Midwives and the commodification of birth

… [W]hen selecting alternative providers of birthing services, women are not simply purchasing health care, they are choosing and purchasing guides for and co-creating an event that is idealized and emotionally charged.

The above quote comes from Great Expectations: Emotion as Central to the Experiential Consumption of Birth by Markella Rutherford and Selina Gallo-Cruz. They offer a unique perspective on homebirth midwifery from outside both the midwifery and medical communities. Rutherford and Gallo-Cruz draw attention to an aspect of homebirth midwifery that we are all aware of but rarely mention. Homebirth is a product and homebirth midwives, like any product manufacturers, are heavily engaged in marketing that product to consumers.

In fact, the foundational philosophy of midwifery, the “midwifery model of care,” serves as one of its key marketing emphases. A crucial component of midwives’ care work is what Hochschild calls emotional labor: “the emotional style of offering the service is part of the service itself.” … [In] theorizing … emotional labor as a commodity to be sold, we ask how we might conceptualize the emotional aspects of the experiences offered in this transaction as a commodity to be consumed.

What are homebirth midwives offering? Their product is the idealized birth experience.

Midwifery is not simply a service to be purchased, but is also an embodiment of cultural meaning; through its consumption women make the ordinary experience of childbirth a symbolically charged and extraordinary experience of “meaning transfer.” … [Campbell] argues that “the essential activity of consumption is…not the actual selection, purchase or use of the products, but the imaginative pleasure seeking to which the product image lends itself …

In marketing homebirth, midwives unconsciously copy the wedding industry.

… [T]he wedding industry … commodifies the wedding experience by constructing the bride as the “heroic creator of her big day.” [Similarly], births are increasingly embellished with the advertised opportunities for luxury and amenities as well as the gendered conceptualization of femininity associated with the transition. [This] work raises important questions … about the role of anticipation and imagination in the birth experience. In particular … the creator of such a rite of passage must negotiate between romantic or hedonic fantasies and rationally planning the event…

Like any manufacturer, midwives strive to create a “need” for their product within the mind of the consumer:

… [T]he midwife’s role is critical … because she is fluent in the alternative symbolic orientations to and understandings of natural birth … [She] also provides her association and emotional support either by sharing beliefs about the experience or by affirming the woman’s right to assign her own unique beliefs to birthing. This seemingly simple service of association and presence is a critical social need in the context of extraordinary experiences and rites of passage that depend a shared cultural consensus for their significance.

Rutherford and Gallo-Cruz point out the striking similarities with the marketing tactics of the wedding industry.

In conceptualizing natural birthing as an emotional and idealized consumption experience, we see that birth has come to mirror aspects of the wedding, another heavily commodified rite of passage. Drawing on [the] insight that the bridal role involves a rational-romantic duality, we see that the woman planning for alternative birth also exercises calm control, rational decision making, and has the illusion of autonomy over her choices at the same time that she is a romantic fantasizer hoping for wish fulfillment.


… [T]he idealization of the birth experience offers a legitimate opportunity to orchestrate another emotional consumer experience in which the bride-now-turned-mother produces, directs, and plays the starring role. Thus commodified birth experiences play an important role in consumer society by continuing the trajectory of pivotal consumption events across the family life course.

Homebirth is not about the baby, and it isn’t really about birth.

… [C]onsumption of a birth experience is an active form of symbolic identity construction through which women give coherence to their own sense of self. The mother who selects an alternative birth outside of the medical model consumes her birth experience for the purpose of producing her own self-image …

That’s what homebirth midwives are selling.