April 22, 2012
Some
Aspects of the Medicalization of Childbirth
Childbirth and a woman’s related natural bodily functions
have become increasingly medicalized and, to some degree, viewed as an illness or
disease which must be dealt with accordingly.
This opposes the true nature of a woman’s body and its functions. In this paper, I will discuss the reasons
leading up to this type of birthing culture as well as discuss some of the consequences
of this birthing model on Western women.
My intention is to highlight
evidence suggesting that Western birthing culture tends to disempower women and
disconnect them from their own bodies and their children uneccissarily.
It appears that, during childbirth in a hospital of an
industrialized nation such as ours, women are assumed to be incompetent and in
need of help. Often times, a woman is
rushed to a hospital, desperate for “help.”
A baby is coming and she can’t possibly do it on her own. She believes she needs medical intervention.
Of course, this notion opposes the thousands of years prior to hospitals
or industrialization or the Scientific Revolution during which a woman’s body
was doing its part to keep our species alive with or without the help of modern
technology. How could this fear and
expectation of trauma and the absolute need
for help come to be?
Firstly, it is important to understand the concept of authoritative knowledge and to describe
where our authoritative knowledge pertaining to childbirth and motherhood is
derived from. Davis-Floyd, while
introducing the notion, states:
56 “The central observation is that for any
particular domain several knowledge systems exist, some of which, by consensus,
come to carry more weight than others, either because they explain the state of
the world better for the purposes at hand or because they are associated with a
stronger power base, and usually both.
In many situations, equally legitimate parallel knowledge systems exist
and people move easily between them, using them sequentially or in parallel
fashion for particular purposes. A
consequence of the legitimation of one kind of knowing as authoritative is the
devaluation, often the dismissal, of all other kinds of knowing. Those who espouse alternative knowledge
systems then tend to be seen as backward, ignorant, and naïve… Whatever they
have to say about the issues up for negotiation is judged irrelevant,
unfounded…”
Helman, while discussing “The Origins of Western Birth
Culture,” brings up several points on which I will hinge a major part of the
discussion of this paper. First, in
terms of where our authoritative knowledge about childbirth originated, he
mentions the Cartesian “body as machine” view which “established the male body
as the prototype for this machine.” Of
course, a woman’s body can never be a
man’s body and therefore cannot live up to this standard. We can clearly see that, as Helman mentions,
“the female body deviated from the male standard, so it was regarded as
inherently abnormal, defective, dangerously unpredictable and under the
influence of nature, and in need of constant manipulation by men.”171
300Cartesian doctrine encourages a conceptual separation
of mind and body as well. The body is seen as a machine. When the machine breaks down, a technician is
called in to repair it. As the standard
for this particular machine is based upon the male form, and the female
derivation from it considered substandard, inevitably a technician will be
needed to fix those derivations. One could then logically pursue the idea that
pregnancy and childbirth, being in extreme opposition to the male form, signify
extreme need for the help of a technician. The fact that a woman enters into
medical care or supervision upon conception of a child and then that care ends
after birth reflects this notion. Pregnancy
is the malfunction; technology and medicine are the solutions. The child is separated from the mother,
leaving them both in a state more closely resembling the male prototype and,
thus, repairing the machine to a large degree.
(303)The
birthing process is treated, quite often, as an assembly line with the baby
presenting as the end product and, perhaps, the mother as nothing more than a
component of the assembly line or a by-product of the process even. This is evidenced by the following quote from
a fourth year resident who states, “We shave ‘em, we prep ’em, we hook ‘em up
to the IV and administer sedation. We
deliver the baby, it goes to the nursery and the mother goes to her room. There’s no room for niceties around
here. We just move ‘em right on
through. It’s hard not to see it like an
assembly line.”
The
labor, for instance, is expected to conform to hospital standards in order to
produce the baby, just as a factory has standards by which it is required to
operate in order to produce its end product.
In The Technocratic Model of
Birth, Davis-Floyd says that “the less conformity a labor exhibits, the
greater the number of procedures that will be applied to bring it into
conformity… the natural process of birth is deconstructed into identifiable
segments, then reconstructed as a mechanical process.” (302) One physician stated “There was a set,
established routine for doing things, usually for the convenience of the
doctors and nurses, and the laboring woman was someone you worked around, rather
than with.” Shedding more light on this
mode of thought, Mckay, explains the history behind our traditional dorsal recumbent position in
which a Western woman is expected to be in during the second stage of labor
when she writes that it “is not based so much in psychological principles as it
is on the needs and convenience of the obstetrician… this posture originated in
the 1600s when Mauriceau, a French obstetrician proposed it as an alternative
to the commonly used birthing stool… because Mauriceau disliked having to carry
the woman to her bed after delivery.”
Jordan
discusses the fact that even a woman’s natural hormones which are used during
childbirth have been replaced with synthetic ones. Jordan notes that pitocin, a synthetic
version of oxytocin, is often administered to speed up labor when the medical
team prepares for the delivery and the woman’s labor slows down. Administering pitocin has been shown to
decrease the production of oxytocin which plays a major role in mother-child bonding,
something pitocin cannot do. Also, there
is evidence to suggest that during the
first hour after delivery there are significant increases in oxytocin levels
which begin with the expulsion of the placenta.
It would appear that this is a crucial time for initiating the bond
between mother and child and that the four hour post partum observation of the
child by hospital staff is depriving them of this natural process. (nissen)
Therefore, we can also see that the institution, or factory, takes
precedence over the individual- either mother or child.
303Parelleling the separation of mind and body is the
separation of mother and child. The new member of society is first observed by
medical staff for four hours while lying in a plastic bassinet before being
placed back into the arms of his or her mother.
Tests are done, medicines or vaccines administered. It seems that Helman summed this up quite
accurately when he refered to the process as being baptized into technology. Not
only is this completely unnatural in terms of bonding between mother and child,
but this act alone displays one way in which “society demonstrates conceptual
ownership of its product.” Thereafter,
the baby is seen by a pediatrician while the mother sees her own doctor for
follow up and it is quite clear that the two are very separate beings at this
point. Six weeks later, the mother
leaves medical supervision, the process of rectifying the problem of her
body/machine malfunction is done, and the child goes on to be vaccinated and
tested routinely for years to come until finally being “confirmed” into the
religion of medical technology once making the move from their pediatrician to
their physician as an adult.
So what does all of this mean for the psyche of the Western
mother? What messages are these
practices sending her? One way to
interperet this birthing culture is through the lenses of control and
power. In this model, the technicians,
or hospital staff, are in control. They
are the ones aware of what’s going on and administering the help or fix which the mother needs. The mother is neither perceived to be in
control of the situation nor have the power to be. She is neither the factory nor the
product. She is merely one component of
the mass production of social members. Her
rite of passage into motherhood is not acknowledged nor is her personal
accomplishment cited as an important function in the process. Essentially, her power and her worth are
stripped from her and she is disconnected from herself, her child and her
social identity.
This message can be contrasted with fieldwork done by
Jordan on Maya in rural Mexico. In these
communities, women are accompanied by and assisted by the people present during
labor which could include family members, the village midwife and other women
with experience in childbirth. Each
birth is individualized through “a shared store of knowledge…demonstrations,
and remedies… a joint view of what is going on in this labor, with this woman-plus-baby, is constructed in which
everybody involved in the birth participates… there is no one in charge here…
the store of knowledge required for conducting a birth is created and recreated
by all participants.” (Davis-Floyd, 60).
In this model of birthing, the woman in not disconnected
from herself through the notions of assembly line production nor is she
separated from her role in society. The
mother is not looking for help or a fix. There is no technician taking specific control
of her problem. There is no dominant authority. She remains an individual, within an
inclusive network of family, and a central aspect of the end product, woman-plus-baby. The individualization
of the process avoids the concept of conforming to standard practice and,
therefore, the perceived need for interventions to bring the labor and birth up
to the desired standards. Their culture establishes
the experienced and/or those vested with personal concern for the mother-plus-baby
as the ones possessing the authoritative knowledge necessary for the specific
birth- including the mother herself.
Through this, the mother is empowered in her roles as a woman,
individual, family member and community member, reinforcing both kinship and
social bonds.
The information covered in this
paper could be eye opening to many health care professionals in the West as
well as women as individuals. In
understanding the social messages being sent to mothers-to-be, medical staff
can shift their expectations of women towards a more natural and empowering
method of interaction with them. One
change that can be made, and absoloutly should
be made is having patience during the labor.
As mentioned in the introduction, birth is a natural process which has
been accomplished more often than not without the intervention of medical
technology. It is an atrocity that
womens bodies are being expected to adhere to the schedules or convenience of
medical staff who she perceives as there to help
her. In America, there has been an
obvious breakdown of kinship bonds which I, myself, have witnessed progressing
during my own short life. This
progression could be slowed, perhaps, beginning
with the separation of mother and child if we begin looking them as connected
both to eachother and their family as well as to the society at large- even during childbirth. Education about childbirth should come from a multitude of knowledge bases which
connect the mother to her natural spheres of influence and not only from a separate and somewhat anonymous medical community
who is only present during the onset of mechanical malfunction.
