Test your knowledge of today’s maternity care system:
Gender Studies | Nursing/Health Sciences | Sociology/Anthropology
There is a pervasive Western discourse that denies female moral agency and embodiment. Is birth a feminist issue? How does the fact that birth involves “two patients” influence perceptions of birth and the nature of maternity care? How are the process of birth and the management of maternal and infant care related to women’s rights? Feminist childbirth means different things to different people. For some, it means embracing the homebirth movement, squatting for birth, or rejecting a healthcare system that operates on a for-profit basis. For other feminists, childbirth is a social justice issue. These feminists focus on affordable maternity care for all women, not just on a particular method of birth.
a. Consider the frequently used phrase “failure to progress” to describe when a woman’s labor has slowed down or stopped entirely. How would this phrase make you feel about your body’s abilities to do something “natural”?
b. There have been numerous philosophical musings about “the leaky body”. Menstruation, childbirth, and breastfeeding are “women’s problems”. How have these and other the female life course occurrences been discussed at your school, in your health education classes? How can such occurrences be normalized?
c. PROJECT: Start a feminist club at your school. What topics will you discuss? What speakers could you invite to give a talk? What films or articles might you watch/read/discuss?
d. PROJECT: Write an opinion piece for publication in a newspaper or magazine about whether childbirth is (or is not) a feminist issue.
Birth is a Feminist Issue (Fraser, Ness)
Choosing Cesarean: Feminism and the politics of childbirth in the United States (Katherine Beckett)
The Body as Property: A Feminist Re-vision. (Rosalind Pollack Petchesky, Conceiving the New World Order, pages 387-406)
Birthing And Anesthesia: The Debate Over Twilight Sleep. (Leavitt, J. W. Signs: Journal of Women in Culture and Society, 6(1), 147)
Abortion and Birth, Together (Quart, A., 2014, June 14, The New York Times)
“They should not breed”: feminism, disability and reproductive rights. (Sayce, L., & Perkins, R. (2002). Off Our Backs: A Women’s Newsjournal, Vol. 32, 18-24)
The Egg And The Sperm: How Science Has Constructed A Romance Based On Stereotypical Male-Female Roles. (Martin, E. (1991). Signs: Journal of Women in Culture and Society, 16(3).
In Labor: Women and Power in the Birth Place (Barbara Katz Rothman)
Women Centered Pregnancy and Birth (Ginny Cassidy-Brinn, R.N., Francie Hornstein, and Carol Downer)
How does the passage of the Affordable Care Act influence maternity care in the US? Should maternity care be an issue for policy makers? What should the state government’s role be in the regulation of maternity care and home birth? What should the federal government’s role be?
a. The midwifery model of care sees birth primarily as a normal, healthy process that the body is capable of completing with minimal intervention. The obstetric model of care sees birth as a series of potential complications to be identified and managed. How do you see birth, and why? Is one model of care better than the other, or do they both have a place in the care of pregnant women? Relate this to other medical specialties (i.e. family practice doctors compared to internal medicine specialists, or nutritionists compared to cardiologists).
b. Merriam-Webster defines “iatrogenic” as “induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures.” How might one prevent iatrogenic complications during pregnancy and childbirth? How does this relate to the overuse of technology (such as cesarean section, induction, medical pain reduction) during childbirth?
c. PROJECT: Choose a childbirth intervention commonly practiced (medical induction with cytotec/misoprostol/cervadil, labor augmentation with Pitocin, epidural use for pain management, electronic fetal monitoring) and research the uses of the intervention, the side effects (if any) and the risks involved (both long term and short term).
d. Familiarize yourself with Dr. Gene Declercq’s presentation “Birth By The Numbers” and hypothesize why evidence-based care isn’t always being delivered in U.S. maternity hospitals.
The Farmer and the Obstetrician (Michael Odent)
Mainstreaming Midwives: The Politics of Change (Robbie Davis-Floyd and Christine Barbara Johnson)
How We Do Harm: A Doctor Breaks Ranks About Being Sick in America (Brawley, Otis Webb)
Has the Medicalization of Childbirth Gone Too Far? (Richard Johanson, Mary Newburn, Alison Macfarlane)
Obesity, obstetric complications and cesarean delivery rate–a population-based screening study (Weiss, Malone, Emig, Ball, Nyberg, Comstock, Saade, Eddleman, Carter, Craigo, Carr, D’Alton)
Health reform: Implications for women’s access to coverage and care (Kaiser Family Foundation)
Transforming Maternity Care: Action Steps Toward a High-Quality, High-Value Maternity Care System
Caesarean section and neonatal outcomes in private hospitals in Brazil: Comparative study of two different perinatal models of care (Torres, J. A., Domingues, R. M., Sandall, J., Hartz, Z., Filha, M. M., Schilithz, A. O., & Leal, M. C.)
Are there “unnecessary” cesarean sections? Perceptions of women and obstetricians about cesarean sections for nonclinical indications (Weaver, J. J., Statham, H., Richards, M.)
SOCIOLOGY & ANTHROPOLOGY
In what ways are birth options and medical decisions surrounding birth communicated to women (based on the film, The Business of Being Born, or your own experience)? How could one change the attitudes and behaviors of doctors? of mothers? of hospitals?
a. PROJECT: We are being constantly bombarded with media images these days, and they have a big impact on how we think, what decisions we make and how we spend our money. Well before we are in a position to make decisions about where to give birth and what to expect from pregnancy and labor, we see movies and TV shows depict birth, and we listen to stories about labor and birth. Pick a movie or TV episode from the following list (link?) and watch it. Pay attention to how birth is portrayed in the episode or movie. Answer the following questions:
i. Provide a brief description of what happens during the episode/movie, specifically dealing with labor and birth.
ii. How did the episode or movie make you feel about birth? What was your emotional reaction?
iii. What else sticks out in your mind?
Now visit the Media Literacy Project online and read their introduction of Media Literacy. Rewatch the episode/movie and answer the following questions?
i. Which tools of persuasion did you pick up on during your second viewing?
ii. What motives do you think the media makers had when portraying birth this way?
iii. What subtext did you pick up on?
iv. What part of the story do you think it missing?
v. What assumptions are being made about the people in various roles (the laboring woman, the partner, the care provider/birth attendant)?
vi. Who has the power in the birth scene? Are the wishes of the laboring woman heard? What impact does that have?
b. PROJECT: Birth Around the World:
i. Visit Women Delivery to view the country ranking by maternal mortality worldwide. Were you surprised to find that certain countries were ranked better than the US? Which countries?
ii. Read the fact sheet about maternal mortality from the WHO. What similarities and differences do you notice in the causes of maternal death in the US and abroad? Why do you think our maternal mortality rates are so high, despite the amount of money we spend on maternity care? Imagine you are a national lawmaker. What would you do to prevent maternal deaths?
iii. Watch Dr. Gene Declercq’s “Birth By the Numbers” presentation, just released this summer.
Fish can’t see water: The need to humanize birth. (Wagner, M. (2001). International Journal of Gynecology and Obstetrics, 75(1), S25-S37.)
Born in the USA: How a Broken Maternity System Must be Fixed to Put Mothers and Infants First (Wagner, M)
Reproducing Race: An Ethnography of Pregnancy as a Site of Racialization (Khiara M. Bridges)
Female Genital Surgeries: The Known, The Unknown, And The Unknowable (Obermeyer, C. M. (1999). Medical Anthropology Quarterly, 13(1), 79-106.)
Difficult Births: Laboring And Delivering In Shackles (NPR, Hsu, A. 2010, July 16.)
China’s Moms Get Postnatal Reprieve (Ni, C. 2004, May 21. Los Angeles Times)
Medical Metaphors of Women’s Bodies: Birth. (Martin, E. 1987. The Woman in the Body: A Cultural Analysis of Reproduction, pages 54-71.)
Birthright Citizenship Looms as Next Immigration Battle (Lacey, Marc. 2011, January 4. The New York Times)
The Creation of New Birth Imagery. (Martin, E. 1987. The Woman in the Body: A Cultural Analysis of Reproduction, pages 156-166)
Public Privates: Performing Gynecology From Both Ends of the Speculum (Kapsalis, T. 1997. pages 3-11).
Birth as an American Rite of Passage by Robbie Davis-Floyd
Testing Women, Testing the Fetus: the Social Impact of Amniocentesis in America by Rayna Rapp
Still looking for more reading?
The Birth Partner – Penny Simkin
Your Best Birth – Ricki Lake, Abby Epstein
Pregnancy, Childbirth, and the Newborn – Penny Simkin
Birthing from Within – Pam England
Pushed – Jennifer Block
Ina May’s Guide to Childbirth – Ina May Gaskin
Birth: The Surprising History of How We Are Born – Tina Cassidy
Deliver This – Marisa Cohen
Taking Charge of Your Fertility – Tori Weschler
Our Bodies, Ourselves; and Our Bodies, Ourselves: Pregnancy and Birth – Boston Women’s Health Book Collective
Baby Catcher – Peggy Vincent
Thinking Woman’s Guide to a Better Birth – Henci Goer
Gentle Birth Choices – Barbara Harper
Birth Without Violence – Frederick Leboyer
Homebirth -Shiela Kitzenger
Birth Reborn – Michel Odent