How natural childbirth educators construct the past

Childbirth educators like to portray themselves as helpmates of expectant women, offering scientific evidence about various childbirth choices, thereby allowing women to make choices that are right for their personal circumstances. The reality of childbirth education is quite different. Childbirth educators have very strong opinions about which choices are “right” and which are “wrong.” And as a thought provoking paper in the Journal of Health Psychology explains, they use a strange an biased view of the past to subtly (and not so subtly) promote their personal opinions.

The paper is entitled ‘Golden Age’ versus ‘Bad Old Days’: A Discursive Examination of Advice Giving in Antenatal Classes. As the authors, Abigail Locke and Mary Horton-Solway explain:

… We identify a pattern of advice giving in which class leaders construct ‘golden age’ or ‘bad old days’ stories variably to contrast the practices of the past (‘then’) with current practices (‘now’). These contrasting repertoires operate against a backdrop of medicalization and societal expectations that are both current and out-dated, providing a constitutive framework to support class leaders’ evaluations and advice on pregnancy, childbirth and infant care.

An objective view of the history of obstetrics over the last 1-2 centuries reveals an ever growing body of knowledge, a greater range of tools to improve outcomes, and an extraordinary improvement in neonatal and maternal survival. Indeed, modern obstetrics has led to a drop in neonatal mortality of 90% and a drop in maternal mortality of 99% in the past 100 years alone. In other words, the advances of obstetrics have occurred in parallel with other advances in medicine, leading to better methods of prevention, better methods of treatment, longer life expectancy and longer periods of disease free life.

Natural childbirth educators ignore the real history of obstetrics and substitute an idiosyncratic and biased “history” of their own. Instead of viewing obstetrics as a progression toward improved outcomes, the recent past is characterized as “the bad old days” and the distant past is constructed as a “golden age.” The authors explain:

In theme one, … the class leader ridicules maternity care and medical practices in times gone by, and sets up a contrast with how medical care has since improved. Extract one shows a typical example of how the extremity and ‘horror stories’ of the past are constructed when the early stages of labour are being discussed.

For example:

The class leader begins a discussion of what to do in the early stages of labour through the comparison of the ‘good old days'(produced in an ironic way) when women in early stage labour were advised to ‘rush’ into hospital when they had their first contraction. A three part list) documents the routine horrors that awaited them ‘enema … pubic shave … pethidine’ in the old days… The listing represents the old fashioned practices as an inclusive package deal that was delivered to all women. The final coda that there were ‘wards full of women … not really with it’ parodies the old days as a humorous but shocking story… By implicit contrast, current practices are evaluated as much improved…

The authors offer a perceptive analysis of this theme:

The ridiculing of out-dated medical practices served to position, and locate, those practices as ‘then’ rather than ‘now’. The ‘then’ practices were constructed as unnecessary, out-dated and at times constructed as ‘horror stories’. In contrast, the class leader did not criticize [her preferred] … policies, rather she invoked the ‘horror’ of the past at precisely the moment when the practices of the present could be called into question.

While the recent past is portrayed as “the bad old days,” the distant past is constructed as a “golden age.” The authors analyze a specific example in which the class leader “explains” a completely made up theory that in the distant past, all babies stated labor positioned head down:

[The class leader} constructs a time when childbirth was more ‘natural’ and it was usually women who did housework. She lists the activities that ‘people’ would do: ‘washing by hand … sweep … make fires’ and the resulting ‘leaning forward’ from all of this activity… [T]here is a linking of these activities and the desired ‘birthing position’ for the baby ‘head down … spine out’. This she contrasts with the common working position of today’s ‘women’) describing how the birthing position of the baby is negatively affected … by pregnant women who ‘sit around a lot at work’… ‘sit back in settees and things.’

This is classic NCB gobbledly gook, a made up theory of what happened in a mythical past that never existed.

Childbirth educators attempt to influence women’s childbirth choices by use of this idiosyncratic view of the past as recent decades of “bad old days” preceded by eons of a “golden age.” The fact that this view of the past bears no relationship to what actually happened, utterly neglecting the dramatic improvements in outcome of the past decades and completely ignoring the appalling levels of neonatal and maternal mortality prior to modern obstetrics, is ignored.

Throughout our data set the class leaders’ advice giving is constructed in two ways through stories of the ‘bad old days’ and ‘golden age’ narratives. Both kinds of account are used variably in the context of making evaluations of good or bad practices, advice giving or offering reassurances about current medical practices…

… [C]ertain practices are constructed as more ‘natural’ and women are implicated in a range of competing moralities and accountabilities about their antenatal and postnatal activities. It is of particular interest how ‘horror stories’ of the past are invoked as a contrast to current medical practices which are positioned as better by comparison. Maternity care is thereby portrayed as greatly improved…

Natural childbirth educators are not unbiased individuals who aim to provide women with accurate information about their childbirth choices. They attempt to position their preferred choices as correct. As this paper details they use bizarre and inaccurate characterizations of the recent and distant past to promote what is nothing more than their personal preferences.

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