The anthropology of natural childbirth advocacy

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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)

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.

Mothers need to understand this, too.

 

A version of this piece first appeared in December 2011.

  • Burgundy

    I thought about the article when I saw this on Youtube today. Anthropologists should have known better.

    [BBC – HISTORY COLD CASE] The Woman and Three Babies
    https://www.youtube.com/watch?v=uNW2HWtXT_U

  • Ardea

    I took a class at Hampshire College sometime around 1989 that used language similar to Cheney’s – it was called Comparative Scientific Traditions, I think, and was mostly about questioning reductionist western science and comparing that to more “holistic” forms of science and medicine, such as acupuncture: “It works on dogs! It can turn a breech baby around!” As a biologist, in the meantime, I’ve become a little frustrated with language like semiotics and mechanistic… I wonder, “What is your reality, and how can you know anything?” (That was the upshot of that particular class: no one can know anything.)

  • Guest

    I think this is actually the most powerful post ever on the Skeptical Ob. The absolute core of the NCB problem.

  • me

    So I hate to thread-jack, and this is totally off topic, so my apologies right off the bat. There are a lot of smart ladies (and men) on this site who might have some insight for me though. I’m ready to consider permanent sterilization (I’m in my mid 30’s, three children and we are definitely d.o.n.e.) but I’m not sure which option would be better – a tubal ligation or Essure. I’m leaning towards a tubal, simply because it’s been around longer and I feel more “comfortable” with it, but would love to hear opinions from those of you who have either performed the procedures, or had them performed on you. I have no medical conditions that would make me high risk for anesthesia and have ‘gone under’ before with no complications. I guess my biggest worries with essure would be the device not “taking” or it migrating and causing damage to other organs, as well as the 3-6 months where you are waiting for it to “take” and having to be diligent with the birth control during that time (TBH my husband and I don’t have the best track record with that). Any other info you think is relevant, just ask. Thanks so much!

    • attitude devant

      Actually, newest best idea is to have your tubes removed, not just ligated. We are beginning to think ‘ovarian’ cancer is actually tubal. This can be done through the laparoscope just like a tubal ligation. So you get sterilized AND potentially reduce your lifetime risk of a deadly (although uncommon) cancer.

      • toni

        wow, interesting. and you’d still get monthly cycles/not induce early menopause?

      • Cobalt

        I have a question: is “post tubal ligation syndrome” real? I looked into permanent solutions and we ended up going with temporary (and another baby), but something I was reading talked about some women have early menopause or other medical problems after a tubal and especially after Essure. Something to do with the ovarian blood supply being damaged or deteriorating due to the procedure.

        I don’t have the education to evaluate if that’s even possible, and the article had a sketchy quackish (ducky?) vibe. Is it an actual syndrome? A plausible syndrome?

        • Susan

          I’d like you to chime in on that too. I think, based on little, that it’s hooey!

      • me

        Hmm. Hadn’t even considered that. Now I have another option to look into!

      • Roadstergal

        I did not know that, thanks for the info! I will have to talk to my doc about it the next time I see her.

      • me

        I looked into that, per my insurance benefits brochure and I don’t think they would cover it – they only cover tubal ligation or occlusion as permanent family planning, not removal (unless there is some other medical reason for it). So I don’t think that’s a viable option at this point.

    • The Bofa on the Sofa

      As a guy, my question is, what about a vasectomy?

      I did it. One day out of commission but that was about it. Moreover, it’s easily checkable to make sure it’s working

      • me

        My husband had agreed to do that initially, but, well, two years later he still hasn’t pursued it; I would rather take matters into my own hands than fall pregnant again, lol. He’s a good guy otherwise, so I don’t fault him for being squeamish. Me, I’m not so fearful of medical procedures (we’re talking about a man who fears the dentist here, just so you know where I’m coming from).

        • The Bofa on the Sofa

          My husband had agreed to do that initially, but, well, two years later he still hasn’t pursued it;

          So because he’s irresponsible.

          Got it.

          • me

            Um. Okay. Yeah, he’s “irresponsible”. Sole provider of a family of five, a veteran, employee of the DOD for nearly 20 years, never had so much as a parking ticket, never been unfaithful, doesn’t drink, doesn’t gamble, is involved in his kids’ lives, helps around the house, volunteers in our community…. but yeah, he’s “irresponsible” because you happen to be more comfortable with medical procedures than he is.

            You, sir, are an ass.

          • me

            Wait, you’re right!

            Clearly I should leave him….. cuz after all that I listed above, if he is squeamish about having his balls carved into that’s proof that he’s and irresponsible jerk and I should ignore the past 8 years of marriage and kick that loser to the curb!

            You aren’t just an ass. You’re a pompous ass. Which I could “unlike” your initial post (which I had “liked”, but I’m posting as a guest. Too bad.

          • Guest

            He’s a good provider, never been fired, is ex military, helps around the house, volunteers, doesn’t cheat, etc etc etc…

            To paraphrase Chris Rock, “You’re bragging about things a normal man is SUPPOSED to do!”

          • Guestll

            She’s not bragging. She’s illustrating her point, which is that her husband isn’t irresponsible.

            Chris Rock’s joke was about men who say things like, “Hey, I pay my child support!” It’s not the same.

          • Guest

            She’s lauding her husband for not cheating or gambling or getting into legal trouble. Are the expectations of men in our society truly low enough that the lack of cheating, etc, is a laudable achievement? That being “involved” with your kids is praiseworthy?

          • me

            Not lauding. Defending against an unjust, unfair accusation from someone who knows nothing of the man. He is my husband, the man I love, the father of my children, a person who has stood by me through thick and thin and put up with my (numerous) idiosyncrasies for over 10 years. We respect each other, and show each other compassion and understanding. I’m irrationally afraid of wasps and hornets. When one decides to build a nest on the overhangs of our home, my husband takes care of it, without poking fun at my fears or pointing out how “irresponsible” it is of me to ask him to take care of it. He happens to be afraid of most things medical (he goes into a cold sweat and has heart palpitations at dental cleanings). I’m not. So, just as he’s willing to assume the risk of wasp and hornet removal, I’m willing to assume the risk of permanent sterilization. perhaps it’s not the same risk level, but phobias aren’t rational (by definition), and my husband is a good guy who deserves my compassion.

            Maybe that’s not how it works in your marriage. But that’s how it works for us. We take care of each other.

          • Guest

            The above post is full of laudatory behavior. Bragging on not getting a parking ticket is not. Sorry, but it’s insulting to fathers when they are complimented on things they are supposed to do (raise their kids, love their spouse, etc).

          • me

            And it’s not insulting to men to be criticized of being “irresponsible” because they don’t live up to some chauvinistic stereotype of a “tough guy”? I suspect a lot of the reason he volunteered to do it in the first place was from that pressure: that he “shouldn’t” be afraid of something so many guys do; that coupled with the feeling that he “should” do it to spare his wife having to get something done herself. I don’t think either notion is rational. It is his body and as his wife I do NOT want him to do anything that he isn’t comfortable with. I, OTOH, am comfortable with getting “fixed”. If it spares him great distress, why on earth wouldn’t I do it??

            And, FWIW, I wasn’t “complimenting” him on doing things he should supposed to do. I was pointing out that “irresponsible” people DON’T do the things they are “supposed to do”. That’s what makes them irresponsible in the first place. Are you claiming that ALL men should get a vasectomey (regardless of how they might feel about it) otherwise they are “irresponsible”? Why do you feel that way? Do you feel the same way about other medical procedures? Should everyone be compelled to have procedures done that they don’t really want to do because it is the “responsible” thing?

          • Guest

            I never actually said anything about the vasectomy (or the initial offer followed by 2 years of delay). Bofa’s opinions on that are his own. I take more issue with the idea of what a father should be. For example, Parents magazine (honestly, just about any version) is almost exclusively directed towards mothers. Except for the June issue (“devoted to dads!!!”) in honor of Father’s Day. Or the wonder and amazement regularly expressed when a father changes a diaper. Being a law abiding citizen who loves and supports (emotionally, financially, whatever) should be expected of all, not thought of as going above and beyond because of a Y chromosome. My FIL likes to brag that he always paid child support and saw his child every other weekend and two weeks in the summer. Umm, good for him for meeting the court ordered standard? We as a society both marginalize fathers and laud them for meeting minimal standards that are well below what us expected of mothers.

          • Guestll

            Oh FFS. She was pointing out that her husband is a responsible person and the fact that he fears a scalpel or laser to his nuts doesn’t negate that.

            I went through a year + of fertility treatment. I stopped counting the number of people who’d viewed my genitals at 22. Not to mention the pain, the endless driving back and forth to the clinic, the bloating, the fun of OHSS, the joy of the drugs, on goes the list. My husband had to get a few blood draw and flog the bishop into a cup a couple times. And he is TERRIFIED of blood draws and I had to beg him more than once to get them done, and even drive him there. That is pretty much the worst thing I can say about my husband, other than his predilection for slobbality and the fact that he is bad at returning phone calls. Is he irresponsible? No, just not great with needles and blood. So what? It says nothing about his character or who he is as a man, husband, father.

          • me

            “Oh FFS. She was pointing out that her husband is a responsible person
            and the fact that he fears a scalpel or laser to his nuts doesn’t negate
            that.”

            You put it much more succinctly than I did! This is precisely what I was getting at.

          • me

            I agree with everything you said here. But I wasn’t claiming he was a “good father” or a “good husband” or even that he was going “above and beyond” because he does what any responsible person should do. I was claiming he is not irresponsible, because he does what any responsible person should do. It’s not fair, or accurate, to characterize someone as “irresponsible” because they are afraid to have a vasectomy. It’s not that he’s opposed to it or thinks BC shouldn’t be his responsibility too; I think he just is more terrified of it than he is able to admit. And the chauvinistic idea of men being big, strong, tough guys who aren’t allowed to be afraid of anything probably makes it especially hard for him to admit his fear. He’s offered to do it because he IS responsible and knows, on some level, that it would be more “fair” (given I carried and delivered the babies) for him to do it, but as I’ve said numerous times, he can’t bring himself to go forward with it because of that fear. I accept my husband for who he is, faults and all. And as far as faults go, being afraid of doctors and medical procedures isn’t all that big of a fault. I wasn’t trying to say he was the world’s greatest dad cuz he doesn’t beat his kids – I was saying being scared and being responsible aren’t mutually exclusive.

          • fiftyfifty1

            But, once again, she was not attempting to brag or compliment. She was providing simple concrete evidence to refute Bofa’s claim that he was irresponsible.

            How do we determine whether someone is a responsible person? We see if they perform duties such as paying their taxes, following all laws, supporting their offspring, holding a job etc.

            This is a completely different question than “Does this person have any qualities that are superlative?”. This is where we look for the above-and-beyond special stuff and where you can bring out anecdotes about foot rubs and trips to Spain and driving all over town on Christmas Eve in a snowstorm to find your daughter the one cheetah beanie baby her heart is set on (Here you see I am bragging on my husband).

            Bofa’s claim about the guy was that he wasn’t responsible. Therefore the correct proof to counter that claim is exactly what “me” provided, nothing more and nothing less.

          • me

            Wish I could up-vote that more than once! BTW- love the visual of your hubby driving all over town to find that special toy!

          • toni

            Yeah… this has taken a nasty turn. It’s not for anyone to say someone else’s spouse is not up to scratch when you only know one thing about them. If not being afraid to have a vasectomy was the only complaint I had about my husband I’d be deliriously happy. I don’t think that’s really a jerky thing anyway.. some people are just afraid of surgery, it’s understandable. There are other options.

          • toni

            *being afraid, I mean

          • Roadstergal

            That’s the thing, though – there’s surgery and then there’s surgery. It’s a very simple and brief outpatient procedure that doesn’t require general anesthesia. With all of the crap women have to go through to not get pregnant, or to get pregnant and actually have a kid, the invasive things they undergo and the pain and downstream consequences – I think a vasectomy is not a lot to ask from a guy. And unlike going to the dentist, you only need to do it once.

            I’m not saying one should up leave a guy if he doesn’t agree to one, but I think it’s perfectly fair to push on it a bit.

          • me

            And there’s fear and then there’s fear. I’m not particularly scared of getting my tubes tied. He tends to neglect his own health care because he’s not good with doctors and medical “stuff” (blood draws, etc). No, a vas is not a lot to ask of a guy. But an elective procedure that has alternatives is a lot to ask of someone who is very afraid of it. At least, IMO.

          • sdsures

            Yes, vasectomy is simpler than tubal ligation, and less invasive…but for someone who has never had surgery (I don’t know if the partner in question has or not), the prospect can be terrifying.

          • me

            No, he’s never had surgery (only stitches). I, OTOH, have, so that’s probably at least part of why it doesn’t bother me nearly as much as it bothers him.

          • sdsures

            If possible, it might help if he can discuss these fears with the surgeon in question. I’ve had many neurosurgeries in my life, all of which I panic about beforehand – crying, screaming, sweating, full-blown freakouts – and most of my surgeons (and in some cases, anesthetists) have figuratively or literally been willing to hold my hand through the process, or at the very least to explain exactly how things will go (in an awake surgery, I found this preparation very helpful, and he even talked to me while he worked. Examples: “Right, I can see the catheter and I’m just going to tie it off again. Are you feeling any pain? Yes? OK, I’ll give you some more Lidocaine.”). This is just my own experience, and I’m a female, so it might or might not work for him. The awake surgery in question was very minor: a small incision in the collarbone area to tie off my shunt catheter. I remember that I was allowed to squeeze the hand of the anaesthetist as hard as I wanted. They weren’t putting me under, but had him there just in case they might need to.

          • Lion

            I had a tubal ligation as I don’t want anymore children. I have no idea about how my husband felt about a vasectomy, I never asked. We chatted about not wanting more kids, and I won’t want any more even if I had to remarry ever, but he might, so, it was an easy choice for me. I’m so glad I did it. It was about four hours in hospital, laparoscopic surgery and a few days off work, but I was up and about and quite enjoyed the two days off to read and relax while the kids were in day care.

          • sdsures

            “And unlike going to the dentist, you only need to do it once.”

            Vasectomies can fail, if I am not mistaken. Just saying.

          • Amy Tuteur, MD

            Yes, this has taken a nasty turn. Let’s stop this.

          • me

            I’m not “bragging”; I’m pointing out that if he were so “irresponsible” he would very likely be doing other (truly) “irresponsible” things. If being afraid of something makes you “irresponsible”, then, well who among is is “responsible”? Everyone is afraid of something.

          • The Bofa on the Sofa

            As opposed to the guy who agreed to get a vas, and two years later is still stalling.

            Yep, he’s responsibly done all the things that he has done responsibly. That doesn’t mean has lived up to his agreement that he made years ago, to the point where YOU are feeling it necessary to consider undergoing a medical procedure to make up for it.

            You deserve better than that.

          • me

            Well, maybe you have no compassion for other people’s fears. I hope your wife and children never have any. I’m not afraid of medical procedures. He is. I don’t fault him for that. He volunteered to get it done after our third child (I was planning on getting myself “fixed”). I was surprised at this offer (given his fears), but I think he really wants to do “the right thing” (his hesitation is not about “maschismo” or not realizing that I carried and gave birth to his three children, it’s about his phobia, pure and simple). At this point I suppose I could encourage him to go to therapy for years so that he could overcome his fears (maybe) and go in for this elective procedure. Or I could be compassionate and realize that it’s simply easier for me – I’m not afraid of getting it done.

            But thanks for telling me what I “deserve”. That’s not at all pompous of you.

            Ass.

          • Susan

            I have to agree that as much as we talk about ethics they apply to men too. If he doesn’t want to be cut it’s not evidence of a moral failing. His body his choice ya know?

          • me

            This. He surprised me when he offered to get it done. Because I know how he feels about medical “stuff”. That he’s having a hard time and is hesitating is evidence not of “irresponsibility”, but that he’s more afraid than maybe he realized (or wanted to let on). In good marriages there is give and take and compassion. I have no problem getting myself “fixed”. I appreciated his offer, but I don’t think less of him because he is too afraid to go through with it. I know who I married and love him, fears, idiosyncrasies, and all.

          • Lion

            Bofa is always an ass. He specializes in nastiness.

          • sdsures

            Or, surgery scares the hell out of him?

      • Mishimoo

        Honestly, it was an awesome decision and I’m so glad that my dude went and got one. Recommending it to my friends that definitely don’t want any more babies.

      • AlisonCummins

        My beloved did it. Eleven years later he still has intractable abdominal pain. It hasn’t helped our sex life at all.

        I asked my sister the MD why she’d gotten her tubes tied instead of her husband since it’s so much more invasive, and aside from her own personal preference she thought vasectomy was riskier because of the possibility of permanent pain.

        Almost all guys have a happy ending. Occasionally, one doesn’t.

        • The Bofa on the Sofa

          Why would it be abdominal pain? The vas deferens are not in the abdomen. They don’t do anything in the abdomen. It’s all in the scrotum.

          • AlisonCummins

            Where do you feel it when somebody knees you in the nuts?

            Now imagine you feel kneed-in-the-nuts All The Time.

          • toni

            That’s horrible. Is there nothing they can do about it?

          • AlisonCummins

            So far, no. Spinal blocks (three different sites) haven’t been effective. Lyrica helped but then his eyelids didn’t work any more and he couldn’t see, so it’s not useful. An orchiectomy might or might not help but it might make things much, much worse so his urologist doesn’t want to take the risk.

            Almost all guys are really happy with their vasectomies! This particular one is not, though.

          • sdsures

            I’m so sorry to hear he’s in such pain. I have chronic severe pain too, but for different reasons.

            Is it possible the spinal blocks didn’t go high enough?

          • AlisonCummins

            The spinal blocks were performed by an anesthesiologist at a pain clinic so they probably knew what they were doing. I’m trying to get him to go back to the clinic to see what else they can offer — even psychological techniques.

            Pain sucks. Sorry.

          • sdsures

            Don’t give up. It’s definitely frustrating trying to find what works and what doesn’t.

          • birthbuddy

            The embryological path commences in the abdomen.

          • Ardea

            The vas deferens arises from the epididymis and loops over the bladder on its way to join the urethra at the prostate gland. It’s all connected, including the nerves that enervate that area.

    • Ainsley Nicholson

      I read everything I could about both options, and ultimately decided to go for another IUD.

      • me

        I’ve never had an IUD. How long can they be left in for? I wouldn’t want hormonal (I’m over 35, a smoker, and have a family history of heart disease, hormonal BC is just not a good idea).

        • Dr Kitty

          Copper IUDs can last 10 years, usually take 10 minutes to insert and have similar failure rates to tubal ligation.

          Vasectomy, FWIW is 10 times less likely to fail than a tubal ligation, Essure or IUD.
          Nexplanon, although hormonal, is more effective than a tubal ligation, but only lasts three years.

          The benefit of all the reversible methods is that if you don’t like them you can get them removed.

          Also worth noting, I’ve had more than one patient with a tubal ligation in her 30s who ends up getting a Mirena IUS in her 40s to control peri-menopausal heavy periods…

          I’ve had two Mirena IUS, which last up to five years, and are my favourite thing ever. They’re hormonal, but I got the benefit of no periods, with the only side effect being a marked improvement in my skin.

          Full disclosure, I had to have both put in under general anaesthetic, and the second removed under twilight sedation because my cervix does not play well with others, but I LOVED my Mirenas.

          Sadly, I don’t think my gynaecologist or my husband would be on board with me getting another one.

          • Dr Kitty

            Oh, and progesterone-only methods like Mirena and Nexplanon don’t have the risks for older smokers associated with oestrogen containing combined pills, so neither your age, nor your smoking status would necessarily be a barrier to those methods.

          • Cobalt

            What’s the connection between DepoProvera and Mirena, side effects-wise? I tried Depo for 18 months and bled lightly (and occasionally very very heavily) the whole time. My sister has Mirena and LOVES it (no periods, no pain, no problems). Is my reaction to Depo at all indicative of my reaction to Mirena?

          • Dr Kitty

            Nope.
            Mirena is low dose Levonorgestrel, Depo Provera is high dose medroxyprogesterone acetate.
            Apples and oranges.

            Contraception really drives home that women are truly individuals.
            Even sisters can have widely differing side effects with the same contraceptive.

          • Cobalt

            Then I’m going to try it. The idea of possibly eliminating or at least seriously reducing my periods is really appealing. That’s why I tried the Depo, but it didn’t work that way for me.

          • Mishimoo

            You’re not alone! I gave up on Depo (and everything else) because the constant spotting was not fun at all, especially since I hate my period.

          • Trixie

            Man, I wish I would’ve had my Mirena for my whole life and only taken it out to TTC. Who wants to get a period?

          • toni

            how common are the other side effects of the injections? osteoporosis,hair loss..

          • Dr Kitty

            I use the UK Medical Exclusion Criteria for contraceptive decision making.

            http://www.fsrh.org/pdfs/ukmecsummarysheets2009.pdf

            If you’re not sure what are medically safe options for you, it might help.

          • Roadstergal

            I tried the Mirena, and my OBGYN could just not get it in there (nullip on the tiny side). I ended up with Implanon, and I adore it (the freedom from both pills and cramps, as well as pregnancy). I’ve gone through one three-year expiration and switch already, and it’s a quick and easy procedure. If you’re squeamish, the thing is indeed palpable under your arm. I think it’s cool.

            We’re having the vasectomy discussion at home, too, on the grounds that you can never be too protected. If tubal ligation were as easy, I’d have done it years ago.

          • Dr Kitty

            As I said, despite the fact I had a failed insertion attempt involving a cervical block, and a failed removal attempt involving another cervical block and a very spiky thread retrieval device I love my Mirena.

            The first one went in at the same time as I was having laparoscopic surgery for endometriosis, and was easily removed in my Dr’s office.

            The second one, 3 months post partum, had to go in under GA and then couldn’t be removed because it got stuck behind some endometriosis, and basically had to be cut out in theatre while I was loopy on fentanyl and Midazolam.

            I absolutely understand that the idea of having needles in one’s cervix or uterine sounds or thread retrieval devices anywhere near you is enough to put a lot of women off the idea of a coil, but if not, it can be a really, really excellent option.

          • MaineJen

            I got the Mirena installed when I was six weeks postpartum after my 2nd (and last!!) was born. It’s easier to insert if your cervix is still “squishy” from having a baby, I guess. 🙂 I have loved it. No side effects that I can tell, no thinking about birth control any more, I barely get any period, and it’s non-permanent. The copper IUD lasts longer and is non-hormonal, but I’ve heard they make your periods unbearable, and I’m not down with that.

    • me

      Thanks to everyone who has joined in (the relevent parts of) this discussion. I have some options to consider I hadn’t thought of, and appreciate all taking the time to chime in, especially the personal stories and special thanks to Dr Kitty for that exclusion chart, very helpful!

      I didn’t meant to start some sort of a debate here, and am sorry that it devolved into that.

      I guess some people aren’t happy unless they’re arguing and griping at and criticizing others. Good luck to ’em. Life’s too short.

      Again, thanks to those who had sensible, mature, intelligent contributions to share. You’ve helped a lot!

  • TsuDhoNimh

    I think she was using this:
    http://www.rationalape.com/2010/12/postmodernism-generator.html

    To write 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.”

    You can talk about all the empowerment and celebrate all you want, but anatomy and physiology gonna win out. And if that baby is transverse breech, mother and baby may be buried as they were in the olden, golden days … as an unseparated unit, with babe unborn.

  • expat

    Cheyney writes, “capitalizing on..” ostensibly in a non-monetary sense. Methinks there was a Freudean slip.

  • expat

    I am struck by he difference between the writing styles of cheyney and bledsoe. Bledsoe uses plain english. Cheyney uses jargon in attempt to make her work sound more academic. Pretty sad attempt. All the jargon does is obfuscate the rather simple and trivial points she is making. Bledsoe conveys complex meaning in clear language. Cheyney conveys simple meaning in unnecessarily obscure language.

  • Sue

    It seems to me that Bledsoe and Scherrer are practising actual anthropological analysis of a phenomenon, whereas Cheyney is immersed in an ideology – not behaving like an academic anthropologist at all.

  • Sue

    liminality
    ”thick” resistance
    rituals of technocratic subversion

    Three red flags.

    • attitude devant

      I’m reminded of that wonderful hoax the physicist perpetrated on the sociologists. He basically wrote an article that was intentionally ridiculous and submitted it to a sociology journal, where is was highly praised. I only remember the phrase “The Einsteinian Constant is not a constant.”

      • attitude devant

        The Sokal hoax. That’s it.

  • Guesty

    My faulty female body is grateful for the medical management that produced three gorgeous children via c-section. The connection, celebration, and power of their births were pretty damned transformative — as was my gratitude for the awe-inspiring things doctors and nurses do for mothers and babies.

  • fiftyfifty1

    “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”

    Well, my own female body did need medical management AND my medicalized birth was ALSO a time of connection, celebration, power (to choose life and health over the sad fate Nature had had in store for me), and transformation (I came out of it a mom!). And never did the medical system treat me like my body was “faulty”. It did, however, treat me and my baby as “separable units”. Which was, I thought, the whole point of birth.

    • Sue

      Indeed – LOLing at the ”separable units” !

    • Elizabeth A

      Right. I definitely needed medical management, and no one’s body was “faulty”, it was simply a question of some problematically located, if perfectly functioning, internal/external organs, which would naturally have killed us. I did not experience birth as a time of connection, celebration or power – I experienced it (both times) as exhausting, frightening, and associated with blood loss. Separating me from my babies (temporarily) was medically necessary.

      Basically: I agree with you, and also, physiology wins.

    • Liz Leyden

      My female body wasn’t as faulty as my daughter’s female body. She needed far more medical management than I did. My son got off easy. Thankfully, we all lived through it.

  • toni

    sorry if this has been posted (it’s gross) but wtf, Milli? http://www.telegraph.co.uk/women/mother-tongue/11238598/Facebook-banned-my-bottom-photo-but-not-Kardashians.-What-gives.html really grasping at straws here

    • Samantha06

      Well there you have it: absolutely no doubt about the fecal contamination in that pool…and the poor baby’s head in the same water….. DISGUSTING..

      • toni

        really not the best picture to use to make her point. it’s absolutely obscene and I question the sanity of any woman who would post such a photograph of herself online. I sympathise with the complaints about the Kim Kardassian picture but it’s hardly comparable.. it’s no more revealing than a rubens painting.

        • Samantha06

          I was actually more disturbed by the obvious feces not only floating around but actually being expelled at the same time the baby’s head is delivering… I wonder if this lovely woman would be willing to dunk her own head into the same water, complete with floating crap, she just subjected her helpless newborn to??

          • toni

            well quite.. that’s what makes it especially obscene. what sane person thinks a graphic photograph of someone defecating, in any context, is appropriate for facebook? and then gets all high and mighty because a simple nude is permitted

          • Samantha06

            Exactly! To be offended by something as stupid as Kim K’s butt after delivering your BABY essentially into your toilet while you’re actually pooping, then plastering it online is pretty damn mind-boggling..

      • Dr Kitty

        Milli could create her own page and post whatever she wants on it. Of course, it would get far fewer views.

        If you want the benefits of the extra traffic from FB, you need to be willing to play by their rules.
        Milli knows, very well, that graphic shots of birth are a violation of FBs terms of service.

        She has no excuse.

        I don’t find nudity offensive.
        I do find pictures of faeces and a rear view of a head emerging from a vulva distasteful, graphic and completely unnecessary.
        It isn’t educational, it isn’t artistic, it isn’t political.
        It’s just “look at me” with extra excrement and a baby thrown in for good measure.

        Milli, take your ball and go home and stop complaining that the goal posts aren’t being moved to your exact specifications.

        • Samantha06

          Amen to that!

  • LovleAnjel

    Cheney very accurately describes the motive for her movement, “homebirths are constructed in opposition to dominant ways of giving birth…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.”

    Basically, wanting to do the exact opposite of what everyone is is doing, for the sake of being oppositional and anti-technology.

    She also admits: “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.” ie the midwives will rewrite history to absolve themselves of errors, just as the mothers who suffered catastrophies come to realize the lies they were told and the warning signs the midwives ignored.

    • Sue

      Most parents just want to procreate, not cocreate.

  • Amy

    So let me get this straight, and I’ll admit straight up I couldn’t read through all her gobbledy-gook…..but it sounds like she’s basically confirming Dr. Amy’s contention that homebirth is NOT about the baby, and IS merely performance art on the part of the mother and “birth professionals.” Which they always claim it isn’t.

    • toni

      ‘I’m different, I’m special, look at me..’
      The fact that their birth stories are so long-winded and painstakingly detailed tells you all you need to know IMO

  • Dr Kitty

    Ms Cheney should just be honest.
    NCB is about people who feel powerless and out of control in hospitals and who value power and control above safety. They are trying to impose control on a situation which is out of their control, and pretending that by so doing they are powerful, strong and enlightened.

    Got it.
    NCB is about a bunch of control freaks lying to themselves to make themselves feel better, because they feel like failures when their plans do go exactly as they want.

    • Samantha06

      And, in trying to be in control, they are actually giving over control to their incompetent midwives.. what a recipe for disaster..

  • arealanthropologist

    As an anthropologist, I am insulted by these fools trying to use their degree to spew bull about childbirth. From someone who actually studied instead of cherry picked to look for material to support my crusade, women did many “unnatural” things to try and survive childbirth. They knew it was dangerous, they knew they could easily die or lose the baby. C-Sections have been around longer then there have been OBs. These idiots make my head hurt,

    • attitude devant

      Oh, so glad you are here, because I have a question: Cheyney describes this culture, but she also PROMOTES it, AND makes her living off it. She monitors the outcomes data (and obfuscates it). She serves on her state Board and in national advocacy groups. Exactly how is this in any way, shape, or form ethical for an academic anthropologist (she is a prof at Oregon State)?

      • arealanthropologist

        That I do not know, as I work in a museum and have only had my degree for five years. I plan to ask my mentor as I was curious myself on if something could be done to shut her down. I know one guy had action taken against him after he used his degree to promote racism (really classy, huh?).

        • Sue

          Cheyney deserves to have the ethics and competency of her practice and academic work closely examined.

      • Lizzie Dee

        But this doesn’t really have anything to do with anthropology, does it? More to do with appropriating a fashionable discourse from French philosophy/lit crit to SOUND as if you are saying something relevant, interesting and/or profound. Actually, SOME of what she says about the way the medical professions views pregnant women may well be true. It is also, unfortunately, completely irrelevant given that it is modern medicine that stops women and babies dying or being damaged in the very large numbers they would be if “natural” took its place.

      • moto_librarian

        I have to go through the conflict of interest process every single year at my university. Even a potential conflict has to be disclosed, and if there are any substantive conflicts, a plan has to be drafted to address them. How exactly does Melissa Cheyney get around this? Surely her institution looks at conflicts of interest as well.

    • Sue

      Indeed, realanthropologist – this stuff looks like very poor anthropological practice – a crusade rather than a detached study.

  • Mel

    *slow claps*

    I thought education had the best buzzword bingo games, but I am in the company of masters in NCB.

  • GiddyUpGo123

    I find it quite telling actually that I had to read and reread Cheyney’s paragraphs before I understood what she was talking about, but the Bledsoe/Scherrer paragraphs were completely readable and easy to understand. Why? Apart from the obvious fact that Cheyney really, really likes her thesaurus, you see this a lot in the writings of pseudo-scientists … Use a lot of 50 cent words, jargon and convoluted sentences and most lay people will be impressed because although they can’t personally figure out what you’re saying, it’s obvious that you’re really smart and well spoken because you can use so many intelligent-sounding words and complex sentences. That to me is a huge red flag that you’re listening to a quack … Their words seek to mimic true medical and scientific papers, but when you decode it, it’s really not very meaningful.

    • fiftyfifty1

      I worry about using “I can’t understand this” as a way of telling that something is bullshit. Yes Cheyney’s writing is hard to understand and uses a lot of words I don’t understand. But I run into the same problem when I read academic papers in almost any field I have no expertise in: psychology, art history, physics, math, you name it. I am pretty stupid when I stray any distance at all from what I am trained in.

      • fiftyfifty1

        ETA: Not that I have any doubt that Cheyney is an idiot. But the reason that I know that she is an idiot is that she advocates for homebirth despite the terrible safety stats coming from her own state, not because she uses words that make me have to run to the dictionary.

      • Are you nuts

        The difference is, in a scientific journal I literally don’t understand the words on the page. I would need a technical dictionary to know what the words mean, and even then, I would have a hard time understanding because I am not a “science person.” With Cheney’s passages, I know the definition of [most of] the words she has written; they just don’t make sense in the sentences she has constructed. It’s very nebulous language that doesn’t actually MEAN anything.

      • Amazed

        I can undestand it (I have graduated from a program that taught anthropology) and I still say it’s shit. Because I can understand it, I can also understand that it’s an attempt to make it sound more authoritative, so readers would not question it.

        I’ve had such professors. Generally, they were guys and galls who were trying to feel better about themselves by “dazzling” the students with their knowledge. Woe on the ones who challenged their theories (yours truly included). They will wiggle and lie, do everything not to admit that another point of view might be a valid one, as Cheyney has a history of doing.

        In contrast, those who are really confident in their message don’t feel compulsed to wrap it in big sciency words when simpler ones are available. Those are the professors who thrive on being disagreed with. Like the one who had just completed a huge thesis on a very important author. I said I disagreed with many of his claims and added a few things that looked important to me from the standpoint of my own, different main field. His reaction? “That’s a very interesting observation. Would you mind preparing a lecture and give it to another class of mine? That’s a very different PoV that should really be explored.” Because he was the professor whose authority could not be infringed on by a young student who had an interesting idea. If the student of Cheyney’s we had here a few months ago is anything to go by, she’s gathering a followers for a cult from among her students.

      • GiddyUpGo123

        I think you have to look at the audience. When you’re writing for a scientific journal, your readers are mostly going to be people who have a good working knowledge of what you’re talking about, and an understanding of the terminology. When you’re writing for lay people (like midwives) and you use a lot of jargon and words you don’t already expect your audience to understand, you’re mainly just doing it to be impressive.

      • DiomedesV

        Within any given scientific field, some papers are better written than others. Those that are better written tend to keep jargon to a minimum. Sometimes the use of jargon is the result of laziness: the unwillingness to work harder to make the language clearer. Sometimes, though, it really is just snobbery.

    • Sue

      SPOT ON, Giddy!

      The use of overly wordy academese often hides a lack of confidence or expertise in the core knowledge of the area.

      Gullible audiences are fooled by the faux-professional language. Happens a lot in the pseudosciences – whether alt med or anti-vax.

    • TsuDhoNimh
      • GiddyUpGo123

        Hahaha!

  • Young CC Prof

    You know, I had a conversation about alternative health with a sociologist on Monday. I went into it thinking he had reasons for believing as he did, reasons to mistrust the medical establishment (Black guy who works with both inner-city Blacks in the USA and various groups in Africa) and I tried to approach him from that point of view.

    In the course of this conversation, I discovered his beliefs were mostly based in ignorance of medicine, statistics, health finances, the law, and basic facts about the alternative healers he admired. I’m really disappointed, because I thought he was a fine scholar, and now I wonder if everything he’s written is so poorly researched.

    You think Dunning-Kruger applies mostly to people who aren’t that bright, but no, it happens to PhDs, too.

    • Alcharisi

      This does bring up a conversation I’ve been wanting to have/write about for a while, though–specifically, the vulnerability to quacks of the socially marginalized. This specifically occurred to me as I read Leslie Feinberg’s (z”l) obit the other day, in which hir death was attributed to Chronic Lyme. Given the overall medical violence and neglect Feinberg suffered on account of hir gender, it comes as no surprise whatsoever to me that zie would distrust the medical establishment. (n.b. for the curious–Feinberg was the author of “Stone Butch Blues” among other books, and a key figure in the trans* liberation movement.) So it upsets me all the more that zie received fake diagnoses to explain hir very real suffering, for the reason that the medical establishment wrote hir off. (And it’s worth noting that trans* health in many ways remains a place where medicine still often has a lot of trouble being science-based and compassionate.)

      So here’s the thing–how to support marginalized folks who turn to quacks in their absolutely legitimate grievances, without also supporting the quackery?

      • Sue

        But there are also the bright people who are NOT marginalised in any way, but still fall for this stuff.

        I suspect it’s a combination of lack of science education/training and a culture of preferring the cultural and rejecting the scientific – often with a moral/political overlay.

        (Oops – I just read back over that…I hope I don’t sound as impenetrable as Cheyney!)

        • Young CC Prof

          I’ve seen several different reasons people fall into the woo, which may overlap.

          – Feeling marginalized by the medical establishment because you belong to a disenfranchised group.

          – Lack of access to medical care, possibly for financial reasons.

          – Having a serious disease for which medicine has no great solutions. (Cancer, for example, many cancers are now highly treatable, but the treatment process can be pretty rough.)

          – Suffering from a problem that, although not serious, is very bothersome and doesn’t have great medical solutions.

          – Naturalist or spiritual bias.

          – Influence of family or friends

  • Amy M

    I noticed that Cheyney says: “Homebirth practices, are not simply evidence based care
    strategies. They are intentionally manipulated rituals..designed to reinscribe pregnant bodies and to
    reterritorialize childbirth spaces and authorities.”

    Her entire paper about the deeper meanings of childbirth to women, and the whole mantra of individualized care of home birth midwives and yet Cheyney reduces the women to “pregnant bodies.” And when she is talking about reterritorializing (is that a word?), I think she means midwives—that midwives should be in charge, as opposed to doctors. And mothers and babies as an inseparable unit—of course, because the mother should always be nursing the baby and holding the baby. The actual mother as a person in her own right is not really recognized here.

    The fact that women embrace that philosophy as empowering is amazing to me. Their personhood is denied, that is the opposite of empowering. I’ve always questioned the vocabulary of the NCB followers, this actually makes me a little sad for them, to be able to be so duped into thinking they’ve gained power, when the leaders of the movement don’t see them as anything more than incubators, milk-making machines and a revenue stream.

    • Guesteleh

      If you look at in the context of social class, it makes sense that it’s viewed as empowering. The ritual of natural, midwife-led birth is one accessible to a privileged few as a way of asserting class fitness. Notice that the rise in the popularity of NCB correlates with the rise in income inequality and an increasingly insecure middle-class.

      • Amy M

        Which is an excellent point. But its only their perception that it is empowering, because they are not actually empowered. Perhaps they gain self-confidence, which is great, but it is not the same as empowerment.

        I suppose you could look at it like they are ALREADY empowered (by being upper/middle-class) and they are using that power, or as you said asserting that power, by choosing NCB. But its still not gaining them any power they didn’t already have.

      • AlisonCummins

        Really? A significant sector of the NCB movement is fundie or fundie-influenced christians. They don’t have class privilege, they are thumbing their noses at those who do. They may have very large families and be uninsured. If you’re uninsured you want a really good reason to pay the full amount of a hospital birth. If you have a DIY/autarchic mentality you may not find the “just-in-case” argument convincing.

        If you are suspicious of government you may homeschool and keep yourself as far away from any conventional institution that you can. People the system is not serving well may be suspicious of government. Michelle Obama gave birth in a hospital. Dreah Lewis gave birth at home.

        Sure, there’s a bunch of insured folks who think that spending the extra money for a home birth is worth it the way they think the extra money for organic produce is worth it. But there’s a lot of cross-fertilization with other groups.

        • Guesteleh

          That’s true but I don’t think those are the people Cheney is speaking to. And when I see NCB promoted in the mainstream media it’s clearly aimed at MC/UMC folks and framed as an aspirational choice.

          Hm, now that I think about it, I wonder if the fundies do it as a purity test–if you’re right with God, everything will turn out okay and if you’re not and shit hits the fan, well you must’ve had it coming you sinner.**

          **I live in Crunchylandia and in my area the people who embrace NCB and reject vaccines are affluent to wealthy, so I’m not being exposed to the fundy flavor of NCB so any opinions in that direction are purely speculative.

  • The Bofa on the Sofa

    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.

    Of course, that begs the question of WHO sees it as failure?

    It’s the NCB crowd that is selling that, certainly not doctors. As I have said before, it’s interesting that while the it’s the NCB crowd who shouts about “variations of normal,” doctors are the ones who will tell that things like pain and even c-sections are completely normal results of childbirth.

    But when doctors call it normal, it’s not good enough.

  • TsuDhoNimh

    So lets go back to the good old days … “We used to say it was good to have lots of babies, because half would die before they learnt to talk.”

    Oh, that’s Nepal in 2014.

    • Young CC Prof

      Yeah, I saw that article. Saving countless babies with just a tube of antiseptic for the cord stump–it’s humbling.

    • Haelmoon

      I have spent the last two weeks in Bangladesh. The number of women I met who had a previous stillbirth, neonatal or infant death was far higher than I have ever experienced before. The antenatal care visits were basic, but planning an institutional birth was a big part of it. Some of the centres I visited had up to 60% deliver in a clinic or hospital. The villages were all on board, the one village chairman was so proud that he donated a rickshaw ambulance to help the women get to the clinics for delivery or transfer if there were complications.
      The NCB crowd has no idea what natural child birth looks like. This afternoon I am visiting a fistula hospital – a whole hospital to deal with obstetrical fistula. They show come see these third world women they aspire to be like – its not pretty.

      On the plus side here, maternity care provision is thought of as team effort – low risk women stay close to home, but even those who can easily get to a regional hospital instead of the local clinic prefer the safety of the hospital. There just aren’t enough trained people to deliver, especially as more and more women shun homebirth as an unsafe option. The project I am here with is about improving access to skilled birth attendants.

      p.s. Yes I am catching up on my SOB all the way over in Bangladesh. The contrast is so stark comparing what I am seeing to was the NCB crowd wants.

      • araikwao

        Lovely to”see” you, Haelmoon! Hope you will be blogging about your experiences