Pregnancy & Birth
Recommended Books and Films About Childbearing
From the start, with its emphasis on problems, the book medicalizes pregnancy. "Now That You Are Pregnant" -- indeed, every chapter -- begins with "What You May Be Concerned About." Divided rather dryly into months of pregnancy, it highlights a vast number of anxious questions in italics at the head of each column of information. While some of the advice is good and some of the answers are adequate enough, most of them express the conventional medical point of view. For instance, a section headed "Your Weight Gain and the Baby's Size" ends with this comment: "...when there is some suspicion of fetopelvic disproportion, the practitioner will allow a trial labor. If you progress, the labor will continue. If you don't, labor may get a boost with the administration of oxytocin. If labor still doesn't progress, a cesarean will usually be performed."(205) This seeming clarity is in fact regressive, for except in some cases (rickets, polio, injuries from car accidents) "cephalopelvic disproportion" is rare. Amazingly, even now, many women are told that they are "too small" to give birth naturally, (pelvic assessment being a rite of medical control. A reader might get the idea that she is unfit to give birth naturally, when labor is actually a dynamic process, with women’s bones and muscles especially designed to open up and be moveable. "Failure to progress" itself is a catch-all term careless used. It often masks a multitude of reasons that labor may stall: The woman may be be laboring on her back without knowing that she can walk around and choose other positions. Perhaps she is too scared, tired or lonely to relax.
Although the authors mention debates about the use of various procedures (induction, forceps, episiotomies) most often they lean toward obstetrical intervention. For instance, the reasons for inserting IVs are given, and then the reader is told: "If you strongly object to a routine IV, say so. It may be possible to hold off until the need for one arises...if you end up needing one, don't despair. (It) is only slightly uncomfortable as it's inserted and thereafter should barely be noticed" (248). This kind of underground coercion occurs throughout the book. It permeates the discussion of cesarean births, as the authors state that "the major reason for the increase in cesareans is not bad medicine but good medicine," (212) and urge women to be as equally prepared for a cesarean as for a vaginal birth, to "start looking forward to the birth of your baby instead of to an idealized childbirth experience," to believe that "Any delivery (vaginal or abdominal, medicated or unmedicated, episiotomy or without) that yields a healthy baby is an unqualified success." (215). All of these suggestions reveal the prevalence of the conventional medical point of view. Placed one after another, they are overwhelming.
The Well Pregnancy Book (WPB) by Mike and Nancy Samuels (updated 1996), one of the more positive modern guidebooks to pregnancy and birth, is also a book of the 1980s in that it doesn't mention change. What makes this book interesting, and what makes it possible for this book to escape initially from the dichotomized or the medicalized views of preparation for birth is its authors' holistic "new age" orientation. They begin with the concept of "the three-million-year-old mother," the inborn body-wisdom within every woman.(5, 507) They describe some of the spiritual beliefs and cultural practices surrounding birth in other cultures. There is constant emphasis upon the mother's comfort and relaxation and upon the value of her intuitive powers. Women are advised in many parts of the book to talk with other mothers. (7, 151, 200-201). Throughout, visuals include diagrams, drawings, paintings, sculptures and photos of mothers and babies, fertility statues and artifacts from around the world. That this book adventures in this way is one of its strongest points.
In general, the authors try to separate descriptions of pregnancy, labor and birth from discussions of medical concerns and procedures so that the reader does not constantly seesaw between health and risk. The inclusion of episiotomy in the chapter headed "The Mother's Experience of Delivery" is an exception, as is the discussion of breech presentations within the section on Cesareans (which suggests that all breech babies will be born abdominally). Without explanation, "Prenatal Care" is conventionally relegated to a medical category brimming with descriptions of all the inevitable tests, rather than being considered as the care the woman takes of herself by eating well, exercising and becoming aware of the various events in her life that affect her and her pregnancy.
While the authors describe controversies and disagreements surrounding the use of fetal monitors and cesareans, their discussions lack clarity and focus. Trapped by the necessity of having to explain the reasons for certain obstetrical practices, even these authors get caught up in medical terminology and justification and forget to separate fact from theory. "More than ever," they say, "in the face of increasing technology, the field of obstetrics must humanize the birth process so that the mother is confident and unafraid, and is able to participate in this primeval experience with joy and enthusiasm...such humanization is not only necessary for the mother's comfort, but is essential to optimize the physiology of labor and delivery, reduce complications, and maximize the health of the newborn." (508) We as readers are back where we started, with the same fallacious assumptions rampant: That the practice and philosophy of obstetrics is compatible with optimizing the flow of the birth process; that it can be separated from the use of technology; that it can be compatible with midwifery; that it can enhance the mother's powers and confidence.
Stepping Beyond the System
The authors of these books rarely ask the crucial questions: Why should women have to "...seek far and be extraordinarily persistent?" (YBYW 108), "...do complicated detective work" (YBYW 110), "...think through alternatives in advance" (S&S 7), negotiate, expect confrontation, be cautious, assertive, write up elaborate birth plans (which have no legal clout) and work for change (AGB 301-319)? Why does our society go to great lengths to deny almost everyone knowledgeable, compassionate care? The fact that women either have to pursue the extravagant activities these books outline so carefully, or be treated like containers on an assembly line shows without a doubt that modern obstetrics is seriously lacking.
It seems that, out of unwitting ignorance and a kind of generalized caution ("Don't you want a healthy baby? Don't you care about your baby? What if something goes wrong?"), the very people who have been instrumental in bringing to light women's needs and desires for humane childbirth and identifying the indignities of the obstetrical system have lost sight of any powerful alternative to the present system. Childbirth educators owe women the fruits of their knowledge by carrying their analyses of the conventional obstetrical system to the logical end – the creation of a midwifery-based, women-oriented maternity care system.
It becomes so important, then, to recall what women can accomplish when they give birth on their own turf, on their own terms. It is not necessary to invent a vision of what true woman-centered childbearing could be. Some people are keeping this information alive, learning from "a worldful of women who have assisted one another at birth." (AWB 146).
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