Week 9: Giving Birth to Children and Mothers Dr. Maria do Mar Pereira [email protected] Transformations: Gender, Reproduction, and Contemporary.

Transformations: Gender, Reproduction, and Contemporary Society

Week 9: Giving Birth to Children and Mothers

Dr. Maria do Mar [email protected]

Transformations: Gender, Reproduction, and Contemporary Society1Structure of the LectureThe Medicalisation of ChildbirthWomens Experiences of BirthHomebirth a DebateMidwifes at Work and the Crisis of MidwiferyInternational Perspectives

2Returning to MedicalisationMuch like pregnancy, childbirth has undergone a process of medicalisation in modern Europe.17th and 18th centuries key turning point: Cartesian conceptualisation of the body as a machine in need of regulationexpansion of the monopoly and authority of medicine, throughthe creation of boundaries around experts the discrediting of other practitioners (wise women, midwives) invention and routinisation of new surgical instruments

19th century forceps3Feminist Critique of MedicalisationThese were gendered processes, which were grounded on, and gave rise to, unequal relations of power. women were barred from these new professions (first female doctor in the UK: 1858) womens knowledge & advice became increasingly disqualified and dismissed as old wives tales

4Professionalisation and Gendered Exclusion

3 midwives attending to a pregnant woman(16th century woodcut)

Obstetrical examination(1822 engraving)5http://www.youtube.com/watch?v=GpARnr353Rk

The Face of Birth (2013)Feminist Critique of MedicalisationThese were gendered processes, which were grounded on, and gave rise to, unequal relations of power. women were barred from these new professions (first female doctor in the UK: 1858) womens knowledge & advice became increasingly disqualified and dismissed as old wives talessymbolically and materially, childbirth structured in line with (male) doctors gaze, rather than pregnant womans experiencematerially: e.g. in Western countries, women are often expected to deliver in the positions which are most convenient for the medical practitioners assisting them (rather than those most suited to aiding the mechanics of labour and minimising discomfort for the woman)symbolically: e.g. Emily Martins study of metaphors of childbirth

7Medical Metaphors of Womens Bodies the womb and the uterus were spoken of as though they formed a mechanical pump that in particular instances was more or less adequate to expel the foetus (Martin, 1992, p. 54)

Birth as factory production: the uterus is held to a reasonable progress, a certain pace and not allowed to stop and start with its natural rhythm (Martin, 1992, p. 59)8

Regulating the Machine Discourse of time and motion

Emphasis on efficiency, predictability, productivity

Deviation = intervention

e.g. the Friedman curve9Feminist Critique of MedicalisationThese were gendered processes, which were grounded on, and gave rise to, unequal relations of power. women were barred from these new professions (first female doctor in the UK: 1858) womens knowledge & advice became increasin-gly disqualified and dismissed as old wives talessymbolically and materially, childbirth became structured in line with the (male) doctors gaze, rather than the pregnant womans experiencemedicalisation facilitated large-scale social (and biological) control of women hence, a key part of second-wave feminist mobili-sing was a critique of medical practice and discourse

10Climates of Confidence or Doubt'Pregnancy and childbirth are normal, healthy processes for most women, the vast majority of whom have healthy pregnancies and babies. But when was the last time you saw a newspaper article titled 3,5 Million American Women Had Normal Labors and Healthy Babies this Year or a TV episode that showed a healthy woman giving birth to a healthy newborn, without a sense of emergency or heroic rescue? The medias preference for portraying emergency situations, and doctors saving babies, sends the message that birth is fraught with danger. Other factors () also contribute to the popular perception that childbirth is an unbearably painful, risky process to be managed in a hospital with use of many tests, drugs and procedures. In such an environment, the high-tech medical care that is essential for a small proportion of women and babies has become the norm for almost everyone.Some advocates for childbearing women describe this as a climate of doubt that increases womens anxiety and fear. In contract, a climate of confidence focuses on our bodies capacity to give birth. Such a climate reinforces womens strengths and abilities and minimizes fear. (Our Bodies, Ourselves Pregnancy and Childbirth, 2008, pp. 7-8)

11Childbirth as a Cultural EventA society's definition of birth is fundamental; it allows those belonging to the culture to develop a set of internally consistent and mutually dependent birth practices. () Birth practices tend to be highly () ritualized (and may even be invested with a sense of moral requiredness) within any given system. Whatever the nature of a particular birthing system may be, its practitioners will tend to see it as the best way, and perhaps the only way, to bring a child into the world. () In the United States birth is predominantly viewed as a medical event and a pregnant woman is accordingly treated as a patient. As such she is expected to fulfill the role of "sick person" (Parsons, 1951): she is considered relatively helpless and exempt to some extent from her normal responsibilities for herself, and she is required to seek technically competent help from medical personnel for treatment of her "condition". In Sweden birth is considered an intensely fulfilling personal experience. The Dutch regard birth as a natural event. The Maya Indians similarly view birth as a difficult but normal part of family life.Lozoff, B. et al (1988), Childbirth in Cross-Cultural Perspective, Marriage and Family Review, 12:3/4, pp. 35-60.

12The Homebirth Debate

HomebirthHospital birthvs.

13The Rise of Hospital Births1920s: 80% of UK births at home

1991: 1% of UK births at home

2006: 2.6% of UK births at home

Cahill (2001) The last four decades have witnessed a largely consistent and persuasive argument from the obstetric establishment that the hospital is the best and safest place to be born.

14Womens Experiences of Childbirth (I)The main trauma for me was all the intervention: being induced, having my waters broken for me and being examined all the time my labour didnt progress well because I didnt dilate enough. In the end they had to use both forceps and a ventouse suction cup to get Amelie out, which was frightening and stressing Staff were too busy to explain what they were doing and why. I didnt know what was happening or going to happen, and I didnt like that lack of control. (Guardian, 15 November 2010)15I had a highly medicated birth--pitocin to induce contractions because my water was leaking, then Stadol for the pain and then (hooray!) the epidural. And episiotomy. Lots of medical intervention. And it was actually a pretty great experience because the people around me were sensitive to my needs and desires and cared for me in the way that I personally needed. My nurse was fantastic--very nurturing and reassuring. At all times I felt like I had control of the situationhttp://mommyphd.blogspot.com/2006/10/positive-birth-experience-can-happen.html

Womens Experiences of Childbirth (II)16Control and Decision-Making Control over ones body and over risky and unpredictable natural processes as a key element of understandings and experiences of pregnancy:Fox and Worts (1999): A sense of control is crucial to women having a positive experience of birth even with intervention Fox and Worts (1999): Technology as both empowering and disempoweringLupton and Schmied (2013): to understand ones sense of control we must consider the nature of the embodied experience of childbirth17The Politics of MedicalisationMartin examines how the micro-politics of medicalised childbirth, and particularly how women resist medicalisation:Similar to strategies used by workersCovert resistanceGo-slowRemove equipmentStay on the move

Childbirth is shaped by broader structures of power: e.g. experiences and degree of autonomy allowed in childbirth are differentiated by race and class

18Woman-centred vs. Institution-centred MidwiferyHunter (2004) argues that the practice of midwifery in the UK is fraught with conflicts. Conflict between teaching and practise of midwifery With woman vs With Institution Authoritative knowledge about childbirth is with the system of production and not with the women

19Childbirth and Midwifery Policies in the UK 1993: Department of Health report Changing Childbirth

1997: Audit Commission report First Class Delivery: Making it Better for Mothers and Babies

2007: Department of Health guidance: Maternity matters: choice, access and continuity of care in a safe service

2008: Healthcare Commission report Towards Better Births: A review of maternity services in England

330 million extra funding over 3 years from 2008

David Cameron accused of breaking pre-election promise to recruit an additional 3000 midwives

20Is there a Crisis in Midwifery?Midwives leaving the profession, leaving trainingExodus related to inability to provide continuity of care leading to poor job satisfactionWalters: midwives are popping in and out of three or four labour rooms and filling out endless forms while women yell for them (The Guardian, 2003).Recruitment has increased but birth-rate has also increasedRoyal College of Midwives: 66% of midwifery heads report insufficient staff (November 2009)12% of midwifery posts unfilled in south-eastRise of doulas

21Campaigns for Continuity of Care Independent Midwives UK: www.independentmidwives.org.ukCommunity Midwifery Model Association of Radical Midwives (ARM): www.midwifery.org.uk/Taking midwifery back to the rootsRe-skilling midwives Association for Improvements in Maternity Services (AIMS): www.aims.org.ukPressure groupOffers advice to women

22The Futurewho knows?The death of midwifery?The implementation of one-to-one midwifery care across the country?Further development of the conveyor belt birthing unit to cut costs?Continued contestation over control in childbirth?

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Dying to have a baby: International PerspectivesChance of dying in childbirth:Niger: 1 in 7Sweden: 1 in 29,800 (Save the Children, 2006)

More than 340 000 women die in pregnancy or childbirth annually around the globe

Many deaths are from treatable conditions such as high blood pressure

15 million women endure injuries, infection and disabilities in pregnancy and childbirth

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Source: The Lancet, 12 April 2010The bottom 10 countries:

AfghanistanCentral African RepublicMalawiChadSierra LeoneLesothoCote dIvoireEast TimorGuineaLiberia25For Seminars, you must read:Fox, Bonnie and Diana Worts (1999) Revisiting the Critique of Medicalized Childbirth: A Contribution to the Sociology of Birth, Gender and Society, Vol. 13, No. 3, pp. 326-346

Hunter, Billie (2004) Conflicting ideologies as a source of emotion work in Midwifery, Midwifery, Vol. 20, No. 3, pp. 261-272

ANDMartin, Emily (2001) The Woman in the Body, Boston: Beacon Press, Ch. 4 Medical Metaphors of Womens Bodies: Birth, pp. 54-70.

Lupton, Deborah and Virginia Schmied (2013) Splitting bodies/selves: womens concepts of embodiment at the moment of birth, Sociology of Health & Illness, Vol. 35, No. 6, pp. 828841PLUSOR