First I have to catch my breath from laughing so hard. I try not to spend large amounts of time wading through complete bullshit, but as a service to my readers, I bought and read Melissa Cheyney’s latest attempt at academic relevance. I ought to try it more often; it’s really funny.
And I did learn something important. Anyone who believes the oft repeated claims that homebirth midwifery is about scientific evidence is at best naive, and at worst a fool.
Melissa Cheyney makes clear, in her new paper published yesterday in the Medical Anthropology Quarterly, Reinscribing the Birthing Body: Homebirth as Ritual Performance, that homebirth is about anything but the scientific evidence.
Cheyney’s paper is a celebration of the crap that passes for “research” among homebirth advocates:
… 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.
Now don’t you feel silly; homebirth is not about birth or babies. Melissa Cheyney confirms what I have been saying for years. Homebirth is about defiance of authority. Of course that begs the question of what Melissa Cheyney is doing as Head of the Oregon Board of Direct Entry Midwifery. How trustworthy is a regulator whose stated aim is to create ritual performances in opposition to standard practice?
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…
In other words, homebirth midwifery is not about what is actually happening, it’s all about pretending that women are strong and capable even when they are ill or their babies are dying.
Indeed:
The midwives who participated in this study openly reject the messages of danger, uncertainty, fear, “tentative pregnancy,” doctor-as-ultimate-authority, strangemaking, and even, to some extent, the separation they believe are communicated by the rituals of medicalized prenatal care…
But if homebirth midwifery is all about banishing messages of danger, uncertainty or fear (even when they are justified), why do homebirth midwives ape the practices of real medical professionals? Cheyney attempt to dazzle us with BS:
The use of prenatal artifacts—equipment for taking blood pressure or for urinalysis, for example—are thus, embedded in the larger power/knowledge matrices of midwifery–obstetric practices. The context, artifacts, and symbolic actions associated with prenatal care function to stack or layer meanings for participants by providing a text and subtext that are simultaneously both literal and metaphorical.
Uh-huh. Evidently that means that homebirth midwives monitor pregnant women NOT because such monitoring provides valuable information to be acted upon as necessary, but simply because it is a ritual that women expect. For homebirth midwives, pretending is far more important than reality.
… Repeated restylizations of the strong, capable, healthy pregnant body in the home communicate connection, safety, and well-being. These reconstructed “natural facts,” while equally socially embedded relative to more medicalized perspectives, are seen by midwives as essential components of the foundation needed for “trusting birth outside the hospital” once labor begins.
In case anyone is confused about what’s really important, Cheyney approvingly quotes a homebirth midwife:
I hope no doctors or midwives are running around thinking all we want is a live baby and mother…
Believe me, I’m not confused on that point!
There’s so much nonsense in this paper that, in the interest of brevity, I’ll offer a few more representative quotes.
On active labor:
… The physiological processes of labor transport women into an inherently liminal space—called “laborland” by mothers and midwives in this study—that carries its own affectivity. During labor, midwives can capitalize on this affectivity to transmit transgressive values about pregnant and birthing bodies, socializing participants into accepting the powerful and life-giving properties of the female body and the unity of mother and baby.
On upright pushing:
… It co-opts and restructures what Babcock has called “symbolic inversion,” where the gradual psychological opening to new messages characteristic of the liminal or transitional period of ritual is intensified by metaphorically turning elements of the normal belief system upside-down or inside-out.
On delayed cord clamping:
Midwives tend to feel very strongly about how the immediate postpartum period should unfold and argue that it is cruel to sever the cord too early.
On neonatal resuscitation:
… [M]idwives advocate for some practices that differ from mainstream hospital resuscitation rituals. For example, midwife participants argued that resuscitation is not simply the physiological process of assisting ventilation. Infants are seen as active participants in the process and, like adults who can be called back to consciousness after fainting by stimulation and speaking of their names, respond quickly to maternal touch and voice. Midwives, thus, encourage mothers to “call their babies back,” to caress and to speak to them as they are resuscitated.
Homebirth advocates routinely complain about the centrality of the doctor in “technocratic” births. Curiously, in homebirth midwifery the mother is not the central actor, the homebirth midwife is. A woman can’t simply be pregnant, labor, give birth or welcome her new baby. Every aspect of the process must be mediated by midwives whose primary purpose appears to be to transmit transgressional messages.
One aspect of birth — safety — is almost entirely absent from Cheyney’s discussion. Homebirth is not about birth and it is not about babies, so safety is irrelevant. It’s all about counter hegemonic empowering values!
… the rituals of homebirth midwifery care are not simply about assuring personal transformation via the transmission of counter hegemonic–empowering value —although many women certainly described their experiences this way. Midwifery rituals, as I have argued, are also self-consciously political in their intent. As the popular bumper sticker “Midwives: Changing the World One Birth at a Time” suggests, homebirth is a performative medium for the promotion of social change.
Actually, what it is really about is self-proclaimed midwives making themselves stars of the ritual “performance”:
… 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.
This paper is Exhibit A in why Melissa Cheyney is grossly unqualified to head the Oregon Board of Direct Entry Midwifery. For her, homebirth is all about three things: the midwife, the midwife’s beliefs and the midwife’s “performance.” Birth, babies and safety have little or nothing to with homebirth.
To be honest, I think a lot of the issues you have with her paper is that it from/draws heavily from a different field than your own: anthropology. As someone who studies both hard science and anthropology at a university, I recognize how the two disciplines have very different ways of communicating and how each are analyzing very different things. She isn’t stating how people should act or what they should do, and is not giving a recommendation; she is analyzing a cultural practice and speaking of what “is” in terms of how mothers and midwives react to and operate in a cultural setting, rather than “should be”. Don’t mistake her talk about rituals and liminal space (VERY common terms with loaded meanings in anthropology, which has a lot of specific vocabulary) as a discounting of science or live-saving abilities of doctors.
You’re commenting on a seven-year-old article?
Midwives evaluate their clients and give physical exams before agreeing to be their midwives. If they receive clients who they do not think are fit for home births they refer them to the hospital.
Unfortunately in practice it turns out that many of them don’t, even in obvious cases. Maybe because their risk perception and priorities are all around the birth process and not the outcome.
Hahahahaha!
…Oh wait, you’re serious.
So, the midwife who wanted to know why I hadn’t had a homebirth because I was a “perfect candidate for one!” despite reading my health record (and the assorted contraindications) is merely a figment of my imagination?
Dr. Cheyney is one of the best professors I’ve had in my entire academic career at Oregon State. She is extremely well educated and approachable. I spoke to her about her demographic of clients for home births and she noted that many OB/GYN’s wives have been clients of hers…Interesting. You should just focus on you’re practice and quite condemning the choices that other people make.
Melissa Cheyney has blood on her hands. She has known for years that homebirth with CPM has a dramatically higher death rate than comparable risk hospital birth and she has struggled mightily to hide that information from American women.
good professor, approachable, educated =/= a good human being. ??? is this even up for debate?
I can’t imagine any OB allowing his wife to have a homebirth. Possibly with some extra high tech equipment borrowed from a hospital and a hair trigger switch on transferring to the hospital. A special sort of urban legend…
There was that one OB/GYN in Wasilla whose wife is a doula and training to be a CPM, they posted the birth video of their child being born at home. It should be noted that he hired the OB who wrote about her own homebirth to be part if his practice. Crazy found crazy.
Michaela “Dr. Cheyney is one of the best professors I’ve had in my entire academic career at Oregon State”
And she’s a professor of what, exactly?
Aren’t anthropologists support to watch and report what they see as neutral observers? They aren’t supposed to be reporting what they see and suggest it should be the norm for all cultures
So many people love Dr Biter and Dr Fischbein too.
The difference is, even those guys managed to get actual medical degrees first. She’s a Doctor of Anthropology. But she calls herself “Doctor” and people think she has some sort of medical training.
True that. I was getting at the fact that just because someone has a likable personality doesn’t make them a knowledgable or trustworthy person.
Also true.
I think it’s best to focus on your own practice and the outcomes you’re dealing with than to start criticizing someone else’s views on things and how they choose to do their practice. I think home birthing is a wonderful thing and fully intend to go through Dr. Cheyney when I go through my pregnancy. I feel that MDs these days are too focused on using every piece of technology thrown at them and it doesn’t necessarily benefit the mother and her child in any way. Of course, if there were any major complications, I’d head to a hospital, but I’d rather have my baby in a relaxed, comfortable environment than getting the impression that pregnancy is a disease not meant for the female body. Maybe it’s just me, but feeling psychologically safe while giving birth is one of my top priorities. I’d also rather experience every aspect of childbirth as naturally as I can. Maybe it’s not beautiful, but it’s worth it to me. And of course that’s just my opinion. But what you’ve written in this article is also just your opinion backed by some statistics. My boyfriend is becoming a DO for the main reason that most MDs he’s met have the same views as you’re stating here- that anyone who believes that a patient’s comfort is important in the healing process is wrong and should be executed from their practice and that statistics are all knowing.
“And of course that’s just my opinion. But what you’ve written in this
article is also just your opinion backed by some statistics.”
Somehow, opinion backed by statistics seems more reliable than naked opinion, but maybe that’s just me.
Look, if you comprehend the danger in home birth and want to do it anyway, that’s your choice. No one can force a mentally competent adult to seek medical care. What aggravates me is people who will lie and claim that birthing at home is actually safer than birthing in a hospital, or that emergencies can always be detected hours in advance. It especially bothers me if these people are trying to charge you thousands of dollars to deliver your baby out of hospital. Some even discourage their patients from getting the prenatal tests that could identify complications before they happen.
So: Even in a low risk pregnancy, labor complications can appear very suddenly. You’re safer in the hospital, and your baby is definitely safer in the hospital. But again, it’s your choice.