Childbirth, rationalization and re-enchantment

One of the reasons I enjoy writing about childbirth issues is that every time I fear I have exhausted the topic, I find a new aspect to study. Particularly interesting to me is the sociology of childbirth. That’s why I was delighted to find the paper Selling the Ideal Birth: Rationalization and Re-enchantment in the Marketing of Maternity Care. It is written by Markella Rutherford and Selina Gallo-Cruz, the same women who wrote the piece on midwives and marketing.

This piece, which is a chapter in the book Patients, Consumers and Civil Society edited by Chambre and Goldner, also focuses on marketing, in this case, the marketing of mainstream maternity services by hospitals. In analyzing their results, Rutherford and Gallo-Cruz apply the principles first enunciated by Max Weber, the famous German sociologist and political economist.

For Weber the disenchantment of the world lay right at the heart of modernity… It is the historical process by which the natural world and all areas of human experience become experienced and understood as less mysterious; defined, at least in principle, as knowable, predictable and manipulable by humans; conquered by and incorporated into the interpretive schema of science and rational government. In a disenchanted world everything becomes understandable and tameable …

Weber describes this process of disenchantment as “rationalization.”

On the one hand, there is secularization and the decline of magic; on the other hand, there is the increasing scale, scope, and power of the formal means–ends rationalities of science, bureaucracy, the law, and policy-making.

In the face of rationalization, some have embarked on a process of re-enchantment:

… [(Re)]enchantment will be taken to refer to [a tendency] which insists that there are more things in the universe than are dreamed of by the rationalist epistemologies … [and] which rejects the notion that calculative, procedural, formal rationality is always the ‘best way’. Among other things, the first encompasses everyday explanatory frameworks of luck and fate; long-established or ‘traditional’ spiritual beliefs; ‘alternative’ or ‘new age’ beliefs; and ‘weird science’.

Sound familiar? Rutherford and Gallo-Cruz think so:

In many ways, the contemporary scene of childbirth services can be characterized as one of cyclical rationalization, re-enchantment, and rationalization. In the first half of the 20th century, childbirth was subject to intense rationalization and birth was culturally transformed from a potentially risky even to a pathogen-like state to be medically managed and controlled.

In other words, the technocratic model of birth gained ascendancy. Neonatal and maternal mortality dropped dramatically as a result. But:

As is often the case, rationalization came with dehumanizing consequences … The birth experience was stripped of many of its subjective qualities… [A] techno-scientific approach to birth often denied — and at least downplayed — the sense of mystery, spirituality and aesthetic beauty that have accompanied childbirth throughout most of human history. Scientific rationalization, in Weber’s words, meant that the birth experience was “disenchanted.”

That’s certainly the way that natural childbirth and homebirth advocates see it.

However, the natural birth movement attempts to re-enchant birth by allowing nature — unpredictable and uncontrollable — to have free reign and by recapturing the subjective experience of birth with its sensuality and mystery. This is most clearly seen in the emphasis by homebirth advocates on the spiritual and/or symbolic meaning of birth

Moreover:

[I]t is also seen in the emphasis on the birthing mother’s individual empowerment as well as the important of birth being a shared family experience, as these themes reassert the power of human autonomy and interpersonal connection over the dehumanizing aspects of birth in the technocratic model.

I agree with Rockford and Gallo-Cruz … up to a point. Their description is accurate, but they are not necessarily describing reality, but rather the way that natural childbirth advocates have rewritten history. The “sense of mystery, spirituality, and aesthetic beauty” which supposedly accompanied childbirth “throughout human history” is mostly a figment of NCB advocates’ imagination. Childbirth was viewed as inherently dangerous and agonizing, and most of the spirituality around it was concerned with placating a higher power in order to ensure the survival of mother and baby.

And the claim that birth was “culturally transformed from a potentially risky even to a pathogen-like state to be medically managed and controlled” is yet another bit of wishful thinking. Birth was not culturally transformed is was actually transformed, Previously it had been viewed as extremely risky, not simply potentially risky. Childbirth prayers and the admonishment to pregnant women to write their wills attest to the historical fear of death in childbirth.

Finally, the supposed transformation of childbirth into a “pathogen-like state” reflects the fact that natural childbirth advocates never ask obstetricians how they view pregnancy; they substitute their own fantasies. That’s because natural childbirth advocates have no idea how dangerous childbirth really is and seem to be unable to grasp the fact that childbirth appears safe because of the “technocratic model of birth.”

In other words, faced with discomfort at the rationalization of childbirth, NCB advocates have chosen not to to re-enchant it, but to enchant it to a state that never actually existed. Rutherford and Gallo-Cruz are correct in the emphasis that they place of the process of rationalization and re-enchantment, because that process does drive the demands of NCB advocates. But they neglect to subject to scrutiny the empirical claims on which the process is based.

NCB advocates think that they are attempting to re-enchant birth because they believe that it was “better” that way. The reality is altogether different and quite harsh. The women who lived prior to the advent of modern obstetrics demanded and welcomed the rationalization of childbirth and they did so for a very simple reason: they abhorred the pain and death that had always accompanied it.