Rhea Dempsey is an educator, trainer, doula, counsellor, speaker, author and birth activist. Her book Beyond the Birth Plan: getting real about pain and power focuses on the importance of prenatal preparation in protecting against postnatal depression.
Is there a moment you recall that shaped your own idea of feminism?
More a series of moments. In the early sixties when I was thirteen in a small country town and my mother, who was pregnant with my much younger sister, reluctantly dropped out of public life due to social mores of the time. When I read Germaine Greer in 1970. When, in the early seventies, before my rite of passage overseas trip I was refused the pill by three GPs because I wasn’t married.
Perhaps the most defining moment, certainly for my work, followed the birth of my first baby. Hers was a far cry from the ‘natural birth’ I intended. I was assured by the obstetric team during pregnancy that they only did episiotomies ‘when medically necessary’. Then, after my distressing birth experience, which included an episiotomy, I asked the women around me in the twelve-bed postnatal ward if they too had had episiotomies. I found that ten women had received episiotomies and the other two had caesareans. This finally provoked that fundamental feminist question—what the fuck is going on here? The treatment I received during my daughter’s birth—which I have now come to see was what is termed ‘obstetric violence’ in a power-over structure—radicalised me, and my birth activism has continued over these forty-odd years and with even greater urgency now I’m a grandmother.
Feminism absolutely underpins my work. When birthing women’s autonomy, birth plans, and human rights in childbirth are disrespected or trammelled by power over behaviours and these violations are not seen as being related to broader power-over #metoo issues and called out as obstetric violence – this is a feminist issue.
You’ve been working with women for many years—what has changed over that time around childbirth—medically speaking, but also in our approaches?
By the time I was having my babies back in the late 70s, after decades in which women were drugged with chloroform and ‘twilight sleep’ and had no memories of their baby’s birth, those of us working with birthing women were reclaiming the kind of physical and emotional support that women through the ages had received from those around them during pregnancy and birth: breathing with the woman, offering massage, holding, soothing words of encouragement—what midwives refer to as being with woman.
When epidurals were first introduced, we natural birth advocates welcomed them in because we could see how wonderful they would be as a pain-relief option in medical emergencies for women needing forceps or caesarean sections. But we were naive about the ramifications. Firstly, we didn’t know much then about the ‘epidural cascade’—the increased likelihood of subsequent medical intervention when you have an epidural. And secondly, we did not anticipate the way that, as epidurals became more and more routine, all those other ways of supporting women would be displaced and downgraded. Routine epidural use now stands in for emotional care in most standard hospital settings and the problem with this is not just the cascade of interventions, but also the longer term impact on women’s postnatal wellbeing.
Linked to our routine epidural use is also a ‘pity’ mindset, in which, instead of recognising the powerful efforts of birthing women, whose bodies are working at peak-performance levels, we instead want to ‘save’ them from the pain. Women should have the choice over what happens to their bodies; my problem with our current birth system is that this pitying frame, combined with ‘power over’ maternity structures and non evidence-based routine interventions means that in practice women do not actually have much choice.
How far has birth come away from women and how do we get it back?
Our stats tell the story of the hijacking of women’s birth intentions. The research shows that the majority of women still highly value normal birth, yet in teasing out our national birth statistics, we see only a tiny number of births actually unfold without intervention. The World Health Organisation suggests no country in the world should have a caesarean rate above 10% for example, yet Australia’s is 35%. There is certainly pushback—fuelled equally by women wanting to claim normal birth as an empowering rite of passage, as well as by researchers and organisations the world over, due to the downside of all these unnecessary interventions.
At present, hospitals continue to use routine protocols that have been widely debunked (by the WHO, Lancet and researchers around the world), such as continuous electronic fetal monitoring, outdated timing protocols, supine birth. Far from improving outcomes for mothers and babies, these routine protocols in fact trigger the ‘cascade of interventions’ that then so often lead to the need to finally save the baby.
We need to dispel the widespread misapprehension that birth is inherently dangerous. The dangers are real, but with the right environment and support they are rare. We should have a system that supports normal birth, and is able to provide the best that modern medicine has to offer in those rare times intervention is actually necessary.
Essentially, in the right environment, with the right support, most women can birth the way they want. To get birth back, women need to demand the environment and care that supports their birthing capacity. To have enough women doing that, we need education. This is what drives my work.
What do you hope pregnant woman and their partners take away from Beyond the Birth Plan?
Many birth books are descriptive ‘stages of labour’ books, ‘how to’ books. Women tell me my books give them the bigger picture: the social, cultural and maternity-system factors that are stacked against normal birth, that leave them traumatised or disempowered, and how these factors affect all women, even those who are not planning on normal physiological birth.
Births occur in a context. When women understand this wider context they make more educated, savvy choices to support the birth they want. Essentially women learn that they will have to actively question and challenge the status quo.
Part of this is just understanding what happens on a hormonal level during normal labour (the process I call the evolutionary regression). When you know what’s happening, what it looks like and what interferes with it, you can better understand how so many births go awry in our present system.
I hope my book gives woman and their partners an understanding of why it is not enough simply to write what you want for your birth down in a birth plan and then wait and see and hope. It is all about the external choices that will best support you, and the inner emotional work that can inform and support these choices.
Could you share some feminist recommendations; which authors, books, podcasts, social media, are you reading, listening too, following right now?
Books: Milli Hill Give Birth like a Feminist, Rebecca Schiller Why Human Rights in Childbirth Matter, Liz Newnham et al Towards the Humanisation of Birth: a study of epidural analgesia and hospital birth culture, Jamila Rizvi (Ed) The Motherhood, Petra Bueskens Modern Motherhood and Women’s Dual Identities
Twitter: Hannah Dahlen @hannahdahlen, Bashi Hazard @bashazard, Sheena Byrom @sheena_byrom, Caroline Homer @CarolineHomer, Sarah Buckley @SarahJBuckley,
Facebook: Rachel Reed @midwifethinkin, Dr Rebecca Dekker @EvidenceBasedBirth