Sunday, November 27, 2011

THE RITUALS OF AMERICAN HOSPITAL BIRTH



Excerpts from "The Rituals of American Hospital Birth" by by Robbie E. Davis-Floyd, Ph.D.

To read the full article, follow this link:
http://www.terrylarimore.com/BirthRites.html

"Routine obstetric procedures are highly symbolic. For example, to be seated in a wheelchair upon entering the hospital, as many laboring women are, is to receive through their bodies the symbolic message that they are disabled; to then be put to bed is to receive the symbolic message that they are sick. Although no one pronounces, "You are disabled; you are sick," such graphic demonstrations of disability and illness can be far more powerful than words. One woman told me:

I can remember just almost being in tears by the way they would wheel you in. I would come into the hospital, on top of this, breathing, you know, all in control. And they slap you in a wheelchair! It made me suddenly feel like maybe I wasn't in control any more.

The intravenous drips commonly attached to the hands or arms of birthing women make a powerful symbolic statement: they are umbilical cords to the hospital. The cord connecting her body to the fluid-filled bottle places the woman in the same relation to the hospital as the baby in her womb is to her. By making her dependent on the institution for her life, the IV conveys to her one of the most profound messages of her initiation experience: in American society, we are all dependent on institutions for our lives. The message is even more compelling in her case, for she is the real giver of life. Society and its institutions cannot exist unless women give birth, yet the birthing woman in the hospital is shown, not that she gives life, but rather that the institution does...

Ritual is marked by repetition and redundancy. For maximum effectiveness, a ritual concentrates on sending one basic set of messages, repeating it over and over again in different forms. Hospital birth takes places in a series of ritual procedures, many of which convey the same message in different forms. The open and exposing hospital gown, the ID bracelet, the intravenous fluid, the bed in which she is placed--all these convey to the laboring woman that she is dependent on the institution.

She is also reminded in myriad ways of the potential defectiveness of her birthing machine. These include periodic and sometimes continuous electronic monitoring of that machine, frequent manual examinations of her cervix to make sure that it is dilating on schedule, and, if it isn't, administration of the synthetic hormone pitocin to speed up labor so that birth can take place within the required 26 hours.(2) All three of these procedures convey the same messages over and over: time is important, you must produce on time, and you cannot do that without technological assistance because your machine is defective. In the technocracy, we supervalue time. It is only fitting that messages about time's importance should be repeatedly conveyed during the births of new social members...

Ritual is marked by repetition and redundancy. For maximum effectiveness, a ritual concentrates on sending one basic set of messages, repeating it over and over again in different forms. Hospital birth takes places in a series of ritual procedures, many of which convey the same message in different forms. The open and exposing hospital gown, the ID bracelet, the intravenous fluid, the bed in which she is placed--all these convey to the laboring woman that she is dependent on the institution.

She is also reminded in myriad ways of the potential defectiveness of her birthing machine. These include periodic and sometimes continuous electronic monitoring of that machine, frequent manual examinations of her cervix to make sure that it is dilating on schedule, and, if it isn't, administration of the synthetic hormone pitocin to speed up labor so that birth can take place within the required 26 hours.(2) All three of these procedures convey the same messages over and over: time is important, you must produce on time, and you cannot do that without technological assistance because your machine is defective. In the technocracy, we supervalue time. It is only fitting that messages about time's importance should be repeatedly conveyed during the births of new social members...

Hospital rituals such as electronic monitoring work to give the laboring woman a sense that society is using the best it has to offer--the full force of its technology--to inevitably ensure that she will have a safe birth.
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However, once those "cosmic gears" have been set into motion, there is often no stopping them. The very inevitability of hospital procedures makes them almost antithetical to the possibility of normal, natural birth. A "cascade of intervention" occurs when one obstetric procedure alters the natural birthing process, causing complications, and so inexorably "necessitates" the next procedure, and the next. Many of the women in my study experienced such a "cascade" when they received some form of pain relief, such as an epidural, which slowed their labor. Then pitocin was administered through the IV to speed up the labor, but pitocin very suddenly induced longer and stronger contractions. Unprepared for the additional pain, the woman asked for more pain relief, which ultimately necessitated more pitocin. Pitocin-induced contractions, together with the fact that the mother must lie flat on her back because of the electronic monitor belts strapped around her stomach, can cause the supply of blood and oxygen to the fetus to drop, affecting the fetal heart rate. In response to the "distress" registered on the fetal monitor, an emergency Caesarean is performed...

Consider the visual and kinesthetic images that the laboring woman experiences--herself in bed, in a hospital gown, staring up at an IV pole, bag, and cord, and down at a steel bed and a huge belt encircling her waist. Her entire sensory field conveys one overwhelm-ing message about our culture's deepest values and beliefs: technology is supreme, and the individual is utterly dependent upon it.

Internalizing the technocratic model, women come to accept the notion that the female body is inherently defective. This notion then shapes their perceptions of the labor experience, as exemplified by one woman's story:

It seemed as though my uterus had suddenly tired! When the nurses in attendance noted a contraction building on the recorder, they instructed me to begin pushing, not waiting for the urge to push, so that by the time the urge pervaded, I invariably had no strength remaining but was left gasping and dizzy....I felt suddenly depressed by the fact that labor, which had progressed so uneventfully up to this point, had now become unproductive.

Note that she does not say "The nurses had me pushing too soon," but "My uterus had tired," and labor had "become unproductive." These responses reflect her internalization of the technocratic tenet that when something goes wrong, it is her body's fault...

In spite of tremendous advances in equality for women, the United States is still a patriarchy. It is no cultural accident that 99% of American women give birth in hospitals, where only physicians, most of whom are male, have final authority over the performance of birth rituals--an authority that reinforces the cultural supervaluation of patriarchy for both mothers and their medical attendants.
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Nowhere is this reality more visible than in the lithotomy position. Despite years of effort on the part of childbirth activists, including many obstetricians, the majority of American women still give birth lying flat on their backs. This position is physiologically dysfunctional. It compresses major blood vessels, lowering the mother's circulation and thus the baby's oxygen supply. It increases the need for forceps because it both narrows the pelvic outlet and ensures that the baby, who must follow the curve of the birth canal, quite literally will be born heading upward, against gravity.
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This lithotomy position completes the process of symbolic inversion that has been in motion ever since the woman was put into that "upside-down" hospital gown. Her normal bodily patterns are turned, quite literally, upside-down--her legs are in the air, her vagina totally exposed. As the ultimate symbolic inversion, it is ritually appropriate that this position be reserved for the peak transformational moments of the initiation experience--the birth itself. The doctor--society's official representative--stands in control not at the mother's head nor at her side, but at her bottom, where the baby's head is beginning to emerge.
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Structurally speaking, this puts the woman's vagina where her head should be. Such total inversion is perfectly appropriate from a social perspective, as the technocratic model promises us that eventually we will be able to grow babies in machines--that is, have them with our cultural heads instead of our natural bottoms. In our culture, "up" is good and "down" is bad, so the babes born of science and technology must be delivered "up" toward the positively valued cultural world, instead of down toward the negatively valued natural world. Interactionally, the obstetrician is "up" and the birthing woman is "down," an inversion that speaks eloquently to her of her powerlessness and of the power of society at the supreme moment of her own individual transformation.

The episiotomy performed by the obstetrician just before birth also powerfully enacts the status quo in American society. This procedure, performed on over 90% of first-time mothers as they give birth, expresses the value and importance of one of our technocratic society's most fundamental markers--the straight line. Through episiotomies, physicians can deconstruct the vagina (stretchy, flexible, part-circular and part-formless, feminine, creative, sexual, non-linear), then reconstruct it in accordance with our cultural belief and value system. Doctors are taught (incorrectly) that straight cuts heal faster than the small jagged tears that sometimes occur during birth. They learn that straight cuts will prevent such tears, but in fact, episiotomies often cause severe tearing that would not otherwise occur. These teachings dramatize our Western belief in the superiority of culture over nature. Because it virtually does not exist in nature, the line is most useful in aiding us in our constant conceptual efforts to separate ourselves from nature.

Moreover, since surgery constitutes the ultimate form of manipulation of the human body-machine, it is the most highly valued form of medicine. Routinizing the episiotomy, and increasingly, the Caesarean section, has served both to legitimize and to raise the status of obstetrics as a profession, by ensuring that childbirth will be not a natural but a surgical procedure..."