Sunday, April 27, 2008

The Medicalization of Childbirth

Last week, I finished watching "The Business of Being Born". Ricki Lake did this documentary to highlight the differences in treatment she had with her two children. One was done at the hospital, and ended up as a Cesarean. One was at home, with a midwife, and it was videotaped.

Interspaced between this was some history of childbirth, particularly in the United States. Starting at around the turn of the century, births shifted from something that was at home, to something that was done at a hospital. This shift was not because medical science was particularly good at childbearing (or really, because it was even as midwifery) but because an interesting intersection that we all know and love: capitalism, sexism, and racism. Doctors at the time went on a massive advertising campaign, aimed at telling women that other women were not as good at delivering babies as they were. That these Russian, German, and other immigrant women just wanted your money, and you were a bad mother if you didn't go to the hospital to get a delivery done there. Interestingly enough; it was not actually safer to go to the hospital, if you were in labor. Midwifery had been around for awhile, women knew how to deliver babies. They, at the very least, knew that you washed your hands before you went to the next birth, something that doctors at the time considered immaterial. Midwifes also knew to listen to a pregnant women when she was in labor, as opposed to putting up a sheet and ignoring her. They also knew that squatting, or in water, was an easier and safer way to give birth then lying on one's back, where you have to not only have to work against your body, but gravity (but hey, with your legs like that, it was easier for the doctor).

It then went on to talk about "twilight sleep" or "zombie sleep". For those of you who are unfamiliar (and I certainly was before I saw this) twilight sleep was when a women came to the hospital, and then was injected with morphine and scopolamine. Now, supposedly this was to kill pain; but what it really did was put pregnant women into an alternate state of mind, so that they forgot the labor pains. They also forgot the labor. And how to control their own body. Women had to be tied down to the bed, (with sheepskin, so that they wouldn't leave big bruises or scratches). Watching the videos were again horrific: a women, tied to a bed, thrashing about, with a curtain at her midsection, and four white guys staring intently at her uterus. For something that is normally held as one of the most feminine of experiences, it was eerily impersonal.*

The movie then continued to show the difference between medical birth and midwifery. For one thing, the births done with a midwife seemed a whole lot less painful. The midwife was there the whole time, as opposed to a doctor who showed up at the last second. The position seemed more comfortable as well; if the woman wanted to get up and walk around, she was allowed to. If she wanted to squat, she squatted. With a midwife, they listened to what the women said she wanted. With the doctors, it seemed as if the doctor told her what she wanted.

Not to say that the movie was Luddite, at all. Every midwife there said that she was grateful that there was the knowledge of obstetricians out there, for the complicated births. But they all made mention that, 9 times out of 10, women did not need to go to the doctor. That first and foremost, those doctors are surgeons, and sometimes do unnecessary cesareans out of misplaced concern, or because of time constraints, that is not actually healthy for the mother or the new baby. They compared infant mortality in the United States with other countries in Europe where it was far more common to have a midwife, and lo and behold, the US has more infant deaths then Europe. However, they never proved a causal relationship; there are a variety of reasons why that might be.

Among the problems of medicalization they talked about, one was talking about how the introduction of medicine was playing weird problems with women's hormones. First, a women is given an epidural, for the pain. But an epidural numbs more than just pain, it also makes it more difficult to have contractions. So then, a women is given pitocin, which is a synthetic form of oxytocin (the birthing hormone). Pitocin has some major problems though: first, the contractions it causes are longer, and stronger (and therefore more painful). Also, it can constrict bloodflow to the uterus, so that the fetus has less oxygen flowing to it. So, to numb the pain, they give the women another epidural. And this starts the cycle again, until the fetus goes into distress (and the mother is also pretty distressed at this point as well). At this point, they rush the women to get a Cesarean, leaving a scar in the women, an increased risk of infection, and a now-distressed baby.

A few things struck me watching this film, in no particular order:

1) Why does any women ever (well, with Tom Beatty make that any person) ever get and stay pregnant long enough to give birth? Seriously, even with the midwife, water births, were it just seemed like a grunt and slip, and "ooo, baby" it still seemed painful, long, and full of viscera. This movie made me hug my orthotricyclin like no one's business.

2) This movie was far too crunchy for my tastes. I can see why childbirth is a unique experience for women, because it is generally just women that can do it. But seriously, I prefer the ideas they mention at the end a lot better: where hospitals have birthing centers, where midwifes work. You can have your birth in a water way, or at the very least squatting, but you are still at the hospital if you are that 1 in 10 case that needs emergency help.

3) What is it with some guys and their seemingly uncontrollable urges to take women's experiences and define them/ control them? First you have medical doctors saying that women don't actually know what's going on for pregnancy, and then you have guys making laws about when it's okay for us to have an abortion, and guys who think that birth control is emasculating, and guys who seem to think they know what happens during PMS better than women. It's really annoying; I don't assume to know what it's like to have blue balls, why should they assume they have any IDEA what it's like to go around in a feminine fleshy meatbag?

This movie is one that I think people should definitely watch** (if you have a netflix account, it's instantly downloadable, by the way). It shows a very interesting perception of childbirth, from women's point of view.

*Interestingly enough, the feminists at the time held up scopolamine as a liberation. The movie made mention that at the time, childbirth was still thought as something that should be as painful as possible, for the "curse of eve". The feminist at the time, saw this as an opportunity to not have to suffer through childbirth, and jumped on the opportunity to show that no, childbirth was painful because there wasn't the medicine to fix it, not because of any Biblical curse. Next time an anti-choicer shows up saying that early feminists were against abortion (which they should have been, because at the time an abortion had more of a chance of killing you than childbirth), point out that they also supported drugging women during childbirth. We are all a part of the time we grew up in, bound by some of those mindsets and technologies.

**If you're like me, you'll watch most of this movie through slits in your fingers. Seriously, think horror movie viscera, and then imagine in that in your most sensitive parts.


At 7:24 AM, Anonymous Anonymous said...

Home Birth Rocks!

At 2:34 AM, Blogger Jhon mac said...

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