Awareness Of The Outcome Focus

I have officially finished my first semester of midwifery school. The cycle has come to a close and I’m left to reflect on what that time has offered, taught and inspired within me. Anatomy and physiology remains my biggest takeaway and I’m grateful for the deepening of knowledge that I’ve already found connecting the finer points of concepts within my herbal medicine education, as well as my birth keeping. I’m trying desperately to hold on to the wisdom of Whapio, who advised us to “become allies with anatomy and physiology” at last year’s Flock Yeah workshop.

On the midwifery front, I had only one foundational level course this semester, a gentle, slow start to what promises to be a flurry of intensity over the next 3.5 years. The material was familiar to me, so for myself this meant time to dig deep into my own thoughts and understandings, infusing and integrating the bits and pieces of philosophy, fears and lived experiences muddled there during my own nearly five years in birth work to better connect with not only the brilliant women around me, but with the culture of birth itself. And knitting, lots and lots of knitting.

I very consciously made the decision to walk this specific path to midwifery. I knew that this path would bring in a very different approach to birth than I currently carried and desire to hold onto, but I also value the gift of multiple perspectives. Having been given ample opportunity to reflect, more so than any other time in my life, I’m understanding that the face of birth that is presented within our culture and others, is one of outcome focus. While the outcome is of course incredibly important, it is only one facet and cannot be adopted into focus to the detriment of all other aspects.

The “healthy mom & healthy baby”phrase is communicated often within the worldwide birth community. This is a phrase that is often used to justify systemic violence against birthing people, a phrase used to ensure compliance of birthing people, a phrase used to dismiss the individual experience of birth through dogmatic recital. It’s usually well meant, a simple way of saying “But look! A baby! You did it all for the baby!” The messaging that is sent to birthing people however, is quite different. In my experience of attending births as a doula, new parents often perceive this as a statement for them to shut up about what happened, bury it deep in a mental vault or else be labelled as selfish, having too high of expectations because in the end, they walked away with a healthy baby.

The gas lighting effect of those words, the stripping of the sacred, the muting of the story for parents and babies – through my years in birth work, I cannot say I have heard a phrase more damaging, more condescending or invalidating that that one.

A second belief in our birth culture:

If pregnant people just “do all the right things, they will get the right result”. If folks can just “let go”or just “listen to their body” then they will have the births they desire. If they agree to the procedures or tests that their midwife/physician wants, then a good outcome will be (almost) guaranteed. Anyone who has spent any decent time in the birth world knows this to be both misleading and a terrible fallacy, even when we might wish otherwise. Birthing people are complex individuals, like any other, coming to their births with a lifetime of learned social “rules” about how they need to behave, think and act in order to be loved and accepted. They also bring with them years of imprinted fear buried deep below the surface, which may or may not mingle with other trauma (and likely does in one way or another).

This implies that pregnant people have control over the birth they experience. In some ways yes, choosing where and with whom you give birth is one of the greatest determinants to the “outcome” of the birth. But getting into the nitty gritty here, you can have the most amazing doula, the most amazing midwife (or physician), have read all the books and taken all the classes, eaten all the right food and still end up going down a path that you did not expect. A person may approach their birth with the mindset that they will “let go” or “follow their body”, and yet, doing so may not be available to them in that moment, for whatever reason.

Is it really a choice, when a birthing person requires the compassionate use of an epidural? Is it a choice, when a pregnant person cannot obtain the care provider or support that they need? Is it a choice when the sensations of labour trigger memories that the birthing person never meant to associate with the birth of a baby, and are unable to let go, or listen to their body? Is it choice when their chosen caregiver makes choices for them, or gives counsel that supports only one specific “choice”? This is the illusion of choice, where birthing people become the most heavily culpable party in a complex, personal and political rite of passage.

The belief that we must follow the “rules” of birth, is consecrated with our social use of absolute language around the childbearing year and beyond. Care providers, friends, family, doulas, childbirth educators, books, techniques and programs all set expectations (intended or not) for a specific “outcome” if the outlined “rules” are followed; if the birthing person just makes the “right choices”. This is a risky endeavour that carries an immense potential for birth trauma. In birth, there are no absolutes, there exists an entire spectrum of experience, of possibility.

Which brings me into the paradox of a third belief:

“Midwives support natural birth. However, we must embrace the inevitability that some women will fail.”

While I am no stranger to our culture’s outcome focus and the ingrained social hobby of parent blaming/shaming nor the disconnect often echoed in birth worker writings around the tenets of midwifery and the pressure to adopt the medical model’s routines, rituals and hierarchal structure; this statement puts neatly to paper a lot of what I feel goes unsaid in the birth community at large.

This statement in it’s wholeness, validates a birthing climate in which failure is not only possible for clients, but expected. The deepest fear of many birthing people, a fear that has been communicated to me as a doula time and time again – the fear of failure.

The fear of failing at birth, failing at pregnancy, failing at being enough of a partner, parent – human being. The fear of being vulnerable, of enduring pain, of judgement.

This statement fails to recognize the fact that despite the historical attempts to separate birth from sex and femme identities, that in one way or another a birthing person’s perception about how they gave birth, how they behaved during their birth, their ability to advocate, “be strong”, “let go” or “just do it”, is deeply tied to their identity, and within that, their place in their community. When they break a personal rule, or a perceived rule that is written from the experiences and interactions that they have with their partner, care provider, doula, friend or family member, they begin down a road of conflict.

A cycle of shame and blame initiates, one that is very difficult to break out of. In a time where their identity is already on the verge of being shattered as they move through their birth process (and become initiated into parenthood), this belief can be absolutely devastating. It becomes impossible to walk with a birthing person without judgement when you are in fact setting ground rules that place a moralistic value on the outcome of their birth and by proxy their worth as an individual.

Let me say that I have a tremendous amount of compassion and understanding of why these beliefs exist in our culture. I really do. I acknowledge that they generally come from a place of fear, of the belief that the more control, the more boxes checked off that birth has, the “better” the outcome will be. That the fear of death (or persecution for outcome) is so powerful that our culture has reduced a “good outcome” to heartbeats while compartmentalizing the rest. I can also see where such beliefs come from a place of love and wanting to “do right”, as birth professionals generally hold a desire to protect and shelter people from having to experience grief, loss and trauma. But even so, I refuse excuse it, because to do so participates in validating the means to justify the ends and allows for perpetuation of harmful beliefs and practices against women and birthing people.

In fact, my initial refusal to participate in this paradigm led me to become a Birthing From Within mentor, a role and worldview that has been immensely helpful in navigating away from the outcome focus and preparing clients for walking down all paths to birth, minimizing birth trauma and in helping to facilitate mindsets of “no failure” around birth.

As birthing people, we never know what will be asked of us, what will be required to get our babies born. We enter into the unknown, as best prepared as we are in that moment, hopefully ready to meet our births where they are and being open to where they will take us, physically, emotionally and spiritually. As birth keepers, we need to engage in a great deal of self reflection and inspection of what we are bringing into the relationship with our clients, the messaging we are sending and how to engage with fear – ours and our client’s with compassion and understanding of its complexity. It’s painful, uncomfortable work, that challenges our ethics, our identities, our belief systems. But then again, so does labour and birth.

If we aren’t willing to engage with the former, what business do we have sitting with the latter?

Photo credit to Michael Simonic.

The personal opinions expressed in this post are those of the writer alone, are not a substitute for midwifery or medical advice, and are not representative of any official healthcare body or regulating college or association.

One response to “Awareness Of The Outcome Focus”

  1. This is the best thing I’ve ever read about birth. These words are a gift. Thank you!

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