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Pregnancy & Birth

Recommended Books and Films About Childbearing

continued...

Even after this tribute, they suggest that it might be useful to justify and quantify precisely the kind of knowledge and experiences they have vividly described as by nature not quantifiable. They discuss the "language of combat" (83) that has evolved in answer to the systematic obstetrical suppression of midwives, not pointing out that this "combat" comes about precisely because the families upset and hurt by such suppression come into conflict with the prevailing obstetrical ethos and are forced to do battle. They claim that "the language of combat" diminishes the likelihood that midwives' view of birth will be given serious consideration" (83) by the general public and, we might add, by the medical establishment. They then raise the issue of the verification of the effectiveness of midwifery: "The midwives showed that they could deliver babies very successfully under the worst of circumstances, but they did not, in fact, put forward the necessary scientific explanations for the success of the births they attended" (84). What follows is both a critique of "scientific" method (but "science" is never defined) and a sense that it is necessary to employ it: "...midwifery was a way of perceiving and assisting birth that was waiting for proof (who was waiting? one might ask). Midwives, cast by history into a laboratory that precluded much intervention, took hold of a method of birthing that worked well in that setting and kept it alive. And while they could describe some of the components that seemed to be present in easy births, they could not track precisely from cause to effect" (89).

Midwives are described as "... doers, not researchers and writers...they aren't taught research, aren't taught the basic tenets of the scientific method..." (186) because, the authors suggest, most don't have the wish to do so, nor the time and money. It seems naive to believe that if midwives "scientifically" establish the effectiveness of hands-on techniques, then fewer women will have to undergo those tests and technologies that undermine women's confidence in their bodies (187). In fact, the vast numbers of studies appearing in The Journal of Nurse-Midwifery, Birth, and many other journals that so clearly demonstrate the excellence, effectiveness and desirability of midwifery care on the whole exert negligible influence upon obstetrical practice.

Thus, the authors insist upon using one mode of proof to prove something that doesn't really need to be proven, or, to put it a different way, that has already been proven by women to women in time-tested ways. In wondering why medical science "didn't figure out what simple measures worked before they started up with the complicated ones" (188), they seem to misunderstand the nature and the politics of (medical) obstetrics, a baffling lack after they have spent so much time critiquing the ways in which obstetrics stifles women's powers and controls the flow of childbirth. They say: "...we did much more than diminish women when we conducted births in antiseptic fashion. We abolished a creative force from all our lives. We took away our opportunity to witness. Not being able to feel it engulfing us, male and female...family following family, we made ourselves smaller, more finite, and less hopeful. Encountering life, we turned our backs and studied death." (119)

Despite these strong convictions, they term the unmeasurable circumstances affecting birth as "invisible" (175) -- invisible to whom? -- a sure way of sabotaging their basic thesis that these are the very factors that constitute the significant, tangible and transcendent substance of harmonious birth.

Although they observe that medicine distorts the process it claims to observe "scientifically," (87) the authors do not seriously consider the likelihood that "scientific" explanation is an inappropriate way to validate what they have learned about women and midwifery. Do they not believe sufficiently in the evidence and the critiques that they have gathered on every other page? Disappointingly, after gracefully stating that we must take on the prevailing culture by challenging prevailing medical practices, (246) the authors conclude the book by settling on freestanding birth centers as the "ideal" locale for women to give birth, combining "the best of two traditions." (250) Though birth centers certainly can be wonderful places to have babies, they too are institutions with rules and protocols.

Do these two thoughtful, bold women feel that if, in the final analysis, they reaffirm all that they have learned attending births in the least interventive setting -- the home --they won't be credible? It seems a tame, restricted and insufficiently explained conclusion to an otherwise complex, dynamic and informative book, a book which contains some of the most beautiful prose ever written about birth.

What to Expect When You're Expecting

Fear and anxiety permeate discussions about pregnancy and birth largely because we have had over one hundred years of crisis-oriented medical practice emphasizing risk, danger, medical intervention and control. What To Expect When You're Expecting (WTE), by Arlene Eisenberg, Heidi Eisenberg and Sandee Eisenberg Hathaway revised 1996), a best-seller in the 1990s, is based entirely upon worry ("How This Book Was Born," pp. 15-16). Under the guise of enlightenment it convinces women that worry is the norm. Its layout is eye-catching and attractive. It alternates between a folksy, matter-of-fact reassuring tone and a kind of truculence. It is a masterpiece of propaganda masquerading as benevolent objectivity: "Consumer advocates...are often tremendously helpful but almost as often they're medically inaccurate, unnecessarily alarming, and/or disproportionately focused on the inadequacies of the health care profession, driving a wedge of suspicion and doubt between parents and their obstetrical caregivers" (l3) and "The three authors, each an experienced consumer of maternity care, have wisely concentrated on giving expectant parents the information that will allow them to intelligently play their central role without threatening the doctors and nurse-midwives with whom they must work closely and congenially"(14). Why should we trust these "consumers" any more than the ones they have criticized? In fact, throughout the book, the authors capitalize upon the changes and improvements brought about by the very "consumer advocates" that they have maligned above, owing much of their store of information to childbirth activists of the past forty years.

This book, a product of the late 1980s (and a best-seller into the late 1990s, having generated an industry of "What to expectů" advice books) is entirely oriented toward hospital birth. The concept of "choice" has become even more restricted. The "human" vs. "medical" birth categories remain, but gone is any notion that the obstetrical system needs to be changed. Pregnant women fall into one of three personality types ("What Kind of Patient Are You"?): One who believes that "doctor knows best?...then you probably will feel most comfortable with an obstetrician who has...a godlike aura, and an unswerving dedication to his or her own obstetrical philosophy." Or one who wants to "run the show...and look for a physician or a nurse-midwife who's willing to give up the starring role and serve as your consultant on the production (sic) of your baby." Or one who wants "a practitioner who'll put you in the position of partner...who will keep, as the number one priority, your health and the health of your baby, not some inflexible medical gospel or your whims or wishes" (23,24). Each category is restrictive, judgmental, and the last contains a hint of punitiveness directed towards the woman who dares to put herself in the second category.

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