"We must and will have women leaders among us. Native women are going to raise the roof and decry the dirty house which patriarchy and racism have built on our backs. But first we must see ourselves as women: powerful, sensuous beings in need of compassion and tenderness." -Lee Maracle

Monday, February 20, 2012

Doula Discourse: Morbidity Matters Part I

A lot of conversation surrounding maternity and infant care in the U.S. laments our reprehensibly high rates of maternal and infant mortality. Mortality is commonly defined as death that occurs within one year of a birth. The U.S. has astonishingly high rates of infant and maternal mortality, ranking as one of the worst and most dangerous developed nations despite our access to life saving technologies and health care. Many birth activists, moms and dads, and professionals have pointed out this fact in books, medical literature, and everyday conversation.

Preventing maternal and infant mortality is central to our work as birth professionals. The fact that maternal and infant mortality continues to dominate discussion gives hope that together we can address these issues and, literally, save lives. That being said, I am troubled that morbidity is not given as much mainstream attention as mortality, and wonder why birth professionals/activists/breeders don't make it more of critical topic.

Morbidity refers to any injuries to the body suffered in birth. Injuries suffered in delivery include natural and iatrogenic injuries - iatrogenic referring to injuries that are partially or wholly caused by medical interventions/medical staff. Common maternal natural injuries include: perineum tears, bruises, soreness, and red eyes from pushing, and hemorrhage. Common maternal iatrogenic injuries include: episiotomy, greater surgery such as C-section, hemorrhage, lacerations from tools, incontinence, and bruising. For babies, common injuries include sprains and broken bones, blood loss, oxygen loss, and lacerations from tools. I consider early cord clamping to be a great injury inflicted on infants, as research and tradition have showed that early cord clamping causes great harm. I am not sure whether or not emotional and psychological trauma officially get counted as injury, but I would argue (as would many doulas) that emotional damage is real damage and should count as an injury.

In addition to having unacceptable rates of maternal and infant mortality, the U.S. also ranks poorly in terms of maternal and infant morbidity. Injury is common in births and iatrogenic injuries in particular are alarmingly high. Why, then, aren't more people talking about morbidity and demanding prevention?

I believe that the efficiency and outcome based model of childbirth contributes to the silence surrounding morbidity. The efficiency and outcome based model asserts that as long as a whole, "healthy" and living baby comes out, then we have achieved the goal of efficient childbirth. How many times have you heard the saying, "Well at least you have the baby!" when a mom or dad explores their feelings of trauma and disappointment related to their birth experience? While these words are meant to comfort distraught parents, they attempt to erase parents' real feelings. The efficiency and outcome based model of birth also demeans the work that doulas do when we work under the philosophy that birth matters.

A tenet of doula care provides that birth and experiences are inherently important, have significant cultural , spiritual, and emotional meaning, and have lasting implications for families. Doulas serve families with this philosophy in mind, hoping that we can help make their experience meet their expectations, and by validating the real feelings of our families if and when injury occurs. Morbidity matters to doulas.

Morbidity cannot be completely eliminated from childbirth. However, it can be reduced with the help of doulas*. I will be exploring morbidity in the next few blog posts and addressing how I believe doulas can contribute to preventing injury to moms and babies. In doing so I hope to move morbidity to the front of contemporary doula discourse, thereby honoring our philosophy that birth matters, and hopefully, also preventing some injury along the way.

In the meantime, feel free to share your experiences with birth injury in the comments, or email me if you prefer. I respect your experiences and want to hear from you.

*I pretty much think doulas are amazing creatures who can save the world if given the right opportunity.  


  1. My son had no birth injuries I can think of now. I thought the blood vessels on the end of his nose might have been scraped, but they still look the same a year later, so I guess that's just how he looks. (It's hardly noticeable.) Except for some early nursing difficulties, he was the picture of health.

    I don't know what's from birth and what's from pregnancy, but my body is not the same. My hips and back, in particular, still feel strange and ache badly around my period (my theory is that the hormones change something) in ways that they didn't before. I don't know who to talk to about that or whether there's any point.

    I tore -- and tore my vaginal septum out -- which I don't think is something that could have been prevented (certainly pushing wasn't fast at 4 hours) but may have contributed to the anemia that knocked me down for a month or so and complicated breastfeeding. It was hard for them to get the bleeding to stop, I imagine because of the septum. (I also think it's possible I had a low-level abruption prior to giving birth, as no one I've talked to since has ever described bleeding as much as I did (with no mucus), but we will never know. I have some serious anger about my concerns being blown off while that was happening, no matter what caused it.) It was two weeks before I could sit up to nurse without passing out. It took 8 weeks for me to be able to walk more than a couple of blocks, 12 weeks to be able to walk a mile without feeling I would literally fall to pieces. I don't know how much of that is common. No one seems to talk about physical recovery from vaginal birth.

    There are many things I am angry at my OB about. I'm not angry at my doula, but I think she was pretty minimally helpful, and only during labor itself. She held my leg, and reminded me to relax my face, which was helpful inasmuch as it got my OB to stop yelling.

    The only people in the medical/birth world who seemed to care how *I* was after delivery were my son's pediatrician and the LC who eventually helped us (not the first, second, or third one we met). My OB certainly didn't, and her nurse less so.

    1. Wow, thank you for sharing your story with me and the readers of this blog. I hope in some small way, sharing our stories of morbidity can help us heal and move forward from the trauma. Or not! It is our right to be mad about the injuries we suffered at birth. It's our right to interrogate them as we see fit. I wish you the best of luck as you move forward into mothering! Thanks for stopping by.