Transcript of Week 9 Giving Birth to Children and Mothers Caroline Wright Transformations: Gender, Reproduction,...
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- Week 9 Giving Birth to Children and Mothers Caroline Wright
Transformations: Gender, Reproduction, and Contemporary
Society
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- Structure of the Lecture 1 The Medicalisation of Childbirth 2
Homebirth a Debate 3 Womens Experiences of Birth 4 Midwifes at Work
5 International Perspectives
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- Returning to Medicalisation Much like pregnancy, childbirth has
undergone a process of medicalisation in modern Europe. 17 th and
18 th centuries key turning point: o Cartesian conceptualisation of
the body as a machine in need of regulation o expansion of the
monopoly and authority of medicine, through the creation of
boundaries around experts the discrediting of other practitioners
(wise women, midwives) invention and routinisation of new surgical
instruments 19th century forceps
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- Professionalisation and Gendered Exclusion 3 midwives attending
to a pregnant woman (16 th century woodcut) Obstetrical examination
(1822 engraving)
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- Feminist Critiques of Medicalisation Gendered processes shaped
by and shaping unequal relations of power o women were barred from
these new professions (first female doctor in the UK: 1865) o
womens knowledge & advice increasingly disqualified and
dismissed o symbolically and materially, childbirth structured in
line with (male) doctors gaze, rather than pregnant womans
experience materially: instead of delivering in squatting position
(gravity assisted) or side-lying (promotes natural stretching of
perineum) lithotomy position predominates (mother on her back, legs
up, against gravity) symbolically: e.g. Emily Martins study of
metaphors of childbirth o medicalisation facilitated large-scale
social (and biological) control of women hence, a key part of
second-wave feminist mobilising was a critique of medical practice
and discourse
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- Medical Metaphors of Childbirth the womb and the uterus were
spoken of as though they formed a mechanical pump that in
particular instances was more or less adequate to expel the foetus
(Emily Martin, 1992, p. 54) Birth is analogous to factory
production: obstetrician is factory supervisor or owner pregnant
woman is labourer, uterus the machine, baby the product aim is
standardised rate of production, through intervention the uterus is
held to a reasonable progress, a certain pace and not allowed to
stop and start with its natural rhythm (Martin, 1992, p. 59)
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- Regulating the Machine Discourse of time and motion Emphasis on
efficiency, predictability, productivity Deviation = intervention
e.g. the Friedman curve
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- Childbirth as a Cultural Event Whatever the nature of a
particular birthing system may be, its practitioners will tend to
see it as the best way, and perhaps the only way, to bring a child
into the world. () In the United States birth is predominantly
viewed as a medical event and a pregnant woman is accordingly
treated as a patient. As such she is expected to fulfill the role
of "sick person" (Parsons, 1951): she is considered relatively
helpless and exempt to some extent from her normal responsibilities
for herself, and she is required to seek technically competent help
from medical personnel for treatment of her "condition". In Sweden
birth is considered an intensely fulfilling personal experience.
The Dutch regard birth as a natural event. The Maya Indians
similarly view birth as a difficult but normal part of family life
(Lozoff et al, 1988, pp. 37-39) Pain in childbirth recognized and
expected in all societies, but treated differently: US - pain
relief controlled by medical attendants, labouring women have to
convince them Sweden - women get full information about kinds of
pain relief and risks and decide themselves Netherlands- women
neither expect nor receive pain relief Maya Indians - pain is
expected as a normal part of birth, a sign of progress Lozoff, B.
et al (1988), Childbirth in Cross-Cultural Perspective, Marriage
and Family Review, Vol. 12, No2 3-4, pp. 35-60
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- The Homebirth Debate Homebirth Hospital birth vs.
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- The Rise of Hospital Births 1920s: 80% of births at home in
England and Wales 1960: 33% 1985-88: 0.9% 1991: 1% 2006: 2.6% 2012:
2.3% The last four decades have witnessed a largely consistent and
persuasive argument from the obstetric establishment that the
hospital is the best and safest place to be born (Cahill, 2001).
74% of new mothers said that they were given the choice of having
their baby at home [so 26% were not] (2011, Quality Care Commission
Survey) We should be aiming to see home births at the levels of the
1960s when a third of women had their babies in their homes (Cathy
Warwick, Royal College of Midwives) Cahill H. (2001) Male
appropriation and medicalisation of childbirth: an historical
analysis, Journal of Advanced Nursing, Vol. 33, No. 3, pp.
334-42
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- Climates of Confidence or Doubt' Pregnancy and childbirth are
normal, healthy processes for most women, the vast majority of whom
have healthy pregnancies and babies. But when was the last time you
saw a newspaper article titled 3.5 Million American [US] Women Had
Normal Labors and Healthy Babies this Year... ? The medias
preference for portraying emergency situations, and doctors saving
babies, sends the message that birth is fraught with danger...
[such that] high-tech medical care that is essential for a small
proportion of women and babies has become the norm for almost
everyone. Some advocates for childbearing women describe this as a
climate of doubt that increases womens anxiety and fear. In
contrast, a climate of confidence focuses on our bodies capacity to
give birth. Such a climate reinforces womens strengths and
abilities and minimizes fear. Our Bodies, Ourselves Pregnancy and
Childbirth, 2008, pp. 7-8
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- An alternative? Midwife led units In 2011 just over 90% of
babies were born in hospital 7% were born in midwife led units
2.49% were born at home Source: Office of National Statistics
Images: 2 recently opened NHS Mid-wife led units
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- Womens Experiences of Childbirth The main trauma for me was all
the intervention: being induced, having my waters broken for me and
being examined all the time my labour didnt progress well because I
didnt dilate enough. In the end they had to use both forceps and a
ventouse suction cup to get Amelie out, which was frightening and
stressing Staff were too busy to explain what they were doing and
why. I didnt know what was happening or going to happen, and I
didnt like that lack of control. (Guardian, 15 November 2010)
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- I really felt a lot of control all the way through, and I think
one of my biggest fears about hospitals was not being in control I
felt like I was making the decisions(Fox and Worts, 1999, p. 335) I
had a highly medicated birth-pitocin to induce contractions because
my water was leaking, then Stadol for the pain and then (hooray!)
the epidural. And episiotomy. Lots of medical intervention. And it
was actually a pretty great experience because the people around me
were sensitive to my needs and desires and cared for me in the way
that I personally needed. My nurse was fantastic--very nurturing
and reassuring. At all times I felt like I had control of the
situation http://mommyphd.blogspot.com/2006/10/
positive-birth-experience-can-happen.html
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- Control and Decision-Making Control over ones body and over
risky and unpredictable natural processes as a key element of
understandings and experiences of pregnancy Fox and Worts (1999) o
A sense of control is crucial to women having a positive experience
of birth even with intervention o Technology as both empowering and
disempowering Lupton and Schmied (2013): to understand ones sense
of control we must consider the nature of the embodied experience
of childbirth
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- Resisting Medicalisation in Hospital Martin also examines the
micro-politics of medicalised childbirth and how some women resist
medicalisation: o Similar to strategies used by workers o Covert
resistance o Go-slow o Remove equipment o Stay on the move
Childbirth is shaped by broader structures of power: e.g.
experiences and degree of autonomy allowed in childbirth are
differentiated by race and class
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- Woman-centred vs. Institution-centred Midwifery Hunter (2004)
argues that the practice of midwifery in the UK is fraught with
conflicts: between teaching and practise of midwifery between With
woman and With Institution approaches between authoritative
knowledge about childbirth residing in the system of production and
authoritative knowledge residing with birthing women Im aware when
Im measuring a womans fundus, Im not freeI want it to measure what
its supposed to measure on the chart, I dont want to have to send
her in because its a little bit bigger or its a little bit small. I
want to protect her, I want to protect her from feeling worried I
mean you know just by looking at a woman when shes lying down and
you know how many weeks she is, you know if shes too big or too
small (Mia, midwife, interview 30.06.2005)
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- Childbirth and Midwifery Policies in the UK 1993: Department of
Health report Changing Childbirth 1997: Audit Commission report
First Class Delivery: Making it Better for Mothers and Babies 2007:
Department of Health guidance: Maternity matters: choice, access
and continuity of care in a safe service 2008: Healthcare
Commission report Towards Better Births: A review of maternity
services in England 330 million extra funding over 3 years from
2008 David Cameron accused of breaking pre-election promise to
recruit an additional 3000 midwives NHS cut funding for maternity
care by up to 15% in half of Englands health regions in 2012-13,
despite births being at their highest in 40 years and childbirth
services being understaffed (Guardian, 13 November 2013)
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- Campaigns for Continuity of Care Independent Midwives UK:
www.independentmidwives.org.ukwww.independentmidwives.org.uk o
Community Midwifery Model Association of Radical Midwives (ARM):
www.midwifery.org.uk/www.midwifery.org.uk/ o Taking midwifery back
to the roots o Re-skilling midwives Association for Improvements in
Maternity Services (AIMS): www.aims.org.ukwww.aims.org.uk o
Pressure group o Offers advice to women The Birth I Want:
http://www.thebirthiwant.org.uk/http://www.thebirthiwant.org.uk/ o
Campaign for all birthing women to have support from a midwife she
knows and trusts
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- http://www.faceofbirth.com/index.html The Face of Birth (2012)
Film about pregnancy, childbirth and the power of choice Importance
of education in birthing and the right of a woman to choose the
best birth method for her and her baby
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- 2013 maternal mortality ratios - 230/100 000 live births in
developing countries - 16/100 000 live births in developed
countries Niger: 1 in 7 chance of dying in childbirth Sweden: 1 in
29,800 (Save the Children, 2006) More than 800 women a day die in
pregnancy or childbirth globally, 99% in developing world Many
deaths are from treatable conditions Since 1990 maternal deaths
worldwide down by 45% 15 million women endure injuries, infection
and disabilities in pregnancy and childbirth Dying to have a baby:
International Perspectives
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- Source: The Lancet, 12 April 2010 The bottom 10 countries:
Afghanistan Central African Republic Malawi Chad Sierra Leone
Lesotho Cote dIvoire East Timor Guinea Liberia
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- Cherry Has A Baby (BBC3 September 2010)
http://bobnational.net/programme.php?archive=36613&view=flash_
player Also links to Timing Parenthood next term