The anthropology of natural childbirth advocacy


A startling number of professional natural childbirth advocates are anthropologists or sociologists. They believe that they ground their advocacy of unmedicated vaginal birth in the ancient practices of indigenous cultures. One of the best known is anthropology professor Melissa Cheyney, who is also a homebirth midwife and an executive of the Midwives Alliance of North America (MANA) the trade organization of homebirth midwives.

In her paper Reinscribing the Birthing Body: Homebirth as Ritual Performance  Cheyney writes about the importance of “meaning-making” among homebirth midwives.

… As a socially performed act of differentiation, homebirths are constructed in opposition to dominant ways of giving birth, although just where the lines between consent and resistance lie are not always clear, shifting with each provider and each mother, over time and in the retellings.

You might have thought that prenatal and intrapartum care was about delivering healthy babies to healthy mothers. How tragically naive; it’s all about peeling away fictions:

Midwives describe the desire to peel away these fictions of medicalized prenatal care, exposing strong and capable women who “grow” and birth babies outside the regulatory and self-regulatory processes naturalized by modern, technocratic obstetrics…

And if that wasn’t enough jargon for you, how about this?

… Capitalizing on the semiotic potential, heightened emotion, and the liminality of the birth itself, midwives seek to overturn mechanistic views of the faulty female body in need of medical management, replacing them with the language of connection, celebration, power, transformation, and mothers and babies as inseparable units. Homebirth practices, thus, are not simply evidence based care strategies. They are intentionally manipulated rituals of technocratic subversion designed to reinscribe pregnant bodies and to reterritorialize childbirth spaces and authorities. For many, choosing to deliver at home is a ritualized act of “thick” resistance where participants actively appropriate, modify, and cocreate new meanings in childbirth.

There are others anthropologists and sociologists is whose work is not colored by the need to justify the beliefs of the natural childbirth/homebirth subcultures. They have investigated the anthropology of the natural childbirth movement itself. In the chapter The Dialectics of Disruption: Paradoxes of Nature and Professionalism in Contemporary American Childbearing, Caroline Bledsoe and Rachel Scherrer examine why meaning-making is so important within the culture of natural childbirth advocacy.

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)


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.

Mothers need to understand this, too.


A version of this piece first appeared in December 2011.