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