Though Cowards Flinch

(What follows is a guest-post by Sara Hannam, a lecturer working in language teaching and socio-linguistics at a university in Thessaloniki, Greece. This article is a startling wake up call for those who think that feminism has run its course. Sara can be found on twitter and she maintains an excellent blog).

One area of gender inequality that is in serious need of attention the world over is that of reproductive rights – and it is one of the first to be held up for moral and economic scrutiny by governments.

This includes the right to contraception, free and safe abortion on demand and should also include access to birthing services that offer choice and support to ensure the best experience possible for the woman and their unborn baby.

And yet in many countries of the world today, the situation is far from perfect, and this is particularly the case in some capitalist countries of the west, despite the popular belief that these countries are more ‘advanced’.

Birth as a social and indeed natural event, rather than a medical emergency, appears to have been long forgotten as the birth industry has become increasingly medicalised and interventionist. In Greece, where I live, it is also largely privatized and doctor rather than mid-wife led, despite the fact that it is midwives who deliver the majority of the world’s babies with an overwhelmingly positive outcome.

My blog post for International Women’s Day 2010 will focus on the dire consequences for women and their unborn/newborn children when it is the pursuit of profit that drives the birthing ‘industry’ rather than mother-baby centred practice.

Moving Away from Home Birth in Greece

Like many things in Greece, the model upon which birth practices are based did now grow up in the country itself but was imposed from outside. Until the 1960s, many women gave birth at home with the assistance of a local community trained midwife, and birth was very much organized and controlled by women in the community at large.

Doctors were called in only when there was a medical emergency, which accounts for a very small percentage of births. Breast feeding was the norm and was considered the safest and cheapest option in a country that had been recently torn apart by civil war. As the population was primarily rural at that time, the idea of a hospital birth was alien to most people. There were cases of women dying in childbirth, but the reasons for this were often attached to other factors such as malnutrition and illness, rather than birth being intrinsically dangerous (other than in a minority of cases).

The myth of birth as dangerous has instilled fear into subsequent generations of women (and men) who have grown up to believe that their bodies are working against them during birth, and assistance is required by a doctor to control the forces of nature. The hospitalization of birth which came into force post-60s has moved so swiftly that home birth is not even offered as an option for women as part of national health provision. In a recent meeting I spoke at, I asked those present how many felt home birth was dangerous, and approximately 80% of people (of 250) answered yes. When I asked how many of them had ever seen or attended a home birth, the answer was none.

As an aside, and in view of the location of the readership of this blog, in the UK a recent move to make home birth a real option for women is a step in the right direction, although this is often blighted by resources being available on demand. The Association for the Improvement in Maternity Care (AIMS UK) had a recent march and rally “reclaiming birth” on 07/03/10 around this cause.

The Model Imposed – American Birthing

The Greek system is based on the American model which is amongst the most interventionist in the world with one of the highest rates of C-section and infant mortality (see here). C-section is a procedure that needs to be performed in a very small number of cases (the World Health Organization says around 5-10%). Indeed when the C-section rate rises above 15%, the WHO claims that it has already reached crisis point. In the US, the C-section rate currently stands at 50% in the private sector.

The US has championed the doctor-led system which some critics believe over-promotes the idea of surgery as a viable and safe option (and emphasizes that it cannot be performed by midwives). The system is privatized and motivated by profit, and C-sections are more expensive, both in terms of payment to the hospital and to the doctor. So otherwise healthy women are being advised to have C-sections with the pressure that it will be dangerous if they refuse. They are rarely informed that a C-section is major abdominal surgery that requires substantial recovery time, often affecting breast feeding outcome and post-natal depression rates.

The side effects to mother and new born of pain relief medication such as epidural are rarely revealed and in a last minute panic situation the mother (and her partner or support network) often encounter what has become termed the birth conveyor belt.

Intervention begins with breaking the waters or use of drugs to speed up labour (synthetic hormones), the latter being followed by the onset of sudden and intense contractions. There is no chance for the woman to adjust to this which is made possible naturally if the stages of labour are evenly paced. Pain relief such as epidural is administered and an episiotomy is carried out as the woman’s body has not had time to expand. If ‘lucky’ the baby is born vaginally, or, inevitable mother/baby distress is followed by emergency C-section. The new mother is left exhausted and often with a feeling of having been violated.

The Greek Birth Environment

In Greece the C-section rate has broken the 50% margin, and in some parts of the country stands at 55% (Bouloutza & Giannarou, 2007). Other worrisome procedures that do not attract so much attention are the routine episiotomy and vaginal shave that all women are given.

I consider episiotomy an abuse of women’s bodies as it is unnecessary in almost all cases if labour were left to develop at a natural pace, and sloppy stitching can have long term affects on a woman’s sexual enjoyment and post-natal pain levels. It is done purely for reasons of convenience for the medical team, and accompanies the illogical practice of making the woman lie down on her back thus preventing her from moving around or squatting during labour (a much more helpful position for delivery of a baby for the woman, but requiring those assisting to ‘catch’ the baby).

As is the pattern in Greece in relation to public services, most Greeks choose to go to a private clinic believing the service to be superior, which in turn provides a convenient reason to grossly underfund the public sector with the excuse that the bed side service is non-existent. The private sector is under-regulated and seemingly allowed to operate in a vacuum of outdated birthing practice. The average amount paid for the birth of a child, from onset of pregnancy to post-natal check up, currently stands at 5,000 Euros (based on informal research carried out amongst a sample of approximately 300 new mothers, and comparative clinic prices).

Despite the draconian environment in public hospitals (out of date equipment, partners not allowed in the birth room, newborns routinely removed from their mums and put into a separate room and given formula milk, women who have just given birth in beds next to those who have recently miscarried), the C-section rate is significantly lower as doctors are willing to wait for the progression of a natural birth. Public hospitals are often better outside the centres of Thessaloniki and Athens and women report better experiences there at all levels of service.

In research carried out by Mossialos et al (2005: 288) which compared public/private services, it was found that “physicians are motivated to perform CS for financial and convenience reasons” in private clinics which is linked to “the recent commercialization of gynaecology services in Greece”. All the private clinics mushrooming over Greece allow the woman to keep her baby with her constantly and for it not to be removed (other than for feeding as it is in the state hospital), but only if she pays extra for a private room. The excuse is that she will be disturbing people otherwise.

What is to be done: Real Choice for All Women

On a personal level, I gave birth at home with a midwife to avoid this system – drug and intervention free. Pregnant with my first baby at 38, I had already been flagged up by all the doctors I spoke to as a definite C-section and decided early on that I wasn’t going down that pathway (another aspect of sexism/age discrimination as my general health was not even taken into account).

An increasing number of women are doing this in Greece, despite the fact that it is not supported legally by the state. It is not illegal, but you cannot register the baby’s birth unless there is a doctor present which causes anxiety for some and makes them reject it as an option.

As a supporter of choice, I also want there to be options available for women who might not want to give birth at home and I would never argue against women having access to pain relief or other procedures, if these are informed decisions.

That means a dramatic improvement in public services, and the development of birthing centres which remove birth from hospitals and back into the community where it belongs – this service should be free to all. So far in Greece myself and another 150+ concerned parents have set up the Campaign for Birth Choices in Greece which has regular talks, documentary screenings and demonstrations against the commercialization of birth in Greece.

This is effective in providing a much needed support mechanism for individual women in realizing their anger over previous birth experiences and improving future ones, and in almost all cases our members get a much better birth experience as they are more assertive and demand their rights having gained the confidence to do so.

However, the resistance and change needs to spread much wider as part of political protest. At the present time, the focus in Greece is on the economic system and the major cuts being made by the current government. Health issues, although so crucial and affected by the cuts, have taken a back seat, along with education and other public services.

The fact remains that if something is not done about this soon, the rate of 55% is only set to rise, and the need for urgent change has never been greater. One positive step is letting people know what is going on here and blowing the lid off the fact that what has become the ‘norm’ is so far away from where it should be. If anyone was ever in any doubt that mixing business and health creates a better service, let the Greek example be a sobering lesson in how wrong that thinking is. I am happy to answer any questions and expand further on any part of this article but to keep the word limit manageable I had to cut the detail in part.

Further Resources

Article on US Birthing System “Drugs, Knives and Midwives” http://www.utne.com/2007-03-01/Science-Technology/Drugs-Knives-and-Midwives.aspx

Documentary “The Business of Being Born” (about the US system) http://www.thebusinessofbeingborn.com/about.php (Ricki Lake who made has been under constant subsequent attack by the American Medical Association for advocating home birth and exposing the financially driven US system) see http://www.aolcdn.com/tmz_documents/0617_ricki_lake_wm.pdf

Obstetric Myths versus Research Realities: a Guide to the Medical Literature http://www.amazon.com/Obstetric-Myths-Versus-Research-Realities/dp/0897894278

Bouloutza, P. & Giannarou, L. 2007. ‘Η Βαριά βιομηχανία της….καισαρικής’.  Located at www.kathimerini.gr [02/09/07].

Mossialos, E., Allin, S., Karras, K. & Davaki, K. 2005. ‘An Investigation of Cesarean Sections in Greek Hospitals: The Impact of Financial Incentives and Convenience’. In European Journal of Public Health. 15/3. pp. 288-295.

Pushed: The Painful Truth about Childbirth and Modern Maternity Care http://www.amazon.com/Pushed-Painful-Childbirth-Modern-Maternity/dp/0738211664/ref=pd_sim_b_1

Birth Centres: A Social Model for Maternity Cases http://www.aims.org.uk/Journal/Vol15No4/bookReviews.htm