Book Review: The Sacred Gift of Childbirth
Many books teach and focus on the health and safety of giving birth, from comfort techniques to medical procedures. But few delve into God or His principles and plan for women. Childbirth offers a unique benefit from many divinely designed blessings–spiritual, emotional, and physical. The Sacred Gift of Childbirth: Making Empowered Choices for You and Your Baby empowers women with valuable information that allows them to make informed decisions about birthing.
In this book, Marie-Ange Bigelow explores that spiritual connection and asserts several ways that she believes childbirth can bring women closer to God. She argues that rather than being feared, childbirth is “an event that should be celebrated with gratitude” and an opportunity to partner with God and strengthen our relationship with our Heavenly Parents. She first lays out “God’s Plan for birth,” then moves on to describe how birth has been increasingly medicalized within the U.S., offers factors to consider in making decisions for an upcoming birth, and then concludes with how a woman can best be supported before, during, and after her birth.
Our bloggers decided that this book needed more than one reviewer. Liz, a doula, hoped to find a uniquely Mormon take on childbirth. Libby, who had three medically-necessary cesareans, hoped to find an affirmation of the spirituality she felt in her decidedly non-traditional births.
As a birth doula and Mormon woman, I have spent a lot of time pondering the spiritual aspects of childbirth. There were several sections in this book that I really liked. I particularly the passages where she discussed how birth can be empowering: “Some of our greatest moments of pride and accomplishment come after we have worked hard for something.” I think this can be applied not just to childbirth, but to any time women do hard things and emerge victorious, whether it’s giving birth to a baby, finalizing an adoption, defending a dissertation, and/or nailing that high-stakes presentation at work. She highlights scriptures where birth is used as an analogy to Christ’s atonement, and how pain can be “one of life’s greatest teachers” if we let it. She highlights the bonding that can happen between mother and baby, mother and partner, and mother and God during childbirth. Her chapter on the role of husbands during birth was particularly helpful on this front; she spends several pages explaining how important it is for husbands to support–not manage–their wives during childbirth. She even lightly touches on how men are culturally accustomed to presiding and making decisions in relationships, but that the most important thing they can do during childbirth is to encourage, assist, and believe in their laboring wife: “as spouses, being equally yoked is beneficial during birth.” Having witnessed many births (including un-medicated, medicated, and cesarean births), I can add a hearty “amen” to the power of women being supported, encouraged, and empowered to make decisions during childbirth.
That said, I do have two critiques of the book, one minor and one major. My minor critique is the author’s repeated emphasis on childbirth being The Divine Role of women on Earth, equating motherhood and priesthood in a way that I think is doctrinally inaccurate or incomplete. I know many women whose bodies are unable to carry a pregnancy and/or give birth, and to dismiss them as simply aberrations to God’s plan with no capacity to fulfill their divine role is hurtful and causes many women to wonder if they have a place in God’s kingdom as a woman. Additionally, I think suggesting that a woman’s principal role is motherhood is limiting, because there are plenty of women who don’t experience pregnancy, birth, or motherhood, and who participate in the building of Zion and doing good on Earth in a way that both glorifies God and shows divine nature and worth. I wish the language in the book had been less prescriptive of all women fulfilling their divine role through motherhood.
My major critique of the book also has to do with prescriptive language: the author repeatedly prescribes natural birth as God’s plan and the “best” way to give birth. While she does give the occasional carve out for requiring medical assistance (“the divine design of childbirth is perfect, but our bodies are not”), there is an overwhelming bias towards natural birth being the optimal way to experience childbirth. She argues that if Eve can give birth naturally, so can you, and outright says that she “believe[s] in natural childbirth and encourage[s] all low-risk women to have this as a goal.” While I agree with the author that medical interventions are often pushed upon women without full education as to the risks/benefits, and that there is a predominant culture of fear surrounding birth that may affect a woman’s decision-making surrounding her birth, I am strongly opposed to suggesting that natural birth is the best way to give birth. There is no validation given for women who simply want a pain-free or cesarean birth, but instead an insistence that God designed natural birth and that is the best way to grow spiritually during childbirth. Having witnessed many women who feel empowered, strengthened, and spiritually edified during and after medicated and/or cesarean births, I simply believe that natural birth can be one empowering way to connect with God, but definitely not the only way. I would also argue that just as God designed the human body to give birth, God also inspired scientists and obstetricians to perfect various interventions that, while generally overused in the American medical system today, have saved countless lives and are incredibly helpful to women who choose a medicated or cesarean birth.
Overall, I think this book can be incredibly helpful to women who have already made the decision to have a natural birth and are looking for affirmation and support. I don’t fault women who choose this path: I chose it myself! But I also think it’s crucial to carve out space for women to have a spiritually uplifting and empowering birth experience with the use of medical intervention, as well as space for women to experience spiritual connection through avenues other than pregnancy, childbirth, and/or motherhood.
The title would seem to say it all. Marie-Ange Bigelow’s The Sacred Gift of Childbirth drives home the simple, and to her largely LDS audience, obvious, point that childbirth is important and transcendent, a gift of God to women. If you’ve had easy natural births, easy transitions into motherhood, and are looking for a book to confirm your convictions that childbirth is sacred and natural childbirth is the One Best Way to birth babies, you may find it uplifting.
The rest of us probably won’t.
Bigelow’s repeated insistence that natural childbirth is God’s plan for women is more than tedious; it creates false and dangerous expectations for Mormon women and their babies, effectively setting up many women to “fail” at childbirth or, worse, refuse life-saving medical care. Moreover, her invocation of LDS General Authorities’ opinions about gender roles and family planning allows for no variations from anything but the most idealized (and idolized) of Mormon families, which is likely to alienate many of the people she hopes to reach.
It’s difficult to know exactly what God’s plan is about many things, and childbirth certainly falls into that category. There’s little scriptural guidance aside from “be fruitful and multiply.” Digging into the history of childbirth further complicates things: in 1900, for example, the maternal mortality rate in the U. S. was somewhere between 600 to 900 per 100,000 births (with approximately 1 in 10 babies dying in their first year of life). After more than 100 years of significant public health initiatives and medical breakthroughs, that rate was down to about 28 per 100,000 births in 2014. Dare we make assumptions about which number better reflects God’s will?
Bigelow points out that the maternal mortality rate was even lower from the 1970s to the 1990s–just 6.6 in 1987–and links the rise since then to increased maternal choices about cesareans, epidurals, and inductions. Yet Priya Agarwal of the World Health Organization, looking at the same numbers, identifies three major risk factors. The first, she says, is that “[h]ospitals across the USA lack a standard approach to managing obstetric emergencies.” Second, poor health management and chronic health problems–an unfortunate byproduct of our failure to ensure accessible, affordable medical care to all citizens–mean that more women in the U. S. begin pregnancies with preexisting health problems. Third is a business management truism come to life: that which is measured improves; that which is not doesn’t. “Only half the USA’s states have maternal mortality review boards,” Agarwal writes, “and the data that are collected are not systematically used to guide changes that could reduce maternal mortality and morbidity.”
Are elective cesareans a problem? Certainly. But does that problem stem from individual women’s insistence on convenience? Likely not.
Bigelow also frowns on lesser forms of intervention. She links epidurals (correctly) to higher use of Pitocin, higher risk of breastfeeding problems, and decreased maternal satisfaction with the birthing process. Again, however, we should be wary of equating unmedicated birth with God’s plan, just as we would be leery of setting a broken bone or undergoing necessary surgery without the benefit of anesthetics. Bigelow counsels, “While we are now able to choose an optional intervention, we are never able to determine the consequence of that choice. And because all interventions carry potential risks, the only way to keep childbirth safe is to learn how to decipher when the benefits outweigh the risks.” Here, however, she declines to mention that a less painful childbirth might indeed be a benefit that outweighs the slight risks of complication. Instead, she tells mothers-to-be, “[I]f avoiding pain is the number one goal of your birth, you will not be satisfied with the recommendations I offer.” Guilt-trip induction complete.
Her general distrust of the medical profession brews throughout the book. Despite the extreme cautions that obstetrics researchers take (a policy that has actually slowed our understanding of some perinatal complications), Bigelow writes, “In between the implementation of new interventions and the completion of research to determine their effectiveness and safety, there will always be women experiencing unknown side effects. . . . Couples will put their trust in unproven methods, making these methods socially acceptable and approved of.” While she’s careful not to dismiss cases that legitimately require intervention, she clearly considers even accepting an epidural (something that 80 percent of women in the U. S. opt for, and which nearly all medical practitioners consider to be safe) to be a mere convenience that a truly enlightened mother would eschew: “When deciding if you desire an epidural, it is important to remember that the discomfort of labor is not a risk. Experiencing the pain of contractions actually makes your birth safer. However, for many women, the pain involved is a definite con. For this reason, I encourage women to weigh the benefits and risks, not the pros and cons.”
This is not to say that I’m anti-natural birth. When I was diagnosed with preeclampsia during my first pregnancy, landing in the hospital meant that I missed the last two weeks of natural childbirth class. I didn’t have a choice about interventions; cesareans saved my life and my babies, and while I’m grateful to be alive I mourn the childbirth experiences I might have had if things had been different. I think every woman should have the option of natural childbirth if it’s safe for her to do so. But I’ve also seen that pregnant women tend to consider their babies’ well-being before their own (hands up if you’ve gone off medication during pregnancy, lived through mandated bed rest, or downplayed your own medical concerns for fear they would trump your child’s), often to their detriment. By advocating solely for the ideal outcome for baby, Bigelow ignores the very real strides we’ve made in caring for mama. The story she relates of her sister, who was determined to breastfeed despite extreme pain, gives us the impression that bottle-feeding is somehow a less righteous choice, and fails to mention recent studies, controlled for parents’ socio-economic levels, that find little difference between breast-fed and bottle-fed babies. Her insistence that mothers sacrifice everything for their babies doesn’t allow for us to lean in to natural childbirth partway, nor does it acknowledge the scriptural caveat that “it is not requisite that a [woman] should run faster than [s]he has strength.”
The best chapter in the book by far is on post-partum depression. Bigelow gives us a very real look at the frequency and depth of PPD, and urges Mormon women to reach out for help rather than sticking it out on our own. If there is anything to take from this book, please remember this:
Many women with postpartum depression do not share their experiences with others. Imagine how difficult it would be for an LDS mother to admit that she does not enjoy being a mother. She may feel ashamed or worried that others will judge her. It is isolating to feel like the only woman who isn’t happy since she became a mother.
. . . I want to be clear in stating that Satan and sin are not the causes of postpartum depression, and all women are susceptible to this trial. Struggling with depression is not a sign of unrighteousness.
Well, thank goodness. Unfortunately, she spends much of the rest of the book shaming women who have made birth choices other than natural childbirth; just a few pages earlier, her disapproval shows through clearly as she attributes a mother’s disengagement with her child to the medical interventions involved in the birth:
I remember a particular birth in which the mom was so disengaged with her baby that when the nurse asked her if she wanted to hold her baby before they took him away to wipe him off and perform a newborn assessment, the mom said, ‘No, I just really want a milkshake.” . . . [T]hink about that: a woman who has carried a child for nine months, has anticipated his arrival, has wondered what he would look like and what color his hair and eyes would be, isn’t even interested when she finally gets to see him.
I’m concerned that Bigelow attributes this effect to medical intervention rather than exhaustion or depression. She’s prone to conflating the two, suggesting throughout that the higher instance of PPD rates among women who have medical interventions are the result of those interventions. But it just isn’t so: correlation does not equal causation, and there are alternative explanations that make more sense, beginning with the fact that medical intervention typically occurs when mothers are already under undue stress or babies’ lives are in danger, and including the observation of a nurse in the ante-natal unit at Brigham & Women’s Hospital, where I was placed on bed rest before the birth of my last child, that the most significant predictor of post-partum depression seemed to be ante-natal depression, which can be triggered by a high-risk or otherwise difficult pregnancy, itself in turn more likely to require medical intervention. Life–and giving life–is complex and difficult; telling us that we’re doing it wrong just makes it worse.