“Is birth philosophical?” I asked my mum, who has two philosophy degrees and, thanks to me and my brother, two qualifications in giving birth, so to speak. Her answer was detailed, ending with the ever-so-philosophical idea that, “maybe at the edges, philosophy and birth collide. There are the ethical questions of competing rights, choices, and controls. There are the glimpses of beauty, truth, the divine.” 

But my mum is a rare case study when it comes to being clued in on the philosophy of birth. Currently, if you type the phrase into a search engine, you’re more likely to come across books and articles on the birth of philosophy. So how can we pivot the conversation from the Enlightenment to something more enlightening? And what benefits would this actually yield, if any?

I started thinking about this collision a year or so ago after attending a talk about the “battle to make our birthing experience communicable.” At least, this is how the speaker, Stella Villarmea, a coordinator of the Philosophy of Birth Network, framed her subject.

Villarmea sparked my interest because her belief in the philosophical significance of birth-givers lies specifically in their physicality. Though we might typically think of philosophy as a mental process and birth as a physical one, Villarmea pointed out that we give birth “with our capacity, our reasoning skills, our cultural past, our thoughts and intentions, our desires, our fears. We birth with everything that matters to us. In short, with our values.” 

This pivot astonished me. I think if you asked most people who haven’t had a direct experience in a birthing room to picture a person giving birth, they’d describe a discombobulated, screaming woman on a hospital bed. A woman who has lost control of mind and body.

This is a far cry from the way Villarmea understands the experience; she very literally takes the screams of a birthing person as rational and premeditated actions. The comparison Villarmea made was to that of a battle cry — we don’t usually think of soldiers as behaving irrationally, so why think of people crying out during labour in this way? 

Yes, the cries can be an expression of fear and pain, but it turns out the act of engaging the throat muscles can also help to open the birth canal. This is the first I had heard of such a phenomenon. As it happens, it’s apparently relatively common knowledge that female opera singers similarly use their pelvic floor muscles to help their singing. 

This tension between maintaining full control over the body and surrendering to the body — with both states indicating a unity between body and mind — has various philosophical implications. To Villarmea, the key question is whether we should take the birthing person to be in a special, altered state of mind-body, or whether we should take them to be in full capacity to make sound medical decisions?

This dilemma is important because it informs a wider understanding of consent in the birthing room. Most societal contracts are based on the signing individual having full mental capacity and rationality. In Ireland, to grant consent in a medical setting requires the consenting individual to have “the mental capacity to make the particular decision”.

But are we simply running around in semantic circles here, chasing our academic tails? To help ground my thoughts, I spoke to some current medical students about the possible practical applications of these questions. 

Brian Counihan, a fourth year medical student at Trinity, had his first birthing ward experience during a night shift at the Coombe Hospital. “The ward is possibly the most energetic place you could find in Dublin in the early hours of a Monday morning”, he said, reminiscing on how helpless he felt, offering “words of encouragement to the mum, and the usual sports chat with the dad, who was almost as useless as I was, the poor fella”. 

I also spoke to Alex Rowlands, 24, who completed her medical degree last month. She summarised her experiences in the birthing ward to date as “honestly a battlefield”.

Both conversations pivoted to rights in the birthing room. Rowlands told me how, despite the questions at hand, hospital policy maintains that “being in labour alone may not qualify someone as lacking capacity”. Counihan confirmed his belief that “most people during childbirth absolutely retain their cognition.” 

“Of course there are cases where a mother is assessed as lacking capacity and therefore is not considered capable of making the right decision for herself”, he explained. Under Irish law, doctors may only make decisions without the patient’s consent “in exceptional circumstances”. Such circumstances could include becoming unconscious, or having an infection that affects cognition. Decisions could be as various as moving the mother’s body into a different position to carrying out a C-section.

Typically, I was told, birth plans and worst case scenarios are run through before the big day in order to ascertain what the birth-giver is comfortable with. “We’ll discuss where they want to give birth, who will be there, whether they would like an epidural, their attitudes towards medical intervention if it is required and how they feel about a C-section”, Rowlands explained. 

But it is these worst case scenarios where our questions of capacity and consent crash into one another. What if someone changes their mind? Rowlands, who studied in England, said she was once with a woman who decided mid-labour that she wanted an epidural, despite having previously expressed a desire to go without

medication. 

  “I think this broaches an interesting question regarding consent”, she said. “In some ways, this was not informed consent — there was no clear two-way discussion of the risks of having an epidural. Maybe this is a good example to argue against the idea that there is an altered state of mind which precludes a patient from giving their consent: if that were the case, then the birth plan would have to be followed without any deviation possible.”

Clearly, there is a very grey area here. “I just don’t know how else you do it”, said Counihan, at a slight loss. “These situations are far more complex than the legislation provides for. No matter how many hundreds of pages are written on the legislation, some situations just occur that no one could ever have predicted.”

When asked if either of them had encountered ideas about the philosophy of birth, both Rowlands and Counihan explained they’d had medical ethics lessons, but nothing that touched on the detailed ideas developed by Villarmea. To Counihan, Trinity’s yearly medical ethics modules “often feel as if they’ve just been thrown in somewhere as a ‘tick the box’ module”.

His opinion of the modules was honest and enlightening: “I think medical students struggle to engage with medical ethics — I think we all tend to think in more binary, right or wrong, true or false, very precise ways. [Yet] the nature of medical ethics is that it can be somewhat obscure or vague, and while there are things that are black and white, so often real life medicine is not so clear. I think us medical students struggle with that way of thinking even if we would be too proud to admit it.”

Admitting the grey area, in my opinion, is the first step towards embracing Villarmea’s dilemma. I began with my mum and I’ll end with an idea that she drilled into me as a child: science and medicine answer questions, but philosophy asks them. Sometimes, we must remind ourselves that  there’s no specific
answer.