerical performance. We vacuumed out babies who were a bit slow in second stage, with episiotomies for all vacuum deliveries and for a fair few “non-assisted” deliveries.Our epidural rate was quite low by today’s standards, and our C section rate was somewhere around twenty percent, again a bit lower than today. I don’t recall C sections being pushed for hypothetical “big baby” diagnoses; I remember seeing a women birth a 12-pound baby vaginally. We offered vaginal delivery for some breech, twin and VBAC (Vaginal Birth After Caesarian) mums, but only after screening for the lowest risk level; all others were pushed to C section. The language was obstetrician-centric; we talking about “allowing trials of labour”, not about mothers birthing babies.

But now? Just about every mother not experiencing the lowest of low risk pregnancies is pushed toward caesarian section in the first instance, or into artificial induction of labour if they demur, starting the cascade of interventions. For those who manage to go into labour, epidurals are done early and done often, incapacitating continuous electronic fetal monitoring is used, and babies are cut out at the slightest provocation. Labour wards are infused with danger, risk, fear and adrenaline (the enemy of normal, physiological labour). Adrenaline suppresses the oxytocin release essential for normal contractions, so oxytocin is supplemented via an IV, and cranked as high as it will go. And when this all fails to result in a baby emerging within a set time period, a doctor swoops in and “saves the day”. With C section rates edging up above 30% and episiotomy rates above 20%, this means that half or more of all mothers are subjected to a surgical birth by obstetricians. Women have been thoroughly colonised by technologised obstetrics.

And there is a giant private/public hospital divide in intervention rates, not accounted for by obstetric risk factors. If a non-governmental payer is involved, C sections skyrocket as high as fifty percent, and episiotomy rates jump by 50% or so also. We’re paying to get our vaginas cut open – even though episiotomy is associated with higher risks of posterior perineal and anal trauma, more sutures, and slower healing, and offer no improvements to incontinence or dyspareunia rates. The only advantage of episiotomy is that it is a little quicker and easier for a doctor to sew it back up. Only if you ignore the woman can episiotomy be considered a useful procedure.

How is this absurdly high private C section rate justified? Choice politics.This C section propaganda piece on a large mainstream medical “information” site opens with the quote: “I believe that we live in a civilised society and, as a woman living in a civilised society, I have choices.’ The quotes continue:

Even before I fell pregnant, I always felt that I’d rather have a Caesarean because the normal birth process was too painful for me to contemplate. I liked the idea that you could book in on a certain day, you would know what to expect, and there would be no surprises or agonising pain for hours or days on end. It all seemed very civilised to me. […]

“I know some people are horrified by my decision but for me it was a case of making choices that are right for the individual. I live in a civilised Western country and, in today’s society, I can be in control of what happens to my body. I feel I chose the civilised option.’

And while the obstetric industry is paying lip service to maternal choice of delivery method, this only applies so long as that choice is C section. The President of the American College of Obstetricians and Gynecologists is on record telling outright lies in support of routine “maternal-choice” C section on Good Morning America. ACOG has released a formal opinion supporting “a woman’s choice” of C section for no medical indication. And yet – the obstetric-industrial complex does not support a woman’s choice to birth vaginally, and they do not support a woman’s choice to birth at home. Choice is a one-way street.

Rosanna Capolingua, the new Australian AMA President, stormed into office this month hot on the heels of national press on her anti-choice stance on homebirth. The Western Australian government has responded to people’s calls for an increase in funding for the spectacularly successful and well-run Community Midwifery Program, and the AMA is running scared. And at the centre of Capolingua’s hand-wringing? She is worried that offering a choice of birth location, competently assisted by registered midwives, will make mothers who choose hospital birth feel guilty. Run that by me again – having a choice of safe, competently-attended birth locations will make mothers feel guilty, so we should not offer it? Capolingua goes on to misquote an obsolete, discredited study on homebirth, one in which the attendants were not even required to be certified midwives. She carefully ignores this study demonstrating the safety of homebirth where the homebirth attendants are certified professional midwives.

Offering choices involves relinquishing a bit of control, and bringing women back into the picture. Masterly inactivity doesn’t pay well. It’s not a predictable workload. You don’t get to use the gadgets, the machine that goes ping. You don’t get to sweep in and claim you “Saved the baby’s life!” once every two or three deliveries. You have to watch, to wait. You have to step out of the spotlight and let someone else, a woman, a mother, take the credit.

Categories: gender & feminism, health

Tags: , , ,

12 replies

  1. Because we wont see it anywhere else… Congratulations to the woman who gave birth in such difficult circumstances, without an attendant who speaks her native language.

  2. Yes congratulations to Aline and her daughter Barbara. How frightening to discover you were going to give birth in mid-air when you didn’t even know you were pregnant. (I find it interesting how most reports make sure we know that Aline is blonde even if there’s no picture, is that just so we stupid readers don’t think she’s got the special non-white stupid about not knowing she was pregnant, so that we know how to properly calibrate our disdain? Yeesh.)
    The information about the increased and increasing medicalisation of labour against all evidence of actual benefit is scary. Makes me wonder just how much I needed that vacuum extraction and episiotomy for my first birthing (I know I definitely needed the caesarean for the second).

  3. Thanks Lauredhel, fantastic post. I’ve just got on a bit of a blogging kick, having just moved somewhere where I have broadband again (yay!), and I’d decided to read this blog regularly already – this post just confirms that resolution 🙂
    I’m steaming about the pushing-the-caesarian issue and I don’t even *want* kids! Seems to me it’s part of the general acceptance of “if it’s medicated, it’s good” that we seem to be moving towards. Not that I’m saying medicine or medical intervention is BAD, far from it, I’m just deeply mistrustful when someone starts spouting off “everyone should do/take X or Y”, because one-size-fits-all approaches don’t work for everyone. Especially not when you’re talking about something as complex as pregnancy and birth…
    I also second the congrats to the mother, Aline. It must have been incredibly scary to find out she was pregnant as she was giving birth. A friend of mine found out she was pregnant at 7 months and that was scary enough!

  4. Hooray!! A beautifully written, thoughtful piece on so many things that are so very wrong in our society’s picture of birthing. It gives me hope to see that there is one more of us who thinks this way! Thanks!!
    National Convenor
    Joyous Birth – Australian homebirth network.

  5. I don’t think my midwife has ever forgiven me for choosing a caesar for my second baby, after the Obs went through the whole dead baby thing several times. I was 37 weeks before I gave in (and terrified of losing my baby, who wouldn’t be?). She wanted me to change hospitals and take pot luck with whatever doctor turned up, which I wasn’t impressed about because having already had one caesar and had scar tissue removed subsequently I knew what could happen, and my obs this time was a surgeon as well.
    That said, I think if you want a natural birth you are better off taking your chances in a public hospital because they are more likely to leave you alone long enough to establish labour.

  6. Thanks Jo, Janet.
    Tigtog – I go back and forth on the usefulness of debriefing and examining previous births. On the one hand I think occasionally it can be a bit of a trigger for regrets and dragging up old hurts; but on the other, sometimes those hurts are simmering away and need to be dealt with, and the process of bringing mismanagement (if any) into the light fortifies people to keep fighting the battle for reproductive choice.
    I see the parallels between birthing and breastfeeding here – 50% of people think they’re the 5% (2%, 10%, pick your figure) that “just couldn’t”, whose baby’s life was saved by modern medicine. We somehow need to get at who is committing this psychological and physical violence to the other forty-something percent – and stop them.
    Sadly, I think many of the perpetrators think that they’re well-meaning and just misunderstood, and they’re certainly supported by society as a whole, so we’re uphill all the way here.
    And that also makes it really, really suck when you are that 5 (2, 10)%. Because a whole lot of people, the people whose opinions you actually value, don’t believe you. And odds are it’s NOT YOUR FAULT, either way.

  7. Despite the vast misunderstandings amongst the community about what constitutes a ‘safe’ birthing environment, I really feel the tide is turning.
    I have long lamented that we currently don’t have any *real* choice, and I resent the fact that I had to pay for my homebirth (when a public hospital birth would have been free), whilst feeling tremendously grateful that I could actually afford to do so.
    This is a wonderful article, and let us all continue to advocate for real choices in childbirth.

  8. It is interesting to note the media’s current love affair with birthing issues when a few months ago you could not get a maternity issue into print (see the actual date of the Aline’s birth story?)
    Like the disappearing Aline, a recent story in the Courier Mail reporting on the midwifery group practice running at Brisbane’s Mater hospital – only midwives and babies were photographed. I was overhead to (rather loudly protest as the photos were being taken) ‘Where are the mothers’. ‘Yes its not right’ another woman agreed with me – turns out she is the midwife assigned to my gorgeous VBAC friend – so we’ll be seeing more of each other as I support my friend as her doula!
    It appears to me when mothers attempt to reinsert themselves into the equation – they we are told that we are ‘selfish’ and putting our needs/experience before the ‘safety’ of our babies! How rude of us, when we are the ones left literally ‘holding the baby’ when things go pear shaped from wrongful medical intervention. Like you say – women are meant to be thankful for having a live baby at the end of it. As my incredibly wise acupuncturist Heather Bruce ( ) proclaims – all family members need to be ‘on board’ after birth – Mum, Baby and Dad all intact – physically, emotionally, psychologically and spiritually. Being ‘alive’ isn’t enough! This was not how we evolved to birth and be birthed.
    I remember reading while pregnant that prior to the turn of the 20th century, when a baby was born the first question asked was, ‘How is the mother?’ but over time there has been a motherlode of a shift. Now we ask ‘How is the baby?’ As women we have some how become expendable in the process of birthing, yet we’re the first to be blamed when we dont have a ‘perfect baby’ or society starts to wig out as a collective unit. If we have had so much ‘progress’ – you would think that we would have moved on from Freudian mother bashing?
    When we speak about choices – we really need to speak about options – as pointed out in a recent correspondence by Home Midwifery Association (Qld) founder Kerry McGovern. She states ‘The concept is that it is possible to have lots of choices and no options. Perhaps we need to talk about options for mothers, rather than “choices” within a monocultural option.’ We have lots of choices as to how we want to birth, but unless you have the money, and are able to find a midwife, you dont have the option to birth at home with a midwife. You have the ‘option’ to free birth or take your chances in a hospital – but that’s not really an option is it, if you are forced to have to do one or the other?
    I would like to see the uproar created if we simply shut down maternity serices in hospitals and forced everyone to birth at home – because ‘that’s the safe option’. That would be deemed competely unethical and irresponsible – however its OK to leave midwives without PI insurance, out on a limb in terms of being easy targets for registering bodies (such as the Queensland Nursing Council), in such small numbers that there are no longer enough midwives to provide back up and down time for each other, creating circumstance that so drastically reduce the privately practising midwifery workforce that basically there is no option to homebirth in Queensland and women are forced to birth in hospital or alone. Double standards at its very worst I fear.
    How very dare you (in the words of the Catherine Tate Show!) as mothers demand something better … to put ourselves back into the picture and remind all that birthing is not a motherless event – it is the mother of all events. When we mess with the beginning of life, we irreversibly change the future and I know this time, it is not for the better.

  9. Dear all
    What a great post! I loved it. Can I suggest that you all join Maternity Coalition (if you haven’t already) as we are working very hard – and have done for years – to make women and their babies more visible and to have a voice when it comes to our childbearing choices.
    As you point out, many women are kept uninformed (and dangerously, too many are misinformed), afraid, anxious and needlessly harangued for their need to be listened to/respected at what can be a very vulnerable time.
    Maternity Coalition ( is a group of passionate mums, dads, midwives, doctors, grandmothers, and just plain everyday people. We don’t tell women how to birth, but instead, are working at increasing the REAL choices available to women so hopefully, there is a choice that feels right, feels safe and is economically viable for them.
    MC is here specifically for systems reform and influencing that by working directly with politicians, bureaucrats and other groups.
    I do this, and I’m sure others do too, so that mothers can once more feel empowered by birth, and able to move into motherhood confident that their own, and their baby’s bodies, are working well.
    I’ve had two amazing birth experiences and feel so sad for women who don’t know that birth can be uplifting, joyful, peaceful, and triumphant. It’s also bloody hard work and probably the biggest physical and mental challenge I will ever be faced with. For me, realising I could do this, under my own steam, supported by my loving husband, is the GREATEST triumph and achievement of my life. I just really hope my daughter feels like that if ever she births a child.
    Thanks again for such a great expose on birth in Australia at the moment.

  10. Sorry I’m so late with this, but Rachael, Jodi, Joanne, thankyou for your thoughtful posts. Rosanna Capolingua is driving me up the wall at the moment – for someone who fancies herself science-educated, her posturing around birthing and breastfeeding is woefully misinformed.
    A few days ago she said this in an ABC interview about formula advertising:

    It would be best if we could encourage mothers to breastfeed beyond three months, certainly at least to six months. Six to eight months is a good period of time and some mums go on a bit further than that.


  1. Another invisible mother at Hoyden About Town
%d bloggers like this: