Using woman-centred language regarding childbirth is about more than semantics

Two things kept me awake at nights, discouraging me from writing this article. One was a loud voice that kept telling me: “It’s just semantics — it doesn’t matter what you call the body, it’s still a birthing body.” The second was more compelling: I was afraid.

Addressing the former: the debate around gender neutral language and childbirth is not just about semantics — if it were, this conversation would be irrelevant, and people wouldn’t care one way or another. But people do care. Pretty intensely. Debates around transgender rights and identity politics are front and centre these days, and are evermore heated. So we can’t really just be talking about an impactless change in terms and language. And even if this were just about “semantics,” it would matter. As a writer, words are important to me. Language in the birth room has always been something I teach my students: the words we use are powerful; watch your tongue.

The second thing, though, was what really kept me stuck. If you ask anyone who knows me, most will say I’m pretty fearless. I’ve lived in foreign countries, raised a bunch of kids, travelled alone for months at a time, questioned authority, run marathons, and done risky and illegal things. I’ve gotten into some serious situations. But writing this article scared me. And not because I fear physical attack, but because I am afraid of the backlash on a more personal level. Several people I care about deeply, truly, and passionately believe that the transgender rights movement is an intelligent, imperative, radical step forward for feminism. By disagreeing with this assessment, I put myself forward as an enemy, and I am afraid that those friendships will not survive.

I was raised a feminist, but learned, nonetheless, that one of our greatest attributes, as women, is our ability to think laterally — to compromise, to see things from other peoples’ point of view, and to say “yes.” I’ve always tried to please people. I’m like Grover: I want to be friends with everybody. And of course it isn’t only me — women have been taught for centuries to agree, and it is costing us dearly.

I got myself out of many dangerous situations by using my so-called feminine wiles to manipulate people into believing I was agreeing with them, while in fact I was figuring out an escape route (literally and figuratively). I said “yes” far too often, agreed when I shouldn’t have, and didn’t really ever learn to say “no.” This was useful, in some ways. If I hadn’t said “yes” so often, I wouldn’t have experienced as much as I have in my 63 years. My kids always came to me when they wanted an affirmative, and my flexibility allowed me to develop more empathy towards others. But I believe this flexibility and desire to please led me down a wrong path. I made faulty choices based on how I was feeling towards people, rather than on my intellectual understanding of the transgender debate and its impact on maternity care.

The work of feminists to normalize woman-centred maternity care in our hospitals and birthing centres, and indeed at home, has been jeopardized by a movement to impose gender neutrality in the name of “inclusivity.” Instead of supporting women, activists are shouting, “People give birth!” and “Chest-feeding is best!” As a radical feminist, I interpret this as a co-optation of our original aims to provide maternity care that respects the female body and its strengths.

The respect and honour that the female body deserves has, once again, been jettisoned. And too many have been complicit by remaining silent and politely nodding our heads, instead of probing or demanding dialogue.

In 2003, I founded an organization to provide free doula support to the most marginalized women in Montreal. Through Montreal Birth Companions (MBC), refugee claimants, women without status, domestic workers, recent immigrants, and other women without medical insurance had access to two doulas that would provide prenatal, labour, and postpartum support. We served about 1000 women over the 13 years we were active. The organization never received funding. The women who volunteered for MBC knew they were providing radical care: providing free doula support for a marginalized woman is a political act.

I had also founded a doula school linked to MBC, and they had a good symbiotic relationship. Every year, I got a great bunch of students who sought a more radical approach to maternity care. We believed we were making a difference, and maybe we were.

But in 2016, I was told that my focus on women was bad, blind, and passé. I was told that trans people were being murdered and raped at very high rates. It all sounded so awful. I decided to change my language. I wrote a blog post about how hopeful I was about the new direction feminism was taking, which I believed was a radical overhaul of gender-based stereotypes. I thought this meant an opportunity for everyone to joyfully express ourselves, but failed to look beneath the surface to see that the trans movement supported the very stereotypes we are trying to break down as feminists. While I didn’t fully understand the implications of this “new direction,” which claimed that if one doesn’t feel aligned with gender stereotypes, they must actually be the opposite sex, I saw passionately held beliefs and assumed we were all fighting for the same thing. It’s hard to admit how ignorant I was then.

At the time, I was excited to learn and discuss, so asked my students for more information: what was the theoretical framework for this interesting new approach to radical feminism? Because there was not much to read that wasn’t anecdotal, propaganda, or overdramatized, I wasn’t able to fully comprehend the ideology behind the movement. What did it mean to “identify as a woman”? Why was it important to avoid discussing a person’s biological sex?

At first, my curiosity was met with enthusiasm. But, over time, the people I approached became less interested in sharing information and more abusive: “I don’t have time to explain this to you — just Google it!” My teaching suffered. I began to stutter and wonder whether it was offensive when I said the word “woman.” I became unsure as to how to talk about the vulva, breastfeeding, and the sexuality of birth. I rationalized my feelings of discomfort by telling myself that this new way of looking at language and identity predicated a positive change, and constituted a move forward in the fight against oppression.

By 2018, I was starting to think that my wholesale acceptance of these new ideas might be wrong. I worried that my desire to keep friends and for everyone to get along was in conflict with my ideals. Was I throwing away all the work I had done to change the maternity care system? I had also experienced a public attack against my doula school and other projects: I discovered there was an online campaign to boycott my workshops and activities because of my “anti-trans” stance (which was really nothing more than a pro-woman stance), and realized I needed to rethink the whole thing.

I am not alone. So many women I talk to who work in the maternity care system feel very uneasy about efforts to erase “woman” from the centre of our vision. But we are scared to speak up. In part because we have been trained, from the time we are young, that the best way is to compromise and be flexible — we have been taught that we must support the underdog, whoever that may be. But we also know that, for many decades, women have endured violent birth practices, painful beauty customs, domestic and sexual abuse, the glass ceiling, and pressure to dumb ourselves down. So why, after pushing back against all of this, should we submit, yet again, because a bunch of young people with a cause demand we change our language and focus?

In 2014, the Midwives Alliance of North America (MANA) revised some key elements in one of its documents. The “core competencies” document describes the responsibilities and duties of a midwife. The revisions removed the words “woman” and “women” from the descriptions of the competencies. The following year, Woman-Centered Midwifery wrote a letter to MANA, asking them to reconsider these revisions:

“We are concerned that, except for in the trademarked section from the Midwives Model of Care, the word “woman” has been erased from the MANA core competencies document and replaced with ‘pregnant individual’ and ‘birthing parent.’ We recognize that the words maternal and motherbaby were not removed from the document, implying that the reviewers maintained a mutual and shared respect for the sanctity of the motherbaby unit in midwifery. But women are now all but missing from the language, as if we can separate woman from mother from baby. Woman is recognized now only in relation to her baby. This is harmful to female adult humans; we women have fought long and hard to be recognized as autonomous beings.”

In response, MANA explained why the language had been changed: “In order to better reflect the diversity of midwives and the clients they serve.” In other words, “We want to please everybody.” What erupted after these letters were exchanged was a nasty little tempest in a very big teacup. The teacup being, essentially, the erasure of women and women’s rights in our advanced capitalist patriarchy. MANA explained:

“The same elements that threaten holistic care for pregnant and birthing folks also perpetuate violence against trans, queer, and non-gender conforming people. These systems include, but are not limited to, profit-based, industrialized medical care, colonialism, sexism, and patriarchy. When gender-nonconforming folks are also people of colour, low-income, or disabled folks, they disproportionately experience discrimination.”

Women throughout history have been erased from their own reproductive processes: shame, laws, and violence put others at the centre of these events. Doctors, doulas, midwives, and other health care practitioners often put their interests above the birthing woman’s, deciding what is best based on their own political, scientific, or social agendas. And now, the very people who were fighting for woman-centred care have turned their backs on the birthing woman and are erasing her from their language. Even if high-quality, best-practice, evidence-based, respectful care were available to women, it is not in our best interest to agree to our own erasure, no matter how much we want to please, make good, and comply.

As a birth attendant, I’ve witnessed women being pinched, prodded, and poked against their will. In Canada, where socialized medicine is our norm, I’ve seen a doctor stand between a woman’s legs and yell that she had to pay $1600 in cash before he would “deliver” her baby. I’ve witnessed unnecessary surgeries: caesarean sections for no reason, and episiotomies for the sake of training students. I’ve even seen an extra tight perineal repair done with a wink to the husband. I’ve watched while intelligent, educated women are convinced that their babies are too big, too small, or badly positioned. I’ve heard countless stories from women who told me that their cervixes didn’t open, their vaginas were too small, and their uterine contractions were ineffectual. I’ve heard women told that if they don’t agree to interventions like inductions, amniotomies, or epidurals, their babies will die. I’ve seen countless women try to convince medical staff that their pain medication wasn’t working, in vain. I’ve seen other women tell staff they would be giving birth soon, but be ignored. When a woman is held down, made to do things she doesn’t want to do, threatened, or ignored when she is giving birth, that constitutes abuse.

The struggle for woman-centred maternity care is far from over. I have attended the births of some of the wealthiest families in my city, and I have provided maternity care for migrants fleeing the war in Syria. I have watched refugees from Congo being abused in a hospital birth room, and I have witnessed a scientist arguing in vain against the bad science her doctors employed to convince her of their unnecessary protocols. The common thread that runs through all of these stories is abuse. Medical professionals abuse birthing women every day, all over the world, because they are female.

Women are not oppressed and abused because they like pink, wear high heels, or aren’t good at math. These are societal myths about what it means to be a woman. We are oppressed because it is in the interest of patriarchal society to keep us oppressed. The root of patriarchy is control of the means of human reproduction, and women’s bodies contain the means of reproduction, therefore patriarchal capitalism needs to control them.

The struggle against patriarchy must be led by those who own the means of reproduction: women. If we obfuscate reality by saying that, actually, it’s not only women who give birth, we lose our focus, in terms of the feminist movement, and risk losing the small triumphs we have achieved in our struggle for woman-centred childbirth.

In the 1950s, women were regularly given a deadening cocktail of drugs and tied down, while their babies were pulled out. In the 21st century, lip service is given in many affluent countries to the idea that women should have a companion with them while they give birth, and that they are actively involved in their care via “informed consent,” but we still have a long way to go.

Despite this, I have given up attending births. I can no longer witness women being abused and maltreated. I knew when I grabbed a young doctor’s arm roughly that it was time to leave. He was sitting on the bed next to a woman in labour. Her legs were spread for a vaginal exam and he surreptitiously opened a drawer to grab an amniotomy hook (a plastic hook that looks a bit like a crochet needle, which is used to rupture the membranes, commonly referred to as “breaking the water”). He had not asked the woman’s permission or explained what he was planning on doing. I told him off, and he politely and sheepishly asked the woman if she wanted her membranes ruptured. She said no. He left. I feared that next time I would poke him in the balls with the damn hook. So I retired.

It doesn’t matter to me what a person wears or doesn’t wear, how they want to be addressed, or what they choose to do to their bodies. What matters to me is how women are treated during childbirth. You can identify as whatever you please, have breasts or have them removed, have a beard or not, but if you have a uterus and you’re in labour, there’s a very good chance you will get treated abusively in most hospitals in the world. That says something to me. No matter how much we would like to be compassionate to our sisters and brothers, we cannot afford to let go of the fact that childbirth is a time of intense vulnerability and abuse — and that particular abuse happens to women.

I refuse to allow women to be removed from the centre of maternity care. Women deserve self-determination in our own birth experiences. We deserve respect and truly informed consent in maternity care: this is not just a slogan or something silly — to be ridiculed — but a right. We have work to do, as women, to regain and retain the means of human reproduction.

Rivka Cymbalist has worked in women’s health for most of her life. She is the author of a book on doula care, and is the founder of Montreal Birth Companions (MBC), an organization that provides free doula care for marginalized women. She lives in Montreal and Italy. Follow her on Twitter @montrealdoula.

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