If natural childbirth is so natural, why must it be taught?

If there’s one thing that all natural childbirth advocates agree upon, it is that natural childbirth requires preparation and education. Such education includes classes, books and websites. No natural childbirth advocate would ever propose doing what women have done for most of human existence, nothing. Here’s what I want to know: If natural childbirth is so natural, why must it be taught?

The answer, of course, is that the philosophy of natural childbirth has little if anything to do with childbirth in nature. It is an elaborate set-piece, designed to give participants the illusion that they have recreated nature. It bears about as much relationship to childbirth in nature as an infinity pool in your backyard bears to the local watering hole.

Indeed, in the paper The social nature of natural childbirth (Social Science and Medicine, December 2007), Professor Becky Mansfield, claims that rather than representing a return to nature, natural childbirth posits a specific set of social and cultural practices. Mansfield begins by asking the obvious:

… If childbirth is so natural, how can there be strategies to facilitate it? If it is instinctive, why does it need to be learned? …

The answer, of course, is that it is a conceit of privileged white women in first world countries in which a a specific set of cultural practices is imagined to represent “nature.”

Mansfield reviews natural childbirth books written for lay people, and identifies 3 types practices that appear to be required for natural childbirth to be natural. Although Mansfield concentrates on books, websites and childbirth classes exist to promote the same information.

1. Activities during birth

The first theme is the variety of activities during labor and delivery that the books represent as necessary for making a non-medicalized birth possible. This theme is “social” because the books represent natural childbirth as something women must do; according to these books they cannot do nothing or just anything.

Not only is doing nothing forbidden, but special equipment and preparations are necessary:

… Books promote having a range of props to help a woman be active (e.g., squat bars or birth balls) … The books place even greater emphasis on using the environment to help women be emotionally comfortable, on the premise that the wrong environment increases fear and anxiety (thereby inhibiting labor) while the right one reduces them…

2. Preparation

The second theme of these books – preparation – emerges from this emphasis on activities and learning. According to these books, women wanting birth without intervention must prepare themselves by doing a variety of things in advance…

Prescribed forms of preparation include physical preparation “as for an athletic event”, emotional preparation and elaborate “birth plans,” written documents meant to establish choices in advance.

3. Social support

The emphasis on choice of caregiver and place of birth is one indication that social support … is considered an integral part of natural childbirth… The books contend that social support makes natural childbirth possible by helping women build “trust” in themselves, their bodies, and the “natural” process of childbirth…

In other words, childbirth isn’t natural unless you pay money to someone to facilitate it.

The role of the caregiver as presented in these books is a complicated one… As a result (and despite their emphasis on instinct), books imply that women … rely on someone with knowledge, training, and experience to help figure out what is happening and what to do…

And let’s not forget all the “natural” interventions recommended by the caregiver, including

… a whole host of “non-pharmacological” practices meant to change the course of labor. Examples include herbal remedies, homeopathy, acupuncture, … massaging the perineum to prevent tearing, and transcutaneous electronic nerve stimulation (TENs machines) for pain relief. While books represent such interventions as “gentle” or “natural,” the message they send is that natural childbirth often does involve actively intervening in the birth process…

Evidently:

… “letting nature take its course” requires a complex sociocultural milieu that must be fostered through a range of social interactions.

Mansfield concludes:

… The books … represent natural childbirth as requiring social practice to make it successful… Thus, although the central theme first appears to be about letting nature take its course … [t]he central finding of this study is that proponents represent natural childbirth as a set of very specific social practices that are seen as facilitating nature, and in so doing, they also present a vision in which nature depends on social practice…

In other words, natural childbirth bears about as much relationship to childbirth in nature as an elaborately designed infinity pool in your backyard bears to the local watering hole. A quick look reveals a superficial resemblance, there’s a hole in the ground, water, rocks at the margins and plantings surrounding it all. But a more detailed analysis demonstrates elaborate planning, paid help, special tools to place the rocks, set in and care for the plantings and hidden technology like a water filter. There’s nothing natural about it.

Similarly, a quick look at natural childbirth reveals a superficial resemblance, but a detailed analysis demonstrates elaborate planning, paid help, special tools and hidden technology, such as fetal monitoring, blood pressure measurements, herbal supplements, chiropractic, and acupuncture.

Why must natural childbirth be taught? Because it is not natural; it is a simulacrum of natural designed to promote the conceit that privileged white women in first world cultures have returned to nature.

Adapted from a piece that first appeared on Homebirth Debate in January 2008.

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