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Pregnancy & Birth

Recommended Books and Films About Childbearing


The next chapter, "Dealing With Pain," begins by listing the physiological and emotional causes of pain, mentioning the drugs used by physicians to dull the pain and then describing how to handle pain with one's own resources – another instance showing us that the ordering of topics can influence a reader’s orientation towards the issue. "Obstetrically Directed Birth" contains a section on "high-quality obstetrically directed labor with each person having her own personal midwife and continuity of care" as practiced in Dr. Kieran O’Driscoll’s Dublin hospital. This "Managed Labor" approach – obstetrically directed labor at its best" (the latest thing in U.S. hospitals) – is contrasted with "autocratic and invasive obstetric management which routinely interferes with the natural process of labor and introduces unnecessary risks." (252) It may be difficult for and ordinary reader to distinguish between the two methods, for each requires an inordinate amount of medical control. Discussions of induction, "labor by the clock," fetal monitoring, amniotomy, IV drips, episiotomy and cesareans follow. Next comes a chapter called "Ceremonial Birth Procedures," which includes sections on "preps," enemas, immobilization, transfer to delivery rooms, drapes and masks, and "pushing to order."

A reader might wonder at the unqualified use of the word "ceremony," which can imply joy as well as torment, but here definitely describes unpleasant hospital procedures to avoid if possible. Why are the interventions common to obstetrically managed births not linked with the in-hospital "ceremonies" described? It is clear that they all belong to that class of modern medical rituals designed to control the course of labor. (Kitzinger has made this connection strongly in other books and in the talks she has given). In leaning so heavily upon issues of pain and interventions, the author makes their occurrence more probable, even as she advises women about how to handle the events and procedures they are worried about or do not want to accept as part of their birth experience.

The fifth chapter, only seven pages long, is called "Autonomous Birth." Its placement at the end of the Birth unit and its brevity implicitly inform readers of the numerous hurdles they will have to jump before they can even dream of autonomy. The possibilities are slim for them to realize their wish to give birth in a way that makes them feel, like one woman whose story is told, as though they "hold the universe in their hands." (293)

The reader is plunged simultaneously into a recognition of women's capabilities and a barrage of concerns and cautions about obstetrical tests and interventions. This profusion of information may reassure and strengthen, but it can also lead to more questions, more worry. Readers are shuttled from fact to advice to critical analysis and back again in dizzying fashion without much guidance as to how to weigh one kind of statement against another.

One reason for this confusion is that the book is written in several "languages" -- the language of women talking about themselves, an inward, subjective phenomenon, and the language of "scientific" speculation which moves outward into an objective yet also perilous world. "What if's" take place not in the past or present, which are somehow comprehensible, but hovering, threatening, in an unpredictable abstract future. Pregnancy, a personal affair becomes vulnerable to medical scrutiny and assault.

When the author falls into the "medical risk" mode she perpetuates it even while criticizing it. It is wonderful to hear that a woman who is pregnant is "...performing a normal physiological function for which her body is beautifully made." But then: "...things can go wrong." And then, a paragraph later: "...thinking in terms of risk is...dangerous. It is a self-fulfilling prophecy: if doctors continually remind a woman of risk factors and all the disasters that may be just round the corner, after a while she is bound to lose confidence in her body and see it as an enemy, rather than something through which she expresses herself by giving birth" (7). Once the author begins describing the advantages and drawbacks of tests and procedures, covering the interventions she believes women should know about, she becomes bound by technology's promise to tell us more than we can ever find out by ourselves. If amniocentesis reveals approximately 400 genetic conditions, the very fact that it exists and offers an "acceptable" kind of information makes it hard to resist. To decide against it means rejecting information we are encouraged to absorb, which sets a woman against herself (and sometimes her family and practitioner). Once chosen, the procedure can cause worry both before and after receiving results. Some women can take in just the kind and amount of information they need. Others may not be sure when they will have read more than they ever wanted. When in the learning process does knowledge nourish, when does it undermine women's confidence? (Rothman) When do women begin to internalize the medical model of birth while in another part of their psyches the inner voices and dreams of a woman-centered birth endure?

A Wise Birth

Even a book as promising and insightful as A Wise Birth (AWB) by Penny Armstrong and Sheryl Feldman (1990) undermines its own powerful message by bowing to the modern demand for "scientific proof." This is not a childbirth preparation book but an amalgam of personal observations and an analysis of the current obstetrical system. The authors bear consistent, compassionate witness to the Amish women's calm, grounded strength as they labor and give birth at home, and make it clear that pregnancy and birth, like sexuality, dying and death, are potent states of being and transition which escape most attempts to measure, tame and control them. They depict birth in words and concepts more poetic than we are accustomed to reading: "Birth is infinitely dynamic. We can not adequately understand it by naming anatomical parts and describing physiological processes, nor are we done when we describe its choreography. Birth functions in the context of mind and spirit. They act directly on birth and give it the complexity we associate with life. When we acknowledge this, we invite the power of birth" (50).

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