Giving Birth to Children and Mothers

1. Giving Birth to Children and Mothers Transformations: Gender Reproduction and Contemporary Society Week 7

2. Structure of the Lecture • Homebirth – a debate • The Medicalisation of Childbirth • Women’s experiences of birth • Midwifes at Work • The future…

3. TheHomebirthDebate Homebirth vs. Hospital birth

4. The rise and rise of hospital births • 1920s: 80% of UK births at home • 1991: 1% of UK births at home • 2006: 2.6% of UK births at home • Cahill (2001): ‘The last four decades have witnessed a largely consistent and persuasive argument from the obstetric establishment that the hospital is the best and safest place to be born’. • Medicalisation of Childbirth

5. Feminist Critique of the Medicalisation of Childbirth • 17th century conceptualisation of the body as a machine in need of regulation • Boundaries around medicine • discredited midwives • New surgical instruments • Women denied access to 19th century forceps • medical training

6. Professionalisation and gendered exclusion Obstetrical examination 1822 engraving 3 midwives attending to a pregnant woman 1500s woodcut

7. Martin’s Medical Metaphors • ‘the womb and the uterus were spoken of “as though they formed a mechanical pump that in particular instances was more or less adequate to expel the foetus”’ (Martin, 1992, p. 54). • Birth as factory production: ‘the uterus is held to a reasonable “progress”, a certain “pace” and not allowed to stop and start with its natural rhythm’ (ibid, p. 59).

8. Regulating the ‘Machine’ • Discourse of time and motion • Emphasis on efficiency, predictability, productivity • e.g. Friedman Curve • Deviation = intervention

9. Women’s Experiences of Childbirth • ‘The main trauma for me was all the intervention: being induced, having my waters broken for me and being examined all the time… my labour didn’t progress well because I didn’t dilate enough. In the end they had to use both forceps and a ventouse suction cup to get Amelie out, which was frightening and stressing… Staff were too busy to explain what they were doing and why. I didn’t know what was happening or going to happen, and I didn’t like that lack of control’ • (Guardian, 15 November 2010)

10. ‘I really felt a lot of control all the way through, and I think one of my biggest fears about hospitals was not being in control… I felt like I was making the decisions’. • (Fox and Worts, 1999, p. 335) • I had a highly medicated birth--pitocin to induce contractions because my water was leaking, then Stadol for the pain… and then (hooray!) the epidural. And episiotomy. Lots of medical intervention. And it was actually a pretty great experience because the people around me were sensitive to my needs and desires and cared for me in the way that I personally needed. My nurse was fantastic--very nurturing and reassuring. At all times I felt like I had control of the situation… • http://mommyphd.blogspot.com/2006/10/positive-birth-experience-can-happen.html

11. Control and decision-making • Fox and Worts: Control and autonomy are crucial to women having a positive experience of birth – even with intervention • How might technology empower birthing women? • How might it disempower them?

12. Resisting Medicalisation of Birth • Similar to strategies used by workers • Covert resistance • ‘Go-slow’ • Remove equipment • Stay on the move • Experiences differentiated by ‘race’ and class

13. Woman-centred vs. Institution centred Midwifery • Conflict between teaching and practise of midwifery • ‘With woman’ vs ‘With Institution’ • Authoritative knowledge about childbirth is with the system of production and not with the women

14. ‘I’m aware when I’m measuring a woman’s fundus, I’m not free…I want it to measure what it’s supposed to measure on the chart erm, I don’t want to have to send her in because it’s a little bit bigger or it’s a little bit small. I want to protect her, I want to protect her from feeling worried. I mean it’s ridiculous, I mean you can know if a baby’s too big or too small, just by looking at a woman when she’s lying down and you know how many weeks she is, you know if she’s too big or too small, usually, you know’. (Mia, midwife, interview 30.06.2005)

15. Childbirth and Midwifery Policies • 1993 Department of Health report Changing Childbirth • 1997 Audit Commission report First Class Delivery: Making it Better for Mothers and Babies • 2007 Department of Health guidance Maternity matters: choice, access and continuity of care in a safe service • 2008 Healthcare Commission report Towards Better Births: A review of maternity services in England • £330 million extra funding over 3 years from 2008

16. Is there a Crisis in Midwifery? • Midwives leaving the profession • Exodus related to inability to provide continuity of care leading to poor job satisfaction • Walters: midwives are ‘popping in and out of three or four labour rooms and filling out endless forms while women yell for them’ (Guardian, 2003). • Recruitment has increased but birth-rate has also increased • Royal College of Midwives: 66% of midwifery heads report insufficient staff (November 2009) • 12% of midwifery posts unfilled in south-east • Rise of doulas

17. Campaigns for continuity of care • Independent Midwives Association www.independentmidwives.org.uk • Community Midwifery Model • Association of Radical Midwives (ARM) • www.radmid.demon.co.uk • Taking midwifery ‘back to the roots’ • Re-skilling midwives • ukmidwifery yahoo group • Association for Improvements in Maternity Services (AIMS) www.aims.org.uk • Pressure group • Offers advice to women

18. The Future…who knows? • The death of midwifery? • The implementation of one-to-one midwifery care across the country? • The embrace of technology as a welcome part of normal birth? • The further development of the ‘conveyor belt’ birthing unit to cut costs? • The empowerment of all women in birth…but by what means?