For Christ's Sake, Quit Invoking Christ*

So, the latest scandal involving Christians Who Make The Rest Of Us Look Bad is the story of a store owner in Dekalb, Illinois, who earlier this week demanded that a breastfeeding mother cover herself or leave the store. She got distressed (naturally) and left, but not before he asked her if she wanted to purchase some items she'd previously set aside. Her fiance later went back to store and explained to the owner that Illinois state law protects breastfeeding mothers and allows them to nurse wherever they and the baby are allowed to be. Moreover, it also has an enforcement provision: mothers who are told not to breastfeed or are asked to leave can sue for civil rights violations. The owner apparently was not intimidated by the fact that he'd just violated state law. Because, see, his law is a higher one. His law is THE BIBLE. Which is about purity and modesty and decency, not flagrantly feeding a child from the mounds on your chest put there to entice men to sin. In subsequent interviews, he's mentioned that Christians and families shop at his store. And Christians and families, of course, CANNOT be exposed to the things God put there to trick men into wickedness.

We can file this one under "Christianity Being Used to Rationalize One's Own Prejudices" (see also: the Crusades, pogroms, "witch" hunting, the Inquisition, slavery, segregation, etc). Here are some specific reasons, though, why "Christians Who Oppose Public Breastfeeding" need to quit invoking Christ:

-As activists have pointed out whenever Christianity is brought up as an opposition to nursing in public, the fact that Jesus survived past a day old indicates that he was most certainly breastfed. Argue about whether he was the Messiah, or if his resurrection was physical or symbolic, or whether he was blond and blue-eyed, but how he was fed is not something that's really worthy of argument. Market research conducted two thousand years ago around Nazareth shows that Nestle and Gerber had not yet gained a corner on the baby food market (this didn't happen until after the Fall of the Temple in 70 CE). As such, when 1000 women were asked why they breastfed, 999 indicated "so my baby won't die" as their primary reason. The 1000th woman answered "because G-d told me to." Researchers like to speculate that this woman may have actually been Jesus's mother, Mary, which indicates an ongoing relationship with his father. So, rest assured, Jesus ate from boobs. Probably his mother's.

-Biology and divine design. If you believe, as many do, that God created humans and that our systems were formed to work perfectly, it certainly follows that that same God intended for breasts, which make breast milk, to be used to feed babies. Lactation almost exclusively occurs when a woman is pregnant, has just given birth, has previously breastfed or has stimulated her breasts to the point where she can produce milk (known as inducing lactation and becoming more common among women who adopt and women who have stopped breastfeeding but would like to start back up). Breast milk is meant for, designed for babies. Now, by all means, every woman has the right to feed her child however she wants, and she should make the choice, but there's not much way to get around the fact that breasts were intended to produce milk to feed babies. We learned about syllogisms my senior year of high school, so here's my rusty attempt at one: God gave women breasts. Breasts feed babies. Therefore, God gave women breasts to feed babies. And, because of this perfect design, breast milk is also the perfect food for babies. Going back to the "purity" argument, what is more pure than feeding your baby the very thing, in the very way, that God intended it be fed?

-The Bible. Oh, the Bible, filled with its screeds on the dirtiness of breasts and breastfeeding and boobies shown in public. When I started looking for references to breastfeeding in the Bible, I searched "Bible and hooter hider" and "Bible and nursing in public." NOTHING. I was disappointed. I'd really thought that Leviticus would have covered the fact that a woman should not nurse in public without a cover. And if not Leviticus, surely Paul. But no. So I just looked up the Bible and breastfeeding and this website came up, which did all the work for me: http://texas-midwife.com/breastfeeding.htm There's also this one: http://www.openbible.info/topics/breastfeeding, which is interesting because it quotes Lamentations 4:4 "The tongue of the sucking child cleaveth to the roof of his mouth for thirst; the young children ask bread, and none breaketh it unto them." This passage suggests to me that the Bible-blaming store owner was actually going against the Bible when he asked the mother to stop or leave.

-Modesty. The argument for modesty is such an interesting evocation because it's such a subjective thing. I'd be willing to bet that my idea of modesty differs from say, Kim Kardashian's (she can pull a lot off better than I can!) or Michelle Duggar's. So whose is correct, and who decides? Is the act of feeding a baby, albeit from the second dirtiest part of woman's body, one that requires a degree of modesty? Breastfeeding a baby is not the equivalent of motor-boating someone. First, there's the utilitarian aspect of it. The. Breast. Is. Feeding. The. Baby. Second, I have it on good authority (from a priest, y'all, so you know it's right) that the dirtiest part of the breast is the nipple. Janet Jackson and Jennifer Lopez taught us that. And the milk comes out of the nipple, which means that when a woman is breastfeeding, the nipple's totally covered! Also, it should be pointed out that the passage often cited that urges "modesty" is in Timothy (which means its author is unknown) and, rather than referring to exposing flesh, it instead urges modesty in dress---as in, no fancy jewelry or expensive clothes or anything that draws attention to yourself. At a time when the choices were breast milk or death, it seems safe to assume that a woman breastfeeding with her breast out was not cause for concern.

-And the number one reason "Christians Who Oppose Breastfeeding in Public" should quit invoking Christ: you're making the rest of us look like assholes. Seriously. When you display a lack of general historical perspective or appeal to a bunch of strung together synonyms as proof that the Bible is "against" public breastfeeding, people start to think all Christians believe the way you do. Then those of us who are not like you are put into the uncomfortable situation of having to somehow explain why you're wrong and not all Christians believe like you do. And that's tiring. I have enough on my plate. I'm still breastfeeding a 22 month old.

*When I thought of this title I immediately thought of "Steel Magnolias" when Annelle is fighting with Sammy over the beer in her refrigerator (from imdb):
Annelle: Sammy Wayne Desoto, what is this in my Frigidaire?
Sammy: Beer.
Annelle: I don't care what you do with your refrigerator, but you will not keep liquor in mine.
[dumps the beer out in the yard]
Sammy: Oh, Annelle, for Christ's sake!
Annelle: Who? Who did you say?
Sammy: Christ, Christ, Christ!
Annelle: Are you speaking of our Lord? Is that whose name you're taking in vain?
Sammy: That's the one.
Annelle: Well, I'm sorry, Sammy. But I am not about to spend the next fifty years of my life with someone I'm not gonna run into in the hereafter.
Sammy: Oh, Annelle, goddammit!
Annelle: I think we should pray.
Sammy: Oh, I'd rather eat dirt!

Worried

Dear Prudie,

I have been in a relationship for the past almost 19 months with a great guy. He is, in my opinion, smart, kind, handsome, adventurous, funny and full of surprises. He is somewhat socially awkward, but that's getting better. He has some undesirable habits, to be sure, but I assume that's to be expected in every guy, right?

Here's my problem: I am worried he only loves me for my breasts. At the beginning of our relationship, I gave him unfettered access to them. It seemed like he wanted them every 20 minutes, but I was ok with that. I know it's important to be accommodating in the beginning, and I figured when we'd been together awhile, his interest would taper off. He'd see there was a whole world out there besides my breasts, and I imagined that we'd explore it together.

Prudie, this has not happened! He is as obsessed as he was in the beginning. He wants them all the time: to go to sleep, when he wakes up, when he's fallen down, when he's bored, when I leave the room, when I come back in. I'm starting to think he really only wants to be around me for them. Sure, I get some kisses and hugs and smiles, but even then they seem like a means to an end. I can appreciate that he thinks they're great, but, well, no one wants to be loved for just their breasts. Do you have any advice for me?

Signed,

Hidden Under Two Layers of Clothing

Public Health by Financial Pressure?

Well, if there's one thing middle and upper middle class parents love to obsess about, it's vaccinating our kids. And if there's another, it's the cost of insurance today. Thankfully, Dr. Rahul Parikh has found a simple solution to combine the two: charge the parents who choose not to vaccinate their kids higher insurance premiums. They're putting their kids, and anyone else who cannot or has not been vaccinated at risk, so they should be punished. Maybe if they weren't so stupid to worship at the altar of Jenny McCarthy and her boobs, they wouldn't have to be charged extra. But, since they are clearly unable to trust when the FDA says a vaccine is safe (oh, and yes, it IS the same FDA that brought you Thalidomide, DEA and Phen Phen--thanks for asking!), let's hit 'em where it really hurts: their middle class pocketbooks.

I really appreciate Dr. Parikh's proposal. But I'm a little concerned that it doesn't go quite far enough. Last year, a study found that not exclusively breastfeeding a baby for the recommended six months costs an estimated $13 billion and almost a thousand deaths annually (which, for you math nuts, is about 12 billion, eight hundred seventy-five more dollars and 911 more deaths than what Dr. Parikh claims were incurred by these non-vaccinating assholes who caused the measles outbreak in 2008 in San Diego). Jack Newman, Katherine Dettwyler and countless others assert that most, if not quite all, women should be able to breastfeed their babies. So, why not start making women who choose not to breastfeed pay higher premiums? We can adjust them if they tried and failed, or if their doctors say the baby needs formula. We'll be flexible here.

Really, though, why stop there? Let's start at birth! How about higher premiums for women who opt to get epidurals? I had a natural birth, and so did a lot of other women I know. Why should we have to pay the same premium a woman who opted to get one does just because she "doesn't like pain"? Or what about women who choose to have elective c-sections? I stayed in the hospital less than 24 hours when my 18 month old was born. I bet my insurance company loved the fact that I saved them money on the private room and the food, and then some other woman decides to have a c-section and stays in the hospital for four days and I'm expected to offset that cost? Oh, hell no.

And what about extended rear facing? The fact is, a child who is forward facing before age 2 is five times more likely to be killed or seriously injured than one who is still rear-facing. If someone decides to turn their child before age 2 and the child gets hurt and has to spend time in the hospital, my insurance premium could go up due to their choice! Why don't insurance companies just send out little surveys to parents when they're children turn one asking them if they're still rear-facing? If not, then I'm sure someone could calculate the average cost of a hospital stay for a child with a neck injury, divide it by 12 and then apply it to their parents' premium for that whole year. Just as a precaution, you know.

Now, this could get controversial, but we have to talk about working parents. Because, let's face it, everyone knows that kids whose parents work and have to go to daycare get sick and incur more healthcare costs than kids who have a parent who stays home. So, if you are selfish enough to decide to...work, then, well, it's a good thing you're rolling in the dough, because get ready for that premium to go up! But then other studies have shown that kids who go to daycare develop faster and greater immunity than kids who don't. Which means that the kids who don't get around other kids until they're closer to school-age are going to be getting sick then. So how about this: we'll charge the working parents more until their kids turn 5, and then we'll charge the families with a stay-at-home parent more from ages 5-10? Hope you kept up those resumes, because you're going to need a job now!

Or, there's this: being a parent is the scariest fucking thing ever. We are constantly making decisions that could and do affect our children for the rest of their lives, and most of us do it with our fingers crossed and a prayer falling from our lips. We get nowhere in discussions about public health and public good when one group is singled out to be vilified and punished. Any number of choices we make can affect others just as much as it affects us and our families and hopefully, every parent makes a decision that works best for them and their children So maybe, instead of proposing that parents of children who are only partially or not at all vaccinated pay for their choices (or any of the other above choices), we rather encourage responsible and thoughtful decision making across the board. Because, "to whom much is given, much is required."

Oh, and Paul Offit writing a book about how awful parents are who don't vaccinate would be like me writing a book about how awful people who live in my city and are members of my denomination yet don't go to the church where my husband works are. Except with a lot more zeros at stake.

Breastfeeding Myth One: Extended Breastfeeding and what WHO REALLY says

It should come as no surprise that I am an "extended breastfeeder", i.e. someone who breastfeeds her child past the age of one. It was a personal choice, one that I very rarely regret or question (because having an 18 month old shove his butt in your face while he's nursing when he's changed his position 90 degrees and you've just woken up and are kind of out of it is enough to make one question many parenting choices they've made along the way). There is this belief in the US, though, that breastfeeding past twelve months is somehow extraneous and unnecessary. Six months is great, twelve months is awesome, but past that is not really anything to worry about, except if you're looking to get that medal to put next to the one you get for having a natural childbirth. There's also a large number of people who classify extended breastfeeding as gross and label the women who do it crazy. Peek in on a discussion about EBF and you'll even find people who classify it as sexual abuse. All of this judgment, even though the World Health Organization officially recommends that children be breastfed for a minimum of 24 months:

The World Health Organization recommends that infants start breastfeeding within one hour of life, are exclusively breastfed for six months, with timely initiation of adequate, safe and properly fed complementary foods while continuing breastfeeding for up to two years of age or beyond.

And that's the topic that compelled me out of almost six months of non-blogging to address. Because the one thing women who cite that little fact hear over and over, ad nauseum, is that that recommendation is only for women in developing countries who don't have access to clean water for formula. And frankly, I'm pissed off about it. And I have a degree in History. If there's one thing History majors learn, it's that you get your facts from the source if at all possible. Luckily for everyone, the World Health Organization has a website, with like, information and stuff! Boy, this is a lot easier than the time I had to go through microfiche to see what the public reaction to Mary I burning Protestants was.

So, what does WHO say (WHO, BTW, is an organization that focuses on what is best for health, not what is normal or socially acceptable, which is why their recommendation differs from the American Academy of Pediatrics, which is more apt to take into account what is considered "normal" for the US)? Well, first there's this:

WHO recommends that infants start receiving complementary foods at six months (180 days) of age in addition to breast milk. Complementary foods should be given 2–3 times a day between 6–8 months, increasing to 3–4 times a day between 9–11 months. Between 12–23 months of age, 3–4 meals should be given. In addition, depending on the child's appetite, 1–2 nutritious snacks can be offered between meals. These foods should be adequate, meaning that they provide sufficient energy, protein and micronutrients to meet a growing child's nutritional needs. Foods should be prepared and given in a safe manner to minimize the risk of contamination. Feeding young infants requires active care and stimulation to encourage the child to eat.


And then, in case that's confusing, there's this helpful chart:

Age Texture Frequency Amount at each meal
6–8 months Start with thick porridge, well mashed foods
Continue with mashed family foods 2–3 meals per day, plus frequent breastfeeds
Depending on the child's appetite, 1–2 snacks may be offered Start with 2–3 tablespoonfuls per feed, increasing gradually to ½ of a 250 ml cup
9–11 months Finely chopped or mashed foods, and foods that baby can pick up 3–4 meals per day, plus breastfeeds
Depending on the child's appetite, 1–2 snacks may be offered ½ of a 250 ml cup/bowl
12–23 months Family foods, chopped or mashed if necessary 3–4 meals per day, plus breastfeeds
Depending on the child's appetite, 1–2 snacks may be offered ¾ to full 250 ml cup/bowl
a Note: If baby is not breastfed, give in addition: 1–2 cups of milk per day, and 1–2 extra meals per day.

You can view the whole page here: http://www.who.int/features/qa/21/en/index.html

So, nothing specifying for which countries extended breastfeeding is best there. In fact, the question is quite broad and would seem to apply universally for mothers in every country. This isn't the last of the WHO's information about breastfeeding, though.

There's also this statement:

Breast milk is also an important source of energy and nutrients in children 6 to 23 months of age. It can provide one half or more of a child's energy needs between 6 and 12 months of age, and one third of energy needs between 12 and 24 months. Breast milk is also a critical source of energy and nutrients during illness and reduces mortality among children who are malnourished.


I guess they forgot to specify that they meant only for children in developing countries. For God's sake, I live in the United States and can afford to buy healthy food and my 18 month old would be undernourished if he wasn't nursing. He eats what he eats and that's that.

I wanted to probe this a bit further, however, specifically the claim about clean water. It's well-known that formula feeding caused several hundred deaths in developing countries in the seventies due to contaminated water. And it's been estimated that 911 children's lives could be saved per year if breastfeeding rates were higher (not to mention healthcare costs). But, as most people with children have probably heard, at one year a child is able to switch from formula or breast milk (at their parents' discretion) to whole milk. So why would the WHO recommend 24 months due to concerns over formula and the cleanliness of the water it's mixed with if a child over the age of one could just drink cow or goat or even camel milk?

Luckily, the WHO has a guide to nutrition for children who are NOT breastfed from 6-23 months. Find it here: http://whqlibdoc.who.int/publications/2005/9241593431.pdf

I decided to make my work easier and just do a search for formula to see what they had to say about mixing it with unclean water. And lo and behold, right there in the introduction: However, because these guiding principles are targeted primarily at populations in
which use of commercial infant formulas after six months of age would be uncommon, the
energy requirements of breastfed infants have been used as the reference.

Huh. So, just to get the argument straight again: the WHO recommends breastfeeding for a minimum of 24 months, but that only applies to mothers in developing countries because they could have dirty water and it'd be unsafe to mix with formula, even though their own Guiding Principles for Feeding Non-Breastfed Children Ages 6-23 Months state that they're targeted at populations in which babies would not receive formula past six months (which I would assume means are also the populations with the highest risk of malnutrition and contaminated water)? Glad we cleared that one up.

So, just for the record, what ARE the benefits of breastfeeding past the age of one?

-In the second year (12-23 months), 448 mL of breastmilk provides:
29% of energy requirements
43% of protein requirements
36% of calcium requirements
75% of vitamin A requirements
76% of folate requirements
94% of vitamin B12 requirements
60% of vitamin C requirements

-The American Academy of Family Physicians notes that children weaned before two years of age are at increased risk of illness (AAFP 2001).

-"Antibodies are abundant in human milk throughout lactation" (Nutrition During Lactation 1991; p. 134). In fact, some of the immune factors in breastmilk increase in concentration during the second year and also during the weaning process. (Goldman 1983, Goldman & Goldblum 1983, Institute of Medicine 1991).

-According to Sally Kneidel in "Nursing Beyond One Year" (New Beginnings, Vol. 6 No. 4, July-August 1990, pp. 99-103.):
"Research reports on the psychological aspects of nursing are scarce. One study that dealt specifically with babies nursed longer than a year showed a significant link between the duration of nursing and mothers' and teachers' ratings of social adjustment in six- to eight-year-old children (Ferguson et al, 1987). In the words of the researchers, 'There are statistically significant tendencies for conduct disorder scores to decline with increasing duration of breastfeeding.'"

And let's not minimize the positive health effect extended breastfeeding has on mothers:
-Breastfeeding reduces the risk of breast cancer. Studies have found a significant inverse association between duration of lactation and breast cancer risk.
-Breastfeeding reduces the risk of ovarian cancer.
-Breastfeeding reduces the risk of uterine cancer.
-Breastfeeding reduces the risk of endometrial cancer.
-Breastfeeding protects against osteoporosis. During lactation a mother may experience decreases of bone mineral. A nursing mom's bone mineral density may be reduced in the whole body by 1 to 2 percent while she is still nursing. This is gained back, and bone mineral density may actually increase, when the baby is weaned from the breast. This is not dependent on additional calcium supplementation in the mother's diet.
-Breastfeeding reduces the risk of rheumatoid arthritis.
-Breastfeeding has been shown to decrease insulin requirements in diabetic women.

(all examples are from the wonderful kellymom.com: http://www.kellymom.com/bf/bfextended/ebf-benefits.html)

Now, this post is not meant to be an order or even a recommendation. I believe above all else in a person's right to bodily autonomy, and choosing to breastfeed or not, as well as choosing when to wean, is a personal choice every woman deserves to and should make for herself. But there's too much misinformation out there, especially when it comes to who actually benefits from extended breastfeeding. And it's nice to know my acrobatic 18 month old living in the United States is getting just as many benefits from still nursing as any of his counterparts in the developing world.

How did we get here (and how can we go back?)?

I do a lot of reading while I'm nursing. If I haven't been to the library and gotten new stuff, I tend to choose old favorites like this one by Gail Collins. I first read it when my first was born, and can't even count how many times since then. What's great is that every read I seem to pick up on something I'd missed beforehand---almost like themes emerging from every subsequent journey back into it.

Anyway, if that's the case, this current reading's theme is childbirth. I was actually brought to tears yesterday when I read one woman's story of giving birth on the frontier with no one around but her two toddlers and the dog. She set out food and milk for them and the dog kept watch and delivered a baby boy. Her daughter said she fainted a few times while trying to dress the baby shortly after his birth.

This is not how birth looked for most women for the vast majority of our existence. Of course, for some women birth was a lonely event, depending on where she lived and who was around. It's not as if this pioneer woman had the option of company and declined it. But, since humans have from the beginning been social creatures and lived in groups, birth was done in front of the group, too. The word "gossip" is actually derived from the term "God's sibs," a term given to the women who accompanied a laboring woman in the delivery room (i.e. usually her bedroom).

The group approach to birth served many purposes: it provided the laboring woman with support and encouragement, which is absolutely vital, especially to first-time mothers; it helped to actually facilitate the birth, with various women working to prop legs, wipe brows, catch the baby, etc; and it provided women with a system of built-in knowledge and advice on everything from breastfeeding to diapering to postpartum care (in fact, in some cultures a newly postpartum mother wouldn't immediately nurse her baby--if a woman in her attendance was lactating, the baby was passed on to her). Birth is an inherently feminine activity, and for all but the past 150 years or so, it has been dominated by women who called the shots and doled out the advice.

To me, this is an immensely comforting image. Childbirth and the first days of motherhood are tough. To be surrounded by a group of women one knows and trusts, who impart wisdom and knowledge and care, feels like it'd just be right somehow.

So what happened in the United States that changed this? People started moving around, first of all. Instead of being born, living and eventually dying all within the same small geographic area (or moving to where your husband was born), families started striking out on their own. Sometimes women were fortunate enough to end up where there were other women, and friends replaced sisters and mothers and cousins as birth attendants. For many, though, like the aforementioned pioneer woman, there were no friends to be had, and husbands had to do their best (I should add that the woman mentioned above went into labor while her husband was traveling about 20 miles away to get wood) at being midwife and support person.

The next phenomenon was the entrance of the doctor into the delivery room. Starting around the turn of the eighteenth century doctors started attending births, mainly of wealthier women in larger cities. They quickly started gobbling up the midwives' business, in part because they used forceps, a life-saving tool when needed, and enough of an incentive for women to trust them. Unfortunately for the women, the doctors also had astronomically high rates of maternal mortality. Skilled midwives typically had much lower rates than the male doctors, as is evidenced by Laurel Thatcher Ulrich's eighteenth century midwife:

"Her results attest to her skill. Her comment on August 20, 1787, that the death of Susanna Clayton and her infant was the "first such instance I ever saw & the first woman that died in Child bed which I delivered" allows us to add the 177 prediary deliveries to the total: in almost 1,000 births Martha did not lose a single mother at delivery, and only five of her patients (including Mrs. Clayton) died in the lying-in period. Infant deaths were also rare. The diary records fourteen stillbirths in 814 deliveries and an additional five infant deaths within an hour or two of delivery.

By our standards, mortality was high. Martha saw one maternal death for every 198 living births. Today that rate is one per 10,000. But as late as 1930, there was one maternal death for every 150 births in the United States; the major gains in obstetrical safety have come in the past fifty years. In fact, many historians believe that the routine employment of physicians in the nineteenth century probably increased rather than decreased mortality. Records of an early-nineteenth-century New Hampshire physician, whose case load was almost identical to Martha Ballard's, shows higher stillbirth ratios and four maternal deaths at delivery, though only one during the lying-in period (see Table IV). What is even more striking is the large number of complications recorded in his records: 20 percent of his deliveries (as opposed to 5.6 percent for her). The difference was partly in perception- as a physician he was attuned to biological anomalies in a way that she was not- yet there is good evidence that birth had become a more complex process in the nineteenth century, as physicians began to employ ergot, opiates, and forceps in what Martha Ballard would have considered routine deliveries. Those dangers did not decrease as hospital delivery became more common. A study of a Portsmouth, New Hampshire, hospital found stillbirth rates in the second decade of the twentieth century five times as high as Martha's."

The third factor is the movement from homebirth to hospital birth. Birthing at home a woman can have as many people around as she can tolerate or her bedroom or house can hold. Hospitals, understandably, have limits on the number of people who can attend a woman in labor. In the interest of public health, many have restrictions on visitors during the postpartum period as well. A woman attended by her partner, her doctor and a nurse may not feel the need for a circle of women to support her during childbirth.

The fourth goes along with the third. Men started being present in delivery rooms around the sixties. Pioneered by OBs like Robert Bradley (who for all his misogyny, had an important and vital point about women feeling supported by their partners during labor), men were encouraged to take over the role of support person while their partners labored and gave birth. If a hospital restricts the number of people who were allowed to accompany a woman in labor, she invariably, and understandably, chooses her partner to be the support person. For what it's worth, my husband was an excellent support and showerhead-holder during my two labors and deliveries. And I loved him being in there with me. No offense to him, though, but I also loved giving birth with a midwife and a doula present in addition to him. I felt like I was a part of some kind of historical continuum that included all the women in history who had given birth surrounded by a group of supportive women.

Ok, so that's the brief and very generalized story of how we got where we are now. The question then, for those who want to, is how to get back to that intimate cocoon of support women can offer each other.

The first answer is obvious: have a home birth. Unless you have an OB who's willing to attend you at home, chances are your midwife will be a woman and she'll likely let you have whomever you want present, from your mother to a picture of your dead dog. Home birth for low-risk women with a trained midwife and access to a hospital has been shown to be extremely safe. And not to scoop myself, but I want to address the pathology of birth in a separate post that goes along with this.

The second option, if home birth isn't for you (or, if like mine, midwife-attended home birth is illegal in your state), would be to have a hospital birth with a doula and preferably a midwife or "midwife in disguise". This is not just for women who want to have natural births! Sometimes labors are long and in-laws are a pain and the laboring woman and her husband may still be cognizant enough to not want to hurt someone's feelings by kicking them out of the room. A doula is an excellent enforcer.

Most doulas who call themselves such are the products of various training workshops put on by professional organizations, but the idea of a doula is not exclusive to a professional association. Having a friend or family member who is experienced in birth and can offer appropriate support is practically the same thing (and usually free!).

Contrary to what is sometimes said (I love you, Sam Mendes and John Krasinski, but that whole line in Away We Go about doulas only being for women whose partners are uninterested or uninvolved in childbirth is total bullshit), a doula is not there to replace the mother's partner, but rather to be a support to both. A doula can do everything from massage to taking pictures to ushering out nosy relatives. The pictures I got from my labor and delivery--ones I will never, ever share, I promise--were worth every penny I paid to have her there.

I hope everyone has enjoyed today's history lesson. Stay tuned for my hopefully forthcoming "the pathology of birth" post!

Why is it about birth?

I have a confession to make: I read other people's mail.

We bought our house from a doctor and his family. As it turns out, they had also purchased the house from a doctor. Through some mail mix-up, we have been receiving the first owner's copies of The Lancet. I throw most of them away, but that's after first going through the list of articles to see if any interest me. I read this article, in the news recently because of its take on the safety of homebirth, and today I found an extensive article on pre-eclampsia, a subject in which I have a personal interest.

Reading The Lancet makes me feel like something of a voyeur, like I'm witnessing something I'm not supposed to be privy to because I'm not a doctor and can't understand much of what is written due to the technical terms. This article, though, was fascinating to me. I've learned the terms over the years through my own research and perusal of my personal medical records, and it was interesting to compare my own experience with HELLP Syndrome with what statistics indicate happen to other women with it.

I wanted to write a post that kind of explained what this is for me---why birth matters to me at all---and it was coincidental that I read this article on the same day I planned on doing that. I view having had HELLP Syndrome as the central issue that has affected my views on birth. I didn't view birth as much of an experience before I had a baby. I fell firmly into the "healthy mom + healthy baby = successful birth experience" camp. I knew there were things I didn't want: a caesarean, an episiotomy, and things I did: an epidural. I read with some interest the books on natural childbirth a friend lent me, but knew it wasn't for me. I trusted science and medicine and my doctor and never anticipated that things could go differently than he promised they would ("do I need to worry about not taking a childbirth education class?" "Nah, we'll just get you an epidural and you'll be fine").

So, of course, things came up as things tend to do, and there was no epidural for me and man, those classes could have come in handy (had I not been on bedrest and able to take them). And afterwards I was left so damn confused and worried. I felt like my body had failed me (which, actually, it hadn't; I went into labor as the HELLP was getting serious, and this is ideally what would happen in a full-term mother), and was worried it could happen again or that it was brought on by an undiagnosed condition. I spent months obsessing over what had happened.

And then I watched The Business of Being Born after a LLL meeting one afternoon. And I suspect I'm just the sort of impressionable woman it appeals to. Birth looked so natural and perfect in that documentary. It's edited perfectly---the doctors come across as assholes (remember the scene where the OB asks if a HB midwife would have fetal monitoring capabilities?) and the births go right and it makes everyone want to give birth in their bathtub. It left a lasting impact on me, but really, its influence was secondary to the book Pushed. If anything, it was that book that convinced me I wanted a midwife and a natural birth when I got pregnant with Number Two. It made me remember everything my old OB said that had bothered me, and it made me want to resist letting my child's birth become medicalized simply because I wasn't sure how much I still trusted medicine.

Number Two's entrance into the world was everything I'd wanted it to be, and was quite healing, actually. With Number One I'd felt fear and ignorance; with Number Two I felt empowered and strong. And it was lovely to revel in a physiological birth, knowing it was kind of a "screw you" to the old OB who'd recommended against it before.

So, in general, why does birth matter? Why is it that pregnant women are inundated with birth stories from the beginning? Why does what happens or what can happen affect some women and not others? Certainly part of it is that birth is a monumental experience simply because it's the process by which your child is brought into the world. And we like our experiences to be meaningful and special.

Are women selfish for wanting birth experiences, even if they're contrary to what their doctors or the medical community in general thinks is best for them? If policy is built on liability and preventing actionable events, is it even clear what is best for women and babies versus what is best for the hospitals? Jennifer Block quotes a doctor in Pushed who asserts that the c-section rate won't go down because people sue over dead babies, not dead mothers. If an intervention is going to mitigate the risk to a baby, even if the intervention is a problem for the mother, most likely the intervention will be pushed for. It's not perhaps a problem with the doctors or the midwives per se, but rather the systems in which they function.

In the end, what matters to me is that if the birth experience matters to a woman, she deserves to get the experience she wants. And I'll be totally upfront here: I don't see many impediments to women who want interventions in the way of epidurals or elective c-sections. And that's fine; how they give birth is their choice. I do, however, see and hear all the time about impediments to women who desire a true physiological birth. So my point here is not so much to figure out why a woman wants she wants, but rather how she gets there. And this is a favorite subject, so I like talking about it. Stay tuned!

Birth Rape

This has gotten a lot of publicity lately. A piece ran earlier this year on salon.com, with a follow-up on msnbc.com, recounting one woman's experience with childbirth-related PTSD. The latest person to wade into the debate is Salon's Tracy Clark-Flory, a woman who, as far as I know, has never given birth. The article is on why "birth rape" is not "rape" and doesn't deserve to called such. Clark-Flory writes: "Far too many women are being subjected to this kind of medical mistreatment, and damn straight activists should be making noise about it. The experiences being described as "birth rape" are undoubtedly harrowing. How awful to feel so violated while giving birth. What a devastating way to have your child enter the world. Did I mention that it is profoundly, horribly and tremendously wrong? Because it is. But here's what it's not: rape. It is unbelievably horrific -- but it isn't rape, and the suggestion that it is seems like a violation in its own right.

Not to be all Debbie Downer, but there are countless ways to be abused and mistreated in life -- and that is true even just of modern medicine and our healthcare system. In a hospital setting, as your caretakers look after you, while also trying to protect the hospital from legal liability, it is easy to feel violated; and that's true whether you're giving birth or undergoing emergency surgery."

I normally only mentally note when someone who is childless comments on something related to child-rearing or childbirth; I think every parent has had that moment of "just wait and see" when a childless friend or stranger offers advice or opinions. But I think the point is an important one here: having not experienced childbirth, how can one possibly imagine all the emotional and physical reactions it brings? The same is true for survivors of sexual assault--it is not the place of anyone but the survivor to name what they went through.

I am not a therapist or a childbirth educator or a midwife or a doctor. I am not, thankfully, a survivor of a past sexual assault or birth rape. But I care about women and I care about birth. And I believe in birth rape just as much as I do date rape and marital rape, other notorious forms of rape that took centuries to be recognized.

This is Take Back the Night 101: if a woman goes on a date with a man and they start making out, but she says no to doing more and he goes forward anyway, we rightfully, comfortably call that sexual assault. Yet, if a doctor breaks a woman's water or performs a cervical check against her express consent--while she's objecting to it--that is something different. How? The woman in childbirth ostensibly chose her doctor, or at least the practice. The woman on the date most likely chose her date, too. The woman in childbirth may consent for certain procedures to be done; it shouldn't follow then that every procedure is consented to, just as consent to making out is not consent to sexual activity.

How do you arrive at the point where you can claim a violation during childbirth is not equivalent to a sexual assault? My first instinct is to assume a misunderstanding or lack of knowledge about what childbirth involves. If you think or have heard that cervical checks, amniotomies, episiotomies, etc are a mostly necessary component of childbirth, then perhaps a woman refusing one looks foolish to you, and thus the doctor or midwife going ahead and doing it without consent is only doing what's needed. Obviously, these interventions and often the interventions that lead to them are many times unnecessary during physiological childbirth, but as a culture it seems we've absorbed the birth attendant's "it's time to push!" cry in the movies and TV to the point where we assume it's required. It's not, and a woman who refuses to be checked (or to have her water broken artificially or to have her perineum cut) is within her rights to refuse it. And what is the birth attendant who proceeds anyway doing, if it is not assault?

My second instinct is to question whether the disconnect is in the event itself. The words "sexual assault" connote sex, some form of the act being forced onto another. Yet, legally the definition of rape in most states includes forced penetration with something other than just a sexual organ. If an instrument is used during rape, it is still rape. The key, again, is consent. If someone has not consented (or has explicitly denied consent) to have something foreign inserted into their body, regardless of the circumstances, it is assault.

Along those lines, I think the deniers of birth rape (or, in this case, the people who recognize that some women do have things done to them during childbirth from which they later suffer psychologically, but who dislike the label "rape" for it) may miss the most relevant connection between "rape" rape and "birth" rape: power. Rape is first and foremost about power, not sexual gratification. And I'm fairly certain that women who believe they were raped during childbirth do not believe their caretaker received any sexual gratification from the assault. So if we take the sexual pleasure aspect out of rape, we're left with one person doing something to another simply because they can. Take out the "for your/your baby's own good" argument (or, think about a woman raped by her date or her partner because "she really needed it") and there's not much of a difference.

Finally, as I said earlier, there is something distasteful to me about one person telling another what label to apply to their experience. If a woman feels she was raped during childbirth, it is not my place, nor anyone else's, to tell her that her rape wasn't "real" rape. We get nowhere, as women and as feminists (as I and Clark-Flory both identify ourselves to be) by applying our own prejudices and pre-conceived notions to other people's issues.

I don't think birth rape is black and white (not that "rape" rape is, either), and one woman's birth rape is another woman's fabulous birth experience. I am reminded, though, of something that was pointed out to my group when I did rape crisis counseling: there's a scene in Gone With the Wind, arguably one of the top five most famous, commemorated on posters and paperbacks. Rhett is drunk and Scarlett comes down to have her glass of whiskey and finds him at the bottle first. He expresses his frustration over her obsession with Ashley Wilkes, about how she shuts him out in favor of fantasies about Ashley. Suddenly, he grabs her at the foot of the stairs and tells her that tonight is one night she's not shutting him out. He sweeps her up the stairs as she pounds on his chest in anger. She wakes up the next morning, giggling and singing. Yeah, she had a good time, and yeah, she's happy now. But Scarlett said no.