Essay: Labouring through birth and death

Jenny Nelson says that if we get the beginning and ending of life right, we might have a better chance of getting the bit in the middle right too

October 29, 2016
12 min read


Jenny Nelson is Red Pepper’s political organiser.

birthdeathIllustration: Andrzej Krauze

Birth is a kind of dying and dying a kind of birth. These transitions are in many ways the same’. That is how Alana Apfel recalls the words of a therapist in her new book Birth Work as Care Work.

As my baby son learned to climb a flight of stairs, my mother-in-law found it increasingly difficult to reach the top step without losing her breath. He began to explore solid foods as she lost her appetite; and he became more vocal as she gradually withdrew. They passed one another through a period of rapid transition, in opposite directions, and for a few short months they brought each other comfort that was heartening for the rest of the family to see.

Within a year I lost my mother-in-law Sonia Markham to cancer and gave birth to my first child, Isaac. Both were ground-shaking events that demanded a lot from myself, my partner, family members, friends and professionals. They won’t be my last encounters with life and death, so next time I hope I can draw on the experience to support others or feel some degree of readiness.

But when approaching birth or death, whether it’s a direct experience or via someone close, it’s hard to imagine what a fully prepared state looks or feels like. I suspect that much of the taboo surrounding these life experiences is unhelpful, and since today’s capitalist society places a relatively low value on caring work, there is a lot of room for improvement.

Before giving birth I did a lot of research and found reading stories told directly by birth-givers or birth-workers to be the most helpful. By sharing reflections on birth and death we can help support each other through the most challenging of times and identify ways that support can be embedded in our communities. It’s in that spirit that I share these notes on my own experience.

Mystery and intensity

The processes of birth and death hold a raw intensity so often glossed over that I don’t have any immediately appropriate turns of phrase for description. To be ‘welcomed into the world’ or to ‘pass away’, ‘from the cradle to the grave’ all bypass the moment I have in mind: the roaring, screaming, sweat and blood of birth and the choking death-rattle in the final hours of life call for recognition. Of course each experience is different and some are more peaceful than others, but there’s a profound energy the events share.

Just weeks before I was due to give birth I started watching YouTube videos of women in labour and found them somehow mesmerising and at times difficult to watch. I saw a woman give birth virtually unaided into a beautiful river in the Australian rainforest. Shocked that over 52 million people had watched the video, she recently said: ‘So many women, especially first time mums, have thanked me, saying I have inspired them to not be as terrified.’

Most videos I saw showed more conventional hospital births with people trying different positions and labouring for varying lengths of time. Mainly, it struck me as strange that despite every one of us having been through this dramatic event there is an enduring air of mystery around birth.

Sure, we’ve come a long way from just two generations earlier. A friend tells me that while pregnant, her grandmother tentatively asked a doctor how the baby was going to get out. Now we get a basic sex education in school and watch movies with scenes of screaming and hand-holding around a hospital bed, sometimes peppered with canned laughter. But I still struggled to visualise all the physical stages of labour. It was through the videos that I began to understand how far the fairly shocking scenes and sounds were part of a reassuringly normal process. This would all sound familiar to a 1970s feminist activist like Sonia, who made the pioneering decision to have the birth of her second child captured at home for an educational film.

Likewise for death, I wasn’t familiar with the common stages that a body goes through as it begins to shut down. There are cues to look out for, such as cold feet as circulation slows and difficulty swallowing, and I’m not alone in wondering about this – one of the most common questions asked of Google is ‘How do people die from cancer?’

Squeamishness with our bodies at the points of birth and death might stem from a reluctance to come to terms with our own mortality, but there could also be a gendered explanation. While the rawness of death is hushed over in an effort to soothe, the rawness of birth is often dismissed with a laugh. ‘I’m a bit sore today, lol’ read one friend’s post‑partum Facebook status, and there are tired old jokes about ‘squeezing a melon out’.

I wonder if this reluctance to take vaginal trauma seriously is a disturbing sign of our attitudes towards women? Could a more direct engagement with the gory elements of birth disrupt a cultural horizon where women’s bodies are depicted across media as sex objects? Perhaps one day we will share some of the awe reserved for robots. ‘As a real-life Transformer, I’m saying Megatron ain’t shit,’ says poet Hollie McNish.

We could start by showing birth videos in schools. It can’t be a bad thing to learn how much hard work goes into labour, and young children can surprise us with their ability to understand. I’ve met one three-year-old who watched birth videos in preparation for the home birth of her baby brother and although she might have been more interested in Peppa Pig, she was happily unfazed.

Support workers and networks

Fortunately we don’t necessarily have to face these intense times alone. There are midwives, night-sitters, carers, doctors, nurses and doulas who repeatedly navigate these phases with calm and skill. The range of skills and the number of different people who could potentially play a supporting role through birth and death is a reminder that we don’t exist as lone individuals in this world. We are co‑dependent and connected, and the old adage that it takes a community to raise a child could also apply to the birthing and dying processes.

‘I do wonder how a ruggedly individualistic ideology can survive the cancer experience, though I know that it does. What an effort of denial that must involve!’ wrote Mike Marqusee in The Price of Experience: Writings on Living with Cancer.

Those who deal with life and death on a daily basis deserve a rewarding employment contract at the very least. They don’t just give their attention and practical skills, but simultaneously hold emotional space, relieving the strain for people in heightened states of anxiety, distress and grief. These workers face the contradiction of being paid to look after other people but not to look after their own children or parents. They might be juggling care roles day and night, inside and outside paid work. So we should be asking what proportion of their work goes unrecognised along with the historically taken-for-granted emotional labour of women’s work. It’s a damning indictment of our times that maternity workers have been forced into a series of strikes for fair pay. In 2014, members of the Royal College of Midwifery went on strike for the first time in their union’s 133-year history.

Another undervalued role is the birth doula or death doula, currently limited to a fairly elusive and exclusive service in the UK. They operate on a freelance basis outside of institutions and with diverse possibilities they essentially support a pregnant person or dying person in any way desired. They can act as a calm constant presence while others are focused on medical tasks or overcome with emotion, and they can ensure your wishes are respected while you might be unable or unwilling to speak.

Apart from turning to professionals there are informal support groups, such as Facebook groups for new parents (great for light relief and soothing late night worries), or, at the other end of the spectrum, ‘death cafes’, where people gather to eat cake, drink tea and discuss death. Another inspiration from Sonia and her decades of feminist organising was the women’s collective of friends who organised a rota to accompany her to appointments and visit while she was bed-bound, bringing cake, writing materials or whatever else was requested.

Further parallels and fault lines

For birthing and dying there can be many decisions to be made. Do you want to be at home or in a hospital or hospice? With company or alone? How far do you want to remain conscious or prioritise pain relief?

Broadly speaking, in recent history, there have been two opposing paths to embrace: one of self-education and self-determination, the other within the customs and facilities of an institution. Great campaigning efforts have been made to push for change within the institutions to empower the individual – hence the birth centre at my local hospital offers furniture and equipment such as adjustable chairs with hanging ropes and birthing pools, designed for comfort, not just for the easy access of a doctor or emergency team. The natural childbirth movement has long fought against a ‘production line’ approach of women birthing with their legs in stirrups, and one of the pressing challenges today is to resist the neoliberal impetus to push alternative birth practice into a costly individual endeavour. There is a growing middle-class market for antenatal yoga classes, hypnobirthing courses and alternative therapies – none of which are bad things per se, but when they require a budget of time and money that excludes so many, we have to keep seeking birth justice.

Whether or not you live in a country with a free (at the point of delivery) health service, money will impact on many of your birth or death choices. Leaving aside the terrible truth that life expectancy is relative to income levels, in the event of death itself, your options will be affected by capital relations, such as whether you can afford to experiment with cannabis oil or take a final holiday, or whether your family are able to take time off work to care for you. With this in mind we have to ask: how long are we going to let economic fortune brutalise our most intimate relationships?

There are a plethora of companies vying to exploit the anxiety of new parents. So if you find yourself with a huge shopping list before birth, I recommend crossing half of it out and making some time for yourself instead. There might not be such a detailed shopping list for death but there is an unregulated funeral industry in which hefty bills are the norm. In the UK the state will contribute to the funeral costs of the poorest but the amount available has been frozen for 13 years, so families are increasingly falling into debt in order to cover the full costs.

When inevitable social costs such as these are borne by struggling individuals, I’m reminded of the Robert Fulham quote: ‘It will be a great day when our schools have all the money they need, and our air force has to have a bake-sale to buy a bomber.’ Or in this case, when society can collectively provide for the immense costs of bank bailouts or war, surely we can organise ourselves in a way that caters for our human needs, from birth to death.

As for imagining an empowered death, there are wonderful hospices in the UK that can give the dying and their loved ones much emotional and physical space, and there is support available from charities and the NHS for people who wish to remain at home. But it is when assisted dying is legalised that the possibilities become more elaborate and really break the mould of a religious legacy that situates death as a private matter between yourself and god. For instance, artist Betsy Davis recently organised a two-day gathering for friends and family before taking a lethal dose of drugs under California’s new assisted dying law. There was music, cocktails, her favourite food, a screening of her favourite film, and her friends described it as a beautiful event.

Yet far from curating the perfect event, sadly the majority of us have little control over the circumstances of birth or death. The poorest, or those who are pushed to the margins and suffer discrimination, are the ones most likely to have their needs overlooked. In the UK this summer it was widely reported that a Sports Direct employee gave birth in the toilets for fear of taking time off work and losing her job, and in refugee camps across Europe volunteers are frantically raising money to rent apartments so women can give birth with a roof over their head. Together we must say this isn’t good enough.

Movements around beginning- or end-of-life care are enriching areas to think about political or social change because they depend on listening rather than prescriptive measures. The political terrain of social reproduction is vast and deep-reaching. But if we pursue a just and empowered approach to the very beginning and end stages of life, we might stand a better chance of getting things right in the middle too.

Jenny Nelson is Red Pepper’s political organiser. Contact jenny@redpepper.org.uk if you would like to share your experiences of birth and death. This article was first published on novaramedia.com


Jenny Nelson is Red Pepper’s political organiser.


✹ Try our new pay-as-you-feel subscription — you choose how much to pay.

Utopia: Work less play more
A shorter working week would benefit everyone, writes Madeleine Ellis-Petersen

Short story: Syrenka
A short story by Kirsten Irving

Utopia: Industrial Workers Taking the Wheel
Hilary Wainwright reflects on an attempt by British workers to produce a democratically determined alternative plan for their industry – and its lessons for today

Mum’s Colombian mine protest comes to London
Anne Harris reports on one woman’s fight against a multinational coal giant

Bike courier Maggie Dewhurst takes on the gig economy… and wins
We spoke to Mags about why she’s ‘biting the hand that feeds her’

Utopia: Daring to dream
Imagining a better world is the first step towards creating one. Ruth Potts introduces our special utopian issue

Utopia: Room for all
Nadhira Halim and Andy Edwards report on the range of creative responses to the housing crisis that are providing secure, affordable housing across the UK

A better Brexit
The left should not tail-end the establishment Bremoaners, argues Michael Calderbank

News from movements around the world
Compiled by James O’Nions

Podemos: In the Name of the People
'The emergence as a potential party of government is testament both to the richness of Spanish radical culture and the inventiveness of activists such as Errejón' - Jacob Mukherjee reviews Errejón and Mouffe's latest release

Survival Shake! – creative ways to resist the system
Social justice campaigner Sakina Sheikh describes a project to embolden young people through the arts

‘We don’t want to be an afterthought’: inside Momentum Kids
If Momentum is going to meet the challenge of being fully inclusive, a space must be provided for parents, mothers, carers, grandparents and children, write Jessie Hoskin and Natasha Josette

The Kurdish revolution – a report from Rojava
Peter Loo is supporting revolutionary social change in Northern Syria.

How to make your own media
Lorna Stephenson and Adam Cantwell-Corn on running a local media co-op

Book Review: The EU: an Obituary
Tim Holmes takes a look at John Gillingham's polemical history of the EU

Book Review: The End of Jewish Modernity
Author Daniel Lazar reviews Enzo Traverso's The End of Jewish Modernity

Lesbians and Gays Support the Migrants
Ida-Sofie Picard introduces Lesbians and Gays Support the Migrants – as told to Jenny Nelson

Book review: Angry White People: Coming Face to Face With the British Far-Right
Hilary Aked gets close up with the British far right in Hsiao-Hung Pai's latest release

University should not be a debt factory
Sheldon Ridley spoke to students taking part in their first national demonstration.

Book Review: The Day the Music Died – a Memoir
Sheila Rowbotham reviews the memoirs of BBC director and producer, Tony Garnett.

Power Games: A Political History
Malcolm Maclean reviews Jules Boykoff's Power Games: A Political History

Book Review: Sex, Needs and Queer Culture: from liberation to the post-gay
Aiming to re-evaluate the radicalism and efficacy of queer counterculture and rebellion - April Park takes us through David Alderson's new work.

A book review every day until Christmas at Red Pepper
Red Pepper will be publishing a new book review each day until Christmas

Book Review: Corbyn: The Strange Rebirth of Radical Politics
'In spite of the odds Corbyn is still standing' - Alex Doherty reviews Seymour's analysis of the rise of Corbyn

From #BlackLivesMatter to Black Liberation
'A small manifesto for black liberation through socialist revolution' - Graham Campbell reviews Keeanga-Yamahtta Taylor's 'From #BlackLivesMatter to Black Liberation'

The Fashion Revolution: Turn to the left
Bryony Moore profiles Stitched Up, a non-profit group reimagining the future of fashion

The abolition of Art History A-Level will exacerbate social inequality
This is a massive blow to the rights of ordinary kids to have the same opportunities as their more privileged peers. Danielle Child reports.

Mass civil disobedience in Sudan
A three-day general strike has brought Sudan to a stand still as people mobilise against the government and inequality. Jenny Nelson writes.

Mustang film review: Three fingers to Erdogan
Laura Nicholson reviews Mustang, Deniz Gamze Erguven’s unashamedly feminist film critique of Turkey’s creeping conservatism

What if the workers were in control?
Hilary Wainwright reflects on an attempt by British workers to produce a democratically determined alternative plan for their industry


3