How midwives market homebirth

On Friday I wrote about midwives and the commodofication of birth. In order to create a perceived “need” for their services, midwives must convince women that a safe birth in the hospital attended by highly knowledgeable, highly trained providers is not enough. They attempt to create that need by selling the “birth experience.”

In Great Expectations: Emotion as Central to the Experiential Consumption of Birth by Markella Rutherford and Selina Gallo-Cruz deconstruct midwives’ websites to examine the 5 components of the midwifery marketing plan.

1. Safety

Here homebirth midwives* find themselves with a problem. Homebirth increases the risk of neonatal death. American homebirth midwives are grossly undereducated and grossly undertrained. Indeed, they have less education and training than midwives in ANY other first world country. Faced with this dismal reality, midwives do something simple and straightforward: they lie.

… [M]idwives deal with potential clients’ anxieties and fears about the safety of birth in two ways: they attempt to convince them both that midwifery care is competent and safe and that hospital care is risky and suspect, at least for most healthy women.

Those overarching lies rest on a variety of other, smaller lies of omission and commission:

… [Midwives] point out that many complications in birth often arise because of hospital practices and procedures. Midwives describe the increased likelihood that hospital births will result in stalled labor and unnecessary cesarean sections, expose mothers and babies to infections, and cause respiratory distress in newborns. In addressing safety concerns midwives attempt to shift anxieties about the risks of birth in general to a fear of the often-cascading interventions of hospital birth.

2. Fear of pain

Homebirth midwives have yet another problem; they cannot dispense the only truly effective relief for labor pain, the epidural. Therefore, midwives work to discount the reality of labor pain. That involves a variety of marketing strategies: minimizing the actual pain, grossly exaggerating the effectiveness of non-pharmacologic methods, and glorifying the pain itself.

… [Midwives] recommend using visualization, hypnotherapy, affirmation, and psychological empowerment to approach labor as a positive experience that does not have to be painful. A sense of empowerment to overcome pain is a notable feature of the narrative of natural birth … [T]hese websites reinforce the narrative themes of empowerment and the natural ability of women to give birth by including graphic pictures of women in labor. By depicting women’s laboring bodies and their facial expressions of strength, determination, and joy, these websites reinforce the idea that giving birth [should be] embraced and celebrated as an empowering experience.

3. Choice

Choice is portrayed as the sine qua non of the “birth experience.” Certain choices are portrayed as superior (particularly those that are transgressive) and defying medical advice is framed as being “educated.” This is integral to the overall project of creating a specific self image.

A major selling point of non-medical birth services is women’s desire to experience the personal autonomy fostered by a view of the woman as active agent and rational consumer…. One of the ways that midwives encourage this sense of control is through their promotion of knowledge and education … In general, limited choice is an affront in consumer culture; midwives construe hospital birth as limiting the birthing woman’s choices and diminishing her autonomy. Instead midwives promise to offer a wide range of choice and to hand over control to the consumer…

Moreover:

As marginal providers of a commodified experience, midwives specializing in alternative birth cannot afford to overlook their clients’ satisfaction, which is often based more upon a romantic idealization of the birth experience than upon a rational calculus… [M]idwives … claim that women who birth outside of the hospitalized, medical model are more satisfied with the experience of giving birth…”

4. Intimacy

Emotional intimacy with the midwife is deemed critical to the “birth experience.”

… Intimacy between midwife and client begins to develop before birth through time spent together in prenatal visits that may last up to an hour or more. In these visits, midwives not only attend to the physical health of the pregnant woman, they also spend time talking with her about her anxieties, concerns, desires, and expectations…

But emotional intimacy is also critical to homebirth midwifery in a way that midwives never discuss. It is critical to the midwives themselves to forge an intimate emotional connection. That is why homebirth midwives feel free to turn down clients who do not share the midwives’ view on approved choices. The midwife needs to feel validatation and emotional fulfillment produced by rendering the client as an intimate friend.

5. Symbolic Meaning and the Idealization of the Birth Experience

This is really what homebirth midwives are selling: the creation of “meaning.”

The alternative birth is an idealized experiential commodity… [I]t is the idealization of birth that transforms the experience itself into a desired consumer experience. Midwives encourage the idealization of the alternative birth experience through the emphasis they place on emotions, symbolic meaning, imagination, and planning.

Homebirth is not about birth, and it is certainly not about the baby. It’s all about creating a desired consumer experience, an experience (midwives encourage clients to believe) that defines them as women and as mothers.

The idealization of birth emphasizes its symbolic meaning and enchants the experience through a romantic ethic… Midwives refer to birth as a spiritual, sacred, and miraculous event. Giving birth is described as “an opportunity for spiritual and emotional transformation”, “a peak human experience”, “a sacred rite of passage”, and “a magical, transformative, and truly empowering experience”…

In their concluding remarks Rutherford and Gallo-Cruz once again stress the similarity to weddings:

In conceptualizing natural birthing as an emotional and idealized consumption experience, we see that birth has come to mirror aspects of the wedding, another heavily commodified rite of passage… [W]e see that the woman planning for alternative birth also exercises calm control, rational decision making, and has the illusion of autonomy over her choices at the same time that she is a romantic fantasizer hoping for wish fulfillment… the idealization of the birth experience offers a legitimate opportunity to orchestrate another emotional consumer experience in which the bride-now-turned-mother produces, directs, and
plays the starring role.

In marketing her services, the midwife portrays herself as crucial to creating the “experience”:

With a midwife’s guidance and through her own idealization of the birth experience, the birthing mother is both a producer and a consumer of the birth experience. Not only is her physical labor a productive activity, but she also produces her emotional response to the experience. Furthermore, as with other extraordinary experiences, consumption of a birth experience is an active form of symbolic identity construction through which women give coherence to their own sense of self. The mother who selects an alternative birth outside of the medical model consumes her birth experience for the purpose of producing her own self-image and her family‚Äôs lifestyle.

Homebirth midwives are no different than wedding purveyors, or even certain drug manufacturers. They are hawking a product that no one really needs.

You can have a wedding without all the expensive trappings, save thousands of dollars, and be just as married. Drug manufacturers often find themselves with products that aren’t needed, so they set out to create a new “condition” that requires treatment with the otherwise useless drug. Homebirth midwives are not as knowledgeable as other medical providers, are terribly unskilled, and add no real value to childbirth. You can have a baby in a hospital, pay only a copay and get a healthy baby, which is presumably the goal of pregnancy.

Since homebirth midwives add no value to birth, they have created the “birth experience” with themselves as guides. Women are encouraged to believe that the “meaning” of childbirth does not rest in the baby, but rather in the mother’s emotional connection to her caregiver, the mother’s ability to exercise autonomy and, above all, the mother’s creation of a specific self-image. She may no longer be the princess at her own wedding, but now she is the queen at her own child’s birth.

*American midwives who hold a post high school certificate (CPMs and LMs), as opposed to American certified nurse midwives and European, Canadian and Australian midwives who have university degrees