The Medicalization of Childbirth
Published by Antigone April 27th, 2008 in Punkass!, Health, Reproductive Rights, Bodily Autonomy, Historical Wankery, Fetii, "Science"Last week, I finished watching “The Business of Being Born“. Ricki Lake did this documentary to highlight the differences in treatment she had with her two children. One was done at the hospital, and ended up as a Cesarean. One was at home, with a midwife, and it was videotaped.
Interspaced between this was some history of childbirth, particularly in the United States. Starting at around the turn of the century, births shifted from something that was at home, to something that was done at a hospital. This shift was not because medical science was particularly good at childbearing (or really, because it was even as midwifery) but because an interesting intersection that we all know and love: capitalism, sexism, and racism. Doctors at the time went on a massive advertising campaign, aimed at telling women that other women were not as good at delivering babies as they were. That these Russian, German, and other immigrant women just wanted your money, and you were a bad mother if you didn’t go to the hospital to get a delivery done there. Interestingly enough; it was not actually safer to go to the hospital, if you were in labor. Midwifery had been around for awhile, women knew how to deliver babies. They, at the very least, knew that you washed your hands before you went to the next birth, something that doctors at the time considered immaterial. Midwifes also knew to listen to a pregnant women when she was in labor, as opposed to putting up a sheet and ignoring her. They also knew that squatting, or in water, was an easier and safer way to give birth then lying on one’s back, where you have to not only have to work against your body, but gravity (but hey, with your legs like that, it was easier for the doctor).
It then went on to talk about “twilight sleep” or “zombie sleep”. For those of you who are unfamiliar (and I certainly was before I saw this) twilight sleep was when a women came to the hospital, and then was injected with morphine and scopolamine. Now, supposedly this was to kill pain; but what it really did was put pregnant women into an alternate state of mind, so that they forgot the labor pains. They also forgot the labor. And how to control their own body. Women had to be tied down to the bed, (with sheepskin, so that they wouldn’t leave big bruises or scratches). Watching the videos were again horrific: a women, tied to a bed, thrashing about, with a curtain at her midsection, and four white guys staring intently at her uterus. For something that is normally held as one of the most feminine of experiences, it was eerily impersonal.*
The movie then continued to show the difference between medical birth and midwifery. For one thing, the births done with a midwife seemed a whole lot less painful. The midwife was there the whole time, as opposed to a doctor who showed up at the last second. The position seemed more comfortable as well; if the woman wanted to get up and walk around, she was allowed to. If she wanted to squat, she squatted. With a midwife, they listened to what the women said she wanted. With the doctors, it seemed as if the doctor told her what she wanted.
Not to say that the movie was Luddite, at all. Every midwife there said that she was grateful that there was the knowledge of obstetricians out there, for the complicated births. But they all made mention that, 9 times out of 10, women did not need to go to the doctor. That first and foremost, those doctors are surgeons, and sometimes do unnecessary cesareans out of misplaced concern, or because of time constraints, that is not actually healthy for the mother or the new baby. They compared infant mortality in the United States with other countries in Europe where it was far more common to have a midwife, and lo and behold, the US has more infant deaths then Europe. However, they never proved a causal relationship; there are a variety of reasons why that might be.
Among the problems of medicalization they talked about, one was talking about how the introduction of medicine was playing weird problems with women’s hormones. First, a women is given an epidural, for the pain. But an epidural numbs more than just pain, it also makes it more difficult to have contractions. So then, a women is given pitocin, which is a synthetic form of oxytocin (the birthing hormone). Pitocin has some major problems though: first, the contractions it causes are longer, and stronger (and therefore more painful). Also, it can constrict bloodflow to the uterus, so that the fetus has less oxygen flowing to it. So, to numb the pain, they give the women another epidural. And this starts the cycle again, until the fetus goes into distress (and the mother is also pretty distressed at this point as well). At this point, they rush the women to get a Cesarean, leaving a scar in the women, an increased risk of infection, and a now-distressed baby.
A few things struck me watching this film, in no particular order:
1) Why does any women ever (well, with Tom Beatty make that any person) ever get and stay pregnant long enough to give birth? Seriously, even with the midwife, water births, were it just seemed like a grunt and slip, and “ooo, baby” it still seemed painful, long, and full of viscera. This movie made me hug my orthotricyclin like no one’s business.
2) This movie was far too crunchy for my tastes. I can see why childbirth is a unique experience for women, because it is generally just women that can do it. But seriously, I prefer the ideas they mention at the end a lot better: where hospitals have birthing centers, where midwifes work. You can have your birth in a water way, or at the very least squatting, but you are still at the hospital if you are that 1 in 10 case that needs emergency help.
3) What is it with some guys and their seemingly uncontrollable urges to take women’s experiences and define them/ control them? First you have medical doctors saying that women don’t actually know what’s going on for pregnancy, and then you have guys making laws about when it’s okay for us to have an abortion, and guys who think that birth control is emasculating, and guys who seem to think they know what happens during PMS better than women. It’s really annoying; I don’t assume to know what it’s like to have blue balls, why should they assume they have any IDEA what it’s like to go around in a feminine fleshy meatbag?
This movie is one that I think people should definitely watch** (if you have a netflix account, it’s instantly downloadable, by the way). It shows a very interesting perception of childbirth, from women’s point of view.
*Interestingly enough, the feminists at the time held up scopolamine as a liberation. The movie made mention that at the time, childbirth was still thought as something that should be as painful as possible, for the “curse of eve”. The feminist at the time, saw this as an opportunity to not have to suffer through childbirth, and jumped on the opportunity to show that no, childbirth was painful because there wasn’t the medicine to fix it, not because of any Biblical curse. Next time an anti-choicer shows up saying that early feminists were against abortion (which they should have been, because at the time an abortion had more of a chance of killing you than childbirth), point out that they also supported drugging women during childbirth. We are all a part of the time we grew up in, bound by some of those mindsets and technologies.
**If you’re like me, you’ll watch most of this movie through slits in your fingers. Seriously, think horror movie viscera, and then imagine in that in your most sensitive parts.
Re #3 - Laura Q put a great post about that up on FSF lately.
Someone really needs to teach me how to put stuff under a fold.
#1, I think, is related to #3. A lot of men look at childbirth and how painful it is and think, “If women are allowed to control this, they will refuse to do it and then I WILL NEVER HAVE AN HEIR.” Not across the board, but this feeds a lot of it.
Also, higher infant mortality—it’s pleasing to think it’s a simple solution like midwifery. More likely is lack of health insurance means a lot of women don’t get decent prenatal care.
To put stuff under the fold: It’s a button that looks like a small box, a dotted line, and then a bigger box. Put the cursor where you want the fold, then hit that button.
As for your point # 1)…
Birthing pain isn’t like normal pain. Part of what makes pain so scary is: it’s meaningless, beyond our control, without any breaks, and we don’t know if and when it will ever go away. Birthing pain is different. It’s not continuous. Once the baby’s out, the pain is GONE. To some extent we can influence our pain (breathing, positions, relaxation etc). It’s pain with a purpose: less like getting mugged, more like lugging a very large wardrobe up the staircase all by yourself. Your pain makes your body produce some painkilling hormones, and those help. Best thing: they enter your baby’s bloodstream as well. (So at least SOMEONE’s happy.)
But whenever you see a women giving birth in the movies*, it isn’t like that, is it? The woman is never someone who actively DOES something. She’s a victim of a terrible attack of pain. One moment she’s walking along singing to herself, the next: SCREAMING her head off, having to be rescued and rushed to a hospital. There, she’s either unconscious (=Caesarean) or just screaming and screaming and screaming. Or there’s this mysterious Something happening behind closed doors, with the woman’s friends worrying themselves sick outside. Like she’s having surgery done or been in a car crash. The fact that she’s DOING something gets blanked out. The stress is more on the woman as victim, and on birth as something dangerous and horrific that needs monitoring and rescue work (often done by men).
*in the ones I’ve seen
I pay a lot of attention to this birthing debate because I intend to have kids at some point in the future and am way into making informed choices. (imagine that!) It is so frustrating to me because there seems to be very little middle ground between the doctors and the home birthers.
I hate the idea of having a regular hospital birth where doctors tend to do things for their convenience or to protect them from lawsuits or whatever as opposed to what is best for *me*. The idea of being bullied into interventions is terrifying, it’s even worse when you hear that you might not be informed at all before they happen. I don’t want to be rushed, I don’t want to not be allowed food and water while I do something exhausting (it’s called labor for a reason) and I don’t want anyone to act like I only have one option when in fact I have more than that. I want to be respected as a person while I am in the hospital.
On the other hand, glorifying the idea of a perfect birth experience is both, as you said, too crunchy for me (”natural” anything is not always better and I wish people would stop insisting it was) and sets up these high expectations that women will feel shitty about if they don’t meet. I know I’m not failing anyone if I take pain meds. Not myself, not my baby and certainly not anyone else who feels like they might have a stake in the birth. I don’t want anyone who has a c-section, necessary or not, to feel like they missed out on this Amazing, Mystical Birth Experience that the home birth movement is pushing. Motherhood is fetishized enough and women don’t need another thing to feel bad about.
Hopefully I can find a no-nonsense midwife and give birth in a hospital and avoid these issues. Whatever, I’ve got at least 5 years before I need to find a solution. In the meantime it just pisses me off to no end. Makes me stabby.
Random thoughts as I read:
Doctors nowadays are very good about handwashing, and a midwife may try to force you to walk around and/or squat when you are totally positive you feel better lying down.
I am a huge fan of painkilling drugs during childbirth personally. In general I believe every woman should be fully educated about the various kinds offered, their effects on both her and the fetus, also educated about the stark reality of a drug-free childbirth, and that she should never be pressured one way or the other.
Midwives don’t actually show up any sooner than the doctor does, but once they’re there, they do stay by your side a whole heck of a lot more.
It is far from a foregone conclusion that if you get an epidural, you will also be given oxytocin, and that avoiding an epidural will prevent them from giving you oxytocin as well.
Any mention of episiotomies in that film?
#1 Cause we have no idea how awful it’s going to be til it’s too late.
#2 Every time some woman who’s had a caesarian starts babbling about how she’s missed out on the true experience of giving birth and her maternity is forever incomplete thereby, my brain shuts off.
#3 I think some men can’t process that there could be anything that a woman could do better on the physical plane without his direction, even something that literally never and cannot be performed by a man, resulting in sensations and physical activities that a man can never experience.
“#3 I think some men can’t process that there could be anything that a woman could do better on the physical plane without his direction, even something that literally never and cannot be performed by a man…”
Hear hear.
I think men are so used to being “the experts” that it doesn’t even enter their heads that there’s something they can’t be experts about. Being reminded that some areas are out of bounds, that they won’t get to pontificate, and that all they can do is listen and take notes - they seem to be taken aback. As if, on a scale that measures your authority and goes from -10 to 10, they’re used to being 3 all the time and come to see this as the norm, as “their” zero. And once you tell them that their authority is 0, instead of being reduced to a neutral position, they’re feeling like you’re knocking them straight into a minus area - telling them they’re being idiots or something.
Amanda:
…higher infant mortality—it’s pleasing to think it’s a simple solution like midwifery. More likely is lack of health insurance means a lot of women don’t get decent prenatal care.
That’s what I was thinking, that an Europeans are just generally more healthy then Americans, probably because of the health care thing, but after being in Europe, I’m going to also say it’s because of all the walking.
schrödinger’s cat:
I’ll take your word on the childbirth pain thing- I think I’ll just bypass the whole process. While I’ve always loved little kids, I think I’m one that’ll be a better aunt or neighborhood mom than actual mom.
Lisa KS:
I don’t know why the mother-goddess, sisterhood bonding thing makes me grit my teeth (aside from Fantasy novels, I’ll accept it there the same way I’ll accept Magic). I don’t think you can HAVE an unnatural experience: your experiences are yours alone. Now, if you had a cesearan that you didn’t want, I could see that as being a BAD experience, but you’re not missing out on the “natural” experience or “real” experience.
True, doctors wash their hands now; and maybe some midwives do force women to do things that they don’t want. But I know the vast majority of doctors do make women lie on a bed in a fashion that goes against both anatomy and gravity, and that can’t be comfortable.
As just a general note, can I mention how very cool it is to have a blog post that has people actually staying on topic? This is very cool to me.
@ElleDee: here in Germany the hospital vs home birth debate isn’t so extreme. There’s a middle ground. You can give birth in a hospital, but instead of staying the whole 5 days, you just stay for a few hours and then you (and the baby) go home. The aftercare is done by your midwife.
Or you hire a midwife as soon as you become pregnant. She does all your check-ups, and you just go to a doctor’s office for the ultrasounds. I found that much less stressful and more personal. All German health insurances cover the costs.
Or you can do what I did and hire a team of three midwives who works with your local hospital. This cost me about € 250. The team will do your antenatal care, doing turns so you’ll get to know all three of them. You’ve got the choice between a homebirth or a normal hospital birth. If you’re planning a homebirth, you’ll still have the option of chickening out at the last moment and going into a hospital. Either way —AND THIS IS THE AWESOME BIT— your midwife will go with you. She’s authorized to go into the labour room with you and do her job there, using all the facilities and being fully in charge (so there won’t be another midwife supervising her or something; there’ll just be the doctor called in, as usual). She’ll stay with you the entire time. If your labour lasts for a very long time, one of the other two team midwives just takes over from her.
I’ve done that for my 2nd birth and it was so worth the money (about € 250). That way there isn’t this strict black-and-white thing of hospital vs home birth. You can choose one option and then chicken out, or you can go into hospital and still have some of the advantages of a home birth, i.e.:
1) You already know and trust your midwife. That takes one element of surprise out of an already scary experience. It’s like you’re friends. Very reassuring. A birth is over much more quickly if you can relax. Your midwife will know you very well, including stuff you find relaxing (or NOT, more importantly), and she’ll know whether you or the baby have any medical conditions or hangups that need to be taken into account.
2) Unlike a hospital midwife, “your” midwife won’t have to monitor many births simultaneously. She’ll stay with you from start to finish, and then some. So she’ll have enough time to help you relax and breathe etc. That’s of enormous help.
3) Among people I know, we’ve had one birth gone wrong because the medical staff didn’t see the warning signs in time (the baby’s severely disabled now). So I found it very reassuring to know that someone would be with us all the time.
Of course all that costs extra, about € 200 to 300. I don’t understand why the medical insurance doesn’t cover it. Home births are much cheaper for them than hospital births. If women generally had access to this type of service, surely more of us would feel they can plan a home birth.
having had an elective c-section, i have been disappointed at the negative view that it has, especially among the communities that i feel would be accepting of my choice. i have a wonderful ob/gyn who has always been very good at listening to my needs/wants as a patient, and has done a lot to keep me informed of the things available to me as a soon to be mother. she let me know that if i wanted a midwife or doula it was good, but that she would need to know beforehand (the hospital i was going to give birth in was going to have construction going on in the labor and delivery) so that plans could be made to include the midwife/doula. anyway, i told her that i was thinking about having a c-section, and she let me know that there was some reading i should do before i made up my mind, and gave me the names of a few books. so, i did my research and talked to her some more and decided on a c-section. actually, her being so open and kind with me about it made me think that people in general would be the same way about my choice. not the case. actually, my husband and i had such a hard time with people’s reactions that we decided to lie to people about it and just let them think there was a need for the surgical removal of our child. i have never heard the end of it from the few people that knew the c-section was elective. my mother-in-law even told me that i would feel empty afterward, not having done the one thing i was made for (wtf? can you believe?) i actually felt guilty, more than once, for the birth, although it was fleeting, and have really wanted someone to understand that it wasnt an awful decision on my part.
#1: children are worth it.
#2: i agree that all women/families should be able to have all birthing methods avaliable to them, even the madicalized ones.
#3: who knows?
Great to have supportive in-laws, isn’t it…
Anyway, even if having children really were the one thing you were made for (and I don’t think it is), you did just that, didn’t you? You brought a child into the world, and the fact that you could have given birth without surgery doesn’t make any difference on that account. And you didn’t choose an obscure or dangerous birthing method either, so it shouldn’t be anyone’s business but yours, your husband’s and your doctor’s.
@ timidvenus: “the one thing you were made for”?! … If it’s about the “bonding” moment, then all I can say is, I never got anything mystical out of either birth. The bonding came gradually, over the next few weeks. … The only thing I got from the whole thing is: I know that I’ve done something that looked so overwhelming at first. But given the choice, I’d rather get this knowledge by climbing a mountain. … No, I can’t think of anything that’s better or truer about natural childbirth. The only advantages or disadvantages concern the baby’s and your own health and welfare. Morally, I can’t see any difference.