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Anne Drapkin Lyerly, M.D., M.A., is associate director of the Center for Bioethics and an associate professor at the University of North Carolina, Chapel Hill, in the departments of Social Medicine and Obstetrics and Gynecology. She lives in Chapel Hill with her husband and their four sons.
A Conversation with ANNE DRAPKIN LYERLY, author of A GOOD BIRTH: Finding the Positive and Profound in Your Childbirth Experience Why did you write this book?I was frustrated by the national conversation about birth – by debates that were so strident and agenda-driven, that didn’t get the heart of what I had a sense mattered most to women in birth. And I was concerned that in these “birth wars” it was women themselves who took the greatest hit, were confused about who to believe going into birth and – even when they had a healthy baby in arms – often felt guilty or sad about their births looking back on them. I saw it in my patients, my friends, myself even. I felt like women (and doctors, and midwives) needed a better way to think about birth, they needed a framework for understanding birth based on the things that experienced mothers tell us matter most. Why is this book different than other books on pregnancy and birth? There are three big differences. First, most of the books out there are written primarily from the perspectives of doctors, or midwives, or other so-called “experts.” The voices of the real experts – mothers – are buried. A Good Birth gives voice to women themselves – wise women who have given birth and know from experience what makes it meaningful and manageable. Second, the literature on birth is, for the most part, overly simplistic. It either takes a “how to” approach, or it is overly academic and narrow. The fact is, though, that birth like death is a bookend of life, an event with bodily and existential meaning, it is profound and powerful – and as such it deserves a literature that is at least as rich, complex and nuanced as literature on other health issues. The dearth of something thoughtful is not just strange (and I think it is strange) but it is insulting to the intelligence of women and the importance of birth as a human experience. A Good Birth treats birth with the seriousness it deserves. Third, many other books on birth play into the birth wars: they take a side, and then present their view as “truth.” A Good Birth reveals and then gets us beyond the birth wars, to give us a new way of thinking about birth that validates women’s diverse experiences and values, that pulls us together rather than pulling us apart.How will your book change things for women thinking about birth? My book will provide a new way of thinking about birth as a major life event, will provide guideposts for navigating the choices they’ll face approaching birth, and the challenges to understanding and valuing births that many of us have experienced in it’s wake. It will help them cast of what I think are misleading frames for looking at birth (Was it “natural” enough? What more can I ask for if my baby was healthy?). I also hope they’ll come to understand that the goal is not an idealized or scripted birth, but a birth that aims at participating in certain goods – these are the elements of a good birth, and there are many ways to find them, whether you give birth at home in a tub or are having your third cesarean. Why does a “good birth” matter? I spend a fair amount of time on this in my book – it’s a press I had to deal with a lot as was in the early stages of writing. And I offer four reasons. One is that women matter. People talk about the fact that when women get pregnancy they become “invisible” – that they fade from view – it’s an undeniable pattern. But in addition to the entry of a child, birth is our transition to motherhood, it a major undertaking, physically, emotionally, and for some of us existentially. Two, birth matters to women – we do care about how our births go, we remember our births for years, decades, they are part of the fabric of our lives. And birth is not just a source of memories but of meaning – it can be an opportunity to claim (or reclaim) power, it can be a self-test, a form of resistance, a way to heal from loss. Three, birth is a beginning, and beginnings matter to us. And four, with the massive changes in health care, we had better understand what is at stake in birth if we are going to advocate for the sort of maternity system that meets the needs of women, children and families. Isn’t having a healthy baby enough? No. And it never has been. Of course a healthy baby is a blessing, a big reason for celebration. But across cultures birth has always been a life event, an important threshold, an experience to which we attach meaning. It was clear to me as my utterly pragmatic father contrasted, repeatedly for us when we were growing up, my birth and that of my other brother – we both were “healthy” but believe me how we came into the world mattered to him, to my mom, and ultimately to us. As a society, we have come to agree that the way that we die matters – that life’s distal threshold requires a certain amount of respect and consideration. How in the world could we argue that the same is not true of birth? What is the Good Birth Project and how did it come about? The Good Birth Project is a three year study I conducted while I was at Duke University. It involved more than 100 diverse women – with diverse birth experiences — as well as a range of maternity care providers. My research team and I interviewed them at length – asked these women to tell us about their births, what went well, what didn’t, what they’d do differently the next time around – and what they thought made for a “good birth.” They told us amazing things, and we learned so much. Perhaps most striking was not what distinguished one birth from another, but what about them was the same. I was moved by what these women had in common, despite their differences. The ways in which their diverse stories converge constitute the backbone of my book, the core elements that emerged as important to a good birth, wherever and however it occurs. In conventional wisdom, what is a “good birth” (for physicians, midwives) and what is different between those ideas and the ones set forth by the women you spoke with? Most doctors have trained to think that a good birth is a good outcome: as long as the mom and baby emerge healthy, we have done our job. On the other hand, at the heart of the midwifery view is the idea that a good birth is a “natural birth” – that less is more, that technological intervention is by definition a complication. But the fact is neither view has it quite right: we know that there is more to a good birth than a good outcome (It talked about this above); we also know that for some women technology is welcome, it enhances their birth experience, and it may be life saving. My book goes beyond these polarized views, outlines what is essentially at issue in birth – what experienced mothers tell us really matters. What message are you hoping women (and caregivers) come away with after reading your book? I am hoping that women understand that there are many ways to a good birth – that they should listen to themselves and take seriously what they themselves value, what makes them feel safe and respected and connected, when making decisions about birth. And I hope they understand that a good birth is something that can evolve over time – that we can understand our births as good – find in them the powerful and profound – however it was that they unfolded. My message for caregivers is a little different: I think we need to stop our bickering, to move beyond the “natural” versus “medical” debate, find our way to a common language and set of values, and ultimately start orienting our conversations and efforts to shape the maternity care system not around professional agendas but around the deeper considerations that will shape assessments of birth and the lives it affects in the long run.
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