Birth and the Culture of Fear- Part 1

[eleri]

Western childbirth practices and culture socialize women to be afraid of the process of physiologically normal childbirth. This is not an opinion, not a floofy "yay midwives and doulas" position. It's a documented fact. Over the next few days, I'm going to dig into this fact.

Let's start with the abstract for a sociology paper.

Performing birth in a culture of fear: an embodied crisis of late modernity.
Publication: Health Sociology Review
Publication Date: 01-OCT-06
ABSTRACT:
Drawing on recent multidisciplinary work, this paper considers the emerging sense of a crisis around childbirth in late or post-modern western culture. Not only are many health professionals and birth activists expressing concern about rising rates of medical intervention in birth but physiological birth is increasingly defined as difficult and even unattainable. A decline in cultural and individual confidence in women's birthing capacity seems paradoxical in view of women's increased social power and achievement in the modern west, along with their improved health and living conditions. Many feminist theorists are ambivalent about childbirth developments though, seeing natural birth advocates' critiques of technological birthing as essentialist, moralising and patronising towards women's choices. The paper argues for a theoretical framework that overcomes the tensions between these positions, one which focuses on the interplay between the physiological processes and the internalisation of cultural norms. The paper draws on seemingly disparate work from feminist cultural analysis and philosophy, and from physiology and neuropsychology, to argue that childbirth is collectively and individually performed. It is best seen as an active embodied practice, as a 'biopsychocultural' activity. The final section of the paper then uses this framework to examine parallels between the challenges of birthgiving and those of intense creative effort in fields such as sport and the arts. It identifies the importance of embodied interactions in managing the crisis of confidence commonly experienced by performers struggling with emotionally challenging tasks. Cultural norms of anxiety and fear of birth can be materialised in the body through social processes that instil or diminish women's confidence of 'doing' childbirth, thus limiting women's capacity to experience the agency of their lived bodies in the performance of birthing.

What do we mean when we say "physiological birth"? Why use this term instead of "normal" birth.

Take a moment to visualize what is considered a 'normal' birth in western culture.

For most people, this visualization is a woman in labor, going to a hospital, where she will don a hospital gown, have an IV, and have electronic fetal monitoring done regularly. Pain medication, often an epidural, is expected, as well as assisted pushing in a semi-lithotomy (lying down) position. In 28-35% of cases, pregnancy will end in surgery. In 20%+ of cases, labor will be started or augmented by chemical means.

This is what our culture describes as 'normal' birth. This is not physiological birth. Vancouver BC doctor Andrew Kotaska says physiological birth is “An unmedicated birth in an environment where a woman feels comfortable, where she’s adequately supported, where she has a degree of privacy that allows her brain and her uterus to do the dance that we understand very poorly called labor, is physiological birth.”
While this is very poetic, it is also fairly accurate.

Physiologically normal birth is one that begins spontaniously, is allowed to progress without assistance or intervention, and ends with a vaginal delivery.

This, the physiological norm, what women's bodies are designed to do, should be the benchmark, the standard to which we strive, rather than something that has do be advocated for, fought for. Instead, women are increasingly paying out of pocket for providers who will emphasise and support a physiological birth, and in many cases being told they are 'crazy', 'crunchy granola' or 'extreme' for doing so.

Does this mean that medical intervention is never justified? That all medical procedures are interfering with 'natural' birth? Absolutely not. Medical advances, medical technology used appropriately in birth, save lives on a regular basis.

But, looking at the numbers... are 1/5th of women truly unable to go into labor, and continue in labor without assistance? What is making 1/3rd of pregnancies end in major abdominal surgery? Could our routine interferance with the physiological baseline be causing more complications than they solve?

Evidence is starting to show yes. And that's just on a technical, medical intervention level. What about what our society says about birth?

More on that in part 2...

Comments

[zanda-myrande.livejournal.com]

I've added a link to this to my post on the subject. Thank you for doing this, and I'm sorry you got given a hard time.

[eleri.livejournal.com]

Wasn't so much a hard time, but they utterly misunderstood what I was saying, and this is needed information anyhow. The lack of evidence-based medicine in childbirth is epidemic, and off of everyone's radar.

[siliconshaman.livejournal.com]

"What is making 1/3rd of pregnancies end in major abdominal surgery?"

HMO's profit motive and doctors arrogance, at a guess.
For a start, the lying down postion is not natural or optimal for giving birth. It is an early Victorian invention that was supposed to be more 'modest' [i.e the whole business could be covered up with a sheet]

[eleri.livejournal.com]

More than the HMOs and Drs... it's the Malpractice Insurance. A Dr at the conference I went to said "You never get sued for doing a Cesarean, you get sued for *not* doing one."

Anecdotally, Louis XIV was the first to push (*ahem*) the use of the lying down position. He wanted to watch his mistress give birth, and it afforded the best view.

[siliconshaman.livejournal.com]

umm.. yeah. I checked my references and I had misremembered. It became accepted as 'normal' in the late Georgian/early Victorian period. But it had been around longer.

Thinking about it, you're probably right about the M.I too. So much of today's society is driven by litigation that we're practically child-proofing the entire world... any risk is seen as unacceptable.

[eleri.livejournal.com]

funkily enough, the lithotomy position is one of the earliest recorded positions for abdominal examinations and surgery, even Hippocrates mentions it.

Wasn't until guys-trained-as-doctors got into the childbirth business that it started being used there.

I really try to avoid the 'zomg, men ruined it!' phraseology, but this is an area where the women had more sense.

[farmleaf.livejournal.com]

My mother was a Labor & Delivery nurse for 30 years or so. One of the main reasons that many pregnancies end in C-sections is actually surprising. The doctors often don't want to be bothered with waiting around for someone to labor and deliver on their own. That's it. They have a tee time or they're tired or they're going on vacation the next day and want some extra time or they have dinner/movie/opera/concert/sports game plans and don't want to miss it. It used to frustrate Mom that she couldn't tell anyone what she was seeing, too.

[lizzibabe.livejournal.com]

I'm seeing that line of reasoning being used for the women themselves when they request inducement. "Oh, well they said I'm due on the 21st, but my doctor/me is going on vacation/having a party/whatever that day/week so I better schedule my inducement now so I can do this on *my* terms."