Being a Change Agent: Not as Scary as it Sounds

Why is it that when we talk about birth in the U.S., more of the conversation focuses on WHERE it takes place than on HOW it takes place? When I mention to people that I am a doula and an aspiring midwife, I find that they usually have strong opinions about the best location for birth--and assume that I have equally strong opinions. I'm always happy to discuss birth because it's one of my favorite topics, but I'm also bothered, because I feel these strong opinions may be the reason why most of the mothers I meet tell me that they felt judged for their decision on where to deliver their baby/ies. Women who gave birth or are planning to give birth in hospitals feel just as criticized as those who have had or want to have home births.

These debates over where women should give birth distract us as a society from figuring out the true puzzle of how to make birth better in EVERY environment in which it takes place. What if, instead of alienating these mothers, advocates for both home birth and hospital birth focused on what they have in common: a desire to lower maternal and fetal mortality rates and increase the number of positive birth experiences women report? What if mothers interested in low-intervention hospital-based childbirth had more support in advocating for what they want both before and during birth—and in providing feedback to the hospital after the birth about their experience? What if mothers interested in home birth had similar support for their efforts to increase insurance coverage for home birth midwives and improve hospital treatment of home birth transfers? And what if both groups of mothers felt respected and affirmed in their choices and their right to make the best decision for themselves at that time in their life?

I wonder if so much energy is channeled into telling mothers the "right" and "wrong" places to have their babies because we don't feel that it is truly within our power to shift maternity care practices in this country. Mothers must make the best of the inadequate choices available to them because the system is so much greater than we are. Do we not believe that our voice and actions make a difference? This brings to mind a quote from author Marianne Williamson:

“Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness that most frightens us. We ask ourselves, Who am I to be brilliant, gorgeous, talented, fabulous? Actually, who are you not to be? You are a child of God. Your playing small does not serve the world. There is nothing enlightened about shrinking so that other people won't feel insecure around you. We are all meant to shine, as children do. We were born to make manifest the glory of God that is within us. It's not just in some of us; it's in everyone. And as we let our own light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence automatically liberates others.”

When you feel angry or inspired about something, honor those feelings by taking some action. It doesn't matter how large or small it is: even a brief conversation with an acquaintance envisioning ideal labor care practices starts wheels spinning. You will never know the full outcome of your actions. If you're feeling more ambitious, write a letter to a newspaper or political representative, or get some friends together and organize a demonstration or meeting with local hospital administrators. (Check out the "Worst to First" campaign, http://www.njmaternitycare.com/new_jersey_hospitals, for a terrific example of a group that combined the last two tactics with very successful results!) Debra Bingham, Director of Patient Care Services for Maternal-Child Health and Clinical Practice at St. Luke's-Roosevelt Hospital Center in New York City, has some very do-able suggestions in her articles outlining the nuts of bolts of becoming a birth activist in your community (see the links at the end).

We CAN shift maternity care practices in this country. We need as many people as possible talking about what's going right and what needs fixing in as many places as possible: living rooms, coffee shops, childbirth classes, new mothers' groups, community forums, birth centers, hospitals, politicians' offices, pediatrician's offices, public assistance offices, and on the street. We do not need to do it all by ourselves or become full-time activists. Together, all of our little steps will add up into one great movement. We just need to believe in our power to do it!

For some ideas on what others are doing, please see:

Debra Bingham, “Helping Hospitals Change Part 1: What Childbirth Educators Can Do,” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595254/?tool=pubmed

Debra Bingham, “Helping Hospitals Change Part 2: Childbirth Education Techniques to Empower Women,” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595258/?tool=pubmed

Debra Bingham, “Every Change Needs a Champion,” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1948095/

Childbirth Connection’s Maternity Quality Matters campaign: http://www.childbirthconnection.org/article.asp?ck=10576

Coalition for Improving Maternity Services: http://www.motherfriendly.org/

New Jersey Maternity Care "Worst to First 2010" campaign: http://www.njmaternitycare.com/new_jersey_hospitals