Waiting for the Village; Pregnancy

They say it takes a village to raise a child but most of us are still waiting for them to arrive. Don't get me wrong, I'm lucky to have familial support but trying to balance work, money and parenthood is the hardest thing I've ever done.

Whenever I start to think about societal issues in relation to capitalism, there are common themes which shine through; separation of humans from nature but also our own bodies, cultural norms and stereotypes typically perpetuated by a white male ruling class and processes of extraction and exploitation which are a necessity of an economic system driven by profit. Pregnancy, birth and post partum exemplify all of these.

Over the past five years I have become more alive to the traditions, knowledge and community lost through the medicalisation of pregnancy and birth. Although culture across the world differs, pregnancy and birth were often celebrated in female only circles, with ancestoral knowledge passed down through female familial lines. Mothers, sisters and aunties would provide support during pregnancy, labour and post partum. This is the village we have lost. With birth now viewed as a medical event, we have lost trust in our bodies to grow, birth and feed our babies. We have been taught to ignore our instincts to follow medical advice and cultural norms even whilst our instincts scream NO!

This blog series explores how our economic system, cultural norms and systems of oppression impact pregnancy, birth and beyond in WEIRD (Western, Educated, Industrialised, Rich and Democractic) countries, including the UK where I'm based. This first part covers pregnancy, part two birth, part three post-partum and beyond.

Distrust in female bodies

In the 16th Century Francis Bacon and Rene Descartes introduced new ideas about the human body, reimagined as a machine with childbirth now a mechanical process*. As women were considered mentally feeble and men more mechanically minded this meant the process of childbirth, which had previously been in the realm of women, now had men redefining the process. Equipment was invented to "rescue" babies with women and traditional midwives slowly pushed out of birthing rooms as pregnancy and birth became more medicalised and women were unable to access professions.

Thousands of years of tradition where knowledge of pregnancy and childbirth were passed down through maternal lines were further disrupted by the industrial revolution where factory shifts prevented mothers, sisters and cousins attending female relative's births.

"...the rise of obstetrics and its eventual dominance over midwifery in the Western world, was achieved by the argument that those who cared for the female body could only do so by viewing it as a machine to be supervised, controlled and interfered with by technical means" Clare Davison

Growing medicalisation of pregnancy and birth has led to a mistrust of women's bodies which in 2024 is exemplified through tests and interventions throughout pregnancy and an increased focus on due dates and induction. To learn more about the herstory of modern birth I offer this podcast with Rachel Reed, author of Reclaiming childbirth as a rite of passage which inspired the themes of this blog.

Maternity care

In the UK, thanks to the NHS we have antenatal appointments and scans included as standard, starting from a booking appointment at around 8 weeks through to birth. Whilst scans and midwife appointments can be incredibly helpful for highlighting serious medical issues, they can also plant seeds of doubt about our ability to grow and birth our babies.

Infographic from the Naked Doula; scared of birth? It's no wonder you've been programmed from day dot

In Western culture and in modern life in general we are taught to fear pain and encouraged to avoid it where possible. Therefore childbirth is something to be feared. This cultural norm is amplified through the depiction of birth in TV shows and films as a painful medical emergency which always requires medical intervention. In the absence of the maternal village, we have often never seen or heard of physiological birth withouth medical intervention, so the distrust in our bodies starts from an early age.

At scans and appointments we are primed for medical intervention; baby is small, baby is large, baby is breech. The seeds of doubt are sown that you will be unable to birth your baby without medical intervention which builds reverence for the medical profession, whilst our "good girl" conditioning encourages us to ignore our instincts that might go against medical "advice".

Are maternity guidelines evidence based?

I say "advice" because a review of guidelines set out by the Royal College of Obstetricians and Gynaecologists found that only 9% of guidelines published since 2007 were based on level A evidence. 40% weren't evidence based at all and simply driven by "best practice". We know that medical research has historically focussed on men with "medication trials run exclusively on men or male animals until the 1990s" and racist assumptions around pain tolerance continue to impact black, brown and mixed ethnicity women and birthing people today.

Hospital guidelines are routinely used to route birthing people into certain maternity care pathways. Anyone deemed "high risk" because of high BMI, geriatric pregnancy, suffering from Gestational Diabetes, or having had a previous traumatic birth are often led down a consultant led pathway with more scans, hospital appointments and planned interventions.

Whilst additional care may be viewed as better, because the NHS is inherently risk averse, once you tick the box of high risk you're on the pathway and it's hard to get out. You are categorised as high risk without anyone really explaining what the actual increase in risk is. Choices are removed from the pregnant person and we are told to blindly trust the guidelines/consultants because they know what's best. Information is shared asymmetrically, whereby the risks of doing nothing are exagerrated whilst the risks from intervention are minimised.

Take pregnant people with a high BMI; hospital guidelines vary but if you are classed as having a high BMI you are subject to additional tests, interventions and restricted from certain birthing options due to higher "risks". Weight stigma, provider attitudes and disrespectful care have already been linked to differences in outcomes for plus sized pregnancies. Some evidence suggests providers are actually perpetuating ideas around plus size bodies having longer labours and requiring early intervention.

Whilst the risks from our bodies failing us are often overstated the risks from increased intervention are rarely discussed or properly explained.

From my own experience of being on a high risk pathway, increased scrutiny of my pregnancy led to more issues being found; baby was too small, too large, I had excess fluid, baby was breech and two weeks before my "due" date they thought I might have had Gestational Diabetes which would prevent me from having my planned homebirth. This heightened my stress and anxiety around the forthcoming birth which we know is not supportive of physiological birth, so we have to ask what is the purpose of this increased monitoring and medicalisation of birth?

Due dates and induction

As soon as you announce your pregnancy your friends and family immediately ask when you are due and the countdown and subsequent pressure begins. What we are not told is that the calculation of your due date was created in the 1700s and is basically 40 weeks after the first day of the last period. This doesn't account for varying menstrual cycle lengths, which is important because after 40 weeks or even earlier in some NHS trusts you are then classed as "overdue". Early scans can provide more accurate estimates of gestation, but there is still the underlying assumption that all babies will be ready to be born at 40 weeks.

Across the world countries define "term" differently, in France your due date is 40 weeks, plus 6 days which aligns more closely with evidence that 50% of women give birth 40 weeks and 5 days after their last period. Read this for a comprehesive review of evidence on due dates and risks. This fundamental lack of understanding of the variation in women's bodies leads to pressure for medical induction to reduce the perceived risks of going "overdue".

From as early as 38 weeks, midwives may begin to pressure you to have a "stretch and sweep" to get things going. Often you are encouraged to book an induction if you go "overdue" past 40 weeks reduce the risk of infant mortality; however recent research has highlighted that "whilst a reduction in stillbirth is a significant benefit, other studies have shown that this may come at the cost of higher rate of neonatal mortality, including sudden infant death syndrome" Seijmonsbergen-Schermers et al

Once again we are presented the risks from our bodies failing us, yet the risks from medical intervention are rarely provided.

Working whilst pregnant

Whilst we navigate the medicalised world of Western pregnancy, many of us must also do this whilst working. Whether planned or unplanned pregnancy is disruptive. Morning sickness, fatigue, discomfort and poor sleep are all part of the deal of growing a new human. Whilst many employers can be supportive to pregnant people suffering from pregnancy related illness; unfortunately many are not as Pregnant then Screwed can attest to.

Pregnant then Screwed; The workforce of today raising the workforce of tomorrow

Whilst pregnant I was fortunate to have an understanding boss who was supportive if I needed time off; however looking back I felt the pressure, consciously or unconsciously, to keep up my performance and productivity to match my pre-pregnant self. The fatigue hit me hard at different points and the inability to sleep created a brain fog that made it difficult to power through. On reflection I should have napped a lot, lot more but having grown up in a culture where rest is viewed as unproductive or lazy I didn't feel able to do this.

In online parenting communities I see so many pregnant people beating themselves up for feeling exhausted, but is it any wonder when society expects us to carry on as normal as we grow a new human?

Maternity policies and protections

In the UK pregnant employees have 4 main legal rights once they have informed their employer of their pregnancy; paid time off for antenatal care, maternity leave, maternity pay and protection against unfair treatment, discrimination or dismissal. Whilst this is arguably much better than in some countries there area still areas it fails to support women and pregnant people.

Whilst expectant mothers can attend antenatal appointments as paid leave from work, partners cannot. Having support and advocacy can be crucial in ensuring pregnant people's voices are heard throughout maternity care. This became abundantly clear during Covid-19 as women and pregnant people were prevented from partners attending scans, appointments and even birth.

Pregnant then Screwed ran an amazing campaign with #butnotmaternity which highlighted the inequity of Covid-19 restrictions being eased for football matches, but not maternity services. Research run by the charity indicated that in Dec 2020, more than 75% of women that received bad news at a scan received the news alone. Two years later almost a quarter of pregnant people had been told if they contracted Covid they would have to birth alone. As someone who had both of my children during the Covid pandemic I can wholeheartedly say the constantly changing restrictions, the uncertainty as to where I would be able to birth, whether I would be able to have my husband there and whether there would be sufficient midwives to attend the birth was absolutely terrifying. My anxiety was sky high, especially as I neared the end of my pregnancies.

Something that we have known for a long time is that a lack of diversity in decision making leads to poorer policymaking and decisions that affected society as a whole. Covid-19 demonstrated this from multiple dimensions. Evidence from senior civil servant Helen McNamara to the Covid-19 inquiry described a macho and heroic culture during the pandemic that limited discussion and was deeply misogynistic at its core. From her evidence;

“There was a disproportionate amount of attention given to more male pursuits in terms of the impact of restrictions and then the lessening of the same (football, hunting, shooting and fishing). There was a lack of guidance for women who might be pregnant or were pregnant and what those who were key workers should do (this was particularly significant in education and the NHS given the demographics of their workforces). The restrictions around birth and pregnancy care seemed unnecessarily restrictive and were comparatively slow to adapt. I never understood this.”

To summarise, part one has explored the ways society perpetuates fear of birth and distrust in women's bodies encouraging medicalisation of a biological process. Policies designed to manage risk are not always evidence based and information is shared asymmetrically with risks from our bodies emphasised whilst downsides from intervention rarely mentioned. A lack of diversity and representation in those making decisions around maternity care impacts on birthing people but also undervalues the reproductive labour required to grow new life.

To finish part one I invite you to reimagine pregnancy with some what if statements. Have a read through mine and reflect on any of your own;

• What if society acknowledged the energy and exhaustion of growing a new human life and provided financial antenatal support, similar to maternity pay and leave?

• What if pregnant people were the decision makers for maternity support? What could maternity support look like?

• What if the most important aim of antenatal services was to support pregnant people and their babies?

Endnote

*This dualism philosophy where humans were separate from nature and also viewed as a machine fundamentally shifted how we understood our bodies and connected with the world around us. It enabled white, wealthy men to "dominate" nature but also to dominate "lesser" humans such as women, those from different races or religions or those with disabilities. This dominance over nature and hierarchy of humans is one of the cornerstones of capitalism and will be covered in future blogs.