Yesterday I wrote about Melissa Cheyney’s disquisition on the anthropology of birth. Cheyney does provide insight into the “meaning making” of natural childbirth and homebirth advocates, but she does so from a position of complete credulousness. Since she (herself a homebirth midwife as well as an anthropologist) is part of the subculture she is investigating, she does not question the meanings, the meaning-making or the relationship of such meaning-making to reality. It as if an anthropologist writing on human sacrifice ascribed to the belief that the gods could be propitiated by throwing virgin girls into volcanoes, and having accepted that assumption, proceeded to describe the meaning and meaning-making of the ceremonies surrounding the sacrifices.
Cheyney, however, is not the only anthropologist of birth. There are others whose work is not colored by the need to justify the beliefs of the natural childbirth/homebirth subcultures. Consider the chapter The Dialectics of Disruption: Paradoxes of Nature and Professionalism in Contemporary American Childbearing by Caroline Bledsoe and Rachel Scherrer. It appears in the book Reproductive Disruptions: Gender, Technology, and Biopolitics in the New Millennium.
The chapter covers many areas of the anthropology of childbirth in contemporary first world countries. The one that is relevant for our current discussion is the issue of meaning-making explained by Cheyney. However, they go far beyond Cheyney in that they explore why and how NCB/homebirth advocates have come to believe what they do. Unlike Cheyney, who so eagerly accepts the meanings and meaning-making of contemporary NCB/homebirth advocates, Bledsoe and Scherrer examine why meaning-making is so important within the subculture.
Their description of the current situation is spot on:
… Birthing is depicted culturally as an individual achievement, one in which a woman should be in control of her actions. For this, women attempt to present themselves as professionals, medical as well as legal: as close as they can come to being equals with their medical peer doctors, informed and trained to evaluate their qualifications (my emphasis).
Bledsoe and Scherrer recognize that meanings and meaning-making are luxuries of a society in which childbirth is so safe that women have forgotten that in reality it is inherently dangerous:
… As childbearing became safer and more benign visions of nature arose, undesired outcomes of birth for women came to consist of a bad experience and psychological damage from missed bonding opportunities. Today, with safety taken for granted, the new goal has become in some sense the process itself: the experience of childbirth… (my emphasis)
In other words, as I have written repeatedly since for NCB/homebirth advocates outcome is taken for granted, the focus has shifted entirely to process. And the most critical element in the process, the one to which the most significance is imputed, is control.
Their critical insight:
… But with *control* being such a crucial issue in cultural ideals of childbearing, the greater the expectations that a scripted birth plan creates, the greater the surety that the woman will fall short of her ideal. Some elements will go wrong, and with them the hope of remaining the equal of the professionals who deals with her birth. This relegates obstetricians, who have the power to disrupt a naturalism but also to save lives if something goes wrong, to being the inevitable targets of opposition. (my emphasis)
Specifically:
If nature is defined as whatever obstetricians do not do, then the degree to which a birth can be called natural is inversely proportional to the degree to which an obstetrician appears to play a role. The answer to why obstetricians are described with such antipathy thus lies not in the substance of what obstetricians do that is unnatural – whether the use of sharp incision. forceps, and medications that blunt sensation. or anything else- but in the fact that obstetricians represent a woman’s loss of control over the birth event. Obstetricians are thus perceived as the chief source of disruption in the birth event, backed by the licensing power of medicine and the law. And yet it is not what obstetricians do that women find problematic but the fact that they are the people who step in when the woman is seen to have failed. (my emphasis)
In other words, as I have written repeatedly, the “natural” in natural childbirth has nothing to do with nature. Natural is defined as anything a midwife can do. In contrast, if only an obstetrician knows how to do it, it is “unnatural” by definition in the NCB subculture.
The authors summarize:
… Today, because of medical and technological advances that have brought so many of the life-threatening complications of childbirth under control, the naturalism in childbirth that women now envision is not only benign but desirable. But to the extent that childbearing remains less about nature than control, animosity will likely continue to be directed at doctors because they represent failure to attain nature, and animosity will continue to be directed at obstetricians, regardless of what they actually do or what their gender is. (my emphasis)
Ultimately, there is nothing wrong with Cheyney’s attempt to describe the meanings and meaning-making of contemporary NCB/homebirth advocates. The problem is that she fails to question the fundamental assumptions that undergird these meanings. Just as human sacrifice only makes sense to those who believe that the gods are pleased by throwing virgins into volcanoes, natural childbirth only makes sense to those who believe that childbirth is inherently safe. And while we have no idea whether there are “gods” and whether they are pleased by human sacrifice, we do know that childbirth is not inherently safe.
Bledsoe and Scherrer understand:
… As we turn to the disruptions that preoccupy US middle-class women as they contemplate the birth of a child. it is vital to keep in mind both the dangers that reproduction can entail and the science that has allowed us to imagine as common sense a safe, uninterrupted, reproductive life trajectory.
It is precisely these points, the inherent dangers of childbirth, and the science that has allowed us to treat and prevent them, that Cheyney fails to take into account. Therefore, her analysis is flawed to the point that it is nearly nonsensical.
I find it very strange that this MD has chosen to compare home and natural birth advocates to people who believe in the benefits of human sacrifice. She really hasn’t done her research. My OB attended my home birth! She admits that many of her routine practices were unnecessary and she has totally revamped her practice over the years to take an approach more aligned with that of the midwife than the OB. Why? Because it made a hell of a lot more sense. Educate yourself, Dr. Instead of making fallacious arguments and comparisons based on an erroneous and relatively vacuous interpretation of the ‘other side’.