Pluralism and Diversity: How Much are you Willing to Tolerate when it Comes to Pregnancy and Birth Choices?

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Pluralism and Diversity: How Much are you Willing to Tolerate when it Comes to Pregnancy and Birth Choices?

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There’s nothing like discussing birth choices to invite judgment, finger-pointing, and castigating from every which way.

I’d point you to a message board or mainstream news article or relevant blog post to demonstrate this point, but I don’t feel like raising your or my blood pressure to dangerous heights simply to highlight just how rapidly Internet disagreement can rise to the level of the ridiculous.

Just take my word for it: people like to judge, and they like to be know-it-alls (yep, that’s you and I too), and they really like to mix their judginess with their know-it-all-ness when it comes to matters of pregnancy and birth.  And then BOOM.  They’ve created a magnet for douchebaggery and mudslinging and riding off in the sunset on a big fat giant high horse.

I’ve been thinking lately, however, that what we all need–what all of our conversations on pregnancy and childbirth would benefit from–is a moment to step back and reflect on our own openness to pluralism and diversity when it comes to birth choices.

It’s not that we all need a uniform take on pluralism and diversity: that would defeat the purpose of the concepts themselves, you know?  But we do–that’s you and me both–need to think carefully about the extent to which we are willing to cast our intellectual nets and extend our hands to one another.

Because if the nets only encompass those who think exactly like us, and if our hands are only holding the hands of those who look like us, then that’s a problem.  In my nerdy, semi-humble opinion, that is.

 

So just ask yourself:

How much pluralism am I willing to tolerate when it comes to issues related to pregnancy and birth?

How many diverse perspectives am I willing to entertain when it comes to matters of pregnancy and birth?

 

What are your limits?

Are you willing to respect someone who makes a choice that you would never make, ever?  (A home birth?  An early elective induction?  A repeat cesarean?  A VBAC after multiple cesareans?)

What are your boundaries when it comes to tolerance for diverse perspectives?  What perspectives or practices are you willing to work actively toward dismantling or prohibiting?  (Physicians who promote elective cesareans for all births?  Care providers who offer elective inductions to their patients?  Home birth with anyone but a Certified Nurse Midwife in the United States?  People who see birth as a completely natural event that, except in extreme circumstances, is typically only successful when women are left alone to listen to their bodies?)

What pregnancy or birth choices do you, or would you, find yourself automatically dismissing as dangerous, foolish, or even just plain “bad”?  (An abortion?  Carrying an “unviable” fetus to term?  An elective cesarean?  An elective induction?  Epidurals or narcotic pain medication during labor?  VBAC?  Home birth?  VBAC at home?  Unassisted birth?  Unassisted VBAC?  Unassisted VBAC with multiples and baby A presenting footling breech?)

 

Are your limits able to encompass grey areas, flexibility, or nuance?

If you are opposed to all early elective inductions, would it make a difference to you if you knew that one woman was inducing her labor early so that her dying mother might get the chance to meet her grandchild?

If you are opposed to all maternal request cesareans, would it make a difference to you if you knew that one woman requesting the cesarean was a survivor of sexual assault and felt triggered even when experiencing menstrual cramps?

If you are opposed to all physicians who do not attend VBACs, would it make a difference to you if you knew that one doctor was so traumatized by a catastrophic uterine rupture that he witnessed that he still finds himself crying over the loss years later?

 

Are you able to see your perspective as one that is unique and subjective, no matter how entrenched it is in research and real-life experience?  Are you able to understand the ways in which your educational and personal background informs your perspective?  Are you willing to accept that no matter how objective you think your perspective is, it undoubtedly encompasses “blind spots” and biases?

Are you a maternity care provider?  (How do all of the individual births you’ve seen affect the way you approach pregnancy and birth as a whole?)

Are you a doula?  (How does your perspective on birth color the recommendations you make and the support you give to your clients?  How does it affect the ways in which you interact with hospital staff and care providers?)

Are you a parent?  (How do your experiences with your own children frame the way that you approach pregnancy and birth?)

Do you have a background in public health?  (Do you always view the world through the lens of public health?)

Do you have background in law?  (Do you always view the world through the lens of the law?)

Do you have a background in medicine?  (Are you exasperated when others do not articulate their personal decisions in a way that defers to medical expertise?)

Do you have a strong tendency to support “natural” living?  (Are you exasperated when others do not articulate their personal decision in terms of what is “natural”?)

What are your personal experiences with pregnancy and birth?  (Are you on a mission to have others replicate your experiences with pregnancy and birth?  Are you on a mission to help others avoid at all costs your experiences with pregnancy and birth?)

What stories have others told you about their pregnancies and birth?  (Have others’ stories made you more fearful of pregnancy and birth?  More anxious?  More excited?  More willing to consider one option over another?)

 

Are you willing to accept that others might articulate their decisions and prioritize their values differently according to their unique backgrounds and circumstances?

Are you willing to accept that your “limits” for good decision-making should not incorporate only those decisions that you would make for yourself?

Are you willing to accept that, because of health circumstances or community resources or deeply-held personal values, some women might choose an option that is not what the evidence tends to suggest for the population at large?

Are you willing to accept that two women could have the exact same medical history and the exact same resources available to them and still make completely different decisions regarding their pregnancies or births?

 

Are you willing to concede that we should all strive to avoid:

Mishandling Research and Anecdote: Research is not an absolute, nor is it unchanging.  What we know now to be “the best evidence” might turn out to be “wrong” some day.  Except in case studies, it reflects data on populations and not individuals.  It should inform, and not coerce, maternity care practices.  At the same time, anecdote is only a starting point.  It is a foundation for hypothesis, but not a guideline for far-reaching practice patterns.  It can affect the way that an individual makes choices, but it should not restrict others’ choices in any absolutist way.

Myopia: As a philosopher, I’ve studied autonomy and decision-making for the past decade.  It should be no surprise that I have devoted so much of this blog to exploring the process of making pregnancy and birth and parenting decisions.  But it would be unfortunate if this were the only perspective that I found to be valuable: if I decried the importance of those who come from a perspective different from mine.  If I viewed pregnancy and birth choices through this singular lens and refused to acknowledge what was in my own peripheral vision.  If I failed to acknowledge the plurality and diversity of lenses through which people view their own pregnancy and birth choices.

Perfectionism: There is no such thing as a perfect choice.  There is no such thing as a foolproof choice.  You will make decisions whose consequences don’t turn out as you expected them to.  I will make these sorts of decisions too.  We might even (and likely will) make “bad” decisions.

Dogmatism: Beware the person who presents their position dogmatically, or who seems to move from one dogmatic perspective to the next.  They might be mishandling research and anecdote.  They probably maintain a myopic view of the world.  And they likely see their choices as distilled through the lens of perfectionism.

 

And so I ask again–of you and of me–how much pluralism diversity are we willing to tolerate when it comes to pregnancy and birth?



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14 Comments

  1. The Hipster Homemaker
    The Hipster Homemaker02-05-2013

    I love this post times a million, Kristen!

    • BirthingBeautifulIdeas
      BirthingBeautifulIdeas02-05-2013

      Thanks. :)

  2. Ren
    Ren02-04-2013

    I heart this post, Kristen. One of your best on this topic, I think. Such an important message.

    • BirthingBeautifulIdeas
      BirthingBeautifulIdeas02-05-2013

      Thanks, Ren!

  3. Michelle King Cohen
    Michelle King Cohen02-05-2013

    This is a great post! I definitely have my strongly help opinions but I am willing to be tolerant and accepting of almost anything, except pure uneducated ignorance. That is where I get hung up. Make whatever decisions you want for yourself and your baby for pregnancy and childbirth, but know ALL the facts – not just the sugar coated do-as-I-say-and-all-will-be-rosy information that docs shovel down our throats (or, on the flip-side, do-as-I-say-or-you-both-are-sure-to-die information doled out by docs).

  4. Molly
    Molly02-04-2013

    I just don’t feel a lot of judgment toward individual pregnant, birthing, and parenting people. (I do think it’s absolutely wrong to hit children, ever, period. And I sometimes feel sad for people, that they’re in tough situations that push them toward choices that may not be ideal in terms of the outcomes they want–which I know can end up feeling like or being judgment, especially when it misunderstands the situation/desires/outcomes at play.) I truly do feel like most people are trying really hard and I have no idea what’s going on in their lives.

    I judge the living daylights out of systems and institutions, though. A medical system in which a person can become an expert on childbirth without ever having attended a person from beginning to end of an unmedicated labor? Seriously un-freaking-acceptable. The state of relations between midwifery and hospital-based obstetric care? Hospital-based birth education that teaches how to be a convenient patient rather than how to get what you want and need? A culture that hates women’s bodies, that sees them (us) as messy, dirty, scary, disgusting, in need of control? Racism, classism, and the messed up attitude to teenagers who are birthing or parenting? And so forth. THAT’s the crap that needs attacking and raised eyebrows–not people trying to navigate this mess.
    Molly´s last blog post ..BionicBlox review

    • BirthingBeautifulIdeas
      BirthingBeautifulIdeas02-05-2013

      WORD. Yes, yes, and more yes.

      I too judge the hell out of the systems and institutions. And think that’s part of why I’ve been so interested in writing about casting our judgments away from individuals, in the vast majority of circumstances. For it is so difficult sometimes to see just how the systems and institutions are operating upon women (sometimes quite literally).

  5. Molly Fiegel
    Molly Fiegel02-05-2013

    Yes and yes and yes!

  6. Natasha Batsford
    Natasha Batsford02-05-2013

    The only thing I struggle to tolerate is the willful abdication of responsibility for your own care. That said thank you for the timely reminder of how complex birth choice can be.

    • BirthingBeautifulIdeas
      BirthingBeautifulIdeas02-10-2013

      How often, or in what circumstances, do you think that women willfully abdicate responsibility for their own care? Part of the reason I ask this is that I too used to judge women for “not taking responsibility for their maternity care” and “voting with their feet” and so on (especially when I had my first birth advocacy awakening…ha). Then, however, I realized just how much privileged access there is to information about birth and maternity care and pregnancy and even sexuality. Especially as someone who is a “birthworker”–and as someone who was lucky to have parents who were very open and honest about sex education, and as someone who had the ability to choose who my care providers were for each of my pregnancies, and so on–I have a hefty dose of privilege in these respects. And it was this foundation of privilege that allowed me to “assume responsibility” (?) for my pregnancy and birth choices in the first place.

  7. Melanie Mawji
    Melanie Mawji02-05-2013

    As a Doula I try not to "recommend" though I may offer information if I have any I think my client might find relevant. My role is to support a mothers choices. With the exception of bullies I am humble to medical staff. I always want to encourage peace and calm. Thought provoking. Thank you.

  8. KC @ genxfinance
    KC @ genxfinance02-08-2013

    This is an enlightening post Kristen.. My mind is open with these kinds of things. i just wish that some as just as responsible for the consequences of their actions.
    KC @ genxfinance´s last blog post ..Start 2013 Off Right By Reviewing Your W-4 Exemptions

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