Week 9 Giving Birth to Children and Mothers Caroline Wright Transformations: Gender, Reproduction, and Contemporary Society

Structure of the Lecture 1 The Medicalisation of Childbirth 2 Homebirth – a Debate 3 Women’s Experiences of Birth 4 Midwifes at Work 5 International Perspectives

Returning to Medicalisation… Much like pregnancy, childbirth has undergone a process of medicalisation in modern Europe. 17 th and 18 th centuries  key turning point: o Cartesian conceptualisation of the body as a machine in need of regulation o expansion of the monopoly and authority of medicine, through  the creation of boundaries around experts  the discrediting of other practitioners (‘wise women’, midwives)  invention and routinisation of new surgical instruments 19th century forceps

Professionalisation and Gendered Exclusion 3 midwives attending to a pregnant woman (16 th century woodcut) Obstetrical examination (1822 engraving)

Feminist Critiques of Medicalisation Gendered processes shaped by and shaping unequal relations of power o women were barred from these new professions (first female doctor in the UK: 1865) o women’s knowledge & advice increasingly disqualified and dismissed o symbolically and materially, childbirth structured in line with (male) doctor’s gaze, rather than pregnant woman’s experience  materially: instead of delivering in squatting position (gravity assisted) or side-lying (promotes natural stretching of perineum) lithotomy position predominates (mother on her back, legs up, against gravity)  symbolically: e.g. Emily Martin’s study of metaphors of childbirth o medicalisation facilitated large-scale social (and biological) control of women  hence, a key part of second-wave feminist mobilising was a critique of medical practice and discourse

Medical Metaphors of Childbirth ‘the womb and the uterus were spoken of “as though they formed a mechanical pump that in particular instances was more or less adequate to expel the foetus”’ (Emily Martin, 1992, p. 54) Birth is analogous to factory production: obstetrician is factory supervisor or owner pregnant woman is labourer, uterus the machine, baby the product aim is standardised rate of production, through intervention ‘the uterus is held to a reasonable “progress”, a certain “pace” and not allowed to stop and start with its natural rhythm’ (Martin, 1992, p. 59)

Regulating the ‘Machine’ Discourse of time and motion Emphasis on efficiency, predictability, productivity Deviation = intervention e.g. the Friedman curve

Childbirth as a Cultural Event ‘Whatever the nature of a particular birthing system may be, its practitioners will tend to see it as the best way, and perhaps the only way, to bring a child into the world. (…) In the United States birth is predominantly viewed as a medical event and a pregnant woman is accordingly treated as a patient. As such she is expected to fulfill the role of "sick person" (Parsons, 1951): she is considered relatively helpless and exempt to some extent from her normal responsibilities for herself, and she is required to seek technically competent help from medical personnel for treatment of her "condition". In Sweden birth is considered an intensely fulfilling personal experience. The Dutch regard birth as a natural event. The Maya Indians similarly view birth as a difficult but normal part of family life’ (Lozoff et al, 1988, pp ) Pain in childbirth recognized and expected in all societies, but treated differently: US - pain relief controlled by medical attendants, labouring women have to convince them Sweden - women get full information about kinds of pain relief and risks and decide themselves Netherlands- women neither expect nor receive pain relief Maya Indians - pain is expected as a normal part of birth, a sign of progress Lozoff, B. et al (1988), ‘Childbirth in Cross-Cultural Perspective’, Marriage and Family Review, Vol. 12, No2 3-4, pp

The Homebirth Debate Homebirth Hospital birth vs.

The Rise of Hospital Births 1920s: 80% of births at home in England and Wales 1960: 33% : 0.9% 1991: 1% 2006: 2.6% 2012: 2.3% ‘The last four decades have witnessed a largely consistent and persuasive argument from the obstetric establishment that the hospital is the best and safest place to be born’ (Cahill, 2001). 74% of new mothers said that they were given the choice of having their baby at home [so 26% were not] (2011, Quality Care Commission Survey) ‘We should be aiming to see home births at the levels of the 1960s when a third of women had their babies in their homes’ (Cathy Warwick, Royal College of Midwives) Cahill H. (2001) ‘Male appropriation and medicalisation of childbirth: an historical analysis’, Journal of Advanced Nursing, Vol. 33, No. 3, pp

‘Climates of Confidence or Doubt' ‘Pregnancy and childbirth are normal, healthy processes for most women, the vast majority of whom have healthy pregnancies and babies. But when was the last time you saw a newspaper article titled “3.5 Million American [US] Women Had Normal Labors and Healthy Babies this Year”... ? The media’s preference for portraying emergency situations, and doctors saving babies, sends the message that birth is fraught with danger... [such that] high-tech medical care that is essential for a small proportion of women and babies has become the norm for almost everyone. Some advocates for childbearing women describe this as a “climate of doubt” that increases women’s anxiety and fear. In contrast, a climate of confidence focuses on our bodies’ capacity to give birth. Such a climate reinforces women’s strengths and abilities and minimizes fear.’ Our Bodies, Ourselves – Pregnancy and Childbirth, 2008, pp. 7-8

An alternative? Midwife led units In 2011 just over 90% of babies were born in hospital 7% were born in midwife led units 2.49% were born at home Source: Office of National Statistics Images: 2 recently opened NHS Mid-wife led units

Women’s Experiences of Childbirth ‘ The main trauma for me was all the intervention: being induced, having my waters broken for me and being examined all the time… my labour didn’t progress well because I didn’t dilate enough. In the end they had to use both forceps and a ventouse suction cup to get Amelie out, which was frightening and stressing… Staff were too busy to explain what they were doing and why. I didn’t know what was happening or going to happen, and I didn’t like that lack of control.’ (Guardian, 15 November 2010)

I really felt a lot of control all the way through, and I think one of my biggest fears about hospitals was not being in control… I felt like I was making the decisions’(Fox and Worts, 1999, p. 335) ‘I had a highly medicated birth-pitocin to induce contractions because my water was leaking, then Stadol for the pain… and then (hooray!) the epidural. And episiotomy. Lots of medical intervention. And it was actually a pretty great experience because the people around me were sensitive to my needs and desires and cared for me in the way that I personally needed. My nurse was fantastic--very nurturing and reassuring. At all times I felt like I had control of the situation…’ positive-birth-experience-can-happen.html

Control and Decision-Making Control – over one’s body and over ‘risky’ and unpredictable natural processes – as a key element of understandings and experiences of pregnancy  Fox and Worts (1999) o A sense of control is crucial to women having a positive experience of birth – even with intervention o Technology as both empowering and disempowering  Lupton and Schmied (2013): to understand one’s sense of control we must consider the nature of the embodied experience of childbirth

Resisting Medicalisation in Hospital Martin also examines the micro-politics of medicalised childbirth and how some women resist medicalisation: o Similar to strategies used by workers o Covert resistance o ‘Go-slow’ o Remove equipment o Stay on the move Childbirth is shaped by broader structures of power: e.g. experiences and degree of autonomy allowed in childbirth are differentiated by ‘race’ and class

Woman-centred vs. Institution-centred Midwifery Hunter (2004) argues that the practice of midwifery in the UK is fraught with conflicts: between teaching and practise of midwifery between ‘With woman’ and ‘With Institution’ approaches between authoritative knowledge about childbirth residing in the system of production and authoritative knowledge residing with birthing women ‘I’m aware when I’m measuring a woman’s fundus, I’m not free…I want it to measure what it’s supposed to measure on the chart, I don’t want to have to send her in because it’s a little bit bigger or it’s a little bit small. I want to protect her, I want to protect her from feeling worried… I mean you know just by looking at a woman when she’s lying down and you know how many weeks she is, you know if she’s too big or too small’ (Mia, midwife, interview )

Childbirth and Midwifery Policies in the UK 1993: Department of Health report Changing Childbirth 1997: Audit Commission report First Class Delivery: Making it Better for Mothers and Babies 2007: Department of Health guidance: Maternity matters: choice, access and continuity of care in a safe service 2008: Healthcare Commission report Towards Better Births: A review of maternity services in England £330 million extra funding over 3 years from 2008 David Cameron accused of breaking pre-election promise to recruit an additional 3000 midwives NHS cut funding for maternity care by up to 15% in half of England’s health regions in , despite births being at their highest in 40 years and childbirth services being understaffed (Guardian, 13 November 2013)

Campaigns for Continuity of Care Independent Midwives UK: o Community Midwifery Model Association of Radical Midwives (ARM): o Taking midwifery ‘back to the roots’ o Re-skilling midwives Association for Improvements in Maternity Services (AIMS): o Pressure group o Offers advice to women The Birth I Want: o Campaign for all birthing women to have support from a midwife she knows and trusts

The Face of Birth (2012) Film about pregnancy, childbirth and the power of choice Importance of education in birthing and the right of a woman to choose the best birth method for her and her baby

2013 maternal mortality ratios - 230/ live births in developing countries - 16/ live births in developed countries Niger: 1 in 7 chance of dying in childbirth Sweden: 1 in 29,800 (Save the Children, 2006) More than 800 women a day die in pregnancy or childbirth globally, 99% in developing world Many deaths are from treatable conditions Since 1990 maternal deaths worldwide down by 45% 15 million women endure injuries, infection and disabilities in pregnancy and childbirth ‘Dying to have a baby’: International Perspectives

Source: The Lancet, 12 April 2010 The bottom 10 countries: Afghanistan Central African Republic Malawi Chad Sierra Leone Lesotho Cote d’Ivoire East Timor Guinea Liberia

Cherry Has A Baby (BBC3 September 2010) player Also links to Timing Parenthood next term