Appeasing the Patriarchy

Recently, the Association of Ontario Doulas (AOD) released their Statement of Position on Non-Aboriginal Traditional Birth Attendant/Companion (TBC) (January 15, 2024) that you can read by following this link.

Since it is a position that is directed at my work in creating and defining the role of a traditional birth companion, it warrants a response.

Content note: This Statement of Position uses sex-based language. The word ‘women’ is used in its historical and traditional context to mean that half of our species that arrives with the biological potential to ovulate, menstruate, conceive, gestate, birth, and lactate. By continuing to read this post you agree to be entirely responsible for your own reactions and your emotional, psychological, and intellectual well-being and hold us free from liability for use of this word.

Billie: of the family Harrigan, elder and companion, Statement of Position re: the Association of Ontario Doulas’ Statement of Position on Non-Aboriginal Traditional Birth Attendant/Companion (TBC)

 

Whereas the Association of Ontario Doulas (AOD) has released their statement of position regarding non-aboriginal traditional birth attendants/companions that directly misrepresents this emerging sovereign alternative that is spearheaded by me and my efforts, I, Billie: of the family Harrigan offer my commentary and position on their position.

It arrives unsurprisingly, and reads as submissive pandering to existing patriarchal power structures that are both collapsing and increasingly detrimental to the wellbeing of the women who use these services and their babies. It’s filled with innuendo and suggestion that is perhaps meant to intimidate their members into ongoing conformity and obedience.

Since I am the one who has created the unique role of a traditional birth companion in Canada and beyond and I am the one who gave it that name, I am the one who defines it. Not the AOD. Their misrepresentation of my work is stunning. However, it may fit with my hypothesis that the doula profession is limited in its maturation by their alarmingly high and early burnout. Wisdom and insight require time and perseverance.

Prior to the push to move women into hospitals after WW2, it was the tradition in Canada for most women to simply call the neighbour who had some birth skills and experience. This neighbourly support did not include the medical surveillance and interventions associated with modern midwifery. Traditional birth attending or companioning did not have the tools nor the religious-like zeal to engage in today’s fear-based management of a common physiological experience. 

Whilst a TBA has “historically referred to indigenous midwives, lay midwives, and community midwives”, a TBC is an invention of mine based on my own 40 years of experience as a companion (as I define it) and my work as an academic specialising in maternity care. Further, traditional midwifery, as that which was practiced prior to the fairly recent medicalisation of childbirth, in no way resembled what passes for midwifery today. The AOD is conflating practices from different eras by using ‘historical’ to define this role and inserting modern medical regulation & practices to suggest they are operating in tandem.  

The historical role of the TBA has been largely eliminated by that great coloniser, the WHO and its unholy alliance with pharma and their money in favour of the western medical model as created by Rockefeller and Carnegie. Actual traditional practices have been replaced with modern interventions based on our current cultural belief in the supposed perils of women’s physiology. To suggest a TBC engages in these modern medical practices, as opposed to historical (traditional), non-medical, and un-controlled offerings is to incite division through misrepresentation.

Their statement included the medical industry’s response to women’s choices to leave these services. It’s expected that any industry with a monopoly that is losing control will come out with some statement about how their former customers are being foolish or dangerous. It’s just another example of their suffocating paternalism. The AOD would benefit from reflecting carefully on why they too participated in this paternalism.

It was a curious statement that licensed medical practitioners “are the only ones authorized to ‘practice spontaneous childbirth’” as women all over the earth are releasing their babies in a practice of spontaneous childbirth without any authorisation whatsoever.

It should be noted and carefully understood that the “risk that child welfare organisations may investigate” comes ONLY from another human who calls this agency for an investigation. This human is overwhelmingly a licensed medical practitioner who takes exception that the customer, who arrives to access their services, did not use their services prior to needing their services. It’s a well-documented terror tactic in the realm of obstetric violence that is designed to send a message that families will be punished for non-compliance. It comes from deeply rooted medical narcissism, cult-like behaviour and belief in their offerings, and a complete absence of trauma-informed training or skills. It behoves the AOD to take a firm stand against this heinous practice and advocate for families rather than including it as a threat to families who may not acquiesce to medical control over their family decisions. This omission alone disqualifies the AOD from having a voice for medical autonomy in Ontario.

The AOD’s insinuation or assumption that a TBC “manages labour or conducts the delivery of a baby” in contravention to the Controlled Act is an example of organisational ignorance, as no one has actually contacted me to find out what we do. Further, it’s inflammatory and fuels a political agenda that isn’t about women’s health outcomes but rather the AOD’s hopes for a regulated role within Ontario’s massive medical infrastructure.

Their inclusion of “there have been a number of serious incidents, including a death, in which the birther has chosen a non-Indigenous Traditional Birth Attendant/Companion” takes a page from the technocratic medicalised birth services industry’s playbook that excessively threatens their clients with a dead baby or a dead mother to gain acquiescence in lieu of informed consent or refusal. It was an abhorrent attempt to implicate non-regulated companions as being directly responsible for an adverse outcome. Given the extreme circumstances of the last few years, there have been an exorbitant number of serious incidents and deaths. And yet, there was no mention of the rate of adverse outcomes or deaths in the presence of regulated practitioners. The AOD can no longer claim any moral high ground when it comes to denouncing this tactic to bypass consent. They have learned how easy it is to play the ‘dead baby/mother’ card.

It's important to address their vague threat that “Legal entities may confuse individuals operating in this capacity as people working as unlicensed healthcare providers” along with mention of fines and detention. This confusion could be easily eliminated by careful statements that speak the truth. There is no confusion when the role of a TBC, as I have created it, is represented truthfully and accurately.

Their statement declares that “some” Indigenous communities reserve the use of the word “traditional”. Whilst this may be so for some communities, there is no consensus within the English language that limits its use to aboriginal peoples. Instead, it has a broad understanding to mean things that are not new, typical or normal for someone or something, or doing something for a long time for a particular group. The AOD has misappropriated the historical TBA and the current TBC into their political ideology that is an affront to both.

Modern technocratic medical maternity services are the result and technological iteration of Rockefeller medicine that gained a monopoly through the fraudulent Flexner report and oil money. Safer and saner alternatives exist and could be accessed by more families. However, existing power structures enjoy a monopoly and will not yield to women’s sovereignty and their alternatives. The AOD has come out firmly on the side of existing power structures in spite of their devastatingly high adverse outcomes, trauma, and postpartum suicide as a leading cause of maternal mortality. Their allegiance is with historical patriarchy, medical paternalism, and the ongoing bondage of women in childbirth to a medical model that will not change despite any delusion that they will work together with doulas to improve maternal care outcomes.

In fact, if there’s any lingering confusion about the actual position of the AOD, consider that they put out a call for snitches. The witch hunts never did end.

Despite statements like this from organisations who appear to want to appease oppressive systems for potential recognition or ‘credibility’, the real work to improve maternal outcomes is being done by ordinary women who opt for safer solutions so that more babies arrive safely and gently from healthy, empowered, and non-traumatised mothers. They are becoming more useful humans. The AOD misrepresents my work for political gain, but the women carry on. As we always have.

Birthing after Trauma – Seeing the Bigger Picture

It’s frustrating for care providers when their client comes armed with a 10-page birth plan, an army of doulas, and a mistrustful and hostile attitude. Care providers exist for the sole purpose of providing medical or midwifery services for pregnant, birthing, and postpartum clients and their goal is to help them emerge healthy and whole. Unfortunately, this creates friction before the relationship begins. 

A mistrustful client has probably already had her trust broken by someone else long before they come armed with the minute details of how they need things to unfold. They may have already experienced abuse, neglect, sexual assault, victimisation, and trauma. Their trauma might have been the result of an abusive childhood, racial adversity, marginalisation, being the victim of a crime, or it might have been the result of a previous traumatic birth experience.

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Me too

Recently, #metoo went viral as hundreds of thousands of women, and some men, said “me, too, I’ve been sexually harassed, assaulted or violated”. There were stories told for the first time. There were experiences re-told through a stronger voice. And in private forums, women told of rapes, childhood molestation, being drugged, and more. Some couldn’t post “me too” on their social media stories because they didn’t want their parents to know, believed they were partly to blame, or felt it was too exposing. One woman said she didn’t want the world to know she was “weak”. When asked, she said she wasn’t strong enough to fight off her attacker and she felt ashamed for it.

There were waves of trauma as some survivors found it too overwhelming to see the hundreds of #metoo’s across their news feeds and had to disconnect until it passed. It was not comforting to know they were not alone. It was horrifying.

And this isn’t just an issue of female looking or female identifying individuals being sexually violated. Men and boys are also sexually assaulted. Yet, from a cultural perspective, the response is different. Males are not told that “boys will be boys” or "girls will be girls" and they just normally like to grope and grab and hump and fondle males. Males are rarely depicted being sexually assaulted in music videos as a form of entertainment. They are not routinely asked what they were wearing, if they were out alone, if they went to a party, or if they were drinking. As a culture, we don’t victim blame males to the same extent that we victim blame females.

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The epic failure of the evidence-based movement

“All procedures offered to a mother should be researched by herself so she can make an informed decision.”  
(posted on Facebook on a thread about routine interventions)

 “Make sure you hire a doula.”
(said by everyone)

Why are mothers being told to do their own research, find out more about their provider and their hospital, check out the alternatives, and make sure they can make an informed decision?

The pipe on my hot water tank sprung a leak and I called a plumber. Not once was I admonished to check into the possible things he might do to fix it and to decide if it was evidence based or if I should switch plumbers. He did a good job because if he didn’t, it would get around, and no one would hire him again.

And yet, mothers are urged to make sure they find out for themselves the risks of ultrasounds, what the science says about postdates, the risks of synthetic oxytocin (Pitocin/syntocinon), whether an epidural can cause problems, whether Friedman’s curve is actually useful for deciding on a “failure to progress” or if it’s a tool for the hospital to manage their time and resources, whether an induction for a big baby is evidence based, or if their provider supports a VBAC and what the risks are between VBAC and a repeat c-section. And if nothing else, hire a doula. And on it goes.

What’s behind this push for families to do their own research into the routines and interventions of birth? I think it’s been the epic failure of the evidence-based movement.

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The Textbook is Wrong

We were sitting across her kitchen table. A tissue was being nervously mangled in her trembling hands.

“I just can’t do it again,” she said.  “Can you tell me about your daughter’s birth,” I asked her?

She explained that everyone told her it was a good birth. Her doctor said it was textbook perfect. Her mother was there and repeated her version of her granddaughter’s birth to everyone who would listen. It was natural. It was quick. It was the best day ever.

And as the story unfolded, tears welled up in my eyes, finally spilling down my own cheeks. It was an awful experience. And my heart broke into pieces again.

She described a birth where she was tortured with screamingly painful vaginal exams, weeping for them to stop, thrashing to escape the confines of the hospital bed where she was tethered to the monitoring machine for policy’s sake, begging to stand up, move, sway, anything to cope with her rapidly advancing labour. Her voice buried under a gentle shush so as not to scare the other mothers.

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