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Pregnancy & Birth

Recommended Books and Films About Childbearing

continued...

CONCLUSION

Women acquire knowledge in different ways. Niles Newton asks: "Why don't we prepare women for the experiences of childbearing through giving them the type of information that their own great-grandmothers usually had available to them?" ("The Point of View of the Consumer," Newton on Birth and Women, Seattle, Washington: Birth & Life Bookstore, 1990). Speaking of our silent grandmothers of today, "without birth stories" and of the essential questions about life and womanhood that go unanswered, Armstrong and Feldman say: "Women today take for granted the absence of the word. They must think it is the way life is, this having mothers who cannot describe what it's like for the human female to bud, break and bear fruit. (They don't know) that in other times the traditions of birth simmered, making the very aroma of women's lives, that women tended each other in their homes and huts, chanting or singing hymns, preparing broths and hot cloths, oiling, massaging, whispering, giving instruction; that they slept by one another's beds in chairs, prepared food, consulted in kitchens, entangled arms and legs, washed the living, dressed and buried the dead; that the dramas of birth staked women's lives and lore unfurled from them." (AWB 92)

If women cannot live on such intimate terms with birth as they used to, a second way of learning is by talking and telling stories (minimized and dismissed by doctors as "old wives' tales"). Discussing prenatal care Sheila Kitzinger suggests that "What many women feel they need most...is the chance to talk to knowledgeable and understanding women who have first-hand experiences of pregnancy and birth" (YBYW 113). "We use information passed on by word of mouth," says Shafia Monroe, a Boston, Massachusetts midwife. "I teach midwifery, and how to be a parent, how to give birth, by talking. We give information by paper, but we do most of our stuff hands-on, touching and talking." ("Lay-Midwifery: The Traditional Childbearing Group," Interview with Evelyn White, Sojourner, March 1991, p. 2H). Women have all kinds of quirky, local, personal experiences, and say the kinds of lively, poetic, raunchy and delicate things to each other that can rarely be found in books.

A third way of learning is through reading, watching videos and surfing the Internet. Almost every book or magazine contains useful facts and insights which inform and empower. They have the power to bring us imaginatively in touch with other women. Yet, paradoxically, they can also reinforce isolation, as each of us reads or watches at home. With the increasing proliferation of voices that occur in no particular community context, it becomes hard to know how to evaluate available information -- what to keep, what to discard.

The assumption that knowledge is power fuels most childbirth books. This idea is true only up to a point. Different kinds of knowledge impart different degrees of power, depending on the circumstances and the complex dynamics between the people involved. A woman who has given birth several times at home might feel helpless in the turmoil of a big city hospital. Another woman who has gleaned what she could from twenty books may be undone by an unexpected event during labor. Most obstetricians will accept only a certain number of questions from a pregnant woman before feeling impinged upon. Even when a physician remains relatively open, limited time will be a factor (this will be true for almost all practitioners, midwives and doctors alike, who work in busy practices). Kitzinger has pointed out that there is built-in inequality between a doctor and a woman (YBYW 7, 105, 155) who by definition has become a "patient" -- especially if the doctor is a man. The two may have conversations -- indeed YBYW, AGB and S&S provide readers with "model" dialogues -- but rarely if ever in reality does it become a dialogue of equals.

Michel Odent has noted that many women arriving at the birth center at Pithiviers already in labor needed to know very little outside of themselves: "These women...seem quite calm about going through labor..." (BR 22). At one conference (New Hampshire, after the publication of BR in 1984) he mentioned that of the two midwives who attended births at the clinic at that time, both mothers themselves and "not too young," it was the one who didn't talk a lot, who had "nothing to say, nothing to teach" who was chosen most often by women in labor.

Were women in the U.S. to enjoy this kind of care they would not have to prepare and protect themselves so thoroughly. On the one hand, it is not right for them to go into hospitals unprepared. Yet it is unreasonable and unkind to suggest that they cram into their minds all the facts they can manage to retain, and to suggest that an individual can take on the system at such a physically, emotionally and spiritually vulnerable time. Such an expectation places a huge burden upon them. In a realm where surprises abound, women will never be able to foresee all possibilities.

Then there is the issue of class. The women who read these books are almost all middle-class. If even at this level of resources, sophistication and opportunity women cannot exercise genuine choice and feel humiliated by the system, then what is happening today to the women of color, economically disadvantaged women, and all women in the public hospital system of this country? Very few authors go beyond the realm of pregnancy and birth to address social and economic issues. Sheila Kitzinger is an exception: "...poor mothers and babies face greater danger than those who are well off...social factors have a greater influence on pregnancy and its outcome than anything (doctors) can do...In all Western countries the highest rates of death and sickness occur in the babies of working-class mothers and of recent immigrants from Third World countries." She quotes Ann Oakley's statement that to reduce social and economic disadvantage is to improve perinatal mortality and morbidity (YBYW 100).

For the past sixty-five years these facts have been well-documented in government reports, public health and social science studies and documents. An apolitical middle-class pregnant woman seeking an appropriate practitioner might well wonder at their relationship to her search. She might be interested to learn that the crisis-oriented, medicalized care deemed necessary for women in ill health because of poverty is the same kind of care she is being introduced to and warned about -- the same kind of care that childbirth educators, authors and most women have struggled against and increasingly accepted over the past decade.

Which leads to a number of questions and challenges for authors of childbirth preparation books and videos: To what extent does each one of us believe that the system must be changed? To what extent, if any, can and do our books change the existing obstetrical system? What kinds of books make the most impact, and on whom? Does it make sense to try and educate one side of the equation -- women -- when we do not affect the other side -- physicians -- by our efforts? Can we influence obstetrical conditioning at all? How? To whom are we being genuinely helpful? How can we even think of improving maternity care for some and not for everyone? How can we be responsible to the majority of women who don't read books at all? How can we promote midwifery effectively? How can we develop a strong force for change when our constituency changes constantly as pregnant women have their babies and, leaving childbirth concerns behind, go on to live their lives? How can we influence and improve maternity care policy on local, state and national levels in ways that really make a difference? What fears and constraints make us hesitate to go too far? How can we help each other address these issues and find answers to these questions? I believe that it is essential for advocates of childbearing reform (and revolution) to ask these questions and others like them.

Most people in the U.S. see maternity care only as a medical concern. Yet women’s interests have been inadequately served by medicine. The work of childbirth activists, in response to the dreams of women-centered birth that endure in women’s psyches, bears witness to that fact. One way to develop a view of a world in which excellent care becomes possible is always, in our theses, projects and books, to begin by imagining and depicting the creation of a midwifery-based maternity care system. This effort can change our consciousness. It carries us beyond "outcomes," "infant mortality," and "prenatal care" to look at the larger picture. It requires us to envision a society dedicated to the nurturing and enhancement of every life born into it. It leads us to realize that all of us must have adequate food, shelter, health care, education, job security, and physical and emotional safety; that poverty, racism and war must be eliminated; that birth must be considered as a natural, spiritual event of life, an intimate family experience; that women must freely choose to have their babies wherever they feel most comfortable, with the attendant of their choice; that women must control their procreative lives; and that practitioners must value women’s physical and spiritual integrity and the mother/child dyad. This is the starting point, this is a worthy goal. This is the vision to keep in mind. In this world, woman-centered childbearing would thrive.

© Jane Pincus

Companion Pages:  1  2  3  4  5  6  7  8  9  10 

Written by: Jane Pincus
Last revised: April 2010

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