Tuesday, October 18, 2011

Modesty in birth

One element that's crucial to a deeply satisfying birth that has been utterly dismissed in birth culture today is modesty.  Modesty is a bit of a dirty word in America; it has connotations of shame and a failure to self-promote, a necessity in our pull-yourself-up-by-your-bootstraps world.  Nonetheless, it's a concept we need to bring back to birth.  There's no shame in modesty!

Let's rejigger our thinking here:  Birth is a deeply personal bodily function.  I like to compare it to having a bowel movement; it's natural, it's satisfying but not aesthetically pleasing, and having someone bang on the door and shout "Are you done yet!?" doesn't make it go any faster.  But in hospital culture today, a woman in the throes is often shown, like an exhibit, to all kinds of doctors, nurses and students, with only a quick "d'ye mind, thanks".  Well, yes, most women mind if Dr Peep Show and his flock of med students come in and gawk!  But although being embarrassed is second only to being in pain for most women's deepest fears about birth, it seems churlish to say, "Well, yes, I do actually mind, thanks."  After all, refusing is tantamount to denying America's youth a medical education.  But that's every woman's right- and requesting a privilege like that is something that should happen before labor, not during.

I know very well that some women are just fine with sharing their personals with the folks who wander through.  I'm probably one of them.  And my mother always said, as many people have, "Once you're in the middle of it, you don't care.  You just want that kid out!"  But I've seen enough women worry aloud that they'll poo during the birth, or that their husband will never look at them the same way again, or that they won't be able to control themselves.  For undisturbed birth, it literally should be undisturbed.  Women should be provided with coverings, dim lights, respectful caregivers, whatever is needed to make them feel absolutely safe.  Here are some options we could consider:

  • Opting-in beforehand for students to come into the room.  Like spam, you shouldn't have to opt out; you should be able to opt-in.
  • Keeping sheets available to cover the mother during vaginal exams
  • Providing control over the lighting- having dimmers and the ability to turn on some lights without others.  One of the best hospital rooms I ever saw was equipped with lights that followed the doctor's laser pointer, so that the rest of the room could be dim and the lights were focused just where the doctor needed them.
  • Keeping the curtain by the door closed.
  • Reducing unnecessary visits and interruptions as much as possible.
  • It should be understood that the mother is in full control of the room; it's her room, to birth in as she pleases.  She can kick people out, she can wail and grunt and moan and nobody will say boo to her.  
  • As a doula, I've held up sheets for women before and I will again.  That's one of the benefits of having two supporters in the room- one to serve as an extra pair of hands, and one to be physically close with the mother.
  • Providing for alternate positions for pushing.  This is a biggie.  The lithotomy position, with the legs in the air, so on, so forth, is one of the most vulnerable and exposed positions there is, and although I appreciate that the provider wants to have a bead on what's happening, in normal birth it should be reduced to a minimum.  Squatting, kneeling and side-lying allow for more privacy- although it may not be much, it may be just enough.  
What are your experiences with women's need for privacy during birth?  What do you think could be done to provide for this need?


  1. When in labor with my second son I wore a loose knee length skirt and a nursing tank right until I needed to push. The tank could be lifted for fetal monitoring when needed and the outfit was both more comfortable and modest than a hospital gown. I did take it off right before pushing though so it didn't get soaked in amniotic fluid.

  2. I'm a teacher and a bit of a show-off, so I don't think I would have minded it at all (my 2 labors were so short that the issue didn't have time to come up). I certainly didn't care that I was producing blood, feces and strange noises for the strangers and near-strangers of the medical staff to deal with. That said, I agree that this decision is up to the laboring woman and something she should talk with her provider about beforehand. I can imagine that if she is going for a religious/sacred/ecstatic birth experience, for example, a troop of first-year medical students passing through might not be just the thing. Thanks for raising this question.


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