Book Review: Birth as an American Rite of Passage by Robbie Davis Floyd
Birth as an American Rite of Passage
By Robbie Davis-Floyd
Have you ever questioned why certain procedures are performed in the hospital? Perhaps you’ve questioned if your induction or cesarean was truly necessary. Have you ever wondered if the way your birth played out had effects on your first few days, weeks and months postpartum?
Where did the APGAR score originate from? Why do some hospitals “allow” a woman to eat/drink during labor while others do not? Why is the culture among each hospital so different and individual in their “protocol” of care?
Perhaps your questions are leading you down a path to discovering the answers that you can’t seem to get when you “ask your doctor” as you’re advised. If you’re questioning and open-minded, can I encourage you to pick up this book and do a little digging?
As I summarize my takeaways from this book, I will also quote some of my favorite lines straight from the book. As always, never take my word for any of this… Do your own reading, do your own research, ask your own questions and allow an open mind to draw your own conclusions.
Introduction
Birth as a Rite of Passage
(Page 1)
“Why, given the large and growing body of evidence against their routine use, do standard obstetric procedures still shape and define American birth—just as they do in many other countries? I demonstrate that these obstetric procedures are, in fact, rational ritual responses to our technocratic society’s extreme fear of the natural processes in which it still depends for its continued existence.” (Page 2)
Chapter 1: Ritual and Rite
(Page 8)
In chapter one, Robbie Davis Floyd goes over the characteristics and effects of ritual, symbolism, what drives rituals and even summarizes the definition of a rite of passage. A rite of passage being a series of rituals designed to conduct an individual (or group) from one social state or status to another, thereby effecting transformations both in society’s perceptions of the individual and in individual’s perceptions of themselves. It’s a breakdown of one’s belief systems. Have you ever asked yourself or reflected on the reasons behind rituals performed within the confines of Marine Basic Training, or any branch of the military, really.
“Even highly humanistic practitioners who normally function at a Stage 4 (open, fluid) level can regress into Stage 1 or Substage when stress becomes extreme. Such cognitive regression accounts for a great deal of the overt obstetric violence, disrespect, and abuse that is daily perpetrated around the world by birth practitioners as they take out their stress on other practitioners below them in the facility hierarchy, and on the lowest of the low in that hierarchy—the laboring person.” (Page 18)
“I began to envision my upcoming birth. I wrote a detailed birth plan—things to resolve, changes to make, and an experience to embrace ... I remained positive about my body's natural ability to birth my baby. I began a process of undoing some of the fearful thinking that had prevented me from experiencing motherhood on a more blissful level. I also began internalizing the belief that birth—as with other aspects of life—is very much a self-fulfilling prophecy. My state of mind will determine its outcome.” (Page 21)
Chapter 2: The Stages of Matrescence
The Pregnancy/Childbirth/Postpartum Rite of Passage
(Page 27)
Have you ever heard of the term Matrescence? Matrescence is a becoming, it’s a transition. When you become pregnant, you begin the journey of separation from your former self to your new self. Matrescence is becoming a mother. The physical, emotional, hormonal and social transition to becoming a mother.
In chapter two, Robbie Davis Floyd talks about the journey of Matrescence. The journey of becoming. The separation for your former self, the one before pregnancy, as you journey through to meet the new version of yourself through pregnancy, childbirth and postpartum. Each stage from pregnancy, to childbirth, through the postpartum season is a transformation.
Robbie Davis Floyd goes on to explain how the transformation could unfold in different domains; from the personal domain, to the public domain, in the medical domain and in the midwifery domain. This transformation is even a journey of knowledge.
“Birth and early parenting activists around the world have called us to think through the implications of the decline in continuous contact in early childrearing that characterized parenting practices until "plastic babysitter" technologies like monitors, swings, cribs and car seats began to replace physical contact. Midwives and holistic pediatricians who value the external gestation period described by McKenna and others argue that more high-touch (sometimes called "attachment") parenting practices often produce babies who are healthier (emotionally and physically) than bottle-fed, solitary-crib-sleeping, and stroller-carried infants who constitute the norm in technocratic societies. However, pressure to return to work outside the home soon after birth, unpaid maternity leave, and the breakdown of extended families create enormous barriers for new parents who would like to engage in exclusive breastfeeding, co-sleeping and "baby-wearing" facilitated by slings and wraps.” (Page 48)
Chapter 3: The Industrial and Technocratic Models of Birth and Health Care
(Page 55)
In chapter three, Robbie Davis Floyd goes over some history. The history of the industrialization of birth and how the medical model views the body as a defective machine. Where did the technocracy begin and how has the technocratic model progressed?
Robbie Davis Floyd also explains:
The 12 Tenets of the Technocratic Model of Birth and Health Care
Mind-Body Separation
The Body as Machine
The Patient as Object
Alienation of Practitioner from Patient
Diagnosis and Treatment from the Outside In
Hierarchical Organization and Standardization of Care
Authority and Responsibility Inherent in Practitioner, Not Patient
Supervaluation of Science and Technology
Aggressive Intervention with Emphasis on Short-Term Results
Death as Defeat
A Profit-Driven System
Intolerance of Other Modalities
“If the product is perfect, the responsibility and the credit go to the ob; if flawed, any blame will be categorically assigned to the inherent defectiveness of the mother's birthing machine, as obstetrician Michelle Harrison described:
“Yesterday on rounds I saw a baby with a cut on its face and the mother said, "My uterus was so thinned that when they cut into it for the section, the baby's face got cut." The patient is always blamed in medicine. The doctors don't make mistakes. "Your uterus is too thin," not "We cut too deeply." "We had to take the baby" (meaning forceps or cesarean), instead of "the drugs we gave you interfered with your ability to give birth."”
(Page 64)
When I read this, I feel my heart rate rising and I feel the adrenaline and anger course through my body. This is unacceptable and outraging. Medical Gaslighting is unacceptable and outraging. No mother should EVER be led to believe that their body is defective over medical mistakes.
Chapter 4: The Humanistic Model of Birth and Health Care
(Page 77)
In chapter four, Robbie Davis Floyd explains:
The 12 Tenets of the Humanistic Model of Birth and Health Care
Mind-Body Connection
The Body as an Organism
The Patient as Relational Subject
Connection and Caring between Practitioner and Patient
Diagnosis and Healing from the Outside In and From the Inside Out
Balance Between the Needs of the Institution and the Individual: Superficial vs Deep Humanism
Information, Decision Making, and Responsibility Shared between Patient and Practitioner
Science and Technology Counterbalanced with Humanism
Focus on Disease Prevention: A Public Health Approach
Death as an Acceptable Outcome
Compassion-Driven Care
Open-Mindedness toward Other Modalities
“The implications for childbirth of the knowledge that the mind affects what happens in the body and vice versa-are obvious and profound. Far from seeing the uterus as an involuntary muscle that operates in machine-like ways, humanism in childbirth allows for the possibility that the laboring woman's emotions can affect the progress of her labor, and that problems in labor may be more effectively dealt with through emotional support than through technological intervention. For example, if a woman's labor stalls at 8 cm, it might be because she had been raped, and the feeling of the baby's descending head is invoking those cellular memories, causing her to freeze. Another laboring woman may freeze because she is suddenly seized with doubt about her ability to raise this child, and another because she fears that her partner will leave her after the baby is born, or that she might lose her job. Ideally, such issues are dealt with before labor begins, but often they just suddenly arise in the moment. In such cases, asking the laboring person what they are feeling and supporting them to express those feelings and perhaps cry them out, as nurse-midwives often do, will be far more effective than forcing their labor to proceed with Pitocin.” (Page 79)
Chapter 5: Birth Messages in the Hospital
(Page 90)
This section… I will admit that my adrenaline shoots up as I read through this section and I have to sit with uncomfortable feelings and even feelings of anger that women are treated this way, every day, but it has been made “normal” and “acceptable” even though, in other circumstances these absurdities would be seen as abuse, violence and rape.
In chapter five, Robbie Davis Floyd goes over the Standard Obstetric Procedures, most that are still practiced in hospitals all across the United States today, despite there being a lack of evidence and even studies that are not in favor of these procedures.
“Cases where evidence indicates that obstetric procedures either fail to accomplish their state purpose, or actually cause harm, lead to the obvious conclusion that the only possible reasons for the continued performance of such procedures are ritual and symbolic.” (Page 91)
Hospital Rituals
Did it ever strike you as interesting why some procedures and “protocols” are in place? When you dig into the psychology of certain rituals, it begins to make sense. From things as “seemingly innocent” as the hospital gown and a wheelchair ride, to things as big as not asking for permission for procedures like cervical checks and IV lines. Each and every procedure and ritual, big and small, furthers the message that the hospital system owns your body and knows what’s best for you. I encourage you to sit with each of these rituals and get curious about what’s coming up for you.
As you explore what emotions are coming up for you and what rituals are jumping out at you, be open and curious to explore those. Don’t ever take my word for it; I encourage you to get curious and do your own research. Explore what is begging to be explored.
The Wheelchair
(Page 92)
“... “just-in-case obstetrics.”
“It is also incumbent upon the hospital to make the premises of the technocratic model appear to be true and to map this model onto the birthing woman’s perceptions of her situation so skillfully that she will be able to perceive her experience in these terms only.”
“The wheelchair is an interesting first step in this process. To place a healthy woman in a wheelchair is to associate her body with a powerful symbol of disability. Although she may reject this message on a conscious intellectual level, its passage through her body and into the right hemisphere of her brain will guarantee that, on an unconscious level, she will receive the message, “you are disabled”; in other words, she may receive a “felt sense” of her body as suddenly weak and dependent.”|
“As in any initiatory rite of passage, this estranging or “strange-making” device is employed at the very beginning; the effect is to start the breakdown of the initiate’s category system necessary to ensure her openness to new learning.”
The “Prep”
(Page 93)
“The “prep” is a multistep procedure that usually begins with:
(1) separations of the woman from her partner and/or other support persons.
(2) replacement of the woman’s clothes with a hospital gown.
(3) shaving the pubic hair of the woman in labor.
(4) the administration of an enema.
(5) a cervical check to assess dilation.
(6) the insertion of an IV.
(7) electronic fetal monitoring.
“Once a woman enters a hospital, she implicitly (if unknowingly) walks into a social contract of giving up her autonomy in order to receive medical care.”
Replacement of Clothes with Hospital Gown
(Page 94)
“A woman’s clothes are her markers of individual identity; removing them effectively communicates the message that she is no longer autonomous, but dependent on the institution.”
“The gown begins the powerful process of the symbolic inversion of the most private region of the woman’s body to the most public. Its openness intensifies the message of the woman’s loss of autonomy: not only does it expose intimate body parts to institutional handling and control, it also prevents her from simply walking out the door anytime she chooses. Like a prison inmate, she is now marked in society’s eyes as belonging to a total institution–the hospital.”
Pubic Shaving and Enemas: Humanistic Ritual Change
(Page 95)
“Shaving the pubic hair was routinely performed until the 1990s or so in the US hospitals, intensifying the message of institutional control over the woman’s body and indicating the belief that women are intrinsically dirty and must be ritually cleansed by the institution.”
“Yet shaving in fact increases the risk of infection in the open abrasions and small lacerations often left by the razor, which can serve as excellent breeding grounds for bacteria.”
“Cutting hair equals social control.”
“Yet why did enemas and shaving drop away while so many other non-evidence-based procedures remain?... The evidence wins when it does not threaten the core value system on display in hospital birth.”
Separation from Partner and Other Support People during the Prep
(Page 96)
“Those women who were “prepped” during heavy labor reported that the pain of their contractions increased during the separation period and their ability to “maintain control” decreased.”
“This “standard hospital policy” sends two powerful messages: “the hospital has the right to separate family members, and thus holds and authority higher and greater than the family,” and “the laboring woman, soon to deliver its new member to society, now conceptually belongs to the institution, and must be marked as such.””
The Presence of a Doula: Humanistic Ritual Change
(Page 99)
“The Doula Effect.”
“...doula support dramatically reduces problems of fetal asphyxia and labor dystocia; shortens length of labor; enhances mother-infant interaction after delivery; and results in more spontaneous vaginal births, higher Apgar scores in babies, more maternal satisfaction with the birth process, lower anxiety, and better bonding among the mother, birth partner, and newborn.”
“If somebody invented a machine that could generate the doula effect, every hospital would buy them.”
“But because the doula is simply a woman helping a woman, doulas in general are devalued in many US hospitals, and many obstetricians and nurses resent any efforts made by the doula to humanize the birth experience by challenging the use of standard procedures/rituals.”
Fasting
(Page 101)
“Ironically, insisting that women fast during labor may actually, should they inhale their vomitus, increase their risk of pulmonary edema, because the gastric juices left in the stomach after hours of fasting are far more acidic than usual; highly acidic fluids in the lungs are more toxic to lung tissue.”
“Starving laboring women may also result in ketosis–a condition of weakened muscle cells and alterations in blood chemistry that result from too-rapid depletion of the laboring woman’s stores of glycogen, which then causes her to start using her fat stores as a form of energy; ketones are the by-products of this process. Their unchecked buildup in the bloodstream causes the uterus to contract less efficiently and labor to slow down. When this happens, the usual hospital response is to speed up labor with the synthetic hormone Pitocin, which entails its own set of risks.”
“Recent research has found that there are no downsides to women drinking and eating at will during labor–no increased risk of gastric inhalation.”
“Pointing out that this custom started in the 1940s when general anesthesia was widely used for childbirth and the danger from aspiration was therefore higher, they posited that its continuance is the result of “culture lag”--that is, of “culturally patterned behavior that continues to be practiced long after the reasons for doing so have disappeared.”
Intravenous Feeding (IV)
(Page 105)
“People not allowed to drink freely in labor and receiving IV fluids at the rate of 125ml/hr are at increased risk of longer labors by about 1½ hours and are more likely to give birth by Cesarean. Neither the American College of Obstetricians and Gynecologists (ACOG) nor the American Society of Anesthesiologists (ASA) recommend restricting low-risk women to ice chips or sips of water, so hospitals with policies forbidding oral fluids (including among people with epidurals) are out of line with both current evidence and professional guidelines.”
“... risks for the infant include severe hypoglycemia after birth, which can result from the excessive insulin production generated by the baby’s pancreas in response to the high blood sugar levels developed in the baby’s circulatory system by the large amounts of dextrose and/or glucose, which rapidly cross the placenta from the IV bag.”
“The IV is detrimental to breastfeeding as the infant is born with this extra fluid on board, which is recorded in the birth weight. As the infant sheds this weight through urine, it appears as though he is losing weight rapidly. This results in mothers being told that their breastmilk is insufficient, and they must supplement with formula, which diminishes their confidence in breastfeeding and serves to actively reduce their milk supply. As a lactation consultant, I find it maddening that this is neither explained to mothers nor contemplated by pediatricians.” –Umber Darlilek
“The IV makes a powerful symbolic statement: it is the umbilical cord to the hospital.”
Artificial Rupture of the Membranes (Amniotomy)
(Page 108)
Risks of AROM:
24-hour rule invoked
Pitocin induction recommended
Umbilical cord more likely to become compressed
Higher frequency of obstetric interventions
Cord prolapse is more common after amniotomy
“Amniotomy was one of the first things the early “male midwives” of the 1700s figured out that they could do to intervene in the process of labor. Then as now, breaking the waters of a laboring woman was an effective means of making it appear that she could not have the baby without a physician’s assistance.”
“In both cases, the underlying message is clear: culture, not nature, knows best.”
The “Pit Drip”
(Page 109)
“About what actually initiates labor, after decades of debate, the authors of Williams Obstetrics, have concluded what many midwives have intuitively been saying all along–the fetus itself provides the signal to the mother’s body that this baby is ready to be born…”
“This information should give pause to those practitioners and childbearers who want to induce labor or schedule a cesarean before babies indicate that they are ready to be born.”
The “Cascade of Interventions”
“The administration of Pitocin through the (metaphorically) umbilical IV sends several messages to a laboring woman:
(1) that our cultural concept of time as linear, measurable, and a valuable commodity is right and true;
(2) that her body is a machine or can be treated as one;
(3) that her body-machine is defective because it is not producing on schedule;
(4) that the institution’s schedule is much more important than her body’s internal rhythms and her individual experience of labor.”
Friedman’s Curve vs Zhang’s Curve: Humanistic Ritual Change?
(Page 113)
“Among women with failure to progress, 42.6% of primiparous women and 33.5% of multiparous women never progressed beyond 5cm of dilation before delivery… Using 6cm as the cut-off for active labor… may be an important strategy to reduce the primary cesarean delivery rate.”
“In short, these researchers found that half of all those who had cesareans for “failure to progress” had not reached 6cm, indicating that they were not yet in active labor when their cesareans were performed.”
“All these women were told they were failing at something they hadn’t yet been doing!”
–Priya Morgenstern
Types of Obstetric Analgesia
Epidurals, Demerol, Fentanyl, Stadol, Morphine, and Nitrous Oxide
(Page 117)
“(5) Dangers to the baby include oxygen deprivation, slowing of the heartrate, an increase in the acidity of the baby’s blood, increased vulnerability for low blood sugar, and poor muscle tone, which affects the newborn’s ability to suckle and may interfere with breastfeeding and mother-baby bonding. Epiduralized babies are sometimes referred to as “floppy”; said one humanistic obstetrician: “Once I realized that I was seeing too many floppy babies from epidurals, I started trying to discourage my patients from having them, suggesting that they bring doulas instead, and try laboring in water.”
“When I toured the maternity ward of Brigham and Women’s Hospital in Boston, my guide William Camann, then Head of Obstetric Anesthesiology there, asked me what I heard. I replied, “Total silence.” And he smiled, and said, “That’s because all our women have epidurals, and that’s the way we like it!”
“To numb a woman about to give birth is to intensify the message that her body is a machine by adding to it the message that this machine can function without her.”
“It seems to be a fundamental assumption of Western culture that pain = bad–even when that pain is productive.”
Cervical Checks
(Page 126)
“Cervical checks are often performed without consent and without explanation. In any other context, a stranger who forces their fingers or their entire hand deep into a person’s vagina and ignores when that person verbally and physically resists would be committing sexual assault. However, the US obstetric system condones this and similar forms of routinized obstetric violence under the guise of education and necessity.”
“Those who try to push the provider’s hand away or say “STOP!” are responded to in ways devastatingly akin to the language used by rape perpetrators: “You’re okay.” and “I’m almost done.”
External Electronic Fetal Monitor and Tocometer
(Page 129)
“Other risks posed to the mother by the EFM include her immobilization in bed, which prevents the movement and upright positions that can facilitate fetal descent, and can decrease oxygen supply to the fetus, leading to heartrate abnormalities and, again, to a higher incidence of Cesarean Births. And “therefore, electronic monitoring tends to produce the very abnormalities it is supposed to measure”--another example of the “obstetric paradox”--intervene to keep birth safe, thereby causing harm.”
“If you mess around with a process that works well 98% of the time, there is much potential for harm… Most women in labor may be much better off at home than in the hospital with the EFM.”
–Edward Hon
“Observers and participants alike report that the monitor, once attached, becomes the focal point of the labor, as nurses, physicians, partners, and even laboring women themselves become visually and conceptually glued to the screen, which then shapes their perceptions and interpretations of the birth process.”
“Initially in biomedicine, obs were totally dependent on the patient’s verbal report and on their own sense of touch and observation for knowledge about an ailment or condition.”
“Many nurses have told me that so powerful is this illusion, they can’t help but feel that unhooking the woman from the monitor will cause the baby’s heart to stop.”
“...that most laboring women will be experiencing–themselves in bed, in a hospital gown, staring up at an IV pole, bag, and cord on one side, and a computer screen on the other, and down at a steel bed and a huge belt encircling their waists–we can see that their entire visual fields are conveying one overwhelming perceptual message about our culture’s deepest values and beliefs: technology is supreme, and you are utterly dependent upon it and the institution that controls and dispenses it.”
Internal Electronic Fetal Monitor
(Page 135)
“Many mothers leave the hospital firmly convinced that electronic monitoring saved their babies from otherwise certain death caused by cord prolapse, when in fact it was the monitoring (and prerequisite amniotomy) that caused the prolapse in the first place.”
“To the profound message of the external monitor, the internal fetal monitor adds an equally profound footnote: your baby is a technological artifact too. And as such, it is the institution's product, not yours. In fact, your machine is so defective that society’s product may be in danger from your body-machine’s potential malfunction, so it is necessary to apply a special machine to more exactly monitor the product’s progress in order to protect it from potential harm caused by you.”
Bed and Lithotomy and Semi-Sitting Positions for Labor and Birth
(Page 137)
“Pushing a baby out in the lithotomy position quite literally makes the baby, following the curve of the birth canal, be born heading upward, against gravity.”
“It was established in 1976 that an increase of 30 to 40 mmHg pressure is exerted by the fetal head on the cervix as a result of the effects of gravity, that is, standing instead of lying down. This means that, although the frequency of the contractions is the same, their effectiveness is much greater, and hence the efficiency and rate of the dilatation of the cervix is improved.”
“It’s funny–it seems so normal to lie down in labor–just to be in the hospital seems to mean “to lie down.” But as soon as I did, I felt that I had lost something. I felt defeated. And it seems to me now that my lying down tacitly permitted the epidural, or maybe entailed it. And the epidural entailed the Pitocin, and the Pitocin entailed the cesarean. It was as if, in laying down my body as I was told to, I also laid down my autonomy and my right to self-direction.” –Elizabeth Fisher
“...movement is essential for a physiologic birth.”
The Influence of Labor and Delivery Nurses: A Brief Note
(Page 143)
“Many had “nasty” nurses who spoke to them in degrading, insulting and intimidating ways, leaving them in tears. Some requested different nurses; others just waited until the shift changed and were thrilled when a “nice, caring” nurse walked in.”
You’re 10 Centimeters: Now Push!/Don’t Push!
(Page 144)
“Basing readiness to push on the arbitrary standard of full cervical dilation eliminates the more physiologically efficacious possibility of basing such judgment on the childbearer’s urge to push. Homebirth midwives often encourage the mother to begin to push gently whenever she feels the urge, even if she is not completely dilated, as this gentle pushing can help, rather than hinder, the woman to achieve full cervical dilation.”
“Many midwives, after making sure that the mother’s bladder is empty and that her psychological condition and the position and heart rate of the baby are favorable, will encourage her to simply rest, sometimes even sleep for a bit, during this latent period of second stage labor, which is labeled the, “Rest and Be Thankful Stage.” During this phase, the uterus is taking time to lower down over the newly descended baby.”
Episiotomy: Humanistic Ritual Change
(Page 149)
“Think of the episiotomy this way: if you hold a piece of cloth at two corners and attempt to tear it by pulling at the two ends, it will rarely rip. However, if a small cut is made in the center, then pulling at the ends easily rips the cloth. Doing an episiotomy is analogous, and sometimes results in tears that extend into the rectum.”
““I have never had a 3rd or 4th degree tear through the sphincter or rectum unless I did an episiotomy.” The combination of episiotomy with the lithotomy position and stirrups works to offer women the highest possible chance that they will have deep perineal lacerations as they give birth.”
Cesarean Births and Vaginal Births after Cesarean (VBACs)
(Page 152)
As a Cesarean Birth mama who has gone on to have three Vaginal Births after Cesarean, I find this entire section inspiring and wish every woman who has had a Cesarean Birth will read this section to empower and advocate for themselves and their future babies.
“Delivery “from above” is the most extreme manifestation of the cultural attempt to use birth to demonstrate the superiority and control of Technology over Nature:
Performing a cesarean is the one time that truly gives you the feeling of delivering the baby. Pressure was being applied by Dr. Joseph at the top of the uterus while my hand grasped the head of the baby and assisted it out through the incision. I felt a sense of excitement and of power and of personal accomplishment that is not present in a vaginal birth. This is the time the obstetrician truly delivers the baby; in a vaginal birth, it is the mother.”
Maintaining the Same Cesarean Rate Despite Attempts to Lower It: Techno-Maternity Care as a Self-Organizing, Self-Stabilizing System?
(Page 162)
“...have a way of self-organizing to preserve the status quo, whereas implementing lasting change would require the entire system to re-organize–something that is extremely difficult to achieve, in part because every maternity care practitioner in that hospital would have to be on board with it and would have to accept retraining/resocialization in a deeply humanistic approach.”
Humanistic Ritual Change: The Gentle Cesarean
(Page 163)
“What if the conversation that led to the creating of the physical framing of the space was not one of mechanics but transition? What if the focal point is the significance of the moment coupled with the physical act of surgery? What if not her abdomen, but she and her baby were the focal point of the function of the theater? … What if her humanity were included in the surgery because her humanity is recognized by medical science? … Would physicians and nurses and techs find their jobs more meaningful? … Would we accompany each mother through the liminal journey and support her walk back to the world with her baby?”
Apgar Scoring
(Page 164)
Have you ever asked yourself why we do certain procedures and routines? Have you ever questioned why we score babies after their births? What if I told you that there’s a deep, dark history behind the APGAR score? A standardized means to quantify the effects that anesthesia has on babies.
“Just as meat for the supermarket must be inspected, stamped “USDA APPROVED,” and placed in a plastic wrapper that makes it look like it did not come from a cow, so must society’s new product, the baby, be inspected and rated (and wrapped and placed in a plastic box).”
“If the rating is high, the institution, and through it, society, can then claim the credit for a job well done.”
“The Apgar score is but the first in a long series of ratings that society will give its new member; scoring the baby at birth sets up mothers to respect and rely on society’s rating systems to judge their babies by for the rest of their lives.”
Umbilical Cord Clamping and Cutting
(Page 165)
“Cutting the cord immediately after birth has long been a ritual practice symbolic of removing the baby from the worlds of the womb and nature and initiating the newborn into the realms of technology and culture.”
Prophylactic Eye Treatment
(Page 168)
“Prophylactic eye treatment of the newborn once again tells the mother that she – and the father or partner – are impure in society’s eyes and that they have potentially polluted the institution’s product, which technology must now restore to purity.”
Vitamin K Injection
(Page 169)
“Symbolically speaking, the standardization of the Vitamin K injection, and indeed of all the routine procedures performed on the newborn baby, reinforce the messages to both mother and partner that nature is inadequate, that they are now dependent on organizations – that is, on techniques and technologies – for their lives and health.”
The Hospital Bassinet as Cultural Symbol
(Page 176)
“(The isolette, or warmer, when used, intensifies this message by adding to it the additional message that machines are more reliable than mothers.)”
Wheelchair
(Page 177)
“So the message going out of the hospital becomes the message coming in, as she is once again symbolically reminded that she is still – even as she begins her new life as a mother – dis-abled and dependent on society and the institutions that control and disseminate its technological representations.”
Summary: Birth Rituals and Society
(Page 179)
“...they are patterned and repetitive; they are profoundly symbolic, communicating messages through the body and the emotions concerning American culture’s deepest beliefs about the necessity for technological control of natural processes, the untrustworthiness of nature and the associated dysfunctionality of the birthing body, the superiority of (psuedo)science and technology, and the importance of institutions and machines.”
“...the obstetricians she interviewed expected a “good patient” and a “good mother” to accept the doctor’s authority during labor and birth, and not to try to impose her own control over these events.”
“But unlike most transformations effected by ritual, birth does not depend upon the performance of ritual to make it happen. The physiologic process of labor itself transports the birthing woman into a naturally liminal state that carries its own affectivity.”
“It is much more practical for societies to find ways to socialize their members from the inside, by making them want to conform to societal rules.”
The Alternative Birth Center in the Hospital
(Page 181)
“…the birthing center is still hospital territory, where the woman "still gives birth ... attended by unfamiliar people [who retain] the real decision-making power. A guest on somebody else's turf with few rights and fewer resources, [she] still does not own the birth.””
“”"It looks like you're getting something, and what you get is a lot of family-centered cesarean sections." And it is a common joke in hospitals that "ABC"- alternative birthing center actually stands for "a beautiful cesarean."”
“Don't kid yourself into thinking that birthing rooms made up to look just like a real motel bedroom are going to make any big difference. Once you allow yourself to be lured onto Modern Medicine's turf, they've got you. I have the recurring dream of a nice young couple going into the birthing [center]... The doctor smiles and acts just like a friendly uncle [but then he] pushes a button ... and the papered walls slide away, the furniture disappears, and they're suddenly in an operating room ... That fantasy isn't so unreal ... If you're on the doctor's turf, you play by the doctor's rules.”
This statement raises my adrenaline levels because this is all too true. I’ve experienced the “bait-and-switch” right along with so many women that I’ve supported in birth story retelling that shared their traumatic birth experiences where nurses and doctors yelled at them, belittled them, told them they could not do what felt instinctual and natural to them. This authoritative attitude is damaging.
Chapter 6: How The Messages Are Received
The Spectrum of Response
(Page 187)
In chapter six, Robbie Davis Floyd recounts birth stories of women she interviewed, all grouped in various categories. For example, Robbie Davis Floyd talks about women who had full acceptance of the technocratic model, conceptual fusion with the technocratic model and women who maintained their conceptual distance from the technocratic model.
“"What we believe is what can come true for us ... If a woman believes on the deepest emotional level that the hospital is the only safe place to birth, then if she tries to deliver at home, she won't be successful.””
“On the other hand, if a woman believes on the deepest emotional level that home is the only safe place to birth, yet goes to the hospital because, for example, she can't find a homebirth midwife in her area, or cannot afford the cost, or because her partner insists, she may experience a stressful, traumatic labor in which she may battle with hospital staff to avoid interventions and be distressed if she receives them anyway.”
“…the relationships among beliefs, behaviors, and birth outcomes are surely complex—but primarily to call attention to the importance of the relationship between ideology and birth outcome.“
A Note on Hospital Birth with Certified Nurse-Midwives (CNMs)
(Page 247)
“Obstetricians remain the White Knights who rescue childbearers from those pathologies, as is their appropriate role. One ob interlocutor affirmed, "The obstetrician should be the hero of the hospital, swooping in when help is needed. But the normal births--those should be solely under the purview of midwives, as all we do is mess them up, because we don't know how not to intervene!"”
Chapter 7: Scars Into Stars
The Reinterpretation of the Childbirth Experience
(Page 252)
In chapter seven, Robbie Davis Floyd goes over the reflection processes that many women go through after birth experiences. Some women will compartmentalize their births until they’re forced to revisit their previous birth experience once they find themselves pregnant again. Some women choose to initiate “further epistemic exploration” of their traumatic birth. To tell your birth story can give meaning and coherence to your experience. The body keeps the score when it comes to trauma and unresolved trauma will always resurface in the future.
Chapter 8: The Holistic Model of Birth and Health Care
(Page 267)
“I am not alone in wishing that we could scrap the whole system and start over, but I believe that the technocratic praxis is being recognized as insufficient and however slowly it happens, change is happening. We are moving towards a more humanistic future. And as long as we are moving in that direction, birth activists will keep pushing for a more holistic future.”
–Umber Darilek R.N.
Though I can see change is beginning to happen, I have to agree that it is a very slow moving process. I also have to ask the question, how many more women have to suffer the effects of the technocratic system? How many more women have to suffer the abuse and violence before enough of us step up and step away from the system? How many more decades will women and babies be permanently altered due to the technocratic system before real, lasting change is created due to the evidence-based truth?
The 12 Tenets of the Holistic Model
Oneness of BodyMindSpirit
The Body as an Energy System Interlinked with Other Energy Systems
Healing the Whole Person in Whole Life Context
Essential Unity of Practitioner and Client
Diagnosis and Healing from the Inside Out
Authority and Responsibility Inherent in the Individual
Science and Technology Placed at the Service of the Individual
A Long-Term Focus on Creating and Maintaining Health and Well-Being
Death as a Step in a Process
Healing as the Focus
Embrace of Multiple Modalities
Stratification in Holism and Technomedicine
Chapter 9: Birth Messages at Home
Homebirth as Holistic Ideology in Action
(Page 284)
In chapter nine, Robbie Davis Floyd starts off by explaining the background and context of homebirth in the United States. She also explains different motivations for choosing homebirth and recalls birth stories from women who choose birth as a natural aspect of womanhood and as a process for spiritual growth. Robbie Davis Floyd also goes over the different rituals of homebirth and the messages they say. What I found most interesting in this chapter are the tables comparing the hospital technocratic model to the homebirth midwifery model. The conversation about homebirth transfers to the hospital provided some “ah-ha!” moments for me in the ways of the importance of building relationships in our community based on a mutual respect forum. When obstetricians can support and respect midwives who attend community births and vice versa.
Motivations for Choosing Homebirth
(Page 287)
If I can share my own personal story here for just a moment, my reasons for choosing a homebirth after two hospital births were so that I didn’t have to fight for the birth that I deserved and knew my body could achieve. Having to fight every step of the way was not the way I wanted to experience my pregnancy or my birth. Leaving the technocratic system was the best decision I could have made for my pregnancies and my births.
“The mother’s body knows how to grow a baby and how to give birth. The uterus, much more than an involuntary muscle, is a responsive part of the whole; the mother’s mental and emotional attitudes affect its performance during labor, as do the beliefs and actions of the partner and the birth attendants.”
Safety: Ideologize and Realities
(Page 315)
Anyone ever questioning the safety of out-of-hospital births, there are so many studies out there showing the safety of homebirth that I encourage you to read for yourself!
The CPM2000 Study
“...the perinatal mortality rate was around 2/1,000 – almost exactly the same as the rate for nurse-midwives attending birth at home and for physicians attending low-risk birth in hospitals. … This study therefore showed that homebirth with a CPM in the United States was safe; it carried no additional risks over hospital birth.”
“Intensified technocratization does not equal intensified safety.” … “Contrary to our cultural beliefs, hospital birth does not minimize risk as much as most people think it does, and can increase it; planned homebirth does not increase risk, although most people think it does, and can minimize it.”
Chapter 10: Technocracy in Birth and Life
Some Ritual and Political Implications for the Future
(Page 326)
In chapter ten, Robbie Davis Floyd begins the chapter by explaining why most american women accept technocratic birth. She then moves into the politics of birth and that hospital birth as a rite of passage has more in common with male initiation rites than with female initiation rites. As she moves through this chapter, Robbie Davis Floyd purposes many different scenarios for where birth could be headed.
“... prevent the Climate Crisis from turning into a Climate Catastrophe. Can we do the same for birth? Can we prevent the Birth Crisis with its obstetric paradox (intervene in birth to make it safe, thereby causing harm) from turning into a Birth Catastrophe, with cesarean rates rising even higher around the world, until vaginal birth becomes “alternative” to cesareans?”
This thought really terrifies me. As a woman who had an unnecessary c-section due to trust in the system. As a woman who has had interventive births, has experienced and endured obstetric violence and rape in my own births plus have witnessed it in countless births I’ve attended… I can see where this path is heading if something doesn’t change. It takes my breath away to even try and imagine the types of births primarily experienced by society if things do not begin to change at a more rapid pace.
Chapter 11: Holism in Birth and Life
Some Ritual and Political Implications for the Future
(Page 341)
Chapter eleven begins to explain the need for community birth and the need for a rise in midwife numbers around the country.
I conclude with Susan Frye’s words as I feel she sums it all up so beautifully:
“Homebirth brings us back to basics. It’s just simply better for moms and babies. So women who want that should be able to choose it. I want to see a society in which it is more and more acceptable to choose homebirth. Insurance companies even now are starting to cover it… I think if people would look at the statistics, they’d see that homebirth is safer. Thinking that homebirth is dangerous is a societal thing, built into us before we were born. In this society, we are just not comfortable with our bodies. We expect others to take control, we let legislators and total strangers tell us what to do with our bodies. Homebirth matters on a very personal level. When you yourself realize that you gave birth, not someone or something else—they didn’t grow that baby, they didn’t bring it down into the birth canal—you have a much more intense and personal relationship with that baby, and that’s a basic feature of growing up as a whole healthy person, not to be born in a drug-induced stupor. The first arms that baby should feel are those of his family.”
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