Effects of Devaluation of Childbirth on
Women's Self-Esteem and Family Relationships
By Gayle Peterson, Ph.D.
"You are stupid women! You have
nothing to prove. You're not a man!"
------ Comedian Carole
Montgomery, in reference to natural childbirth on
The Oprah Winfrey Show, 3/1/96
The experience of pregnancy and childbirth is uniquely
female. Not all women give or want to give birth. However women who do
give birth whatever the circumstances, are faced with the reality of one
of natures most powerful events. The fact that women can express
extremely negative or incredibly positive experiences of
childbirth is evidence of the generic power of the experience itself.
This most basic fact, that childbirth is a powerful force to be respected,
has been lost in the overall devaluation of the feminine in our society.
Women often feel alone with the responsibility of motherhood,
even when they have supportive partners. Mothers are criticized quickly
when things go awry in childrearing, while their positive contributions
go unsung. In fact, many aspects of female development remain invisible
to our culture at large. Childbirth is no exception. The message of
our society is that the experience of childbirth is unimportant .
Countless women have come to see me in my practice because
they could find no one to talk to about their childbirth experience. Their
psyches called out for an integration of this very powerful event, that
brought their babies into their lives, their hearts and their minds. But
they are questioned for their need to process it, as if the tremendous
physical transformation of a newborn emerging from within their bodies
were not significant enough to address. Their obstetricians often express
dismay that they should want to talk further about the experience for
any reason, because after all they have a healthy baby! Women are left
with the implication that to continue to have any need to discuss the
experience means they dont really care about the baby, or they have
missed the point of it all. Again, this is a way of saying that the experience
of giving birth should not matter to a woman. This gives women the message
that their own development does not matter once they become mothers.
To not take a womans needs seriously, is to contribute
to a lowered sense of self esteem which may also have effects on her available
energy for bonding and enjoying her baby, and may even contribute to postpartum
depression. Without a way to integrate the experience, women are left
to try to feel better by denigrating childbirth. This approach serves
the overall social structure which itself devalues the process. But in
the end it undermines a womans sense of the worth of her own significant
DEVALUATION OF FEMALE EXPERIENCE
Because our culture devalues that which is feminine, even
the most intimate and basic processes of womens lives become targets
for judgment. Our society encourages competition in every aspect of life.
Mothers themselves are exploited to compete with one another, making their
own birth experience a valid or invalid one, arguing whether the experience
of giving birth is sacred, beautiful and powerful or a denigrating process
to endure, even a worthless joke on women. Women comedians sarcastically
attack women who want to experience natural birth, You are stupid
women! You have nothing to prove. Youre not a man! It makes
for good entertainment, but this polarization distorts the continuing
problem of devaluation at the heart of our experience of womanhood. When
a mothers self esteem is undermined, family relationships suffer
as well. Perhaps it is possible for us to validate and share our female
experiences in a manner that would build rather than devalue a womans
sense of self.
Childbirth is and always will be a womans experience.
This does not mean that men are not participants, involved in the process,
but they do not undergo the transformation of physicality inherent for
their mate. For this reason, childbirth is feminine. It is an experience
of sufficient power to generate tremendous amounts of anxiety, fear, excitement
and anticipation. Labor is not by its nature, a neutral event. Our
experience of ourselves and our sense of personal identity is in constant
flux with our lifes unfolding. Because of the intensity of such
an experience as childbirth and all that it entails, it is one that will
help formulate a womans identity. Like any powerfully significant
event in our lives, it has the potential for mastery or c overwhelm, empowerment
or devastation. Getting trapped in a battle about the right way
to give birth or the right way to feel about your childbirth
experience misses the very real need to integrate the experience.
A woman needs opportunity to explore the relationship to her changing
body and identity as she becomes a mother, if she is to feel at all ready
for childbirth. There is no right method or experience. There is a basic
need to psychologically metabolize all that is happening!
DEALING WITH PAIN
Experiences of empowerment and beauty that also encompass
coping with pain threaten the status quo. Women may feel pressured to
lie about the pain to avoid being devalued in their own positive experience
of childbirth. This unintentional deception can leave subsequent generations
of women in our culture vulnerable to a recurring cycle of mystery and
inadequate information surrounding birth. When this happens, messages
recur which promise women the positive experience with no pain if they
adhere to a particular method. Though these methods do not succeed at
very high rates statistically, they fit the socially accepted value that
positive experiences should not include pain. Research has shown that
the best preparation in terms of statistical success for any method of
natural childbirth is a realistic one which includes an experience of
mastery in coping with pain. Why is it that we as a society have difficulty
accepting that something intensely difficult or even painful might also
encompass a feeling of power, beauty and ease?
Approaching childbirth is akin to stepping towards a mountain
range, assuming that what lies ahead is not the ordinary terrain you are
used to traveling. There is no way around it, it must be traversed somehow.
There are choices a woman has, involving preparation--- or not,--- experiencing
it by foot, by horse, traveling with friends,guides, supplies--or not,
and so on. Perhaps one woman plans to experience the trek by preparing
to hike the full way, with friends and guides by her side, learning how
to pace herself along the way and comes out on the other side feeling
empowered and exhilarated. Should we deny her the validity of her experience?
Downplay it because it isnt everyones experience of the journey?
Should we not celebrate her experience of her womanhood in this area for
fear of others jealousies?
Or pretend her own approach to the trek had nothing to
do with her resultant joy? Perhaps another woman plans to cushion herself
as much as possible from the discomfort, (maybe there are even stories
in her family of someone who died on just such a journey) and takes a
horse and carriage team, i.e., sedatives to help her relax through the
ordeal. Perhaps she will come out feeling the bruises and lacerations
of her journey, but without the empowering feelings or any connection
to the trek except for vague and painful sensations she endured.
Should we deny her the validity of her experience? Should
we feel guilty that we did not attempt to help her prepare for what faced
her? Or even ask what her associations to childbirth were beforehand?
Should we try to help her integrate the dissociated experience by talking
with her about it, or avoid discussing it altogether? Should we try to
make her feel better by denying the experience of the other woman? Or
devalue childbirth itself? How cruel it is for any one of us to judge
either woman or to pit them against one another in a failing attempt to
validate their own experiences of life. And yet this is what our society
does to women in the intensely private and feminine experience of childbirth.
We do not validate the experience of pregnancy and childbirth
as an event of unusual and provocative dimensions. In the mountain range
metaphor, we must accept the reality of nature, i.e., that the trek once
embarked upon is no longer a choice. Our choice lies in the freedom we
have in our approach to childbirth. But we do not come to this female
experiencepure. We come with inherited emotional baggage of
past generations and the legacy of female inequity in our social system.
PRENATAL CARE: A HOLISTIC APPROACH
There are a multitude of unrecognized factors which ready
or frighten us as we approach childbirth, such as:
- our experience of how we came into the world,
- our mothers and grandmothers experiences
- our relationships to our own mothers and fathers,
- our expectations about motherhood and the quality of
spousal and prenatal support at the time of birth.
How we visualize ourselves in the world after giving
birth can affect the labor . Childbirth is a journey towards motherhood
and the process of labor can be affected by any of the emotional factors
that impinge on this transition. What we fail to include in the delivery
of prenatal care in our society, is the fact of childbirth as a part of
a larger psychological transformation that is occurring in a womans
life when she becomes a mother. We do not treat the prenatal process as
one of family making, which it is. Prenatal care should include emotional
support through the enormous physical changes involved in pregnancy, the
birth, and the emotional aspects of becoming a family.
New roles, expectations, childhood experience all need
to be discussed throughout the prenatal period for a woman to not feel
overwhelmed with these changes at delivery or postpartum. This is particularly
true in this day and age of mothers working in and outside of the home.
Postpartum depression is in part a result of continued minimization of
the tremendous changes women experience in becoming mothers. Processing
feelings about the birth experience are an integral part of the postpartum
transition. When a child is born a mothers needs may be forgotten.
Support to integrate her experience of the birth, whether through celebration
or supporting her in any emotional recovery needed becomes insignificant
to those around her, and even to herself. It may not be until the childs
first birthday, that the woman recalls the event.
It is as invalidating to withhold celebration of childbirth
as an empowering feminine experience, as it is to insist that all women
should experience natural birth in order to be empowered.
Empowerment is a process. We must not confuse it with
an end product (i.e., medicated or unmedicated delivery, home or hospital
birth, etc.). A womans positive feelings about her femininity come
from a sense of support, acceptance and encouragement to express herself
as a whole person, in any way that contributes to her sense of well-being.
I have had occasion to witness womens empowerment by cesarean birth,
and I have seen women overwhelmed by the experience of natural birth.
The determining factor in a womans self-esteem is that they have
the opportunity to address their own emotional changes about becoming
a mother and the experience of their bodies in pregnancy, labor , birth
and postpartum. If this occurs, women usually feel good about themselves.
Predictably and paradoxically, when women address the
emotional aspects of their transition to motherhood their potential for
complications of labor is decreased. Anxiety and fears have been lessened,
and the body has greater resources available for adjustment to the labor.
When given the opportunity for talking about the emotional
aspects of their pregnancy, birth and motherhood, most women will tend
to make choices for childbirth that suit their needs. Their sense of empowerment
lies in their exploration of themselves. After all, they are giving birth
to a new identity of motherhood!
Overall, when women are assisted in learning about themselves
and the physical process they are undergoing , they come to realize that
even a choice of medication in labor does not entirely shield them from
experiencing pain in the process (contrary to widespread belief). It is
common for women to conclude that a natural or close to natural delivery,
if they are prepared with coping skills, is their most positive choice.
But what is key, is the process of turning inwards, not the type of childbirth
planned or had.
In the media and other segments of society, motherhood
and childbirth too easily become relegated to just one more performance
for women to validate themselves in a world in which they are invisible
in so many ways. Women are encouraged to describe their birth as a product:
a home birth or a hospital birth, a natural
birth or a medicated birth. The emphasis is not on the
woman as birth-giver: I gave birth at home, or I gave
birth in the hospital, or I gave birth with medication,
or I gave birth without medication or I gave birth by
cesarean. The womans experience of herself has gone from process
to product. Similarly, society does not value a mothers ongoing
nurturing , but labels her a good mother or a bad
WHAT CONTRIBUTES TO SELF ESTEEM IN BIRTHING
Research does show that childbirth experience has an effect
on womens self-esteem after birth and can impact her emotional availability
to her baby immediately afterwards. Giving birth will tend to be integrative
or disintegrative, depending on the support, preparation and acceptance
of her feelings before, during and after the birth. Her sense of maintaining
psychological wholeness throughout the labor, whatever the method or kind
of birth, is key to a positive sense of self.. Giving birth is
an experience of great magnitude. It naturally follows that the more intact
a woman feels emotionally, the easier it is for her body to adapt to the
intensity of the labor, as heightened amounts of fear can give messages
in some women for the brain to shut off labor. Self-esteem is a
part of health.
To support womens self-esteem through this very
important transition to motherhood, we must begin prenatally and continue
through the postpartum period. The only hindrance to addressing this is
the unconscious societal belief that this is not an experience
which warrants such attention. Perhaps it is missed because it is such
a common experience---this miracle that is pregnancy and birth---that
we forget that it is an incredibly powerful and unknown force in so many
ways. Perhaps we mistake the scientific ability to describe an
event for understanding its essence. It is not a question of positive
or negative experience. It is an issue of respecting women in their experience
of giving life, and making opportunities available in the course of their
prenatal and postpartum care to openly discuss the emotional and physical
changes they are undergoing, so that they can integrate the feelings involved.
In my clinical experience and research the main factors
in women feeling a positive sense of themselves no matter what kind of
birth they have are:
- that she feels herself to be an active participant
in the process, including decision-making.
- that she perceives her feelings throughout the process
are acceptable and that her caregivers support her free expression and
release of these feelings before, during and after childbirth,
- that she has been realistically prepared for labor
with a sense of mastery in her own coping skills
- that she is not perceived by others or herself to be
in control of the process, the baby or the outcome of labor;
- she is only responsible for doing her best to cope
with the power of contractions in whatever form she is experiencing
them. It is understood in the case of desire or need for surgical or
other intervention or medication, planned or unplanned prior to birth,
she is entitled to respect and supportive assistance in responding
to her physical and emotional needs;
- that she is given ample opportunity to express her
feelings about motherhood, including her experience of her own childhood
- that she is given ample opportunity to explore her
feelings and circumstances surrounding her own birth, her mothers
childbirths, and any previous pregnancy and childbirth experiences of
her own, and
- that she and her partner explore the childhood role
models of their respective parents relationships for intimacy, conflict
resolution and expectations for caretaking, with an eye towards developing
their own plans and values for their relationship as partners and as
WHAT CAN BE DONE?
These criteria can be met in potentially any birthing
situation, by sensitive caregivers and mothers who are able to take some
responsibility in their own preparation. How women choose to give birth
will be influenced by available support structures for doing so. Currently
our prenatal care is poorly lacking in addressing the very normal
emotional adjustments that occur in this period of the family life cycle.
Without any sense of importance placed on it, women are not supported
to integrate their childbirth experience. When childbirth has been traumatic
and no one is willing to talk about it, a woman enters the postpartum
period in a weakened emotional state at a time when her very identity
is in flux! This makes women and their families vulnerable to postpartum
depression and difficulty in the beginning stages of family development.
Emotions are physical. They effect and impact our physical
and psychological well-being. When emotional factors are included as a
part of routine prenatal care research has shown a decrease in complications
of labor and increases in womens self-esteem. One approach to answering
the emotional needs that are present for women at this time is to provide
3-4 hours of counseling that address these specific areas. I believe the
most efficient way to do this in our present society is to put an effective
form of brief term prenatal counseling into standard prenatal care. Prenatal
groups that are a part of the prenatal package could also be an extremely
inexpensive format for some of these discussions with partners.
These support services are really the core,
not the frills, of any prenatal care. What is important is to give women
the attention they deserve for the magnitude of the experience they are
undergoing. I do not believe that a few hours is an excessively expensive
amount to add to a prenatal care package. Particularly when the results
may contribute to decreased complications and increased self-esteem. Mothers
and families are worth it! It is an alternative well worth trying in the
prenatal services we deliver to families.
Is it too much to ask that women and their families be
supported in their childbirth experience, rather than set up to compete
and devalue one another in an effort to make sense of the power of birth?
Whether a woman gives birth vaginally, naturally or with medication,
or by cesarean, it is an event any one of us can help her accept and integrate.
It is an honor to be a part of this process that remains, despite all
that is said----an ordinary miracle.
Peterson, MSSW, LCSW, PhD is a family therapist specializing
in prenatal and family development. She trains professionals
in her prenatal counseling model and is the author of An
Easier Childbirth, Birthing
Normally and her latest book, Making
Healthy Families. Her articles on family relationships
appear in professional journals and she is an oft-quoted expert
in popular magazines such as Woman's Day, Mothering
and Parenting. . She also serves on the advisory
board for Fit Pregnancy Magazine.
Peterson has written family columns for ParentsPlace.com,
and the Bay Area's Parents Press newspaper. She has
also hosted a live radio show, "Ask Dr. Gayle" on
answering questions on family relationships and parenting.
Dr. Peterson has appeared on numerous radio and television
interviews including Canadian broadcast as a family and communications
expert in the twelve part documentary "Baby's Best Chance".
She is former clinical director of the Holistic Health Program
at John F. Kennedy University in Orinda, California and adjunct
faculty at the California Institute for Integral Studies in
San Francisco. A national public speaker on women's issues
and family development, Gayle Peterson practices psychotherapy
in Berkeley, California and is a wife, mother of two adult
children and a proud grandmother.
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