Are You REALLY Independent…In Your Birth Choice?

As long as our country continues to show up so poorly in world rankings on maternal health, I continue to run this article every year on America’s birthday, hoping to illuminate issues around our perceived birth choices. Am I naive in thinking that individual independence around these issues can help pave the way to us being a safer nation for mothers and babies?

It is sad enough that the U.S. sits so poorly in world infant mortality rankings, but a new report published in the prestigious medical journal Lancet and reported in the Washington Post points out that our childbirth-related maternal death rate continues to rise and is at nearly its highest point* in twenty-five years. [*Aside from its sharp spike in 2009 due to the H1N1 influenza virus.] American mothers die in or around childbirth at double the rate they do in Saudi Arabia, and triple the rate of the United Kingdom — and at statistically the same rate as in Iran.

In terms of where it is safest and healthiest to become a mother, America — land of the free and the brave — ranks 60th of 180 nations. In that context, is there any real birth choice?

Okay, now that I’ve totally bummed you out so you feel like you’ve got to reach for an early margarita with a little flag in it, let’s talk about what individual Americans may be able to do to improve the situation. (And even if it doesn’t improve the national situation, it cannot help but to improve your own birthing and parenting wellbeing!)

Moms & Dads, Who Is The Boss of You?

4thOfJulyParadeAs we celebrate our nation’s independence from oppressive rule, I want to explore a related kind of oppression you may experience all the time: the force of culture on birth and parenting choices. The fact is, the status-quo of today’s culture — media, medicine, education — exerts tremendous pressure on well-meaning parents to make choices that simply aren’t good for kids. This is where some knowledge can be a very empowering thing!

The more we know about where our decision-making “blind spots” are, the more we can free ourselves from the prevailing fear-based group-think, and become capable of making positive choices that are in the true best interests of ourselves and our children.

Are We Truly Free to Choose?

Let’s begin where it begins — how we ourselves are born, how we birth our children, and how we perceive the choices involved. Robbie Davis-Floyd, a cultural anthropologist specializing in birth, discovered something both subtle and powerful at work in our attitudes about the safety of non-medicalized births.

“I long ago gave up talking to women about giving birth at home,” writes Robbie. (She’s become a dear friend, thus I will call her by her first name, lol.) “The idea that only hospitals and their technology can make birth safe so permeates this culture that there is simply no point in trying to convince anyone otherwise, even though it is completely untrue and there is plenty of scientific evidence out there to prove it.”

One piece of evidence to which Robbie refers is this classic: Back in 1974 two certified nurse-midwives were put in charge of all normal births in a small county hospital in California for three years in an experimental pilot program. During that time, the rates of obstetrical intervention (like C-sections) fell dramatically, the incidence of prematurity dropped by almost half, and the rate of neonatal deaths dropped from 23.9 per thousand to 10.3 per thousand — less than half of what it had been before the midwives arrived. At the end of the three years (some say due to fear of competition) the local obstetricians fired the midwives and resumed charge of all births in this hospital. Within a few months, the rates returned to their former high levels.

In light of LOTS of research showing that routine interventions & procedures — such as Pitocin augmentation, electronic fetal monitors, IVs in place of drinkingand eating, episiotomies and epidurals — don’t lead to better outcomes and are indeed counterproductive in most normal births, Robbie wondered, “What might explain the standardization and technological elaboration of the American birthing process?”

She came to recognize that there had to be something other than rational logic at work in the vast majority of Americans who trust and believe in the relatively higher degree of safety provided by a hospital birth, despite all contrary evidence. Her discoveries led to the landmark book Birth As An American Rite of Passage.

“In all societies, major life transitions such as birth, coming of age, marriage and death are times when cultures are particularly careful to display their core values and beliefs. Thus, these important transitions are so heavily ritualized that they are called rites of passage. Through these rites of passage, each society makes sure that the important life transitions of individuals can only occur in ways that actively perpetuate the core beliefs and values of their society. Could this explain the standardization of American birth? I believe the answer is yes.”

Birth Choice, or Cultural Rite of Passage?

One characteristic of rite of passage rituals is that participants are in an altered state of mind, whether through music, drumming, dance, chanting, breath work, meditation, or mind-altering substances. In the case of labor and birth, the potent biochemicals flowing through mother and baby — and even father — are extremely mind-altering! Any of these kinds of altered states makes participants highly receptive to symbols, which are prominently featured during ritual and which are imprinted on the image-oriented right brain.

Robbie: “Obstetric procedures are far more than medical routines: they are the rituals which initiate American mothers, fathers and babies into the core value system of the technocracy” (the term for a society driven by an ideology of technological progress. In a technocracy, we constantly seek to “improve upon” nature by altering and controlling it through technology.)

LaboringWithEFMShe writes, “These procedures are profoundly symbolic, communicating messages concerning our culture’s deepest beliefs about the necessity for control of natural processes. They are a perfect expression of certain fundamentals of technocratic life:

~ The IV, for example, is the umbilical cord to the hospital, mirroring the fact that we are all umbilically linked to the technocracy, dependent on society and its institutions for our nurturance and our life.
~ The fact that the baby’s image on the ultrasound screen is often more real to the mother than its movement inside her reflects our cultural fixation on experience one-step removed on TV and computer screens.
~ The electronic fetal monitor wires the woman into the hospital’s computer system, bringing birth into the Information Age.
~ Consider the visual and kinesthetic images that the laboring woman experiences — herself in bed, in a hospital gown, staring up at an IV pole, bag and cord, staring down at a steel bed and huge belts encircling her waist and staring sideways at moving displays on a large machine. Her entire sensory field conveys one overwhelming message about our culture’s deepest values and beliefs:  technology is supreme, and you are utterly dependent upon it.
~ The episiotomy, in which the quite sufficiently stretchy perineum is routinely cut with scissors to speed up delivery of the head, enacts and displays not only our cultural tendency toward impatience but also our extreme commitment to the straight line as a basic organizing principle of cultural life.
~ The technocracy asserts societal ownership of our babies via the ritual separation of newborns and mothers shortly after birth (yet another procedure that is overwhelmingly contraindicated by over 50 years of research on attachment, trauma and brain development).
~ The plastic bassinet in which the newborn is placed metamorphoses into the crib, the playpen, the plastic carrier, and the television-set-as-babysitter—and a baby who bonds strongly to technology as she learns that comfort and entertainment come primarily from technological artifacts. That baby grows up to be the consummate consumer, and thus the technocracy perpetuates itself.

Yes, most of us have been baptized in technology. So let us embrace the blessings of that 21st century brilliance, which was originally meant to bring freedom! Nothing has the power to control our moves once we can clearly name the players and the game.

As we light up the skies in celebration of our independence as a country, let us fire up our own informed independence: let’s be the bosses of ourselves, the masters of our own will. Our children will flourish in that freedom, and the healthy choices it allows us to make!

** Read more about Robbie Davis-Floyd’s fascinating work at her website here. **

cyanocorax under Creative Commons license
miguelb under Creative Commons license

11 thoughts on “Are You REALLY Independent…In Your Birth Choice?”

  1. Babies who are born with technology fear that they cannot survive without it. They need to consult technology for the rest of their lives to “find out how I’m doing.” If born at home, they have total confidence in themselves in the absence of technology in their lives.

  2. Wonderfully written, and as a mom who gave birth at home, I can say for certain there is a marked difference between my attitude about birth versus that of friends who birthed in a hospital. Additionally, I have experienced a difference between my child’s attitude and development with regard to technology as compared to that of her peers born into the technocracy. We must ask ourselves, as a culture, if birth is really a priority and rite of passage anymore. Or has it simply been shifted to the list of “just another medical procedure”? When we lose sight of the power of birth, we lose sight of the power of life.

    1. Thank you, Sandy, for weighing in — as someone who works in a therapeutic way in this area. And as if to corroborate exactly what you said, Andrea added that wonderful comment regarding her own experience. And exactly as you say, Andrea–the loss of a sense of birth as an important moment seems to follow our collective loss of a sense of sex as anything more notable than picking up a tube of toothpaste at the corner store. It has become that “ho hum” and matter-of-fact in our culture, right? I think our loss of sight begins even earlier than birth: we’ve lost sight (or did we ever HAVE sight) of the power of sex, of conception, of pregnancy.

    2. Our Medical model of industrialized birth has little to do with health but a whole lot to do with wealth. It is the portal to consumerism and commercial support [hospitals, anesthetists, obstetricians, pharmacists, dentists, paediatricians, speech pathologists, tutors, physiotherapists, plastic surgeons, psychiatrists, lawyers, bail bondsmen, detox centres and a whack of sundry other professionals required to turn us into Stepford consumers and socially acceptable sheep.

      Children who believe in themselves through love, attention and affection from hour one and while growing up, do not need anyone or any toy, or any brand to validate them…they know they are the sum of their families love and cohesion not the sum of their brands, celebrities, organized sports heroes etc. These children have been raised with love and are not likely to raze the world as we are now. Thank God for Midwives and Doulas and sentient women who pass the knowledge along to empower women rather than rob them of their vitality, strength and amazing abilities to create miracles and feed these little miracles and turn them into civilized, loving, caring and creative adults.

      WE NEED MORE MIDWIVES and the rest will take care of itself.

  3. I gave birth in a hospital and I’m very happy with my outcome. I think it’s all in choosing the right provider. I used an office with four midwives and two doctors (who I didn’t see until I had issues after birth) and they supported me and encouraged me to have exactly the birth I wanted. I used the shower and Jacuzzi tub, no iv, no epidural, I pushed on hands and knees, and in general had the natural, empowering birth I desired. You can have a great experience in a hospital! Just choose your provider carefully.

    1. Thank you, Emily, for pointing out that it is indeed possible to have an empowering birth in the hospital — and each hospital that joins the ranks of the Mother-Friendly is cause for hope. I’m encouraged every time I hear a story like yours. This isn’t about home v. hospital but about true choice for health — and it sounds like you had that. (This makes me realize that perhaps I should self-disclose that I, too, gave birth–twice–in hospitals. The second time–different OB and different hospital–was completely without intervention, and my OB simply sat at the foot of my ABC room bed and caught Eve as she came out with her waters. It was very empowering. It’s a story that maybe I’ll tell one day soon–the difference between my two births.)

  4. Hi Marcy, your comments and paper are excellent. I believe the ideas you are explaining can be organized under the concept of technique. In philosophy of technology this refers to the process underway that continues to organize all activities in health care and society under a framework of logical order and efficiency. All things are attempted to be placed under the framework or they risk exclusion. Natural childbirth under this process will come under pressure and the woman / family are often already pre-prepared to participate by virtue of being a prepared by society (technique effects all parts of societal development). You may feel inclined to read a paper I wrote entitled “philosophy of technology and nursing” – the answers lie in finding opportunity at every moment to find ways to express and enact anarchy in practice for appropriate and person centred care. Alan

  5. I’m a first timer and am planning on giving birth with a midwife in a hospital. My husband and I spent weeks researching and reading up on the benefits/negatives of ultrasound only to find out yesterday that if we don’t get an anatomy ultrasound we won’t be kept on the midwife service (granted an abbreviated anatomy scan- placenta location, number of buns in the oven and heart shots only).

    We feel cheated and silly thinking we could give birth in a hospital and have total control over interventions. We also had to agree to fetal monitoring (whereas I would have preferred using a fetoscope).

    The midwives are great- it’s hospital policy that is making us jump threw a few hoops.

    Just wish no meant no in our healthcare system without having to resort to having to have an unassisted birth. If we said no to the monitoring and u/s we’d risk being labeled “high risk” with absolutely no proof of being high risk. In OB care it seems all women are high risk until proven otherwise. How backwards is that?

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