Illustration: 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.
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.
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.
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 firstname.lastname@example.org if you would like to share your experiences of birth and death. This article was first published on novaramedia.com
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