“Critical discourse analysis (CDA) is a type of discourse analytical research that primarily studies the was social power abuse, dominance and inequality are enacted, reproduced and resisted by text and talk in the social and political context.”
-Teun A. Van Dijk
In Andrew Goldman’s March 22nd article, “Extreme Birth,” he asks whether Cara Muhlhahn, the midwife in Ricki Lake’s documentary The Business of Being Born, and the burgeoning homebirth movement in America are part of an unsafe trend in American birthing women. Goldman’s article uses a brief profile of Muhlhahn, a homebirth midwife practicing in New York City, as a case against homebirthing in the U.S. The subtle dismissal of homebirthing as a plausible alternative for women in the U.S. who desire to birth naturally is perpetuating an inaccurate portrayal of natural childbirth at a time when birthing women in America need choices.
As of 2004, the American cesarean section rate was over 30%. The WHO recommends that for a healthy population, which the US qualifies as, the national average should not exceed 5-10%. If the average exceeds this, the population that makes up the difference is actually being put at greater risk. Although only 5% of women who choose a homebirth end up with cesarean sections, the American College of Obstetrics and Gynecology still holds firm on its anti-homebirth stance saying, “childbirth decisions should not be dictated or influenced by what’s fashionable, trendy, or the latest cause célèbre,” indirectly referencing Ricki Lake’s influence on women’s birth choices.
Why is the U.S. cesarean rate so high and still climbing? Some feminist childbirth advocates have argued that doctors perform cesarean sections as a ploy to make more money, pointing to the evidence that higher cesarean rates occur depending on the type and level of insurance the mother has as well as the time of day or week, with more cesarean sections performed at night and on the weekends. Other theorists suggest that these cesarean sections are due more to the desire to rush the process with the use of pitocin, an artificial labor stimulator, or the rupturing of the amniotic sack, also to speed up labor. Both of things can begin what is known as the Cascade Effect, where what seems like a minor intervention snowballs into a series of greater and greater interventions that disrupt the natural process and lead to a greater chance of a cesarean. The Cascade Effect can be seen in how the introduction of Electronic Fetal Monitoring (EFM), a non-invasive and minor medical practice that monitors the baby's health in labor, in the 1970s coincides with the rise in cesarean rates. This also happened to coincide with the boom in malpractice litigations. High rates of cesarean sections can possibly be attributed to the fear of malpractice suits since obstetricians face the highest number of suits against them with over 70% having had suits filed against them at some point in their careers. Regardless of the cause, cesarean sections and overly-medicalized births have been shown to lead to feelings of helplessness and hurt in the new mother, and in the U.S., women’s highest reported emotion is overwhelmed and powerful is the least reported.
What is the source of this system of thought that continues to be reproduced like in Goldman’s article? Medical anthropologist Robbie Davis-Floyd examines the underlying ideologies that have created a medical system in which pregnancy is viewed as a pathology. She refers to the current medical system as based on a "technocratic model" that views the body as a machine. Descartes, Bacon and others in the 1600s created the paradigm that affects so much of Western culture; they "established the philosophical separation of mind and body upon which the metaphor of body-as-machine rest.” Along with this metaphor she points out the power inequality that exists in Western society and permeates the medical system, saying "modern biomedicine...forms a microcosm of American society that encapsulates its core value system" and is carried out in "bureaucratic institutions founded on principles of patriarchy and the supremacy of the institution over the individual." The patriarchal system views the male body as the prototype and therefore the female body is "inherently defective and dangerously under the influence of nature, which due to its unpredictability, was itself regarded as in need of constant manipulation by man."
The reproduction of this ideology in praxis can be increasingly seen in anthropologist Claire Wendland’s "Vanishing Mother" hypothesis, where she argues that “technology becomes both safe space for and locus of knowledge about the fetus, as the mother is rendered transparent, invisible; she vanishes from view.” With the technocratic model, allowing nature to take course within labor creates a situation in which the obstetrician lacks control, leading them to view vaginal birth as unpredictable and dangerous. This view is then projected on to the birthing woman who will come to distrust her own body and its processes.
Conversely, a positive birth experience has been proven to empower the new mother. The psychological benefits of a positive birth experience include increased self-confidence and self-esteem, lower incidence rates of post-partum depression and generalized depression and anxiety and an overall sense of personal empowerment. Physically, positive birth experiences lead to faster recovery rates and greater ease with breastfeeding and infant bonding.
Can homebirths provide this kind of experience? In the Netherlands, the Dutch have the same knowledge and access to healthcare and technology but operate under different medical and ideological systems. In the Netherlands, in the late 1990s, 40% of women chose home birth though their obstetrical practices are no less advanced. Evidence from the Dutch data indicates that there is no increased risk for low-risk expectant mothers in homebirths attended by midwives, and in fact, homebirths had a 33% lower neonatal mort. Rate and a 19% lower infant mortality rate. High-risk women delivering in hospitals influence these data, but the data still illustrate the safety of home births for low risk women.
So, why then is home birth vilified in U.S. medical systems and the popular media as evidenced by ACOG’s statement and Goldman’s article? Most anthropologists and social scientists agree that power inequality and cultural dominance are not perpetuated as a result of powerful men sitting in windowless rooms determining the systems in which we will operate and understand the world in which we live. Instead, these practices are part of a process that we reproduce unknowingly in a cycle that cannot be stopped without awareness of the cycle and subsequent social action. Some even doubt the ability to disrupt the cycle. Still, it is necessary to examine the ways we think the things we think and to discover if there are alternate ways of thinking. Homebirthing in America has a reputation as being unsafe and irresponsible, but that is not necessarily the case. The Netherlands model of childbirth shows us that hospital births need not be the norm, and this article illustrates reasons why we continue to think that hospital births need to be the norm. The important thing is for women to have choices, and homebirth for low-risk women should be one of them.
