When mainstream media reported that a pregnant person had become “the laughing stock of a group of top US obstetricians”, what they didn’t understand was that they were witnessing an attitude that is foundational to the behaviors identified as obstetric violence. As those US obstetricians attending the annual meeting of the American College of Obstetricians and Gynecologists (ACOG) responded to their UK counterpart’s ridicule of Meghan Markle’s birth plans with “raucous laughter”, they were once again making clear their lack of respect for the autonomy of the birthing woman, their complete lack of belief in the power of birth, and their unwillingness to understand that well-educated families are demanding safe options, including midwife-led community birth.
And then, in such lovely juxtaposition, there was Prince Harry, a new father looking a little tired, with that so typical expression we see on the partner’s face who has just witnessed not just the birth of their child, but the transformation of the mother of that child as she internalizes the power of birth. His words in the announcement of the birth showed that he, unlike those laughing obstetricians, got it: “How any woman does what they do is beyond comprehension”.
That simple sentence sums up the experience of witnessing the sacredness and power of birth. Those few words sum up the understanding that a woman in her birthing power is a force of nature and certainly not something to be ridiculed. That new father’s words and expression of delight were a salve on the wound wrought by ACOG.
The setting of this royal fairy tale birth story, of course, comes with the recognition that this particular birthing family had the resources to make very informed choices and had access to the options to make those choices available. They had privilege and power on many levels making it possible for them to insulate themselves from the obstetrical profession’s judgment of their choices in a way that most families can’t. Most importantly, they had the ability to balance the decision-making power between themselves and their providers in a way that we know improves outcomes. What Meghan couldn’t insulate herself from entirely was the effect of institutional racism that impacts health outcomes in both countries.
The United States is in a maternity care crisis as highlighted by the award winning ProPublica series “Lost Mothers”, which takes an in-depth look at preventable deaths within the US maternal health care system where over 99% of births are occurring in hospitals. With the highest maternal mortality rate of all high resource countries, the USA is the only similarly resourced country with a rising maternal death rate. Black and Indigenous families, in particular, bear the burden of institutionalized racism in our failing maternity care system, suffering 2-3 times more maternal and infant deaths than their white counterparts. ACOGs lack of accountability for their contribution to these outcomes is another clear example of institutionalized obstetric violence. Franka Cadee, president of the International Confederation of Midwives, recently stated: “I urge midwives to stop being well behaved and to take on their duty to advocate for women’s rights to a good birth”.
The Midwives Alliance of North America is responding to that call to advocacy. It is time to bring ACOG to task for their continued misogyny and disrespect for birthing families because to do otherwise is to be complicit in their continued mistreatment at the hands of a system that has shown us through poor outcomes that it is failing us. It is time for the power in decision-making to be recognized as belonging to the birthing person and their family if we are going to turn our broken maternity care system around. It is time for community birth to be integrated into the system in a way that understands that supporting physiology rather than managing it is the true gold standard. It is time for midwives to take their rightful place on the birth team, regardless of credential, and to stand together for birthing families. May we all stand as witnesses to the sacredness and power of birth.
Author: Sarita Bennett, MANA Vice President
Reprinted with permission of the author. Originally published at: https://mana.org/blog/royal-baby-and-acog-response