Bridging Ancient Wisdom and Modern Medical Technology
Welcome to 2025. It feels a little wild to be writing that. It’s a strange time to be alive. Like many of you, I’ve spent a lot of time over the past weeks reflecting on 2024 and thinking about where I want to go over the course of the next year. For me, 2024 was a year of major changes. I took a leave of absence from my PhD program to start my doula business, I attended my first doula births, I met many incredible people who I hope to stay connected to for years to come, and I made the decision to move back to Calgary with my husband and our cats to start a new chapter in our family life. It was a hard year in a lot of ways too. I said goodbye to some important relationships, I navigated ongoing health and fertility challenges, and – like everyone – watched a lot of scary stuff unfold in the world. Forefront on my mind has been the re-election of President Trump and thinking about what that is going to mean for the reproductive rights of our neighbours to the south.
It’s this, in particular, that is on my mind as I write this blog entry today. We deserve better protections for our reproductive rights. And, sometimes, when the powers that be cannot be trusted to protect us, we must protect ourselves. Part of this strategy is advocacy: advocating for protected access to health care, working to make that health care more suitable and responsive to the needs of folks with wombs. Another part of that strategy is collective education: we need to know our bodies, know how to tend them, and how to draw on what is within our own power to get our needs met. We need to find a way to draw upon ancient wisdom about supporting birth to empower ourselves while also strongly advocating for equitable health care access for all, from access to contraception and abortion care, fertility treatment, and into the birthing time. I’m a strong believer in the both/and approach.
Too often, birth spaces become highly polarized ones that become either/or – either you believe in and support the use of medical technologies in birth OR you believe that the bodies of birthing people are innately powerful and require no intervention. Of course, I know many incredible practitioners who understand the delicate balance between the two, but the messages we receive on social media are often skewed toward extremes. Extremes get a lot of attention. However, I have noticed that these extremes – on either end – are loaded with moral baggage that tells birthing people there is a ‘right’ way to birth their babies and that to do otherwise makes them bad parents and bad people. I’m a firm believer that we need to step away from the moralization of birthing people to take a more balanced approach. What and under what circumstances are different approaches to birth useful? How do we promote reproductive justice as birth professionals?
I want to be clear: both ‘extremes,’ as I’ve labelled them, have something to offer. Both perspectives offer insights that can be valuable and are worthy of consideration, while also having their pitfalls and ways that they can contribute to harm. My goal with this post is not to write them off or anyone who advocates strongly for one or the other. My goal is to think about both in a more nuanced way so that those of us who are birth professionals can do a better job of showing up for our clients no matter how they choose to birth. Without further ado, let’s break these down:
Extreme Physiologic Birth Advocacy
If you spend enough time on the birth side of Instagram, you’re bound to run into accounts that promote a somewhat extreme narrative about physiologic birth. By physiologic birth, I’m talking about births that are unmedicated, receive no intervention from medical professionals, and are sometimes not even attended by medical professionals. These accounts, which highlight all the ways in which birth is a powerful and natural process that the human body is well designed to undertake, do get a lot of things right. They identify harms that are caused by the medical model and medical professionals that do need to be acknowledged. For too long, conventional medical treatment of birth has overridden the desires of birthing folks, neglected informed consent, and eschewed the rights to bodily autonomy. A significant proportion of birth trauma is attributable to obstetric violence. This is an essential conversation for those of us in the birth space to be having if we want to improve the birth experiences of those we work with. These accounts also celebrate the capacity of the human body and promote a deep understanding of the natural physiologic mechanisms that make pregnancy and birth possible. And it is absolutely true that possessing this knowledge better prepares us to support more easeful births, sometimes preventing interventions by enhancing what the body is naturally capable of doing with the right support. These accounts also promote a trust in oneself and the birth process that, under the right conditions can be empowering and liberating for birthing people.
However, they can also marginalize the experiences of birthing people that do not fit within the desired narrative of natural birth. For instance, these accounts often assume that birth trauma is caused solely by medical professionals. In truth, sometimes issues come up in birth that require medical intervention to save the life of the birthing person and/or the baby. Any pregnant person who has received lifesaving care or any parent who has medical technology to thank for the survival of their child is likely to feel left out of this perspective altogether – perhaps even feeling stigmatized. If bodies are innately capable of birth, why did my body need help? Why couldn’t I do it on my own? Further, sometimes people choose to use certain medical interventions – even ones that might seen ‘unnecessary’ by outside observers – for reasons that are important to them. I have heard plenty of stories of people who chose elective caesarian births because of significant birth trauma at a previous vaginal birth, or people who know that the use of pain medication is important for them to feel safe in their body throughout birth. Strong advocates of physiologic birth disparage these choices without really understanding them. Finally, these accounts sometimes spread misinformation and promote practices that may endanger birthing people and their infants.
A newborn is placed on a scale to obtain their birth weight.
Extreme Medicalization of Birth
On the other end of the spectrum, we have people who strongly advocate for medical control of birth. These people come from the perspective that birth is inherently a dangerous or risky activity to both the birther and the infant, and that medical oversight is necessary to minimize risk and ensure positive outcomes. The aim is to improve outcomes for both the birther and the infant using available medical technology. In truth, effective medical care helps to prevent infection, reduce and treat postpartum hemorrhage, and can intervene in other complications that occur for the birthing person. Medical technology has also provided means through which we can minimize the discomfort experienced by the birthing person during a very intense, embodied experience. And while people may argue that these things aren’t always necessary, I for one am grateful these tools are available if/when they are needed. Modern medical science does play a significant roll in reducing maternal and infant mortality. In countries and remote areas where access to medical providers is very challenging, we do see higher rates of stillbirth and maternal complications.
However, it is also true that assigning the power and authority over birth to medical providers can be disempowering when it removes choice and bodily autonomy from birthing people and disrupts natural processes that support healthy birth and infant outcomes. For instance, approaches that assign significant control to medical authority may result in early cord clamping, disruptions to skin-to-skin and breastfeeding, and the use of pharmaceuticals that affect post-birth adjustments. Additionally, conventional medicine may encourage the use of practices that directly counteract physiologic mechanisms that promote birth – for instance, insisting that people labour in bed, labour and birth on their backs, avoid eating or drinking during labour, etc.
The Middle Ground
What if there was a way to combine the best of both approaches while leaving behind the harsher side effects? For me, the wisdom of experience acknowledges that a combined approach that pulls appropriately from both bodies of knowledge in a way that meets both the birthing persons needs and whatever circumstances arise during birth is the ideal approach. People need to be empowered to enter this life-changing time, knowing they have tools and resources to support them to step into their power and to be truly held by a community of people that can step into assist them if and when needed. Each person’s experience and needs is going to be different. And yet, as doulas I think we are uniquely positioned to see the best of both approaches in action. If I were to develop a ‘wish list’ of what I wish I could pull from each, here are some things I would include:
Access to knowledge about physiologic birth and preparation techniques that can assist people’s bodies to do what is necessary to birth with greater ease (ex: muscle releases, joint mobility, physical strength and endurance, labour and birthing positions)
Mental, emotional, and spiritual practices that help to hold space for the intensity of labour and birth (fear, discomfort, uncertainty, letting go, trust).
Birthing communities where people are exposed to labour and birth long before it is their time and where members of the community step forward without needing to be asked to care for one another throughout the perinatal transition.
Access to appropriate prenatal medical screening for all birthing people (ex: people in remote communities often lack appropriate access to ultrasounds and other diagnostic technologies needed to improve health outcomes).
Access to midwifery model care as baseline perinatal care with well-qualified obstetric and maternal-fetal medicine specialists acting as consultants as needed (including access to caesarian births, NICU care, etc.).
Choice of birthing location that suits the birthing persons needs and desires (home birth, birth centres, and hospital births).
Access to pharmacologic pain management as needed and desired by birthing people.
Pregnancy and infant loss care that BOTH: 1) destigmatizes loss and recognizes death as a natural part of the human experience, AND 2) applies scientific and medical knowledge to investigate the cause of loss and how it might be prevented to improve future outcomes.
In truth, while I think that we have a ways to go before something like this is possible within our current system, I have a lot of hope that we will see changes in the near future. When I lived and worked in Halifax, I got to watch the rollout of birthing pools in the maternity hospital there. I watched nurses, midwives, and doulas rally together to talk about birth trauma and how we improve birthing experiences for future parents. Now as I find myself supporting clients in a new city, I look forward to learning the ways that we are showing up for birthing people and what opportunities lie ahead to find approaches that truly empower birthing people to step into this transition with hope, comfort, and community care.