#notallobstetricians

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In Tolkein’s classic Lord of the Rings, Arwen Evenstar gives up her immortality for the love of a mortal man, Aragorn. Arwen’s father is against the match. He’s got nothing against Aragorn, it’s just that he understands the full weight of her choice. But Arwen won’t be dissuaded. We often do things that are crazy in the state of temporary insanity induced by love. Like having children. It’d make a great story if I could say that’s why I did obstetrics too. For the love of it. But looking back, it might have been for hate.

My son Colin, the philosopher, tells me that our decisions go back to the big bang if we go back far enough. By this he means that there’s a certain inevitability to our choices. That if we look backwards at our lives, everything that happens nudges us in a certain direction, and we find ourselves falling down a particular pathway under the influence of these unseen forces. That hateful obstetrician who I met the day I attended my first ever birth might have tripped me up a little, but I might have been heading in that direction too.

I like to think that the reason I became an obstetrician was that when I saw that doctor pull that baby out with forceps for no apparent reason, it made me think that I could do better. That I could cancel out some of the abuses that I saw were happening to women. The trouble is that some of those things I did to cancel out the wrongs have been acts of responsible subversion. Because they maintain the status quo, responsible subversion is somewhat irresponsible. And also, since people don’t know about my good deeds, one day history might judge me in the same light as those evil obstetricians. History might think I was one of them. But history lies sometimes. Like, just because I once owned a gold lame pantsuit, it doesn’t mean I was a disco queen. Disco music gave me a migraine in my ear.

I’ve written about Mary Rose McCall’s book The Birth Wars before. In it, she compares the philosophical disagreements between midwives and obstetricians (birth as natural: birth as dangerous) to a war in which women and babies are the collateral damage. I’m aware that one day my grandchildren might well ask me what side of the war I was on. If you read the obstetric history books it would appear that all my predecessors were monsters and maybe they were but more likely they were just human beings trying to do the best they could with the material they had to work with: the lowest human life forms on the planet –mothers and babies. Who knows, maybe Joseph Delee himself, he of forceps = gentle / vagina = skull-crusher fame may have been a closet feminist.

The poet and philosopher Criss Jami wrote “When good people consider you the bad guy, you develop a heart to help the bad ones. You try understand them.” And he’s right. In trying to understand the field of obstetrics we must consider the patriarchy, and the fact that birth must not go quietly into the service of those dark knights.

In the world of obstetrics, there are too many bad guys. #notallobstetricians, that’s for sure, but far too many. The sad explanation is that we do not value motherhood, which is a nice way of saying that our culture (still) hates women. I know many people won’t believe that: they will say they love women, but they only love good women, thin women, beautiful young women, they don’t love women on welfare, women who smoke and who eat junk food, women with rotten teeth and rolls of fat, women who have had too many babies to too many different men.
When I had my first baby one of the first things I felt was a deep connection to all of the other women who had babies before me. This feeling surprised me. I think part of the reason it surprised me was, in truth, that I had been a snob. Before I became a mother myself I hadn’t appreciated the profundity of the act. After all, even stupid women become mothers. Women with rotten teeth, and rolls of fat, who eat too much junk food. These women are often, too often, some might say, mothers too. If ordinary, regular women could do this thing– become mothers— like I just had, then perhaps there was more to them then met the eye. Maybe there were other things I’d overlooked. It wouldn’t be the first time I’d judged someone harshly and then come to find things out about them that shattered my image not only of them but also of myself as a fair minded and reasonable person.

What all women have in common is that they when they become mothers they deserve the best of care. Let that sink in. That woman with the tattoos and badly dyed hair who got addicted and had a baby with a gang member deserves the best of care. Yes, we have a duty to protect the baby from abuse from her own flawed mother. But the best way of doing that is to make the world a better place so that good mothering can emerge from flawed women.  
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The Lord of the Rings trilogy has a long appendix, so maybe you haven’t read it. In it we find out what happens to Arwen in the end. As it gets closer to that day of reckoning, when Aragorn ages and eventually dies, Arwen comes to regret her decision. The reality of a mortal life is before her. It is in the end, looking back, where choices can be regretted. When we suffer, ourselves, for taking what stances we took in our lives. Where what seems like a good idea at the time doesn’t seem like such a great idea after all. Part of this is just what always happens when we have lived a while in the actual life we chose, with all of its disappointments. The road we didn’t take often seems so much better, because it’s always a fantasy. We don’t imagine alternative careers to be boring, alternative spouses to be abusive, alternative children that won’t brush their teeth when asked.

Imagine Arwen sitting at the coffee table with her best friend. There are things even best friends don’t talk about, for example, their choice of partner, especially when it’s a done deal like that. My dearest friends have ended up with some surprising choices. I know left wing beauties married to right wing uglies; down-to-earth earth mothers hitched to conservative snobs; friends who divorced weirdos and remarried idiots. You can’t account for it other than thinking that Cupid is pretty random. We might not comment but we certainly think it, what they hell did she see in him and she could have done so much better. Behind her back Arwen’s friends might have said that Aragorn was pretty hot in the day and a King and all, but seriously, I’m sure she coulda had any pick of the elves AND kept her immortality. To paraphrase my grandmother, “it’s just as easy to marry a mortal man as it is to marry an immortal one”.

We tell ourselves it’s for just and worthy cause, this diminishment of power. But there is no reward for love in the patriarchy. Most women become lesser beings there, in the service of men. We tell ourselves its okay, we’ve done it for a noble cause: because we love them. And we are punished, because they—the ones that write the rules that govern how women are abused and oppressed —-they hate us most of all.

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I am leaving the hospital after a difficult night which stretched well into the next day. A colleague has called in sick, and I have stayed far beyond the rest of my shift. When I get to my car, I realize that in my haste to arrive in a crushing emergency, I have parked in the space reserved for the paediatrician on call. My driver’s side window is plastered with a sticker warning me that I will be towed if this transgression ever happens again. The sticker obstructs my vision and I can’t remove it. I cheer myself up by indulging in a fantasy about what happens if I am killed in a car accident on my way home. The CEO of the hospital attends my funeral, the jerk who is a member of the hospital board, and wait, here is a particular manager who has previously made my life miserable; they all say how great I was. It makes at least page three of the Times. The dream sequence fades into nightmare when a man approaches. I think he’s going to offer me sympathy for a moment; he is looking at the sticker, so I get a shock, because he’s nasty. He strides towards me menacingly. How dare I park in this spot, he (An Important Man!) had An Important Meeting!! in the morning and was Running Late!!! I try to explain about the emergency c section that turned into a postpartum haemorrhage and the foetal distress that followed in the room next door, and the same time and to top it off there was a woman with an intrauterine death who I have just left and how one thing lead to the other and that I didn’t mean it, I try to engender some sympathy, you see, while I appreciate the importance of the meeting there were lives truly at stake, except for that woman with the dead baby which wasn’t an physical emergency but it was an emotional one, but I realize he doesn’t care. All I manage to say, hanging my head, is that I was on call. He knows what it’s like to be on call, he’s done it himself for years, as he (raising his voice)—- don’t I know—, is a Consultant Paediatrician. It doesn’t dawn on me until later when I am at home, that, because of my crappy car, and my crappy clothes, and maybe the mascara tracks on my face from the dead baby, he treats me that way because he doesn’t see me as a peer.

He thinks I am a midwife.