1. Week 8: Giving Birth to Children and Mothers Dr Sherah Wells Sherah.Wells@warwick.ac.uk Transformations: Gender, Reproduction, and Contemporary Society PPUpdateSWells11.2012

2. Structure of the Lecture Homebirth – a debate The Medicalisation of Childbirth Women’s experiences of birth Midwifes at Work The future… International Perspectives

3. The Homebirth Debate HomebirthHospital birth vs.

4. The Rise and Rise of Hospital Births 1920s: 80% of UK births at home 1991: 1% of UK births at home 2006: 2.6% of UK births at home Medicalisation of Childbirth

5. Feminist Critique of the Medicalisation of Childbirth 17 th century conceptualisation of the body as a machine in need of regulation Boundaries around medicine discredited midwives New surgical instruments Women denied access to medical training 19 th century forceps

6. Professionalisation and Gendered Exclusion 3 midwives attending to a pregnant woman 1500s woodcut Obstetrical examination 1822 engraving

7. Martin’s Medical Metaphors ‘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”’ (Martin, 1992, p. 54). Birth as factory production: ‘the uterus is held to a reasonable “progress”, a certain “pace” and not allowed to stop and start with its natural rhythm’ (ibid, p. 59).

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

9. 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)

10. Women’s Experiences of Childbirth ‘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)

11. Women’s Experiences of Childbirth ‘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…’ http://mommyphd.blogspot.com/2006/10/positive- birth-experience-can-happen.html

12. Control and Decision-making Fox and Worts: Control and autonomy are crucial to women having a positive experience of birth – even with intervention Technology: Empowering or Disempowering? Both?

13. Resisting Medicalisation of Birth Similar to strategies used by workers Covert resistance Experiences differentiated by ‘race’ and class

14. Woman-centred vs. Institution centred Midwifery Conflict between teaching and practise of midwifery ‘With woman’ vs ‘With Institution’ Authoritative knowledge about childbirth is with the system of production and not with the women

15. ‘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 erm, 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 it’s ridiculous, I mean you can know if a baby’s too big or too small, 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, usually, you know’. (Mia, midwife, interview 30.06.2005)

16. Childbirth and Midwifery Policies 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 Cameron: accused of breaking pre-election promise to recruit an additional 3000 midwives

17. Is there a Crisis in Midwifery? Midwives leaving the profession, leaving training Walters: midwives are ‘popping in and out of three or four labour rooms and filling out endless forms while women yell for them’ (Guardian, 2003). Recruitment has increased but birth-rate has also increased Royal College of Midwives: 66% of midwifery heads report insufficient staff (November 2009)

18. Campaigns for continuity of care Independent Midwives UK www.independentmidwives.org.uk www.independentmidwives.org.uk Community Midwifery Model Association of Radical Midwives (ARM) http://www.midwifery.org.uk/ http://www.midwifery.org.uk/ Taking midwifery ‘back to the roots’ Re-skilling midwives ukmidwifery yahoo group Association for Improvements in Maternity Services (AIMS) www.aims.org.uk www.aims.org.uk Pressure group Offers advice to women

19. ‘Dying to have a baby’: International Perspectives Chance of dying in childbirth: Niger: 1 in 7 Sweden: 1 in 29,800 (Save the Children, 2006) More than 340 000 women die in pregnancy or childbirth annually around the globe Many deaths are from treatable conditions such as high blood pressure 15 million women endure injuries, infection and disabilities in pregnancy and childbirth

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