I’m reviewing the semester’s lectures today.  I need to take my final exam a week early to head for Kenya so I need to start getting ready. Honestly, I’d start getting ready anyway–it is just who I am.

One of the lectures was on the topics of medical abortion and sterilization. Midwives need to be ready and able to counsel women on the full range of women’s health issues so I need to know my research even if I am not the practitioner performing a procedure. Only, midwives in some areas do have the legal right to provide some medical abortion services – generally the induced abortion from medications rather than the surgical procedures. I’m not sure how I feel about that yet.

On the one hand is my image of midwives as protectors of  women, doing what is needed to help a woman adjust well to her new parenting roll.  Abortion doesn’t fit that image for me. Not because I do not see midwives as full scope health providers, but because abortion represents the exact opposite of that image for me. For many women abortion was not a part of their reproductive plan, and is a last resort because this a world that does not support a woman in her adjustment to the parenting roll unless she meets very specific criteria.

She better have completed her education; have a stable and reliable partner; have an adequate and steady income; not be too old; breastfeed but only at home where no one is offended; and she should go back to her well paying job with appropriate day care plans as quickly as possible and not add to the rolls of the various social programs designed to help the poor.  I don’t subscribe to the perfect “timing” as the only pregnancy that counts. I tend to be a person who supports a woman’s right to believe her baby is worthwhile even if society has decided her baby is a mistake.

I think I can get over my issues and prescribe the medications if a woman wanted them. I have to do that with so many things working in birth and my guess is eventually you just become numb to some things. But I don’t know that I want to become numb to the pain it causes a woman to be told society doesn’t value her baby because she is too poor. Too poor, really?

Yep.  Check out the statistics on abortion at the Guttmacher Institute. Here is a quote:

Three-fourths of women cite concern for or responsibility to other individuals; three-fourths say they cannot afford a child; three-fourths say that having a baby would interfere with work, school or the ability to care for dependents;

But it doesn’t stop there.  54% of women having an abortion had been using a contraceptive method when becoming pregnant – with large numbers using their selected method inconstantly (which means they were not properly educated on how to use the method). These were women who were trying to prevent the pregnancy, but didn’t have good information or good options.

Of the 46% who were not using contraceptive, only 26% had “unexpected” sex (which means about 12% of abortions). The rest did not have a reliable contraceptive method for reasons that I read as “poor education from medical practitioners” because the women had concerns about contraception (but were obviously not helped to find a method that would work for them), or believed they were low risk for pregnancy (either poorly educated about how pregnancy happens or a specific condition they had).

So I see abortion as a symptom of society devaluing women and mothering, and I hate treating a symptom instead of the problem.

I wanted to share a thought that has been brewing in my head.  But to begin with, let me share the story of a young woman whose name I don’t remember.

At the invitation of a teacher in the pregnant teen program, I visited this young woman at her school.  As her teacher introduced her, she told me she was 14 weeks pregnant.  I instinctively replied, congratulations.  The young lady looked very confused, then smiled and said thank you.  As she went to sit, the teacher pulled me aside to inform me this young lady was in a very bad situation and really needed to consider all her options.  She told me this three times, “she really needed to consider ALL her options.”  It was such a creepy feeling to know this teacher was telling me this girl needed an abortion, and I didn’t understand why she had asked me to come talk to her if she never expected her to get to birth.

I left that meeting in shock.  It was the first time I realized how teens are treated differently during pregnancy.  I think I was the first person to congratulate this woman on her upcoming baby, she didn’t even know how to respond to it. I didn’t understand how the teacher could be so insensitive to this girl as to basically insist the only correct option was an abortion.

Fast forward about 8 years and now I am in midwifery school.  One of the first lectures was about prenatal care.  The professor shocked me, “always ask the mother how she feels about this pregnancy before you congratulate her, she may not feel it is worthy of celebration.”  Wait a minute…all the women I work with, the “midwife” type clients, are happy to be pregnant.  You mean people who don’t want to be pregnant choose midwifery care?

I wish I was enlightened enough for this alone to have made me understand.  But I am happy to say that where it stopped, today’s clinical day picked up.  I can affirm the statement, not all women who choose midwifery care are happy to be pregnant.

You see, midwifery care isn’t just about natural birth and realizing your full potential as a pregnant woman.  For some women it is about affordable care, or a clinic that is accessible to them.  For some women it is about feeling they are less likely to be scolded for drinking, drugs or cigarettes.  And for other women it is about being accepted as a person with real issues and real questions.

I am lucky to have worked with some single women and teens who wished pregnancy hadn’t happened when it did.  It has helped to prepare me for the women I am likely to serve when I graduate.  But, and this is a big but, my doula and childbirth education classes alone would never have given me experience with the diverse clientèle that visits a midwifery office.

And as for that young girl I congratulated, I can now see that my assuming congratulations was as wrong as her teacher assuming an abortion.  Neither of us took the time to find out what support the young mother wanted or felt she needed.  Hopefully, I will never make that mistake again.

I had a very interesting conversation with a fellow student this past weekend about the causes of problems in maternal health around the world.  As we discussed this, I shared my concern that there was a general lack of respect for women in many parts of our world.  She stopped me there and challenged my thinking.

“It isn’t really a lack of respect for women, because women do this to themselves. It is deeper than just a lack of respect.”

I agreed.  We had discussed the issues of female family members in Chad hitting a laboring mother if she expressed pain because it meant she was weak.  We had discussed women in the DR Congo who were forced to stop breastfeeding before the baby was two months old because their mother-in-law would find her son a new wife if she did not return to the fields to work. We had discussed the latests birth documentary I had seen where even the traditional birth attendants did not partner with the women, but held themselves in authority telling the woman what she must do.

“You are right,” I told her, “Even women here are made to feel inferior if they breastfeed, if they don’t breastfeed; if they go back to work, if they do not go back to work.” “If they have an epidural.” She added.

Then I came home to find this article waiting for me: http://www.spiegel.de/international/zeitgeist/0,1518,713890,00.html.

The article baffles me, probably because I do not understand the main philosophies of the feminist movement. But in reading her responses, it sounded as if she was annoyed that women would choose to stay home and have children.  As if by making that choice it was evidence to her that they did not really understand what they were choosing, because if they did understand they would have chosen what she did.  And she seemed to say she can tell that even though women made this choice, she can tell they are not happy in it.

And this brings us back to the issue at hand.  We all want to be right.  Or maybe we all need to feel that we are right and so we share wholeheartedly why other women are wrong so we can feel more right. Either way, in behaving this way is a form of mother on mother violence. So instead of having wonderful supportive communities of new mothers and motherly women without children, we create a prison for new mothers.  A prison that separates them not with bars, but with the fear of being rejected.

What if instead of judging women based on what we think is right or correct, we accept women as growing and learning human beings? What if we could accept women for the growth and maturation they have undergone, instead of expecting them to follow our personal path of growth and maturation? What if we could understand that no woman makes a choice believing she is harming herself or her child, and instead of belittling her or condemning her come along side her to share with her and learn from her. What if we agreed that each of us is, at least on occasion, wrong; and that although we are convinced at this moment we are correct, we may come to accept later that we might have been even the smallest bit mistaken in either belief or approach? What if we really trusted that mothers, when given support, will make the best decisions for themselves and their children?

What This Means to You

Take an honest look at yourself over the next few days.  When you hear stories of mothers who made different choices than you made, is your first reaction to prove why she is wrong?  Or is your first reaction to learn about why she made the choice she made and support her in achieving her goals for her family?