Download The Corruption of Obstetrics

The Corruption of Obstetrics
by
Chelsea Michelle Hube
A Thesis Submitted to the Faculty of
The Wilkes Honors College
in Partial Fulfillment of the Requirements for the Degree of
Bachelor of Arts in Liberal Arts and Sciences
with a Concentration in Women’s Studies: Women’s Health
Wilkes Honors College of
Florida Atlantic University
Jupiter, Florida
May 2016
THE CORRUPTION OF OBSTETRICS
by
Chelsea Hube
This thesis was prepared under the direction of the candidate’s thesis advisor, Dr.
Wairimũ Njambi and has been approved by the members of her supervisory committee.
It was submitted to the faculty of the Honors College and was accepted in partial
fulfillment of the requirements for the degree of Bachelor of Arts in Liberal Arts and
Science.
SUPERVISORY COMMITTEE:
_______________________________________
Dr. Wairimũ Njambi
_______________________________________
Dr. William O’Brien
_______________________________________
Dean, Wilkes Honors College
_________________
Date
ii
ACKNOWLEDGMENTS
I would like to begin by thanking my husband and son for all of the love and support they
gave me when my head was buried in books. They continue to push me to be the best
person I can be. Thank you to my mother for all of those late-night phone calls asking
for synonyms, for being my friend and confidant, and for never giving up on me. Thank
you to my father for always believing in me and setting me up for success at an early age.
If it weren’t for those nights we cuddled on the chair and I read newspapers to you, I’m
sure I would not be in the position I am today. Thank you to my family for encouraging
me when I needed a little extra push, for being so patient and understanding, and above
all else for your unconditional support. I would also like to thank the Hollywood Birth
Center for taking me in and teaching me as well as to the women with whom I was
privileged to work. This experience has been one of the most fulfilling of my life and I
am forever changed. I want to specifically thank Dr. Wairimũ Njambi, who has given me
inspiration and the resolve to never settle for mediocre.
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ABSTRACT
Author:
Chelsea Hube
Title:
The Corruption of Obstetrics
Institution:
Wilkes Honors College of Florida Atlantic University
Thesis Advisor:
Dr. Wairimũ Njambi
Degree:
Bachelor of Arts in Liberal Arts and Sciences
Concentration:
Women’s Studies: Women’s Health
Year:
2016
Within the last two centuries, birth has undergone a major transformation as
doctors took over and relocated childbirth from the home to the hospital, leaving the
reproductive female body and female healers devalued and disempowered.
Advancements in medical science have played a fundamental role in this transformation.
As birth has become more and more medicalized, women seem to have lost their agency
and believe the only place to have a successful birth is in a hospital. Reproductive
technologies have certainly had beneficial effects, but they have also turned the mother
into an extension of obstetric machines, communicating a power hierarchy that reinforces
patriarchal control over female bodies. This hierarchy has had long-term repercussions
for reproductive bodies, but it is largely concealed. I argue that the transition of birth
from the home to the hospital is part of a systematic deprivation aimed at maintaining
male supremacy through the corruption of obstetrics.
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TABLE OF CONTENTS
Introduction: The Corruption of Obstetrics...…………………………………………...1
Chapter One: A Historical Account of Condemning Midwifery: Midwives and
Witches……………………………………………………………………………..…...3
The Institutionalization of Medicine & Establishment of American Maternity
Hospitals………………………………………………………………………...7
Technological Manipulation of Body & Mind………………………………….12
Chapter Two: Contemporary Issues…………...………………………………………..36
A Brief History of the Establishment of Nursing as a Profession………………37
Constrained Choices for Midwifery………………………………………….....40
Concluding Remarks: Regaining Control of Women’s Own Bodies……………...……45
Bibliography…………………………………………………………………………….46
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Introduction: The Corruption of Obstetrics
For centuries, childbirth had rested in the hands of midwives who travelled from
village to village to bring new life into this world. Childbirth was very much a routine
part of life – something women just did as opposed to some dangerous condition that
afflicted their bodies (Gaskin 2003, 184). Laboring women held the power over their
physiological processes, whereas today laboring women are virtually powerless.
Midwives were instrumental to this female-centered model of care, for they treated
pregnancy as a normal part of life instead of an illness. They needed no special degrees
or licenses to practice, no hospitals or electric monitoring devices. They learned from
other midwives and passed down that wisdom through generations of mothers and
daughters, working with mothers’ bodies instead of against them. It is this treatment of
women, separating the “humanistic model of care” essential to midwifery from the
“techno-medical model of care,” which prevails today (Gaskin 2003, 183).
In today’s industrialized nations, the United States has perhaps the lowest
percentage of female medical practitioners, and though “midwifery – female midwifery –
is still a thriving occupation in Scandinavia, the United Kingdom, the Netherlands, etc., it
has been virtually outlawed here since the early twentieth century” (Ehrenreich and
English 2010, 61). In fact, in New York City alone midwives’ numbers drastically
dwindled down from roughly three thousand to only one between the years of 1908 and
1963 (Andersen 1997, 213). Many of these midwives have been forced by educational
and medical establishments to practice as nurses or certified nurse midwives, which
contributed heavily to the dramatic decrease.
1
Childbirth occurring in the realm of midwifery makes sense when one considers
the domestic roles traditionally held by women, such as healers, nurturers, and caretakers.
Why, then, is contemporary childbirth dominated by male authorities? The answer lies
within America’s history of patriarchal rule, in which the practice of female-headed
midwifery was condemned as male practitioners seized power and medicalized birth.
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Chapter One: A Historical Account of Condemning Midwifery:
Midwives and Witches
Midwives are the original healers, but their legitimacy in many modern Western
societies has been marred by false accusations designed to remove them from the medical
sphere (Andersen 1997, 226). These attacks were methodical and well-thought-out,
which contributed heavily to their success. The persecution of women was nothing new
to history, but midwives were especially targeted because of their high level of medical
and obstetrical skills. Women had been barred from the rising medical profession as
early as 1750 BC, during the time of Hammurabi (Stanley 1983, 23). Although this was
the case, women still continued to preside over birth. The fourteenth century, however,
marked the beginning of a calculated ruling-class campaign of terrorization that lasted
more than four hundred years, devastating the European peasant population with the
execution of millions of women and children who were presumed to be witches
(Ehrenreich and English 2010, 33-34).
A large proportion of the “so-called witches were in fact healers who relied on
natural herbs and midwives who assisted women in a full range of reproductive needs,”
from contraceptives and abortion to labor and delivery (Alcoff et al. 2014, 68). Herbal
medicine was actually the first type of medicine and a lot of it is still used to this day,
such as anti-bacterial Penicillium, ergot for speed up labor, and antispasmodic belladonna
(Stanley 1983, 22-23). The medical knowledge that midwives held was not so much of a
threat as was the fact that they were women who dared to step out of their prescribed
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roles to practice that knowledge. In their account of women healers’ history, Barbara
Ehrenreich and Deirdre English write:
The witch was a triple threat to the Church: She was a woman, and not
ashamed of it. She appeared to be part of an organized underground of
peasant women. She was a healer whose practice was based in empirical
study. In the face of the repressive fatalism of Christianity, she held out
the hope of change in this world. (Ehrenreich and English 2010, 49)
Underneath all of the accusations of debauchery and witchcraft lay a single theme: male
upper-class control. Whereas male practitioners knew little more to prescribe than
prayers and bloodlettings, women healers and midwives relied on time-tested herbs and
careful nursing (Stanley 1983, 23-24). Midwives cared for the dense peasant population,
so they naturally had much more experience than the dominant group of male
theologians, whose only involvement was with the few elite. Moreover, midwives saw
results; no doubt childbirth carried risks of its own, but the risks would have been far
greater if governed by religious dogma. Obviously, then, midwives’ repeated success
was a threat to the smaller circle of men who often unsuccessfully treated nobles. These
men believed that midwives’ success could not possibly come from their acts alone – for
they were just women. There must be some “accursed interference with the will of God,
achieved with the help of the devil” (Ehrenreich and English 2010, 47). Thus, any cure
must also be evil.
As European medicine became “firmly established as a secular science and a
profession,” male practitioners “actively engaged in the elimination of female healers”
(Ehrenreich and English 2010, 50). The Malleus Maleficarum provided the ruling class
of priests and court physicians with the legitimation and power they needed to wipe out
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these role-defying women who threatened patriarchal authority. This doctrine, issued and
backed by the Catholic Church in 1484, defined what constituted a witch and how to go
about her sentencing and persecution (Andersen 1997, 226-227). Since all evil was
thought to stem from Eve’s original sin, women were condemned as sexually immoral
creatures. It is no wonder that these men – who could not become pregnant – came to the
conclusion that midwives, whose specialty was in the product of female sexuality, were
instruments of Satan. Criticizers went as far as to allege that all midwives were lesbians,
claiming:
…when a midwife physically assists in the birth of a baby it is a
homosexual experience…it is not what the midwife says that makes it a
lesbian experience. It is what she does. She could be a deaf mute. But if
she is handling a private part of a woman who is having a genital
expression (and that is what birth is), then that is a homosexual
experience. Only the husband of the birthing woman should be touching
her there. (Martin 1992, 159)
Given that intentions were to remove women from the medical sphere completely,
including from traditional childbirth practices, such an erroneous claim is not surprising.
By stigmatizing female-lead midwifery as a homosexual practice, heterosexual caregiverpatient relations (i.e. male-female) are deemed as the only appropriate interactions
between genders according to Western/Christian patriarchal definitions.
Accusations such as these have unfortunately made a permanent impression on
society. Even today, midwives are given the same credibility and respect as are fortunetellers spouting off hocus pocus through a discount crystal ball. Clearly, the bold position
midwives held was a threat to the rising male-dominated medical profession, and the
“witch hunts were a mechanism for ensuring the social control of women by men, as
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represented in the emerging hegemony of organized patriarchal religion” (Andersen
1997, 227). By establishing medicine as a profession that required years of university
training, to which women lacked the political power to attend, midwives were quickly
and easily removed for the most part from the scene.
6
The Institutionalization of Medicine & Establishment
of American Maternity Hospitals
If the witch craze set the stage for the condemnation of midwifery, then the
continued growth and institutionalization of obstetrics as a medical profession closed the
curtains. Despite the terror inflicted upon midwives during the witch craze and their
ensuing reputation as being superstitious and harmful, women continued to preside over
most births (Andersen 1997, 210). Prior to the eighteenth century, only the financially
well-off could afford a formal physician’s visit, so midwives and other female healers
were the primary caregivers for the poor. A shift occurred with the onset of the
American Industrial Revolution, however, when a new middle-class strata emerged. In a
time of enormous growth and an expanding capitalistic economy, the middle class
offered a new market for all kinds of medical discourse, including maternity services.
Advancements in scientific medicine, such as a better understanding of sterile
conditions and anesthesia, legitimized male doctors’ claim that childbirth and surgeries
“were tasks that could be performed better in hospitals than in homes and better by
trained personnel than by amateurs” (Schwartz Cowan 1983, 77). These “amateurs”, of
course, were female midwives who had learned their skills outside of institutionalized
educational establishments, whereas “trained personnel” were white men who were both
dominant and predominant within those establishments. Medical schools began to
proliferate throughout the country, and from the mid-eighteenth to early nineteenth
centuries, subsidies were given to white men so they could attend universities and partake
in the increasing knowledge about the physiological processes of pregnancy and
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childbirth (Andersen 1997, 211). Subsidies were not given to women, though, and most
were subsequently unable to attend these institutions. In addition to the lack of financial
resources for private schooling, most women were illiterate and discouraged from
receiving higher education. This solidified the image of an untrained female midwife
juxtaposed to an educated, and thus trustworthy, male doctor.
Furthermore, the emergence of new technologies during the Industrial Revolution
left America awestruck, and “rather than being reflective, let alone critical, of technology,
Americans tend[ed] to embrace it as an inherently powerful force, largely for progress”
(Leonard 2003, 1). Although midwives used technology as well – herbs were used to
ease labor pains or to initiate/slow contractions –, their techniques were not regarded as
valuable because childbirth is “women’s work”; and, because of America’s “peculiar set
of cultural blinders,” the “tools” of midwifery went unrecognized in the technological
realm (Schwartz Cowan 1983, 9). Autumn Stanley emphasizes this point, stating that “in
Western culture men have historically been associated with technology, while women are
more typically associated with ‘nature,’ perceived…as the opposite of technology”
(Stanley 1983, 4). Mechanical reproductive devices such as forceps and slings replaced
male doctors’ hands and fit right into the patriarchal definition of what technology was
and what it wasn’t (Martin 1992, 54). The expanding field of technology and obstetrics
broadened the horizon for many potential careers, just as neuroscience or genetics does
today, and “obstetrical practice among the middle class was quickly transformed from a
neighborly service into a lucrative business” (Ehrenreich and English 2010, 59).
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A dependable market promised to generate a successful practice and thus a stable
revenue. Midwives posed a threat to this new business model, and it was all the
motivation male practitioners needed to eliminate their competition. Doctors baited and
hooked women with propaganda aimed to make them fear pregnancy and childbirth, and
collaborated with government officials to generate legislation that would restrict
midwives’ practices (Andersen 1997, 213). What had previously been a normal bodily
function was now a life-threatening medical condition, and doctors promised the cure.
They were both the architects and the demolishers of this new pandemonium of
childbirth. Midwives could work around fearful expecting mothers and their families, but
they could not (hypothetically) work around the law, which, since 1900, had required
them to obtain licensure.
In order to obtain a license, however, a midwife had to be endorsed by a (male)
member of the medical community and promise only to attend births under a physician’s
supervision (Andersen 1997, 213). This was devastating for the midwifery community,
and their numbers dwindled drastically over the course of sixty years. Not only would it
be extremely difficult, if not impossible, to find a doctor willing to endorse her since she
was his competition, but even if she did obtain licensure she would still be under the
medical community’s thumb. This constraint continues to plague current midwifery
practices, which will be discussed in Contemporary Issues. The restrictions imposed on
midwives were equally as destructive to the poor, who now had even fewer healthcare
options. The combination of fear-inducing propaganda and tactical legislation proved to
9
be an effective commercial ploy, and childbirth underwent a major transformation as it
shifted from the home to the hospital.
With childbirth’s relocation to the hospital, pregnancy and birth mutated to adopt
the discourse of disease and illness. Further advancements in scientific visualization
techniques only legitimized doctors’ claim to unrivaled knowledge because now
medicine encompassed both what was visible and what was not. Of this, Foucault writes:
At the beginning of the nineteenth century, doctors described for what
centuries had remained below the threshold of the visible and the
expressible, but this did not mean that, after over-indulging in speculation,
they had begun to perceive once again, or that they listened to reason
rather than to imagination; it meant that the relation between the visible
and invisible – which is necessary to all concrete knowledge – changed its
structure, revealing through gaze and language what had previously been
below and beyond their domain. (Foucault 1994, xii)
Visualization techniques became even more refined during the twentieth century and, at
the height of the eugenics movement, aided in the removal of childbirth from the home.
The ability to physically see germs as relatable to sickness propelled and legitimized
social ills of the time, specifically ones which stigmatized those from the lower rungs of
the social ladder.
The movement of childbirth to hospitals and medical men was further
increased by popular racist fears of contagion and germs that were
associated with the poor, immigrant, and Black people. The fads of
genetic science and Social Darwinism of the 1920s and 1930s increased
middle-class fears of associating with those from the lower strata of
society. Coupled with the home economics movement of the 1920s that
defined home environments as sources of germs and disease, popular
opinions laced with racist and class ideologies further generated a social
definition of childbirth as a scientific event to be placed under the
authority of medical men. (Andersen 1997, 213-214)
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The number of hospital beds doubled from 1900 to 1920 and again doubled between
1920 and 1970 (Schwartz Cowan 1983, 77).
An increase in occupied hospital beds resulting from fear of germs alone would
be a dubious proposition at best. Much of this increase was due to racist fears of the
impending extinction of the Caucasian race, when a “decrease in population among the
mostly white middle class rang alarm bells… [and] women were exhorted to have more
babies to preserve their race and even ‘civilization’” (Alcoff et al. 2014, 203). And, who
better to take in all these pregnant white women than white male doctors? To make
matters worse, gains in the field of obstetrics were at the cost of poor, unmarried, and
Black women, who were coerced into submitting their bodies for medical
experimentation under the impression that they would be provided with “a more moral
and sanitary environment” and free medical treatment (Andersen 1997, 212).
As research subjects, these disadvantaged women unknowingly suffered
tremendous pain and violation so that more affluent white women would not. Doctors,
who now held “expertise” in bodily afflictions, used their authoritative position of
modern medicine to dictate what was normal – and what was pathological – in women’s
health (Alcoff et al. 2014, 255). In accordance with values of the patriarchal social
hierarchy, “routine bodily functions unique to women such as menstruation, childbirth,
and menopause were reinterpreted as diseases, and treated as such (Alcoff et al. 2014,
136; Martin 1999, 185). The widely-accepted belief that doctors held ultimate
knowledge of the female body opened new doors with respect to technological
manipulation and intervention, for better or for worse.
11
Technological Manipulation of Body & Mind
As the study of the female body increasingly became under the control of males,
the tendency to perceive that body through the androcentric lens became more
established. Control of the ability to study the female body gradually morphed into
control of the actual female reproductive body with the help of advances in reproductive
technology. While new technologies and techniques have certainly been instrumental in
saving many women’s and their babies’ lives, they also have the potential for abuse and
exploitation. Whether or not technology is good or bad all depends on how it is used
(Leonard 2003, 14). Kathryn Pauly Morgan agrees, writing:
The era of biotechnology is clearly upon us and is invading even the most
private and formerly sequestered domains of human life, including
women’s wombs. The domain of technology is often set up in
oppositional relation to a domain that is designated ‘the natural.’ The role
assigned to technology is often that of transcendence, transformation,
control, exploitation, or destruction, and the technologized object or
process is conceptualized as inferior or primitive, in need of perfecting
transformation or exploitation through technology in the name of some
‘higher’ purpose or end, or deserving of eradication because it is harmful
or evil. (Morgan 1991, 265)
Given the high use of elective screenings, anesthetics, and fetal monitoring services, it is
only logical to conclude that these technologies are not always forced upon women.
Take the frequent use of ultrasound during pregnancy and labor, for example. At
least one-third of all pregnant women have had or will have ultrasounds at least once
during their pregnancies and its use is only expanding (Hartouni 1997, 36). Most women
nowadays assume that ultrasound imaging is a given – that it is part of the package of
becoming a mother, not an a la carte service; they do not think twice about its
repercussions or why its use is so thoroughly insisted upon. They would probably never
12
guess that ultrasounds were initially used on pregnant women in order to deter from
abortion by fostering some feeling of “recognition and identification of the fetus as their
own, as something belonging to and dependent upon them alone” (Hartouni 1997, 36).
Regardless of a woman’s reason for considering an abortion, the ease with which
physicians have manipulated technology to serve the dominating party’s anti-choice
belief is disturbing.
Therefore, this one device, which has become so embedded in medical practice
today, is much more than a tool of obstetrics – it is also one of politics. Eileen Leonard
writes that it is not recognized as such though, since “technology is viewed as a mere
tool, developed apart from the pushes and pulls of political constraints and through agents
who are neutral and unbiased” (Leonard 2003, 2). Valerie Hartouni expands on this
notion, writing:
…medical science, the life sciences, and biology occupy a highly political
field and remain today, as in earlier historical moments, culturally
constituted and constitutive reading practices, socially embedded ways of
seeing that operate apart from law but often with its force to regulate and
contain what they, of course, also produce – a proliferation of procreative
stories and alternative procreative possibilities (Hartouni 1997, 25)
Basically, we see ultrasounds and other technologies, reproductive or otherwise, as
beneficial because we have been culturally inoculated to do so. It is important to analyze
where we, as women, stand when it comes to the technological instruments that are used
on our bodies. We assume that the use of reproductive technology is in our best interest
and fail to question what is obscured – that it could be an “instrument of society” with
real political implications and that we may be at risk for becoming merely puppets on
strings (Leonard 2003, 3). Lilia Oblepias-Ramos asks some important questions: “Are
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the women informed of the choices they can make on which technologies will serve or
harm them? Can they, in fact, choose what they feel appropriate for them, or are they
obliged to fit themselves to the technologies they need to use?” (Oblepias-Ramos 1991,
90). More importantly, are women even aware they have a choice?
To begin to answer these questions, we must first consider the five ways in which
the pregnant female body has been objectified and alienated from even herself by means
of “the practices of a science marked not only by its espoused values of objectivity and
rationality, but also by androcentrism, racism, classism, and misogyny” (Price and
Shildrick 1999, 146). Those five ways are: the separation of mind and body, the body as
a machine, the body as harmful, the body as an incubator, and finally, intervention.
The fact that men are associated with technology and women are not sets up the
first germ of alienation: a dichotomous mind/body, or culture/nature, argument. During
the eighteenth-century Enlightenment, scientists took a newfound meaning in what
‘nature’ meant and, by virtue of their reproductive system and the ability to bring forth
new life, avowed that pregnant women evoked nature in its most pure form (Jordanova
1999, 164). This new take on nature coincided with changing meanings of wilderness for
pioneers and settlers: what had once been a great threat to life itself was romanticized as
something of sublimity, provided it could be tamed and placed within man’s control
(Nash 2014, 44-45). Ludmilla Jordanova gives an excellent account of how the idea of
nature was constructed by people and maintained by society as some dangerous force to
be conquered, writing that “woman” became synonymous with “nature” in that their
bodies are, according to Michelet, “so clearly subsumed under nature’s laws…that their
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states of mind and body can be read by the trained person” (Jordanova 1999, 166).
Nature dictated that their “uncontrolled passions” left them less amenable to reason,
which necessitated a means to control them and protect them from their dangerous
potential (Jordanova 1999, 166).
These claims of Western science unfortunately have been taken as matter-of-fact
and persist today due to the fact that it is not just the field of scientific medicine that is
implicated. Nearly every field of study – history, anthropology, sociology, and
psychology, to name a few – has been shaped in some way by the sexist structure of
scientific medicine. Within the techno-medical model of birth (hospital-based obstetrics),
mind and body are considered not as one, but separate (Gaskin 2003, 158). The pregnant
woman’s body, therefore, is not considered to be a thinking body. The Hunter College
collaborative writes that “‘woman’ has been associated with the body, while ‘man’ has
been linked with the mind. ‘Woman’ equated with the body is, therefore, not mind and
not self. She is not a self or subject but an object, not spirit but flesh. She is aligned
against reason” (Alcoff et al. 2014, 128).
Historically, men have linked nature with needing to be tamed and, with the rise
of industrialization and the new techno-medical model of maternity care, have equated
that theory with the pregnant body as well. Hartouni writes of the opposition between
mind and body:
…motherhood is equated with pregnancy and thereby reduced to a
physiological function, a biologically rooted, passive – indeed, in this
case, literally mindless – state of being. Within this understanding,
motherhood is cast as “natural” or “instinctual,” a synonym for female, the
central aspect of women’s social and biological selves, the expression and
completion of “female nature.” It is something that just “happens,”
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something that is initiated at conception, something that, as a biologically
rooted capacity, does not depend upon a woman’s consciousness for its
development, but develops as woman’s consciousness if not disturbed or
thwarted in the process. (Hartouni 1997, 29-30)
Hartouni touches on the point that pregnancy is viewed as some anomaly outside the
mother’s control, despite the fact that a fetus in utero is completely dependent upon its
mother’s actions. The reality is that the mother is the only one in control of her
pregnancy. It would seem that the contrary is the case, however, given the apparent lack
of options mothers have in the delivery room.
In her book, Technologies of the Gendered Body, Anne Balsamo contemplates
whether the pregnant female body’s place in the world belongs to the realm of nature or
of culture, writing that,
If the female body properly belonged to nature…then midwives were
better positioned to serve the laboring maternal body, being female bodies
themselves and skilled in reading the natural labor signs of that body. If
the female body could be secured as belonging to the cultural order, then,
by extension, it was beholden to the cultural authority of medicine and
medical discourse… (Balsamo 1997, 27)
The laboring body of the natural realm would therefore be best served without the use of
technological contraptions, for the body would labor as nature intended. On the other
hand, if it belonged to the cultural realm, it would be obliged to submit to the technoauthority of the male medical professional. It is a classic case of “mother knows best”
versus “doctor knows best.”
The opposition of mind/reason and body/nature has had serious repercussions:
constrained opportunities and choices for the childbearing mother – not because it is
“natural or inevitable but because women have been interpreted through the lens of
16
culture, thought of as ‘natural’ by men who have created the very category of ‘nature’ to
serve their own aims,” suggesting that it is “the cultural, rather than the natural, character
of such limitations in Western culture where ‘woman’ has been defined by her body and
seen as trapped in nature because of it” (Alcoff et al. 2014, 129).
Society’s understandings of childbirth and the bodily fluids which accompany it
are two examples of how pregnant women are trapped within the natural realm. Margrit
Shildrick and Janet Price describe the female body as being understood as “intrinsically
unpredictable, leaky and disruptive” (Price and Shildrick 1999, 2). The pregnant body
‘naturally’ produces more vaginal discharge than women who are not pregnant and the
laboring body releases anywhere between two and six cups of amniotic fluid once the
amniotic sac has ruptured. This ‘leaky’ quality is, indeed, unpredictable as is it disruptive
– labor does not take a timeout or wait for everyone to be ready and this is quite
inconvenient for men. These potentially unsettling qualities unique to pregnancy and
childbirth have thus been claimed to prevent women from making rational decisions. It is
not a surprise that “the ability to affect transcendence and exercise rationality has been
gender marked as an attribute of men alone – and further only some men, i.e. those who
are white, middle/upper class, healthy and heterosexual – such that women remain rooted
within their bodies, held back by their supposedly natural biological processes” (Price
and Shildrick 1999, 2). In this way, she (the pregnant female body) is a “hybrid creature”
which functions as part of a natural order but submits to cultural authority of man
(Balsamo 1997, 27).
17
Many women have been trying to reclaim the category of natural as something
positive and taking pride in their ability to give birth ‘naturally’, i.e. resisting medications
created by the western men of techno-science that serve to control both the birthing body
and the birthing process. While their ability to reclaim negative connotations of
masculinist discourse is certainly something to be admired, the pregnant/laboring body
still retains somewhat of a vulnerable character as a potentially penetrable “place of
ambush” (Price and Shildrick 1999, 4). Giving birth ‘naturally’ may be an important
stronghold for women’s power, but its binary value that is given in western societies as
something that needs to be controlled can always be used counter to women’s power. In
this way, the female body’s association with nature is both good and bad: its capacity for
sentiment and morality renders it practical for raising children, but its detachment from
science renders it ignorant and lacking in intelligence (Jordanova 1999, 163).
Hartouni contests the notion that women, by nature, are better suited for
motherhood because of inherent qualities, writing that “‘being a mother’ is not something
women ‘are’ by nature, instinct, or destiny, or by virtue of being female or pregnant”
(Hartouni 1997, 30). Instead, she writes, “it is something women (among others) do: it is
a conscious and engaged work in the fullest sense of the word and an activity that is still
but need not necessarily be gender specific” (Hartouni 1997, 30). Mothering is
conditioned so much that it appears natural or instinctual. The mindset that women’s
bodies are natural thus legitimizes the male medical professionals’ authority over them
and likewise the alienation of the woman from her mind. A far cry from being “natural,”
18
however, is male doctors’ choice of language for childbearing women, which serve their
purposes well.
When childbirth shifted from the hands of female midwives to those of male
doctors, American obstetrics adopted a language which described the female body as a
machine (Andersen 1997, 210). Seventeenth- and eighteenth-century French scientists
had originally coined the terms, observing that the womb and uterus worked “as though
they formed a mechanical pump that in particular instances was more or less adequate to
expel the fetus” (Martin 1992, 54). It is fitting that American doctors would later
embrace this language, considering the technological boom of the Industrial Revolution.
This new language and association of women with machines marks the second germ in
the pregnant woman’s objectification and alienation.
Describing the pregnant female body in mechanistic verbiage served to distance
the equality between men and women, for “it was the basic premise of physicians in late
eighteenth-century France that women were quite distinct from men by virtue of their
whole anatomy and physiology” (Jordanova 1999, 160). By differentiating anatomical
and physiological features, an argument could be made for ‘natural’ differences – or
deficiencies, rather – that could also serve as the rationality behind inequality.
Additionally, because who we are is conveyed through language, there are two primary
implications that go along with this industrialized model of speech: first, the “reduction
of spirit, affect, and value to mechanistic processes in the human body”; second, the
facilitation of “viewing and treating the body in [an] atomistic and mechanical fashion”
(Morgan 1991, 265). Such an approach aims to “render the individual both more
19
powerful, productive, useful and docile”, securing its hold “not through violence or force,
but rather by creating desires, attaching individuals to specific identities, and establishing
norms against which individuals and their behaviors and bodies are judged and against
which they police themselves” (Sawicki 1999, 190-191). It robs women of the ability to
control their own bodies.
With the machine model, the doctor is the star of a show that had traditionally
been a female-centered event. Ina May Gaskin, an internationally renowned Certified
Professional Midwife, comments on this: “Instead of being the central actor of the birth
drama, the woman becomes a passive, almost inert object – representing a barrier to the
baby’s eventual passive to the outside world” (Gaskin 2003, 186). In her passivity, she is
expected to place her complete trust in the doctor’s knowledge and do as she’s told, when
she’s told. Midwifery, however, follows a far more autonomous approach, listening to
what the laboring mother’s body tells her and doing what she feels is right in the moment.
Take positioning during labor, for example: midwifery practices encourage the laboring
mother to walk around, lean over, use birthing balls – basically anything that feels good
to her, because that is what moves the fetus down and out and into her arms. Physicianled hospital births, on the other hand, constrict the laboring woman’s movements and
usually confine her to a semi-reclined bed, feet in stirrups, and plugged in to intravenous
tubes and fetal monitoring devices as if she is a machine herself. Not only is the hospitalbirth stressful, it is not logical when considering that gravity will work on the laboring
mother’s side – and laying down will not facilitate gravity.
20
In addition to the control over others, the techno-model of reproductive care that
brands the laboring female body as a machine has a unique relationship with production
and commodification. Emily Martin entertains this thought, writing:
In sum, medical imagery juxtaposes two pictures: the uterus as a machine
that produces the baby and the woman as laborer who produces the baby.
Perhaps at times the two come together in a consistent form as the womanlaborer whose uterus-machine produces the baby. What role is the doctor
given? I think it is clear he is predominantly seen as the supervisor or
foreman of the labor process. (Martin 1992, 63)
Childbirth takes on the imagery of a factory job, where laboring women are the workers
and the efficiency of their uterus-machines is managed by the obstetrician-overseer.
Even the word “labor” is ironic, considering that labor is associated with active work but
pushing a baby from the body is considered anything but active. In accordance with
patriarchal notions that define work and labor, medical doctors focus on how technology
and machinery can be used to control the progression of birth. As a machine-body, the
childbearing woman is prone to all sorts of mechanical malfunctions. Subsequently, if
the “woman’s body is the machine”, then the “doctor is the mechanic or technician who
‘fixes’ it” (Martin 1992, 54). In addition to labeling childbearing women’s bodies as
innately irrational and treating them like machines, physicians have also depicted those
bodies as deficient, uncontrolled, and inherently diseased – marking the third germ of
alienation (Price and Shildrick 1999, 145).
For male physicians, who are unable (so far) to give birth, pregnancy and
childbirth are not only mysterious but also frightening (Alcoff et al. 2014, 254).
Consequently, their fears have skewed their understanding of the pregnant female body
and have been reflected in medicine. This has significantly affected childbearing
21
women’s ideals of their own health, for “If men are the authorities to whom women turn
for information about these events, certainly men’s subjective interpretations are
conveyed to women, who learn to perceive the world through men’s ‘expert’ eyes”
(Alcoff et al. 2014, 254). What was probably more threatening to male doctors, though,
was not the supposed dangers of pregnancy and childbirth but the fear of not being in
complete control. Contrary to the belief of the machine-model, the body does not always
function as one wants it to even with the very best medical knowledge and equipment.
Therefore, if women themselves come to believe that their bodies are dangerous, it makes
it all the easier for doctors to maintain control by whatever means possible, all the while
holding the position of the Good Guys.
According to Emily Martin, gynecologists have been vilifying pregnant bodies for
centuries:
From the early description by a nineteenth-century gynecologist of the
uterus as a death missile, through later (1920) descriptions of labor as
being like the mother falling on a pitchfork or the baby’s head being
caught in a door jamb, to contemporary efforts of obstetricians to ease the
terrible experience of birth for the infant by dim lights and warm baths
after birth, a role is constructed for the doctor to ally with the baby against
the potential destruction wreaked on it by the mother’s body. (Martin
1992, 64)
These erroneous conclusions stem from misunderstandings of pregnancy and childbirth.
If uteruses truly were death traps, then we would not be walking the earth today. And, if
the passage through the birth canal really was a traumatizing experience, then babies
would show markers of it like disfigurement or compromised health. Still, the myth of
the dangers of pregnancy has been so deeply embedded in women’s psyche and many
women have come to believe that their bodies are the enemy, making them fear childbirth
22
as well. They have been brainwashed by male doctors whose “profoundly misogynist
beliefs and attitudes” are central to the transformation of the womb from a sanctuary to a
“dark prison,” where “women are viewed as threatening irresponsible agents who live in
a necessarily antagonistic relationship with the fetus” (Morgan 1991, 273). According to
this propaganda, women’s bodies are the catalyst to destruction despite best intentions.
Their bodies are not to be trusted; they must be controlled via technological manipulation
to prevent them from killing their own progeny, which perpetuates “the most deadly antiwoman bias of them all” (Hartouni 1997, 40).
The fourth germ of women’s objectification and alienation during pregnancy and
birth has to do with the way the body has been painted as a mere incubator for the
primary patient – the fetus. The Greek philosopher Aristotle was perhaps the first to
claim that the pregnant female body is a vessel for the man’s seed and that it makes no
important biological contributions to the fetus’s human form; the only thing provided by
the mother is the sustenance needed for growth (Alcoff et al. 2014, 52). Of course
modern advancements in genetic research have dispelled this myth (we know now that
the mother does indeed make formative contributions to the fetus – half of its DNA, in
fact), as well as the myth of the fully-formed, although tiny, homunculus. Like the
homunculus, nineteenth century physicians saw the fetus as an “autonomous, selfdetermining life form and argued that its ‘subsequent history after impregnation [was]
merely one of development, its attachment merely for nutrition and shelter’” (Hartouni
1997, 24).
23
Things have not changed very much in the last two centuries, for the majority of
physicians and birth-advocates still regard the fetus as a little defenseless human despite
the fact that it has no life experiences or any other qualities that differentiate masses of
cells from humans. Just take a trip on Florida’s Turnpike and you too will see the antichoice campaigns plastered on billboards, with piercing lines such as “Take my hand not
my life,” or “PREGNANT? Your baby’s heart is already beating – call 1800848LOVE.”
Of course, these captions are always accompanied by pictures of fully-developed,
adorable bouncing babies – which honestly look nothing like an actual fetus in utero –
and a mother is nowhere in sight. Words such as “baby” and “child” are relative terms
since they imply that the fetus is already a whole person. Such is the popular perception
of the fetus, but here is the heart of the issue: a fetus cannot become a person by itself.
The fetus is not a person; the mother is a person. It is based on her, not on itself.
Scientific advancements in reproductive visualization technologies are to blame
for why the fetus is “personified, perceived, presented, and produced as a person who has
simply been awaiting discovery” (Hartouni 1997, 23). Physician Michael R. Harrison
speaks of the fetal form as a scientific curiosity, saying:
The fetus could not be taken seriously [we might ask by whom] as long as
he remained a medical recluse in an opaque womb; and it was not until the
last half of the century that this prying eye of the ultrasound (that is,
ultrasound visualization) rendered the once opaque womb transparent,
stripping the veil of mystery from the dark inner sanctum, and letting the
light of scientific observation fall on the shy and secretive
fetus…Sonography can accurately delineate normal and abnormal fetal
anatomy with astounding detail. It can produce not only static images of
the intact fetus, but real-time “live” moving pictures…The sonographic
voyeur, spying on the unwary fetus finds him or her a surprisingly active
little creature, and not at all the passive parasite we had imagined.
(Hartouni 1997, 37)
24
While sonographic imaging has been immensely helpful in determining certain aspects of
pregnancy, such as the growth of fetal internal organs or where the placenta is located
(which could literally be a life or death situation), it has also effectively alienated the fetal
body “from its natural association with the female body and is now proclaimed to be the
new and primary obstetric patient” (Balsamo 1997, 9). With the focus now on this little
person who is independent of its mother, a whole range of statutes and surveillance
mechanisms have appeared to secure fetal rights. Hartouni problematizes the split
between woman and fetus and the mechanisms aimed at securing fetal rights further:
Depicting a woman and the fetus she carries as two separate, adversarily
related individuals—one a potential killer, the other innately innocent—
they engender and promote the notion that, whereas women once nurtured
their unborn, they now regularly abuse or neglect them and cannot be
trusted not to. Where gestation was itself once the most natural of
processes, it has now become treacherous. (Hartouni 1997, 41).
What had been created to protect women and their fetuses from harm done to them in
cases of assault and battery is now used to sanction the women themselves for harm done
by them unto fetuses (Hartouni 1997, 41). It is the woman, then, that is the source of
potential harm, the antagonist to maintaining life.
According to Martin, endowing cellular entities with personhood “will likely lead
to greater acceptance of technological developments and new forms of scrutiny and
manipulation, for the benefit of these inner ‘persons’” – from court-ordered restrictions of
women’s activities to rescinding of abortion rights, fetal health will likely be top-priority
(Martin 1999, 186-187). Similarly, Balsamo writes that “the unborn fetus is guaranteed
certain rights denied to the pregnant woman,” and, as in the case with forced cesarean
25
sections, sometimes the pregnant woman’s own health and life choices are overridden in
favor of fetal health (Balsamo 1997, 154). It is quite remarkable when one thinks of it.
A woman can be forced to have a cesarean – to literally be cut and splayed open on an
operating table –, yet we cannot force a person to give blood even if it is to save a life
(Alcoff et al. 2014, 52). The sexist structure of the techno-medical model of birth has
arrested women’s control over their own bodies. Unfortunately, the exploitation of
childbearing women occurs with frequency in physician-mediated births, and intervention
has become the go-to choice for controlling the supposed destructive forces of pregnancy.
Intervention, the fifth germ, is the source of many heated debates between
midwives and obstetricians, who hold completely opposite perspectives. As Margaret
Andersen explains, during the nineteenth century “medical men had adopted an
increasingly interventionist approach toward birth, whereas female midwives relied more
on the normal course of delivery” (Andersen 1997, 211). Although nearly two centuries
have passed, this still holds true for both types of maternity caretakers. Midwives’
position on technological intervention in birth is that it is not inherently evil—it just
needs to be reserved for when it is truly needed and coercion should not be a factor in
determining its use.
There are times, of course, when medical intervention is needed to save mother
and baby. Midwives are highly trained to recognize signs of complications and will
attempt to treat them while mild, but they will also be the first person to transfer the
laboring woman to a hospital before the problem becomes life threatening. The fact is
that there are risks with everything in life, and research has proven that between eighty-
26
five to ninety-five percent of women give birth safely and without surgery or instruments
when the midwifery model of care is applied (Gaskin 2003, 184). Their low rate of
transfers to hospitals is largely due to the fact that they believe there are less harmful
ways of dealing with complications during labor. For instance, many doctors provide
Pitocin (synthetic oxytocin) to induce labor or increase contraction intensity when labor
has stalled, which inadvertently causes more painful contractions, which then causes
higher stress levels for both mother and baby, which potentially leads to fetal distress,
tearing, and more serious intervention measures such as cesareans. It is a rapid tumble
downhill. Midwives assert there are other ways to trigger oxytocin secretion and increase
contraction intensity, such as nipple stimulation, sexual play between her and her partner,
herbal remedies such as blue and black Cohosh root or cotton root bark, and homeopathic
medicines like gelsemium (rhizome of yellow jasmine) or sepia (ink secreted from
cuttlefish) (Debbie Marin 2015; Weed 1986, 64-65). Herbs and homeopathies are not as
concentrated as artificial medications such a Pitocin and are not such a huge shock to the
woman’s body, therefore posing less risk. But since birth now most commonly takes
place in hospitals—ninety-two percent of births—that are controlled by doctors and staff,
interventionist practices are routine in delivery rooms and have become so commonplace
that they are rarely questioned by the women who receive them (Business of Being Born
2008; Andersen 1997, 214).
The techno-medical model of care is grounded in the control of the creation and
terms of fetal life, viewing issues of reproduction in technological, not ethical, terms
(Leonard 2003, 10). Birth is divided into steps, and many doctors walk into labor and
27
delivery rooms with preconceived notions of how birth will progress, ignoring the fact
that women’s bodies are unique and will not necessarily fit into the timeline they are
expecting. In their historical narration of obstetrical practices, Midwifery Today writes:
Dr. Joseph DeLee, author of the most frequently used obstetric textbook of
the time, argued that childbirth is a pathologic process from which few
escape “damage.” He proposed a program of active control over labor and
delivery, attempting to prevent problems through a routine of
interventions. DeLee proposed a sequence of medical interventions
designed to save women from the “evils” that are “natural to labor.”
Specialist obstetricians should sedate women at the onset of labor, allow
the cervix to dilate, give ether during the second stage of labor, cut an
episiotomy, deliver the baby with forceps, extract the placenta, give
medications for the uterus to contract and repair the episiotomy. His article
was published in the first issue of the American Journal of Obstetrics and
Gynecology. All of the interventions that DeLee prescribed did become
routine. (Midwifery Today 2000)
For obstetricians, who are trained to detect and treat pathology, medical intervention is a
necessity and birth is considered safe only in retrospect (Gaskin 2003, 185; Gaskin 2003,
307). Doctors are the ones who are ultimately responsible for the health of their patients
so they often use routine intervention as preventative medicine or apply interventions that
should be reserved for complicated pregnancies to all laboring women. The problem
with such premature measures, however, is that they are often used unnecessarily. This
has side-effects for both the patients, whose health may be compromised and who are
robbed of the birth they may desire, and the doctors, who may initiate a cascade of
complications that may have otherwise not happened.
The fear of malpractice suits is a strong indicator for why many doctors are so
quick to opt for cesarean sections with the slightest change in fetal condition (Andersen
1997, 215). Intervention allows them somewhat control over what happens and at what
28
time. Furthermore, many men already believe that women are weak by nature and that
pregnancy is an illness which must be cured with drugs and medical equipment (Gaskin
2003, 185). They are therefore more likely to make use of these medical technologies
and techniques, such as prenatal screenings, pain management, and episiotomies – even
in normal pregnancies.
There are many types of prenatal screenings available – ultrasound, serum alphafetoprotein, group-Beta strep, etcetera – but the most notable are amniocentesis and
chorionic villi sampling (CVS). Amniocentesis is a comprehensive screening that looks
for the presence of chromosomal and neural-tube abnormalities, among other things
(Gaskin 2003, 194). Similarly, CVS checks for chromosomal abnormalities but can be
ordered weeks before amniocentesis. For fairly invasive procedures that both have the
potential to cause miscarriages, there are a considerable amount of (middle to upper
class) women who opt for them. Point blank, the reason why most women do this is to
determine if the fetus should be aborted due to abnormalities and/or defects. The catch is
that, by the time the results come in, the women have already begun to feel fetal
movement, which may or may not result in bonding (Leonard 2003, 103). If the results
come back positive, there may be a tumultuous array of contradictory emotions as the
woman decides whether or not to continue the pregnancy (Gaskin 2002, 414).
Amniocentesis does not cure anything – it just gives you a heads-up of the bumps along
the road. As Leonard writes, “given the social context, most women will probably
welcome any and all technological intervention aimed at avoiding disability, but we
cannot pretend that this is simply a matter of personal choice” (Leonard 2003, 184).
29
Like ultrasound imaging, amniocentesis and CVS technologies can also be used
as political tools of social control in the way that “the social pressure to control the terms
of birth and to insure a ‘quality product’ implies a devaluation of those who do not meet
certain specifications” (Leonard 2003, 103). So as not to repeat any incidence like the
one which occurred in 1982 – when a baby boy was born with Down’s syndrome and a
blocked esophagus and his parents refused surgery, letting him starve to death six days
later – federal statutes mandate that treatment must be provided for any baby with
positive results for abnormalities, except for in extreme conditions where it would be
inhumane to keep them in this world (Leonard 2003, 103). This ties right into antiabortion laws because a woman may be forced to maintain a pregnancy that she knows
would result in a child that may be better off dead. The Courts make their decisions
considering only their own ethical sensibilities, while the women are the ones who have
to deal with whatever may come from not aborting. Whatever the decision, it is the
woman’s to make; but there is indication that women’s bodies are not their own to
control. The use of amniocentesis and CVS are only the tip of the iceberg when it comes
to alienation.
The development of pain management during labor is a paradoxical story at best.
Pain management may be offered to nearly every laboring woman now, but it actually got
its start in the nineteenth century as a social marker between the middle- and upperclasses (white, whose “civilized nature” necessitated a cure from pain) and the working
class (black and brown, whose presumably “primitive” nature prevented them from even
experiencing pain) (Andersen 1997, 211-213). If the presence of pain was a marker of
30
femininity and of higher social standing, seeking to reduce that pain contradicts the very
idea because by doing so, one would actually become more like the primitive state. It is
not very logical – but then again, racism never has made much sense. Yet again,
reproductive technology has been used to support political motives – in this case, racism.
Relief from the pain of childbirth is undeniably alluring and, instead of bearing through
the pain in the name of white supremacy, middle- and upper-class women embraced male
doctors’ promises of safer and less painful births (Andersen 1997, 212-213).
Consequently, labor pain became seen as unacceptable and unnecessary, and analgesia
and anesthesia became encouraged (Gaskin 2003, 185).
While getting rid of pain certainly had its benefits, such as in decreased fear, it
also had its drawbacks. For instance, epidurals numb the body from the waist down but
they also make it difficult – if not impossible – to feel contractions, which then leads to
ineffective pushing, followed with delivery by either forceps or cesarean section (Martin
1992, 74). It’s a ripple effect; a series of consequences with each one more serious than
the previous, initiated by a single action. Not being able to feel the contractions also
leaves many women with feelings of fragmentation between their selves and their bodies
(Martin 1992, 84). Notice I say the contractions in addition to making a distinction
between the self and the body. When we speak of processes of labor such as
contractions, we speak of them in passive terms as if they are something happening to
women, not something they are actively involved in. This passive language implies that
women are not in ownership of their bodily processes, marking a distinction between who
they are and their bodies.
31
This feeling of alienation and complete loss of control is even stronger for women
who undergo cesareans, who are being cut open like a piece of meat and handled by
many different people who they have probably never even met (Martin 1992, 82). It
makes for a very impersonal experience and also makes bonding between mother and
baby more difficult since the normal process of birth and oxytocin release is disrupted.
And ironically, anesthesia and cesareans (when chosen) are often done to bypass the pain
associated with vaginal childbirth, yet approximately twenty percent of women end up
with permanent lower back pain following epidurals and women who undergo cesareans
are usually in so much pain post-surgery that caring for their newborns is excruciating
(Gaskin 2003, 165). These women do not realize they may only be trading one pain for
another.
Episiotomies, the surgical cuts to enlarge the vaginal opening, are also routine
procedures in hospital-mediated births. Like anesthesia and cesareans, episiotomy
techniques have both upsides and downsides. Sometimes they are done because of a lack
of confidence in the vaginal tissue’s unique ability to expand, despite the fact that the
perineum remains fully intact for nearly sixty-nine percent of natural births (Gaskin 2002,
468). Other times they are done to prevent complications, such as the tearing of pelvic
floor muscles (Gaskin 2003, 165). When the baby’s head is crowning, the vaginal and
perineal skin get extremely tight and can tear from all the pressure. There are four
degrees of vaginal tears: first degree tears involve only the skin surrounding the vaginal
opening and perineum and usually heal without stitches; second degree tears include the
skin as well as perineal muscles, which support the uterus, bladder, and rectum, and do
32
require stitches; third degree tears involve the skin, perineal muscles, and anal sphincter,
and sometimes necessitate surgical repair; fourth degree tears go all the way down to the
rectal lining and require corrective surgery (Debbie Marin).
Women who are forced to have episiotomies, too, can be left with feelings of
fragmentation and alienation, produced from an overreliance on technological
intervention to manipulate their bodies. Oftentimes, women tear or require episiotomies
because of the awkward and restrictive birthing positions imposed by hospitals. Picture
the standard position for delivery: the woman lies on her back, slightly reclined, her legs
are parted, both of her feet are elevated and placed into stirrups, and she is hooked up to
at least three different instruments (one which monitors fetal heartrate, one which
monitors maternal heartrate and contraction strength, and an intravenous drip). That is
uncomfortable for anyone, let alone a woman who is in labor. Although it is
uncomfortable, women are expected to remain in this position and transition through the
stages of birth with ease. This restrictive positioning is clearly a case of technology being
used to assert control over women.
Emily Martin invokes comical but true imagery of the power relationships in birth
technology when it is the dominant party in the hot seat:
If your husband was told that he had to get an erection and ejaculate
within a certain time or he'd be castrated, do you think it would be easy?
To make it easier, perhaps he could have an I.V. put into his arm, be kept
in one position, have straps placed around his penis, and be told not to
move: He could be checked every few minutes; the sheet could be lifted to
see if any “progress” had been made. (Martin 1992, 58)
Although this scenario is funny to imagine, its resemblance to what women go through in
hospital-mediated births is striking. Such limiting positions are not for the sake of
33
women, either. Labor can drag on for hours and hours, which gets pretty uncomfortable
for whoever is attending the birth. Imagine sitting with a laboring woman for great
lengths of time, hunched over to see what is going on down there. Obviously, the
position women are forced into in hospitals was actually put into practice benefit doctors,
because with the women spread out on a table, they could then sit comfortably and still
have a perfect view.
Considering all of this, it would appear that the answer to the initial questions is,
‘No’. Women are not informed of what will serve or harm them, nor can they choose
which technologies are used. Whether it is prenatal screenings, sonography imaging,
etcetera, it is clear that “women are being subjected to increasingly intense forms of
coercion, a fact that is signaled by the intensifying lack of freedom felt by women to
refuse to use the technology if they are pregnant and the technology is available”
(Morgan 1991, 273). According to Ruth Hubbard,
For, as long as childbearing is privatized as women’s individual
responsibility and as long as bearing a disabled child is viewed as a
personal failure for which parents (and especially mothers) feel shame and
guilt, pregnant women are virtually forced to hail medical “advances” that
promise to lessen the social and financial burdens of bearing a disabled
child (however rare and unlikely it may be that any particular one of us
may do so). (Leonard 2003, 184)
Many women feel as though they are morally obligated to say “yes” to whatever the
doctor orders and that they are bad mothers if they do not comply. And no, many women
may not even be aware they have a choice in the matter at all. For a woman, the hospital
is essentially a man’s world; they are complicit with technological imperatives many
times because they are unaware of the power to say “no.” This is not surprising
34
considering the years upon years of manipulation and exploitation done by male hands.
Women have been denied the ability of rational thought, worked on like machines,
accused of innate harm, treated as if they are less important than the fetus which grows
inside, and barraged with interventions left and right.
This is not to say that all males in the techno-medical model of care are foes or
that all females in it are allies—it is the patriarchal structure that operates on using
technology to control reproductive bodies that must be challenged. This is to say that it is
important that we become advocates for our own health by asking questions and
becoming informed of what technologies, if any, will best suit our needs, and being
assertive when we are challenged. Perhaps, if more of us go back to our roots and bring
midwifery back to the forefront of childbirth and maternity care, our absence could
initiate a change that would better serve our needs and desires. This, however, does not
guarantee that similar methods of control will not be present in birth centers or at home
births. Simply removing childbirth from hospitals does nothing to vanquish the system of
patriarchy within Western medicine. What is needed from physicians and midwives alike
are, according to Jana Sawicki, “efforts to ensure that women are not treated solely as
bodies, but also as subjects with desires, fears, special needs, and so forth” (Sawicki
1999, 199). She calls attention to the fact that “attending subjectivity…is necessary if
individuals are to have more control over how their medical needs are satisfied” (Sawicki
1999, 199). To ensure that we are our own agents we need to be proactive and build
bridges across race, class, and religion, among other differences, and form connections
not just between mothers or even between just women, but between women and men.
35
Chapter Two: Contemporary Issues
Chances are, when a pregnant woman walks into a medical establishment, the
person who will take her vital signs will be a female, whereas the person who will offer
care will be a male. In fact, seventy-eight percent of the time the person she will see will
be a man (Andersen 1997, 216). The overrepresentation of males in medical
establishments is part of a long history of monopolization and of the purposeful removal
of childbirth from midwives’ capable hands. With advancements in women’s rights, it is
a wonder that this asymmetry persists and that women continue to serve in subordinate
positions such as nurses. The answer lies in the complex conditioning of women within
the field of medicine, where “women’s occupations were taken to be rooted in and a
necessary consequence of their reproductive functions, whereas men’s jobs were
unrestricted” (Jordanova 1999, 162). Although midwifery is once again growing in
popularity, midwives continue to face many challenges, both in choosing their
appropriate paths and maintaining agency once they are on that path. The power to
control women’s bodies still lies primarily in the hands of males, but there is always the
potential for change so long as people continue to organize on issues of reproduction and
insist on women’s rights to control their own bodies (Andersen 1997, 220).
36
A Brief History of the Establishment of Nursing as a Profession
The nineteenth century struggle between male physicians and female lay healers,
or midwives, over who should control childbirth had caused much damage to the
midwifery community. For many women, the doors to practicing medicine were all but
closed by virtue of their sex and, if they wanted to enter the health care system, nursing
as a secondary status was all that was left (Andersen 1997, 213). Before it was a career,
‘nursing’ just meant to take care of someone, but in later years it became a definable
position. Nursing became an acceptable position for women during the years of the Civil
War and, as the numbers of hospitals increased, and thus numbers of male medical
students and doctors increased, so did nurses (Ehrenreich and English 2010, 89).
In the latter years of the nineteenth century nursing really began to professionalize
and by 1900 there were 432 schools producing roughly 3,460 graduates (Schwartz
Cowan 1983, 76). This was also the time period in which nursing was being transformed
from something of a distasteful occupation to something that represented a good and
sound moral character. Florence Nightingale, hailed as the Founder of Modern Nursing
by some, was instrumental in the shifting perception of nurses and doctors’ reliance on
them. Because of her, nursing became a workplace extension of women’s domestic roles
as mother and wife:
To the doctor, she brought the wifely virtue of absolute obedience. To the
patient, she brought the selfless devotion of a mother. To the lower level
hospital employees, she brought the firm but kindly discipline of a
household manager accustomed to dealing with servants. (Ehrenreich and
English 2010, 91)
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Nightingale, who was praised for her unwavering obedience to doctors’ orders, became
the role model for all nurses and had become so endearing to physicians that nurses
became necessary sidekicks in establishments of medicine (Ehrenreich and English 2010,
94-95). Women had found their place in medicine—it just happened to be in the doctors’
shadows.
Nightingale not only changed the course of nursing; her work changed the role of
the physicians as well. With a loyal nurse now at the doctor’s side, the doctor had time to
take in more patients and spend less time with each one. As Ehrenreich and English
write,
He diagnosed, he prescribed, he moved on. He could not waste his talents,
or his expensive academic training in the tedious detail of bedside care.
For this he needed a patient, obedient helper, someone who was not above
the most menial tasks, in short a nurse. (Ehrenreich and English 2010, 96)
Caring, therefore, became situated as a task reserved only for nurses and curing, by
contrast, an exclusive task for doctors. Ehrenreich and English point out that true healing
“consists of both curing and caring, doctoring and nursing. […] But with the
development of scientific medicine, and the modern medical profession, the two
functions were split irrevocably (Ehrenreich and English 2010, 96).
In today’s day and age, there are certainly more opportunities for females in
medicine, which will lead many uninformed males and females to claim that sexism is no
longer an issue. They may even assert that more males are physicians because they are
natural leaders or because they perform better under stress, or that more females are
nurses because of an instinctual desire to nurture the sick. Not only are these
assumptions belittling to nurses, but they are wrong. As history shows, more males are
38
doctors and more females are nurses not because of any biologically-driven qualification
but because of a history that excluded females from practicing in the big-boy
establishment of medicine.
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Constrained Choices for Midwifery
With regulatory licensing laws and statutes that vary state-by-state, many wouldbe midwives find themselves in a bind in choosing which path they want to go. As of
2016, Certified Nurse Midwives are legally authorized to practice in all fifty states and in
all settings (hospitals, private practices, free-standing birth centers, health centers, and
within homes), whereas Certified Professional Midwives and Certified Midwives are
restricted solely to practicing in birth centers or within homes and are legal in only
twenty-eight states and three states, respectively (Midwives Alliance North America
2016). Because of hospital and doctor policies and sometimes HMOs, Certified Nurse
Midwives may not be able to provide the continuous hands-on care that is associated with
the midwifery model of care (Citizens for Midwifery 2016). They also have to play by
hospitals’ rules and, while they can act as an advocate for the birthing woman, they
ultimately have to follow procedure. Certified Professional Midwives and Certified
Midwives, on the other hand, have fewer clients and have the time and freedom to offer
continuous care. They also are far more holistic in their approach and use alternative
medicine such as aromatherapy, massage, and homeopathy in lieu of drugs.
Ehrenreich and English hit the nail on the head when they wrote that a
“recognized profession is not just a group of self-proclaimed experts; it is a group which
has authority in the law to select its own members and regulate their practice, i.e., to
monopolize a certain field without outside interference” (Ehrenreich and English 2010,
79). By recognizing Certified Nurse Midwifery as the only type of professional
midwifery nationwide, a larger proportion of pregnant females are by necessity going to
40
go to hospitals instead of birth centers to give birth. It’s all about snuffing out
competition. For the sake of job security alone, the safest option is to become a Certified
Nurse Midwife (CNM). This is problematic because CNMs operate in a completely
different manner than the other two types and typically work in hospitals. They are
therefore required to submit to the techno-authority of the institutionalized medicine in
which they may have been trying to avoid.
CNMs are first and foremost nurses, who complete a bachelor’s degree in nursing
as well as additional postgraduate training that specializes in midwifery care and is
accredited by the American College of Nurse-Midwives. Despite their extensive
knowledge of maternity care and childbirth, which rivals doctors’ ‘expert’ knowledge,
they face additional injustices because of their title as ‘nurse’ such as sexist insults and
demeaning jokes (Andersen 1997, 218). Even though they may also have a PhD, they are
still subordinate to doctors, who have the ultimate authority and say-so when it comes to
the care of the patients. Being subordinate and demoted is not the only issue, however.
Hospitals are run according to the techno-medical model of care which routinely use
monitoring devices, interventions, and impersonal care. Many potential midwives are
drawn to midwifery and not obstetrics because of the fact that it is traditionally exactly
opposite of what one expects in a hospital. It is a very personal experience, a relationship
based on mutual love and trust between both the family and the midwife, and midwives
go out of their way for intervention-free births that cater to the desires and wishes of the
woman’s ideal birth. By settling with a career as a Certified Nurse Midwife, these
women may be sacrificing their own happiness for financial stability.
41
Direct Entry Midwives encompass both Certified Professional Midwives (CPMs)
and Certified Midwives (CMs), and are by far fewer in numbers than CNMs for
aforementioned reasons. These types of midwives work in birth centers or attend home
births and are not allowed to practice as midwives in family practitioners’ offices or
hospitals for licensing reasons (Gaskin 2003, 306). CPMs complete a two- to three-year
training program and receive national certification through the North American Registry
of Midwives (NARM) as well as licensure if the state she practices in requires one of her
(Midwives Alliance North American 2016). Their education is no less rigorous than that
of a CNM—it just does not entail the fancy extras that are part of a formal education in
areas such as math, art, or environmental science. If anything, because CPM coursework
focuses solely on the subjects relevant to gestation and parturition, they are more adept at
handling pregnant women. CMs also complete in-depth training but receive certification
through the ACNM Certification Council (ACC), which is not nationally accredited
(Gaskin 2003, 306).
CPMs and CMs are marked by much of the stigmatization from earlier years,
callously regarded as counterfeit professional midwives or counterfeit midwives simply
because they lack a formal education. Kudos to them for branching out and not letting
the medical establishment completely run their practice, but they are not nearly as free as
one might think. The legislation of medical care is a tangled web of “ifs” and “buts” and,
although these two types of midwives operate in stand-alone practices, they are legally
required to be given the green light from an obstetrician before births so he can verify
that patients are ‘healthy enough’ to give birth outside of a hospital (Gaskin 2003, 306). I
42
experienced firsthand how incredibly ludicrous this requirement is during an internship at
a prominent birth center in South Florida. Around the time women were thirty-six weeks
pregnant, they were scheduled an appointment with an obstetrician in partnership with
the birth center for an examination and ‘release’ to the midwives.
First, a release made no sense because the pregnant women had never been in
‘custody’ of any doctor in the first place, or so it had seemed. Secondly, it is not logical
that this doctor could give any legitimate conclusion on any of these women’s health
because he simply did not have the time or the resources to make an educated decision.
In every case, this appointment was the first and only interaction between the woman and
the doctor and he only reviewed each woman’s file for thirty seconds or so. It was the
midwives who were taking care of the pregnant women and reviewing lab results with
acute attention to detail, asking questions and following up on even the most menial of
symptoms. His approval was warranted for no other reason than he was the one with the
recognized profession – he was the one with subjectivity, the one with the authority to
call the shots.
Equally as important was that as soon as women walked into the room with him,
they were suddenly a ‘patient’ and treated as such: for the first time in thirty-something
weeks, listening to their babies’ heart rates and measuring their belly size required sterile
gloves to protect the doctor’s hands from their potentially parasitic skin; the women were
no longer experts in reading signs of their own bodies, for this man had summed up their
states of being within ten minutes; they were scrutinized and accused of irresponsible
motherhood when the doctor did not like the answers they had given. This experience
43
caused intense discomfort and anger, especially so when I learned that he was one of the
better obstetricians who partnered with birth centers. What does this say of the way
childbirth is run? As is apparent by interactions like these and the belittling of midwives’
abilities, “women’s health care is intricately interwoven with the power of men in
medicine and with the profit structure of modern medicine” (Andersen 1997, 216).
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Concluding Remarks: Regaining Control of Women’s Own Bodies
The first step in regaining control is education, which need not be in a classroom,
or even in any book for that matter. By asking questions and informing oneself, one can
begin to critically analyze the conditions surrounding women’s health. Because of this,
women have begun to advocate for the use of more birth centers and midwives and
disseminate what they have learned to others with the goal of enhancing women’s control
over their own bodies (Andersen 1997, 215). Even still, pregnancy is linked to the
essence of being female, and the “process of childbirth still remains one of the
fundamental ways in which women’s reproductive abilities are subordinated to the
definitions, practices, and controls of men” (Andersen 1997, 215). As Price and
Shildrick pointed out, it is imperative that feminists “rethink the traditional claims of
medical practice to cure and care. But the point is not only to make clear that notion of
control, but to uncover its part in the constitution of the body: ‘the discursive power of
biomedicine does not simply direct choice among alternative models of the body…it
actively and continuously constructs the body’” (Price and Shildrick 1999, 8-9).
As long as women’s reproductive abilities define their bodies and as long as that
definition is used to justify others’ control over women’s bodies, regaining control seems
moot. There is opportunity for activism in the simplest of actions, however. The
midwifery model of care offers much hope, for it “recognizes the oneness of mind and
body and the power of woman in the creation of new life” (Gaskin 2003, 184). It is this
model that works with the processes of birth rather than trying to alter them, which is a
necessary step in the path towards regaining control.
45
BIBLIOGRAPHY
Alcoff, Linda Martín, Jacqueline Nassy Brown, Sarah Chinn, Florence L. Denmark,
Dorothy L. Helly, Shirley Hune, Rupal Oza, Sarah B. Pomeroy, and Carolyn M.
Somerville. 2014. Women’s Realties, Women’s Choices: An Introduction to
Women’s and Gender Studies. New York: Oxford University Press.
Andersen, Margaret L. 1997. Thinking About Women: Sociological Perspectives on Sex
and Gender. Needham Heights, MA: Allyn & Bacon.
Balsamo, Anne. 1997. Technologies of the Gendered Body: Reading Cyborg Women.
NC: Duke University Press.
The Business of Being Born. Directed by Abby Epstein. New York City, NY: New Line
Film Productions, Inc, 2008.
Citizens for Midwifery. 2016. “Frequently Asked Questions about Midwives and
Midwifery.” Accessed April 26. http://cfmidwifery.org/midwifery/faq.aspx#7
Ehrenreich, Barbara, and Deirdre English. 2010. Witches, Midwives, & Nurses: A History
of Women Healers. New York, NY: Feminist Press at the City University of New
York.
Foucault, Michel. 1994. The Birth of the Clinic: An Archaeology of Medical Perception.
NY: Vintage Books.
Gaskin, Ina May. 2003. Ina May’s Guide to Childbirth. New York, NY: Bantam Dell.
Gaskin, Ina May. 2002. Spiritual Midwifery. Summertown, TN: Book Publishing
Company.
Hartouni, Valerie. 1997. Cultural Conceptions: On Reproductive Technologies and the
Remaking of Life. Minneapolis, MN: University of Minnesota Press.
Jordanova, Ludmilla. 1999. “Natural Facts: A Historical Perspective on Science and
Sexuality.” In Feminist Theory and the Body: A Reader, edited by Janet Price and
Margrit Shildrick, 157-168. NY: Routledge.
Leonard, Eileen B. 2003 Women, Technology, and the Myth of Progress. NJ: Pearson
Education, Inc.
Marin, Debbie. Interview by Chelsea Hube. Personal Interview. Hollywood Birth Center,
May 25, 2015.
46
Martin, Emily. 1992. The Woman in the Body: A Cultural Analysis of Reproduction.
Boston, MA: Beacon Press.
Martin, Emily. 1999. “The Egg and the Sperm: How Science Has Constructed a Romance
Based on Stereotypical Male-Female Roles.” In Feminist Theory and the Body: A
Reader, edited by Janet Price and Margrit Shildrick, 179-189. NY: Routledge.
Midwifery Today. 2000. “The History of Midwifery and Childbirth in America: A Time
Line.” Accessed Nov 4. http://www.midwiferytoday.com/articles/timeline.asp
Midwives Alliance North America. 2016. “Legal Status of U.S. Midwives.” Accessed
April 9. http://mana.org/about-midwives/legal-status-of-us-midwives
Morgan, Kathryn Pauly. 1991. “Cosmetic surgery and the Colonization of Women’s
Bodies.” In Sex/Machine: Readings in Culture, Gender, and Technology, edited
by Patrick D. Hopkins, 261–285. Indiana: Indiana University Press.
Nash, Roderick Frazier. 2014. Wilderness and the American Mind. New Haven and
London: Yale University Press.
Oblepias-Ramos, Lilia. 1991. “Does Technology Work For Women Too?” In
Sex/Machine: Readings in Culture, Gender, and Technology, edited by Patrick D.
Hopkins, 89–94. Indiana: Indiana University Press.
Price, Janet and Margrit Shildrick. 1999. Feminist Theory and the Body: A Reader. NY:
Routledge.
Sawicki, Jana. 1999. “Disciplining Mothers: Feminism and the New Reproductive
Technologies.” In Feminist Theory and the Body: A Reader, edited by Janet Price
and Margrit Shildrick, 190-202. NY: Routledge.
Schwartz Cowan, Ruth. 1983. More Work for Mother: The Ironies of Household
Technology from the Open Hearth to the Microwave. NY: Basic Books, Inc.
Stanley, Autumn. 1983. “Women Hold Up Two-Thirds of the Sky: Notes for a Revised
History of Technology.” In Sex/Machine: Readings in Culture, Gender, and
Technology, edited by Patrick D. Hopkins, 17-32. Indiana: Indiana University
Press.
Weed, Susan S. 1986. Wise Woman Herbal for the Childbearing Year. Woodstock, NY:
Ash Tree Publishing.
47