ru have alternatives, that you k that pregnancy and birth are : to womenP Looking back on

have had the chance to make

birth did x. en talk about the pregnancy; terested in talking about the lives, and I consider that really learn so much about people." e way how I handle prenatal :stions. A lot of people rvho ask ley're doing; they've done a lot ave, and what I mainly do is : sure of. . . . Some people will and then I will have to find
,k back on pregnancy and

"'

Childbirth: The Social Construction

of Birth

before, go in this avenue :ally ansrvering their questions,

,e said

:eir mind, and building up ically what it is."

ll

rapport probably loom so large as the lay midwives because md risks they take on in agree-

first thing to remember is that obstetrics is a l[ surgical specialty. The management of childbirth within hospitals is essentially the same as the management of any other surgical event. While obstetrics is a patriarchal institution, that fact becomes almost irrelevant in the management of childbirth. Certainly women in labor are treated in a dehumanizing way, are condescended to and ignored, patted and punished. But that treatment is hardly unique to obstetrical patients. It is part of the way in which hospital patients in general, and surgical patients in particular, are treated. In surgery the ideology of technology is dominant. Perhaps
more clearly than anywhere else in medicine, the body is a rnachine, the doctor a mechanic. In the typical surgical situation the unconscious patient is waiting, like a car upon a hydraulic lift, rvhen the surgeon arrives, and is still in that condition as the surgeon leaves. The surgeon and the rest of

IN i,ABOR
the medical staff may care about the person whose body lies before them, but for the duration of the surgery, the mindbody dualism theorized by Descartes is a reality. It scems genuinely diflicult for surgeons to respond to patients as conscious human beings at the same time they are working on their bodies. Marcia Millman reports, from her observations of surgical wards, that when patients have been given local rather than general anesthesia for an operation and are thus awake, their serious remarks about the operation or their attempts to take part in the doctors' conversations as the surgery is underway often bring the staff to laughter.t To them, the talking patient is incongruous, almost as if a car had sighed while one of its ffat tires was being replaced. When women are sedated through labor and made unconscious for delivery, as the obstetrician Delee outlined in his rgzo article in the American !rurnal of Obstetrics and Ggnecology,2 then the only possible description of birth is as an "operation" performed by a surgeon on a patient. Delee's article, "The Prophylactic Forceps Operation," set the standards for obstetrical management of birth, routinizing such procedures as forceps extraction, episiotomies, manual extraction of the placenta, and the lithotomy position (flat on the back with the legs up in stirrups). Although in recent years the use of heavy sedation and anesthesia has been less frequent because of the dangers they pose for the mother and the baby, the surgical nature of the event remains constant. Nancy Stoller Shaw described the physician-directed, inhospital deliveries she observed in the rgTos in Boston as all following the same pattern. The patient is placed on a delivery table that is similar in appearance to an operating table. The majority of patients had spinal anesthesia, or its equiva. lent, the epidural, which numbs the woman from approximately the waist down but leaves her conscious. She is placed

The Social Construction of Birth

be to prevent her from contaminting the ster,e fierd. She cannot move her body below tf," and ..Her active participation in the birth is efl.ectively "t.rt, oro..,,
This does not mean that the woman becomes unimportant, only that her body, or more specifically, the birth canal and its contents, and the almost Lor" UoUy'rre the only things the doctor is really.interested in. Thi fart of her and, in particular,

in the lithotomy positio^n and draped; her hands may strapped

giving birth.3

as effectively as she can be,

those at the foot of the table, is the sge o, *t,i"f, the drama is played out. Ilef:re it, the doctor,"it, or, small metal stool to do his work. Unless he stands ,O r" " clearly see the mother's face, nor she his. "ur.,rt i,
^St " th*'fart "up*"ted frcm of her that

the whole exposed pubic area, visible to

as a persorr,

is

The

Birth

Process

birth canal, ancl out of the mother's body. firis is tf,e'..alirery.,, The thirtl stage is the expulsion of the pracenta, the ..afterbirth.,, I. any situation the possibility exi.sts for alternative definitions of the situation, differeni vcrsioru ol. what i, ,rrtig happening. Which version is accepted and acted upon is a reflection of the power of the parip;n;;. Those with more

closed to its fullest dimension of rpprn*irnutely ten centime ters (almost four inches). This is referred to as ..labor,,, anl the contractions <f the uterus tf,-t prli rpon the cervix, ils "labor pains." In the second stage the UrUy r, pushed thro,g' the opened cervix and through ifro urg or

The medical litcrature cleffnes childbirth as a three_stage physiological process. In the fi.rt,trg" ihe cervix, the open_ ing of the uterus into the vagina, Aiiotu, from being nearly

l16l

lr6s l

IN

LABOR

The Srcial Construction of Birth after that-thirty-six hours after her adrnission*she that woman will have had a thirty*;l1.r.labor. delivers, The medi_ cal authorities wi' sec it as a^thirty-six-hour rabor* and so wi, she.'fhat reality whic.h tt labor began, "y-I[6]uhen becomes-the only reality tfr"y t *i". O"ih* otlr._, hand, if she or i.^*:l::, delays admissiln _".1 ;;;;r;"ts hersetf ro the
n t y-

power can have their deffnition of the situation accepted as reality. Often this involves sorne bargaining or negotiating between the people involved.'fake, for example, a child with a sore throat who doesn't want to go to school. The parent may say the throat is not thot red, and the child counters with "But my head hurts too." Might the child be experiencing some soreness and pain? Certainly. Rut is it bad enough that the child should stay home from school? That depends. Medical authorities may function just like the parent in this situation. Patients recovering from tuberculosis, for example, may claim that they really are well enough to have a weekend pass,a and patients and doctors in mental hospitals negotiate over the patient's mental health.s lrrequently, pregnant women come to the hospital claiming that they are in labor, but by medically established judgments they are not. The state of being in labor, like illness or any dcviance, is an ascribed status: that is, it is a position to which a person is assigned by those in authority.6 But one can also negotiate, to try and achieve that status or have one's claim to it recognized.

ffi?r
labor, she

hospi ta I twe

fou r h ou r s

will have nra ,,Jr,rl"Jr,.'i,

il ;; ;;;;

il;,;il1 ]Il ;:#:

from the time of her admissior,, ttu toiio is preferable, the longer labor being easily percei* i".r,itutional mismanagement. ", the point

E_tr*

of view of th. r,^,r

&I_^

. ;ttf

r"me st,-nge

conliEti,o,rrffi

t us take as an example a woman at term panful contractions at ten-minute intervals, who has not yet begun to dilate. Whether she is or is not in lalror will depend on whether she tht-.n begins to dilate" or the contrac-

self to the hospital claiming that she is in labor, and by weeping, pleading, or just because she seems educated and middle-class, she is admitted, the medical acknowledgment that

she is in labor will have been established. If she does not begin to clilate for twenty-four hours, and then twelve hours

n requiring hospi_ talization, but at the same time wants tc avoicl prolongecl labor, "'real" labor is defined ,-,,rt i,u i".nrs ol the scrsetirns the wrman cxperiences, but i, terms of:.:o..,u.rrrr,.*_cr,r-1, ic;,ii dilatation'fhe pregnant rvoman therefore wants to be accuratr-, (in medical terms) about defining the ,"r"i if she gains early admission, she r.vill f Unor. Otheru,,is,l, have helped to deire the situation as an overly lo,g labor. l, uaaitio., to the strr:ss inherent in thinking oneself t be in labor for thirty_six lrorrs, the medical treatmnt she will,u""iuu p.usents its own rroblems. Laboring women are rrutinely confined to becl in hos_ pitals, a situation that is.as disturbing ;ry"frolngi"*lly as it i.s physically. Not only is the labor n"."Jl"= as being longcr, but,the horizontal position rhu *urt orrr_" in bed physically prolongs labor, as may the routine oa.rri.riot.rtion of seclatives during a long hospital stay. In u.l,ti;i;, to the variatio,s

I 166]

l16zl

IN LABOR
in treatment during the first hours of labor, the treatment she will receive is different in the last hours, when the woman is hospitalized in either case. Women who have been in a hospi-

The Srcial Construction

of Birth

tal labor room for thirty hours receive different treatment from women who have been there for only six hours, even if both are equally dilated and have had identical physical progress. Which woman, after all, is more likely to have a cesarean section for overly lonq labor-the one who got there just six hours ago, or the one who has been there through three shifts of nurses? What the woman experienced before she got to the hospital-how strongly, how frequently, and for how long her contractions have been coming-does not enter into the professional decision making nearly as much as what the medical attendants have seen for themselves.

nd then apply that distinc-

Ionger viewed as laboring urt o, missed, and the womar delivers, .ry, in ifr. nril to the delivery room, then she "; tl;;; ir;";';;;ving..precipped,..

a"iiu;;;."rffi'Jffi,";

It is also important for the pregnant woman to be accurat in iderrtifying labor, because i[ she presents herself to the hospital and is denied admission, she is beginning her relationship with the hospital and her birth attendants from a bad + bargaining positio4. [Ier version of reality is denied, leaving her with no alternative but to lose faith in her own or the institution's ability to perceive accurately what is happening to her. Either situation will have negative consequences for the eventual labor and delivery. That is why childbirth-education classes frequently spend considerable time on the defining of labor and so-called false labor.
The same issues arise when a decision has to be made about when a woman should be moved from a labor to a delivery room. In American hospitals, unlike those in most of the rest of the world, the first and second stages of labor are seen as sufficiently separate to require different rooms and, frequently, different staff. Women attended by nursing and house staff thoughout their labor may not see their own obstetrician until they are in the delivery room. p.ts-aryn

ffi
cess

having had a precipitous delivery. iflf," prir, is called too if the staff decides that the wo*r, ,, ready to deliver and the physical reality is that .h" h;;;rother hour ro gr, then concern is aroused about il; led; of second stage, because she has spent that hor, ?n a delivery rather than a labor room "*t.u Why rnust the hosp-ital make arbitrary clecision.s in deffning labor and its stagesp [lecause tf," ur. otfre facilities requires sclie9uling. The staff has to r."o* *rr"r,'" lrbo, room wiil be fieed and a delivcry room needed. It I t herefore, p"rri"r,r tu ;n;' iir,Xiiliii?; judge cervicar diratation ""o-i.," and to pruai"t derivery time. This is usually done by the nursing staff. Some examinations may be necessary in order to evaluate the physical condition laboring woman an. her f.tus, "Itt. bui i""rl, examinations of cervical dilatation are equally r"h_J;i;; ;r;: poses. Still others are done """.rory-fo. for teaching purposes. Sch exarninations are usuaily quite pairfur, ,o ihrt here we see the institutional demands in/t ic t itg,utfr", tfr"., alleviating pain. There is one more reason for the examinations. The staff
soon,

;fi#

The labor prois usually self_contained; left t"o hu. own devices the woman can produce the baby, in nine cases out of ten, with

..},? ing its prestige as, in this instance, , fJy-_ring institution, rrocessing or "treating" the laboring *_".,.

,[,

Jlffi : ;'-:X Hf

ilni

I 1681

lr6el

IN LABOR
absolutely no prrfessional assistance. Not only may the examination, at its most useful, locate the rninority of women

The Social Crnstntction oJ'Birth

birth preparation, has supported the way rnedical

needing assistance; it also constitutes "treatment" of all laboring women, thus justifying the existence of the institution. The woman can therefore be seen, and see herself, as being in the hospital for the purpose of such treatment, or "medical care." Nancy Stoller Shaw, in her study of maternity care, Forced Labor, notes that for a woman giving birth in a hospital, childbirth involves a "continual inability to protect herself and control the access of others to her body."z Standard "piepptng" procedures, like admissions procedures to the army, jail, a mental hospital, or any total institution, reinforce the idea that the individual loses control over her body and self, including a "systematic removal of all personal effects as well as parts of the body (hair, feces) and its extensions (eyeglasses, false teeth)."8 'lhe custom of shaving the perineum has been repeatedly demonstrated to serve no medical purpose at all, having developed, with the invention of the disposable razor, from the clipping of any very long pubic hairs to a full shave.s While it is a pointless, humiliating, depersonalizing, and irritating experience, it is explained to the woman and staff as being necessary, r.vith the latter being best equipped to provide this "service."

dures are viewed, as is made clear in an unpublished ..Cuide_ lines for ASPO'feachers" (c. r97o). The guidelines state, for example, with regard to exarninations:

proce-

It should be pointel out to patierrts that internal

examina-

tions during labor in the hospital can be performed by the patient's own physician, by a resident physician, an intern, or a nurse. This depends on the procedures established by hospital policy. Examinations will be given either rectally or vaginally, again depending on hospital rules or individ_ ual physicians, but it is not for the parturient to decide who should or should not examine l-rer luring labor.

The Impact

of Prepared Childbrth

Prepared childbirth has tried to humanize medical management-not to do away vi,ith the medical approach, but to make it more pleasant fo wornen, more responsive to their needs. Many corrrpromises have been rnade even with this modest goal. The American Society for Psychoprophylaxis in Obstetrics, ASPO, as the first (and ftrremost) source of child-

This is far from being a consumer-oriented approach and in fact in direct opposition to the legal rights of the woman. The American Civil Liberties Union Ilandbook The Rghts of llospital Patients, states, "All patients have a right to refuse to be examined by anyone in the hospital setting.,'ro g*,Iarly, while the patient has a right to refuse any treatment or procedure,r t ASPO guidelines say, with regard to the ..prep_ ping" procedures, "It is not worthwhile to make an issue out of this." ASPO has not supported childbirth outside of the hospital, and home-birth advocates have been denied acceptance into ASPO teacher-training programs. The hospital is unchallenged as the location for birth, and the training the preg_ nant woman receives usually does not teach her to understand and rnanipulate the hospital environment. For the most part, rather than teaching in detail about hospital facilities and person,el, the childbirth-education classes instruct the woman in ways to avoid clealing with external events. The laboring wornan is taught to take a ..focal point"_a picture or flower she brings from home, or simply a spot on
is

Itzo]

lr7rl

IN LABOR
the wall-and focus on that alone, blocking out all othq:
happenings during a contraction. Rather than being alerteh to which hospital procedures are arbitrary or might be unniers*ry in her case, the woman is taught instead how to ignore-"breathe through"-enemas, perineal shaves, repeated examinations, transfer from bed to stretcher, and so on. The focusing technique is thus one for dealing with the hospital, and may not be directly related to the birth experience itself.

The Social Cotstructirn of Birth the breathing, she might very well be crying or calling out. I{er ability to evaluate hcr own situation, taking her own behavior as wr:ll as that of others, "u.r"frn* b*o_e, ,r".}, important. T'he woman who has just gotten through a con_ taction- without crying out has presc,nted herself with evi-

The cues available to us in a situation include not only physical objects and sensations, but also perceived behavior and even the way we see ourselves acting. The cues we get from our own behavior are an important part of how we understand what is happening. This has interesting implications for childbirth. All of the childbirth-preparation programs teach the use of
breathing techniques for labor. Margaret Myles, author of one of the most widely used textbooks of midwifery in the world,r2 has said that it has been her experience that no rnatter what childbirth-prcparation breathing techniques a woman used, as long as there was a regular pattern of breathing, it worked. Whether it was Lrmaze puffing and panting in rhythm, or plain puh-puh-puh, they all worked. The usual explanation for the effectiveness of these methods is that the concentration on breathing blocks out sensations of pain. Yet wornen practice their breathing exercises while driving or watching television or reading-all activities that require some level of concentration. Anything that won't take one's mind off the road, or away lrom a TV program, is unlikely to distract a womon from the sensations of labor. I believe the real reason that breathing exercises rvork so well in the control of pain in childbirth is that they present the woman with positive cues regarding her situati<ln. If she were not doing

the pain is bearable. fi.it were not bearable after all, she knows, she rvould be crying. The woman,s perccivcd pain and perceived cornposure are conflicting elements. As long- as the composure can be maintainect, thln the r:onflict can be resolved by the sensations being defincld as bearable. In a sense, it is a more structured version <f ..Whenever I feel afraid, I whistle a happy tune." When a laboring woman is lying in a hospital bed, an intravenous needle in her arm (as is strndarj hospital proceclure), listening to doctors being paged, with strangers coming in and out of the r<om, then the cues available to her are olrjectively no diffcrent frorn the cues she could expect if she wc,re dying. People cannot bc placed in hospital go*r, on hospital tables under hospitar rights rvearing rittrc bracerets that will identify them, whethei consciously present or not, witho_ut there being createcl for therr as well a.s for those who care for them, the image of patierrt. All that the birthing woman can rvork for in that situatiot is control over pain anJ. her expression of pain. In emphasizing pain and its control, the chilclbirth-educa. tio grours reinforce the medicar model of childbirth as a crisis situation. The, substitution of self_hypnosis, breathing tcchniques, and the Iike for control by drugs does not challenge the essential rnoder of what is ccurring in the birth. Iloth the educators ancl the physicians are in accorcl that childbirth pain requires proflessional a.ssistance in its control. The two groups are, or rnore accura tely uere, vying for clrrninance or political control over pain relic.f. The resoiution that was reachecl can be secn, certainly in the case of ASpO,
as

d.:":. that

ItTz j

lrzsl

IN

LABOR

The Social Construction of Birth

emergencies, as well as the ..state,,of the patient. The physi_ cian in a hospital birth alway, t ola, tf,. power to create an active-passive relationship by t ruirrf tnu mother anesthetized.

cooption by the medical establishment of the childbirth educator. Withdrawing all fundamental challenges to the medical profession, ASPO worked toward having breathing techniques seen and used as one of a potentially escalating series

of analgesics.

The original ASPO teacher-training course states:

To Be Deliuered or to Cioe Birth

The messages that the woman picks up from the cues available to her rre not limited to the normality, health, and relative painfulness of her condition. The definition of the situation goes much deeper than that, to the very heart of the process and who controls it. This is best exemplified by the use of the word "deliver." Both mothers and birth attendants are said to deliver babies. When the mother is seen as delivering, then the attendant is assisting-aiding, literally attending. Ilut when the doctor is dclivering the baby, the mother is in the passive position of being deliuered. The rvords are of course the least of the cues that the laboring woman receives regarding the importernce of her contribution to the event taking place, the delivery of her baby. Three basic patient-practitioner relationships-ways doctors and patients crn deal rvith each other*have been identified.t3 The ffrst is the actiae-passiue relationship, particularly applicablc to the unconscious patient in an emergency situation. 'Ihe doctor makes all decisions, and the patient is "worked on," rnuch the samc way as mechanical repairs are done. In childbirth this relationship is typified by the doctor using forceps or surgery to pull the baby <lut of an unconscious mother. What is particularly important to note is that the doctor not only has complete control once the mother is unconscious, but it is also the physician who has the authority to dcfine norrnal, variations from norrnal, and obstetric

If your doctor himself suggests merlication, you should accept it willingly_even if you don,t feel the neecl for it_ as he undoubtedly has veri guoa..ru*s for his clecision.ra
n" *,itf,ihe cian," a statement again contradicting individual physi_ the legal rights of patients, as outlined by the A.C.L.U., iJ..fur" ..any me<lical or sur1ical procedure [from] being perforrnecl on thern reor thli r a," t"^,., to th e advi sabli iy
hs to

The rgTo teacher-training guiclelines statc that ..the final cision on the use of dr,,g,

cle_

:ilfli:1;I,',|;;ll:,,""'

in childbirth_ the preparati she has had has taught her to work within th* ira_"rr,r.t of institutional reaccr guiclelines hrr;ih;;;; say abour docror_ :rfr tsp.o ratient relationships: 'l'he patient should be encouragerl to have a good ..rarport" with her physician. tf her do"to. i, not acquaint.rl rvith the Larnaze techniclue, l;t. ,fr"rla try and gct his co,fidence, show that shels not if he rvill read the ASI,O ..Irhysician.s "f;;;;;;,;;;il;;;: dornrru.rlque,.or tht. ASPO training rnanual. It shoulcl " r>ori"O out that, rrritt,

there to be "coached,".a u,ord prerparation classes. AII-

the in-hospitar "prepared" birth.

relationship is one of guidonce_cooterotior:. T,he practitioner guides and directs the patient, who, if ,h. ;;g','l.o}patient, takes guid_ tnce and direction easily.. In chiklbirih, if,l,, -irt best typified

The second possible practitioner-patient

r*r;;'u;ecl

T,lru

o.ing woman

by
is

[rl q)

Irzs

IN I,ABOR
their not cherish to be told by obviously, physicians do tu tn"J"t ir''t:,,t-*:^:::rd"l:HlflX; lr.,w to patients how patrents l"i'*. t'"tfully discussed' ancl from our ever, it can certarntY "'l cu" be gained rrorn this'

The Social Construction of Birth Rather than demystifying childbirth, this sentime.,t ,nou.fl birth further into the sphere of medical activities, too con-
plex for a lay person to understand with<ut special training. r It is perhaps for these reasons that so much emphasis is put on control of both pain and the expression of pain in preparation for childbirth classes. According to the rules of the game, if the laboring woman chooses to deal with her pain by crying ,.n/ ,''' or calling out, she has entirely forfeited hcr right to rnake S decisions. Much is made in childbirth-preparation circles of

ilH;;;.a

r"*

' ffiil;";;';;,*
tt"iT3'tnrru

labor-and delivery' and Note that physicians cottduct the of the oatient role for "patient" tttot" tooit'";;;;;""" her clear that she is not fanatic' laboring wornan) "'"ft"'-tt wishes' her of i" u""o'd rvith some I labor rnav be """;;;;; be tactfrrl' and thc suggestion i physician' The ii is pointedly not *"Jii-t she select u"oihu' is not quesauthority of the physician

if the

;;l'*

legitimate u"ri, oi*tt.

tion,
a

elial of the "patient" role common goal' Ine#,nle';;Ja of But the institutionalization and thus of medical ""trof' development childbirth works'*J;;;-t;; ;:'::ffi; in no iosition to be an equar overShe is outnumbered and oarticipant irr her uitit'i"g' ;;J --,t;..,t mav she maY pow*,"d powered' sne advocate (husband, a patient a< 'nr.,i"tn*,, even :-.:'i:-':, bringing :, coach) *,,t, t-,"',^ot" litoltdl{S'i ,P difficult, or

one of mutual participapossible relationship is patient work together toward inwhich practitioner and

the woman's being in control during labor, but all t.haq is neant by that is control over her expressions of pain.tA woman vvho maintains a fixed, if somewhat glazed, cheerful expression and cont'inues a regular pattern of breathing is said to be "in control"" as she is cartcd from one roorn to another and literally strapped flat on her back with her legs in the air. Certainly a woman who was unconscious, semistupeficd,
amnesiac, or simply numb from the waist down cannot have experienced giving birth as an accomplishrnent, sornething over which she had control. IIuTEt[TEl,voran who is encouraged in childbirth-prcparation classes to see herself as a rnember of a "team" delivering her baby? Though she rnay

:lill'+# ##^i?1;;;;

":tl'i

\A

ffi

;::::::'I3;":,1"iffi:Xl

'

H
.rf"r.

only as long as

accord with institutional :::l':H:'L l"il'iln"';;;'; '" ft ASPO teacher guidelines state:

"

"F-amily ASPO very much encourages delivteam during labor and a husba"tl;;;

Centered Mater'

nity," i.e., ery when possible'

however' that only wife lornral cour-se with their husbancls who have i*ftl'-' " wife' of real help to the in rhe Lamaze ,""#;;;;;;"

;';;;"tstood'

help and watch in a mirror,@' Positioning and draping her in such a wy that she cannot -l directly see the birth, not allowing her to touch her genitals I or the forthcoming bal:y, tells thc mother that the birth is I something that is happening to her or being done to her, not I something she hcrself is doing. The birth is managed, con- I ducted, by the other members of the tcam, those who are \ tc'lling her rvhat to do, and physically manipulating hcr and ) her r baby. DaDY. I I UtI-ryaexciting, thrilling thing to sce, !q-_qn _e_y.r, ffi more exciting-Ind rhi'illing th-to dr.r. F)ncouragig. a w ohlir--T-lall6E h c r sZ' I fl i- a i nir r o r g iv' r [ 6 i r t h rn o v e s h e r from being a participant to an observer ol'the Uirth. TIJ

ry

l,l

rz6l

[ttz

IN LABOR

The Social Ccnstruction of Birth

, r'r'.,";, i"-r'"piii'

nrnes out of the context on "seeing" the birth "":"r'tJ cmphasis -<:-rh

of

"-*l'-iit'"Tl#li1 H:;r"qi19':
taking direcsuggestions and team have had most

) ffi:;::::tl-;;;il; *";;:"

active partion. Rut the n*oltal babies without the **pt'i"""";il;;;** their of know that thev will h*I;;;ti"''"*n"t Jh"'t cooperticipation withou the rvoman's ^"d uuuv mother seithat in bcins there' If the \ Itior,, rhat is ,h;";;;;se theltlg 9n]yfor the birth' I wants to b"

II'n"

'

the miracle"-spoken by i.t't'*""i'inis pre-rg5os I I I was to hau*v less than in the

u**X;gi*H:ffi ,, *ii:Hi:: ;l?'lti?jiiit:s:;:lti":r'

V *uth"r!'5In
medical *oatr"ff,""'1*"'"t"i"tent

d"lil"l;;til;;

"wui"'"";;;;;'""

m*,iiir

# --I(lr.cy

of birthing women; to control or to manage a situation is to control and manage individuals. The alternative to physician and institutional control of childbirth is childbirth outside of institutions, and, most important, outside of the medical model. In this alternamav tive. birth is an activitv that women do. The woman .----_ nee4-_loms_bSJp bU!_tte help i&-[e{ the. [glt par!,- j- lhe &r-belglf As important as "deliver" is in understanding the medical model fc word of childbirth, so too the word "birthing" clariffes the midwifery model. Qitt"g, like sw.i41ming, singin_g, and le for dancing, is somethifi]"rfla-,f, "i'-n"ve

tA!@

Mills is a contemporary lay midwife and an important figure in the home-birth movement. She began as a midwife by visiting a friend in labor, and has since attended over 6oo births. Her r.vords are the most eloquent statement available of the midr.vifery appronch to birth: I see myself going in and being a helper, being an attendant. Sometimes I play with the kids, or I do some cooking. Sometimes I sit with the woman. Sometimes I help the husband assist the woman. Some families need more help than others, but it is easy to go in and see where you are needed and how you can fill that role.r6

o'"';;;;;;u*n,o in the ability to make a to the medical probirthing'woman it't frorn baby is shifted the "coach" becomes fession' In the ""*^;;;areJbirth' teaching the ttam' u'lni"' it in *"ical tt'" of member keeping her a institutioJ demands' *tnt""i;; to woman
in her Place' The Role

of the Birth Attendant

rnrr,",",,r*f uf 'r'u":T:"-l:i'^3:::;:tiT:li"$l?J1; :l::'ffi ::ll,'""j.il:'tili""lqq:f:::::,:,X",:1J,:ff -'proresrer; "i: kes them ;i",#::"'"il'r;;J...............#:,:;"*i*;::#:'J::i:'ii: workers-the other --contr.. currrrv' ii" ""
obviously around, around, they obvrousl] aides. nurses' ot'ott"'f and

iLll".'i; ,ney also "r*"r,'*aerlies, supefvrsn 'L"^r ir--" physician's supervlsrolr rnoans means the management ^-r birth means ^rr L;rrh ifi. *.ai"al management of
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^:nction rrnder f,,,nnrinn under the patients. 1i-'."-:"^lt-*,"r control the patients'

It is important for that wornan to be able to look at you, to know you are there, to hold your hand, to be reassured. I know it helps when I say to a woman, "I know how you feel. I know it's harder than you thought it was going to be, but vou can do it."I7

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IN LAtsOR
. Similarly, the lay midwives of the F'remont Women's Birth \ t:tl"i" say, "Wc feel that people should be in control of their

The Social Construction of Birth

J experience, and we'll lit in accordingly,"ta and a lay midwife from Madison, Wisconsin, says, "People come to us not so we . will care for them but so we vyill help them care for them-

Lolrn.."" I I asked the nurse-midwives

Iloth this sociar rore and this goar are from the a hospitat birth, a re that ::,::|:i:j.,.:nlr 1." th,r shaw sh.,,, sums .,.__ up_as being "tr,e ail."tri";"',i'J'I;:,|,o,," "" Childbirth, in the performed performed br bv r.,.,nbrt;il,#;, is a surgical procedure

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^ff1::l].*odel,

il

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I intcrviewed what they saw

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as

their role in a birth, and what they did when they got to the home:

-"ltJothing, expect me to

Iirst. Which is very important, because they clo sornething, like I'm supposed to do something. Ilut they'rc doing it already and that's what we're going to bc doing, so I find it very important to just come in and sit down." I go in and I firrd the mother is agitated, I'll say 'I{i,' -"If and go straight to the mother. If I find that she's not agitatcd, I'll take a slorver 'hi,' you knorv. . . . If she looks comfortable, I clon't feel there's any rush, and I let her continue to feel that she's doing okay." try to get the main supp<lrt person involved in doing -"I the birth because it's really their birth and not mine. . . . My role is to listen to what's being said." see rne as a consultant, that I do have special skills -"They and know I ecl ge, nui-iIi-i]"artici pate in the <lecisions too, and except fbr sornething really outrageous most decisions are made collcctively. They're not giving me their body and they have to undcrstand that."

ch ird;; * . of' women ,r,",. famiries. lromen can "" do, but teaching to do weil_that ii

mmmm iil';d;,*lf,;lt
n rake the acti ve

j:

In this chapter , focusecl prirnarily ,. on the role of ,n*-J lirth lur.u attenclant vis-_vis,h";*;;;"1
'a

u,suarry;;o;;;,;i;:J,TlIH:H O ,;;;il;,.r., o*n satisfaction. It t

r,
d

Birthin"rl.]_.",

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iT

the rives

And rnost clearly of all:

aim is that rvhen I leave that family feels they -"My birthcd it. I was there and t helped, but they did it . . . that in their whole rccollection of the experience I will very minimal. That's rny goal and that's my aim."

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ils lirrmer is based on the ideologf lxdy is viewed as a in which the "il.",.gy, machin",;i;;;;._rr". -fhe of which ca lx' irnproved by o competent ,ru"f,urri". ttn an integration latter is based of mind *d ;,;;thut phy.t"rl events ;:"" ome is,,o, d.,, u. ;:Ji:l?y

r,onsi

birth, as in the i:r.: -"d,"11..:,r;i.i;;^#ii.tr,i,g woman can active role, with ,t" r,r".ali ::,1. L r a supportive titn; ll" then the lirthi posi-

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