Heating Up The Birth pool: Why We Have To Help Each Other Out

There is more than one kind of freedom,” said Aunt Lydia. “Freedom to and freedom from. In the days of anarchy, it was freedom to. Now you are being given freedom from. Don’t underrate it.”

― Margaret Atwood, The Handmaid’s Tale

I’ve been watching season 5 of The Handmaid’s Tale again recently, in preparation for the much awaited season 6 and reflecting, yet again, on the many and varied ways society controls women and birthing people.

Let’s look at the facts for a moment: Since 2020 the rate of induction has skyrocketed, with many hospitals inducing over half of people using their service, thus contributing to the increasing rate of birth trauma and PTSD. Cesareans have increased too, with their ripple effects of mental health issues, breastfeeding challenges and physical health risks to both parent and child.

There are reported to be 2,500 midwifery posts vacant in the NHS, but this doesn’t take into account the large number of midwives on long term sick leave, caused by the stress and moral injury the system inflicts on them. It also doesn’t take into account the fact that midwifery has an ageing population, with midwives retiring faster that we can replace them. This means that young, newly qualified midwives will lack quality mentoring or have the influence of older midwives who remember what physiological birth even looks like. Meanwhile, after initial big talk and promises, less than half a year after taking power, the Labour government has slashed funding to maternity care, despite being made painfully aware of the suffering and death being caused by the shattered system.

All this medicalisation has been done in the name of safety. In Gilead they say it is God’s Will that justifies rape and torture. We are told to shut up and put up for the baby. The pinnacle of Patriarchy’s aspiration for us is to keep us alive. Doctors tell our partners that ‘they wouldn’t let their wife’ make such stupid choices.

All we need now are our white caps and red cloaks.

Yet all this, if done in the name of ‘safety’, isn’t actually achieving anything. After a small decrease in the stillbirth rate in the early 2000s, it has hovered at the same rate ever since. Even more concerning, the maternal death rate is increasing. According to the National Perinatal Epidemiology Unit between 2020 and 2022, the maternal death rate was 13.56 per 100,000 maternities, a significant rise from 8.79 per 100,000 in 2017–2019. Even when excluding deaths due to COVID-19, the rate remains higher than in previous years.

According to the MBBRACE report, in the 12 months following the birth of a baby the most likely way for us to die is at our own hand. The system is literally making us want to erase ourselves from the face of the earth.

There is lots of focus amongst birth activists on the fact that the maternity system attempts to process us on a conveyor belt of ‘care’ that ultimately coerces and controls us. The usual call to action is a reminder that women and birthing people hold all the cards – we have the human rights so all we have to do is say no, step off the conveyor belt and build our own birthing reality.

But is it really this easy? Why do the handmaids wear their uniforms? Why do they submit to monthly rape and allow their babies to be torn from their arms? In the story, it’s easy to see how the threat of violence and the very visible punishment and murder of their sisters keeps the handmaids compliant, but what makes us toe the line within the maternity care system?

Any birthworker will tell you that many people just don’t want to rock the boat. The fear of punishment is real. We like to tell people it’s not real, but look around you; the maternity system can be so controlling because the wider system shores it up.

If you are a mother who has social services involvement, you will literally be told to do as you’re told by the obstetric system. Attend all your appointments, do not make choices against guidance, birth in hospital ‘where it’s safest’ or you risk being accused of not having your child’s best interests at heart. When you’re fighting to keep your child, social workers can be Gilead’s Eyes, watching, judging and reporting back.

If you are poor, if you don’t speak English, if you are Black or Brown, physically disabled, neurodiverse, mentally unwell, in a violent or controlling relationship, single with other kids to care for, mired in pre-existing trauma or just scared out of your wits, it’s just not as simple as doing your research, making informed decisions and stepping gracefully sideways.

It’s not just the maternity system that coerces and controls us. It’s society. It’s the whole, bloody edifice, designed and built to keep the handmaids in check. And how incredibly efficient it is at this task: 98% of us still walk into hospital to give birth, most either by ‘choice’ or because we have been manipulated into it, hoping or believing the system will keep us safe. Meanwhile, the minority who truly need medicalised care, or truly want it for themselves, are poorly served and often harmed by a creaking machine that is held together with sticky tape and unpaid overtime.

In Margaret Atwood’s story she beautifully portrays how differently the handmaids react to their situation. Some run. Some fight and some tend and befriend their captors. How we react depends on our personalities, capabilities, past experiences, endocrine systems and a whole host of other variables. We can’t judge each other for the way our minds try to keep us safe, especially during pregnancy and birth when we are much more sensitive and suggestible.

This is not a new situation. The water has been heating up for decades and those of us who have spoken up have been painted as mad and sad; hippies touting a natural birth fad. But we are being proved right. What might feel like the warm water of safety has lulled a lot of people into a false sense of security.

As Margaret Attwood says in The Handmaid’s Tale:

“Nothing changes instantaneously: in a gradually heating bathtub you’d be boiled to death before you knew it.”

So it’s not enough to wake up and save ourselves. The system has to improve to save those who can’t get out of the boiling birthpool by themselves. We are being sold Aunt Lydia’s lie that the system is giving us freedom from pain and danger. We are told we do not need the freedom to make our own choices.

As June Osbourne says, “all we have to do is shut our mouths and look stupid, it shouldn’t be that hard.” For some of us, that will the way. Others will shout loudly, march in the street, fight. Others will work underground, quietly, helping people escape, whilst others will seek to undermine or change the system from inside or outside. It has ever been so.

But whoever you are, and whatever your reason for working in this arena, we need you. Because this factory farming birthing machine is literally killing us.