By Ann Davenport Everybody needs a change A chance to check out the new But you’re the only one to see The changes you take yourself through. Don’t you worry ‘bout a thing, Don’t you worry ‘bout a thing, pretty mama. Cause I’ll be standing on the side When you check it out. Stevie Wonder from “Innervisions”1 Stevie could have been a midwife with this philosophy, don’t you think? Midwives know the courage it takes to take ourselves through changes, and we are the one’s who will stand by her side when that mama goes through her transformation. Of course, with any transformation comes that dreaded moment of fear; the fear of letting go, of disconnection, separation, and detachment. Fear in itself is neither good nor bad. Frances Moore Lappé identifies fear as a primal source of energy. She writes, “Our species never would have made it this far if we were not by nature curious problem-solvers and creators – beings who love to act, to take risks, to live exuberantly, to aspire to what lies beyond easy reach.”2 Fear, thus, can also be an opening door, a freeing release, a connecting energy helping us to see a bigger picture. How else would we solve problems if we avoided fearful situations? Curious problem-solvers include the people who bring us technology. Like fear, technology is neither good nor bad. Nor is technology the way to eradicate fear, as many practitioners and patients believe. Technology is just another tool in our birthing kits. There can be advantages and disadvantages to technology.


So, why do we use technology in obstetrics? Physicians and midwives trained in the biomedical model may answer, “To predict and to intervene so that we can prevent death and disability.” It is quite possible that medicos and midwives really do trust technology for their “patient”, and trust technology to augment their “life-saving” skills. Why else are midwifery, nursing and medical students expected to manage so many machines during their obstetrical rotation? But, what does technology really help predict? Do technological interventions help us determine labor and birth outcomes? Why do we want to predict and intervene in the first place? Do we need to “stem the tide” of technology? Or, do we need technology to “stem the tide” of fear? Perhaps that primal instinct called fear leads us toward trusting technology instead of trusting the unknown, or trusting the transformative process of birthing, of trusting ourselves. And what do we fear most during labor and birth and post-partum? Loss of control. Death or disability means we, the professional authority figure, lost control of the situation. After all, women and families trust us, trust our authoritative knowledge, and our use of technology. They may trust any outside authority instead of their inner knowing, instead of their own process and transformation. And how do most professionals promote that trust in us? We start the prenatal sessions with lessons on fear. You know the type: the midwife or doctor begins with a litany of things that “could go wrong in any” pregnancy/birth/post-partum period, and what he or she can do to step in and rescue with all the knowledge/skills/technology available. Why else would anyone want an ultrasound? To predict. Does the fetus have Down’s Syndrome? Does it have a spina bifida? Does the placenta lie over the cervical os? Is the baby a boy or a girl? Yet, what do you do with this information? And what would you do in case you


didn’t have an ultrasound and the baby was born with Down’s Syndrome or spina bifida; or if during labor you detected the placenta over the cervical os; or if the baby was born a girl in a family that already has five daughters and no sons? We all know that now, after years and years of scientific evidence, ultrasound does absolutely nothing to predict outcome. Ultrasounds only give us information, information that we will have eventually anyway. Of course, technology can be advantageous. For example, to determine pre-eclampsia we use a sphygmomanometer to measure blood pressure along with chemically-enhanced test strips to measure the presence of protein in urine. Notice we cannot predict eclampsia, only determine the presence of high blood pressure and protein in urine. And with this determination, we have various means of intervention, some of which involve technology and some that don’t. More frequent vigilance with the sphygmomanometer and urine sample testing may be one intervention that relies on technology. A change in diet, use of herbs or acupuncture, or changing other daily habits may be an intervention based on no technology. Technology used in the treatment of eclampsia does help save lives, and involves pharmaceuticals and IV’s, or a possible cesarean to save the woman’s life. We cannot predict eclampsia with technology, but we can intervene with technology to save a life. How about predicting hemorrhage before, during or after childbirth? Using technology we can measure the amount of hemoglobin in blood, determine anemia, and intervene with iron pills to prevent the possibility of hemorrhage from low hematocrit levels. None of this technology predicts who will hemorrhage nor when. Every midwife in the world knows how to determine anemia without a blood test. She also knows how to intervene without pharmaceuticals to prevent anemia by recommending dietary supplements native to her environment (frijoles in Mexico, goat organs in Ghana, lentils in Nepal). What she needs are the


knowledge and skills to recognize, intervene, and follow-up a woman who is hemorrhaging right now. Unfortunately, most doctors in most countries disconnect specific skill sets from midwives by legal means, to keep the knowledge/abilities/income for themselves. Why else would midwives or nurses be prohibited (by doctors who guide legislation) from using a simple injection of oxytocin to contract a boggy uterus? Or forbidden to manually remove a stuck placenta? Or banned from suturing a torn cervix, because this is a “medical” procedure? Fear is big business. Most women in most countries who die during pregnancy, childbirth or post-partum will succumb to one of five major causes. Identified by the World Health Organization,3 these directrelated causes are: hemorrhage (unsafe abortions come under this category), infection (ditto), embolism, eclampsia, and obstructed labor; except in the USA, where the number one cause of maternal mortality is murder.4 Technology doesn’t help predict or prevent femicide, but does us intervene: like surgery to remove bullets or an emergency cesarean to save the life of the fetus inside a murdered mother. Of the five direct-related causes of maternal mortality, none can be predicted with technology. Some women can be saved with technological interventions after the diagnosis has been made, and those interventions may include appropriate pharmaceuticals, surgery, and trained providers in well-equipped hospitals. But, those interventions are few and far between in four-fifths of the world’s “health care” systems. Failed social health policy and government mismanagement have more to do with maternal disease and death than failed technology. Another example of technology intending to come to the rescue for failed policy involves the neonatal intensive care unit, where we have very high technology at a very high price for


saving the lives of babies that shouldn’t have to be there in the first place. Why are these babies born with septicemia, or at six/ten/twelve weeks premature, or diabetic, or with deformities due to environmental hazards, or addicted to cocaine/heroin/alcohol? Why do doctors in developing countries beg for bigger, brighter baby units with costly machinery, when they don’t even wash their hands between patients because the sinks don’t work? Health policy in the grotesquely rich first world countries – policies which prefer multibillion dollar contracts on “the war on terrorism” over contracts for improving health or education – demands costly technological intervention like fifth-generation pharmaceuticals and sophisticated machines over the tedious pace and proven ability of preventive medicine. We have learned to trust any outside authority – including a machine – instead of connecting with our client’s and our own spiritual, mental and physical healing properties. We trust the pharmaceutical industry, the legislative body of our professional peers, the insurance industry, the medical products industry, or the media industry that hypes all of them. Fear has become such a part of the landscape of our social structure, and so pervasive, that even our economy becomes driven by catastrophe. We need more machines to make us feel safer. Doctors (and some midwives) will tell us that they may over-use technology because they fear a law suit in case something goes wrong and they were caught not ordering a blood test, Xray or ultrasound. Thus, fear is not confined to the labor room, but to a dominant “other.” Ariel Dorfman, a Chilean poet and novelist who escaped after the Pinochet take over during their own September 11, 1973, writes about insidious pressure to keep silent in the face of fear.5 “Fear is

not confined to the knock on the door at midnight: There is the fear of losing a job, a promotion, advertising revenue, or access to power; the fear of ridicule; the fear of appearing too militant and crusading; the fear of being denied access, perks, and prizes.”


Each time we submit to these fears and conform to the overwhelming use of technology instead of transforming our fears, we deny our true natures. Frances Moore Lappé reminds us that, “To reclaim our true natures, we have to step into the unknown and risk being different.”6 After all, isn’t that what being a midwife is all about? By our very nature we have the opportunity to connect with fear and manifest trust: trust in the birthing process, trust in our capacity to learn and change, trust in the appropriate use of technology, and to infuse the woman and her birthing family with the Universal abundance of trust and love. Courage connects us to our Self and to others. Courage is contagious. ---------------SIDE BOX---------------SEVEN WAYS TO RETHINK FEAR From Francis Moore Lappé and Jeffrey Perkins7 Note to users: Try and think of not only how this guide applies to your clients during labor, but also how it applies to you during prenatal visits, or with difficult physicians, or for those especially nerve-wracking birth experiences. OLD THOUGHTS Fear means I’m in danger. Something’s gone wrong. I must seek safety. If I stop what I’m doing, I’ll be lost. I’ll never start again. I have to figure it all out before I can do anything. If I act on what I believe, conflict will break out. I’ll be humiliated and ineffective. Our greatest fears are our worst enemies; they hold us back. If I’m really myself, I’ll be excluded and alone forever. NEW THOUGHTS Fear is pure energy. It’s a signal that could mean stop or could mean go. Sometimes we have to stop in order to find our path. We don’t have to believe we can do it to do it. Showing up, even with fear, has power. Conflict means engagement. Something is in motion. It’s an opening, not a closing Our worst fears can be our greatest teachers.

To find real connection, we must risk disconnection. Our courage draws other toward us. I’m just a drop in the bucket. My effort might Every time we act, even with fear, we help make me feel better, but it won’t help. others to do the same. Courage is contagious.


1 2

Wonder, Stevie, “Don’t You Worry ‘Bout a Thing” in Innervisions, (Motown Record Corporation, 1973) Lappé, Frances Moore and Jeffrey Perkins, You Have the Power: Choosing Courage in a Culture of Fear (Tarcher/Penguin press. New York, 2004) 3 mortality_2000/maternal_mortality_2000.pdf 4 Frye, V. Editorial “Examining homicide's contribution to pregnancy-associated deaths” JAMA (Mar 21, 2001) 285 (11) 5 Dorfman, Ariel, “Fear and The Word” in Autodafe #3/4 (Seven Stories Press, New York, 2004) 6 Lappé, Frances Moore and Jeffrey Perkins, You Have the Power: Choosing Courage in a Culture of Fear (Tarcher/Penguin press. New York, 2004) 7 Ibid