I'm young. Well, 29, but I've seen the complete insistence by some that doctors are always, absolutely right. That science is always good. That to not trust is "quackery". I wonder how they never learned of the scandals of the past. Times when women were sterilized by doctors based on race or mental abilities. When some doctors infected groups of Afro-Americans with deadly diseases to study the results.

Power over another can bring great harm, especially when steeped in our patriarchal society. Who has more power in many cases than a medical doctor? The more we tell women to be quiet and trust, the more power we give them.

Great post, Jill - I like your thoughts on middle ground.

I've also been frustrated that the "official" women's movement doesn't champion the cause of maternity care and women's autonomy to make decisions about birth. These influential organizations support women's reproductive rights, but that seems to only cover my choices about family planning and whether to *be* pregnant. If I own my body when I make those decisions, shouldn't I also own my body when it comes to decisions about birth too?

Jennifer Block's "Pushed" makes this point excellently in one great chapter - she used to write for "Ms." magazine. Then when she decided to research and write about maternity care her eyes were opened and she wondered why the heck this stuff wasn't getting more attention from her fellow feminists. I agree Jill, in part its because you have to go through it to understand.

Well, I'm not anti-science in the least, but I do realize its limitations. We cannot possibly know how everything we do truly affects human development before and after birth. As I've grown into adulthood and taken responsibility for raising my own humans it amazes me to witness how much medicine is based on coincidence, guess work and "We don't know why it works, but it does for some reason, so we're prescribing it". So I don't see a big difference between the earth knowledge that has been passed down through generations of midwives and lost somewhat and is now being rediscovered and protocols that are subjected to very limited trials that cannot determine effects over a lifetime. Actually, after typing that out, I will take generation tested "folklore" not invented to generate a profit over relatively recent pharmaceuticals on which shareholder wealth depends...

Just saying... but I suppose I might be classified as "hippy" by some, even though I live a rather mainstream, suburban life and am good friends with a female PB whose practice I personally use for my medical gyne needs. And I'm not a conspiracy theorist... I swear! Just somewhat skeptical.

For some reason, I don't doubt at all that this could have happened. I'm not familiar with their work (although who can forget the name William Smellie?) and since grave robbing was a popular means of cadaver acquisition during the day, I don't doubt that murder was, either. Mary Roach talks about this (although not on pregnant women) in her book "Stiff: The Curious Lives of Human Cadavers" and I believe does talk about how certain 'expendable' patients would often be knocked off. Like one of the commenters on Lindsay's blog, I also doubt that pregnant women were all that healthy then, either, given what we know about the general conditions of London during that time. Not a very fun place to live.

Although I'm not sure it applies to this time period, after reading some of Jennifer Block's book I wouldn't be surprised if some of the neonatal deaths that were "so common" weren't due in part to interventions. The use of Pitocin and similar induction agents was not uncommon in the early 19th century and were no doubt regulated poorly and their efficacy unknown. Knowing what we know about Pit today, the same risks would have applied in 1800 as much as they do now, maybe even more so.

I think the whole science versus midwifery thing is a false dichotomy. Much of what I read and learned while I was pregnant was scientific, it was just coming from outside of mainstream western medicine. Look at the kind of stuff Henci Goer does, for instance. Look at the evidence-based practices in many western European countries, which are sometimes completely the opposite of American practices. The question is often not whether it's science-based, but which science, whose science? What interests me is how many of the traditional practices of midwives have proven to be effective when scrutinized using standard research methods. For instance, maybe it's true that old-time and indigenous midwives didn't know why they waited to cut the cord until the blood stopped pulsing. This was just a practice that had been passed down to them with no understanding of the underlying mechanism. My aunt tells me that my great grandmother, who birthed 13 healthy babies with no doctors around, told her that babies are "more robust" if you wait to cut the cord. Now it's been well-established through standard research methods that babies who get all the cord blood have an easier time breathing for the first few minutes and do not become anemic if they're exclusively breastfed for the first six months, and back when my great grandma was having 'em they were all breastfed. So now science has revealed the reason behind this old practice, and the huge benefit it provides, but if you specify in your birth plan that the cord not be cut right away, all you get is deep sighs and eyerolling from medical professionals. Because they absolutely do not want to know about any scientific information that interferes with their routine and their control and unquestioned authority over the new parents, and waiting 7-10 minutes to cut the cord is just really asking too much. And the list of traditional midwifery practices that have been confirmed by scientific research goes on and on. So I think that in many cases we have to question this dichotomy to begin with.

This is probably one of my biggest struggles when it comes to my thoughts on birth. I am an LCCE and am constantly trying to be "current" so that I can pass along good information to my clients. But the more I read, the more I feel hopeless about the quality of research out there. There always seems to be some bias, some motive, or some philosophy which drives research or the interpretation of said research. This falls on both "sides" of the debate. I keep reading articles about this doctor or that doctor who got a huge payout to publish sketchy stats on some drug from a pharmaceutical company. How can we trust that? Things like this call into question (for me at least) almost anything I read!

However, there are some things on the "natural" side which I feel flabbergasted at when I read them. How can we expect the average American woman to wade through everything and try to make an "informed decision"? It is no wonder, in my mind, why women are just usually more content to trust their care provider's philosophy (be they midwife or OB, or any other doctor for that matter).

And for the record, I thought that original article about the OBs seemed a little too implausible for me to believe.

I think I should qualify that while I do in fact trust *science* (as in the process of gathering evidence, experimenting, and observing results as objectively as possible) I do not think *scientists* (or doctors, or any human) are trustworthy just by nature of what they do, however noble their stated intentions.

Of course, human beings often claim to be using the principles of science while still being blinded by prejudices/their own interests (which explains many of our problems in healthcare, as well as in other areas). And science itself is complex enough that nonscientists are forced to have some trust in those who use it simply because we don't have the knowledge to refute them. And since most scientists and/or doctors are regular and decent human beings, we don't have to treat them like enemies.

However, when it comes to medicine we *can* point out things you don't need a medical degree to see, like prejudicial attitudes, or practitioners refusing to accept research from their peers for reasons that have nothing to do with good practice. Said practitioners might retreat behind their degrees and terminology (or roll their eyes, or dismiss us as anti-science cranks) but the more research we gather for our point of view, the less credible they look.

And actually, I think it's quite scientific to look at midwifery practices--which are, after all, the result of experimentation and midwives who killed off lots of mothers were not likely to stay in business long. One of the biggest mistakes early obstetrics made was driving skilled and experienced midwives out of business instead of learning from them and bringing them into obstetrics itself. How much knowledge of pain managment, safe labor, and delivery techniques was lost because it was never written down and practitioners were silenced? What we have now may only be a remnant of what was actually known and lost forever, and now has to be rediscovered.

How idiotic is it that we have two groups fighting over best birth practices anyway? They have the same stated goals, and each has a vast pool of knowledge that can benefit women, but are split apart by prejudices and power struggles (mostly on the OB side) going back centuries, and women lose out. Nothing logical about that whatsoever.

Hmm, this is one of my biggest complaints about the feminist movements and one of the many reasons I do not identify myself as a feminist. It was not until I met "crunchier" women such as members on mothering.com, that I found self-proclaimed feminists who truly valued dignity and respect for womanhood.

IRL my only experience with feminists leads me to believe that they are quite ready to lie down and spread their legs for any man in a lab coat, whether the result is to kill their offspring or have their offspring "delivered."

Thankfully, my online networking has shown me that other women are out there who want to promote equality and rights for women, as WOMEN.

As I research and write on women, their status, bodies and birth, while men did their powers plays and women's victimization did happen, it happened with the collusion of women--usually affluent--who worried about men's opinion of them and aspired to be accepted by the male power paradigm. Have traced this going back into the 17thc. This desire, this looking outside one's self towards men for our very reflection and meaning undergirds the change of midwifery being a respected profession of educated women to those women rejecting it for what was called, but was anything BUT, scientific medicine. As women gained a modicum of acceptance they did so by dissing the sister next to them and proving they could man up. While in the past I understand that such things were not thought out--we have INSIGHT to this now, when are we going to stop being Athenas to our fellow woman--and thus ourselves? Jennifer's book (of which I'm in) points out female pro-choice ob/gyns who say a women looses her right to choose by going to term. Go figure.

Guggie...while you have the right to your own politics, phrases like "spreading their legs" and implying that feminists are not "real" women are clearly hateful and uncalled for. Please address the conversation without ad hominem attacks.

The thing is, science IS on the side of midwifery and their models of care. How many studies have shown the ineffeciency and increased dangers of many common obstetrical practices? How many studies have shown that using evidence-based, non-interventitive, midwifery-style care is more beneficial to mothers and babies? It's not science against midwifery. Science and midwifery AGREE with each other!

"This desire, this looking outside one's self towards men for our very reflection and meaning undergirds the change of midwifery being a respected profession of educated women to those women rejecting it for what was called, but was anything BUT, scientific medicine. As women gained a modicum of acceptance they did so by dissing the sister next to them and proving they could man up."

But you have to remember that we are largely constructed by our culture, and these women were living in an extremely patriarchal context. Gaining the approval of men was not just some sort of optional thing they could strive for but didn't need. In a world where you can't earn your own money or own property or make your own legal decisions, the "approval" of men is a very different thing than it is in our context. Then there's the fact that we think of ourselves as intelligent autonomous beings now, largely because of cultural changes that allow/encourage this. But women were trained from birth to view themselves and their choices very differently in the periods you're referring to. So, while I agree with the claim that women were also imposing this stuff on themselves and each other, your characterization of it seem really oversimplified.

I wanted to add that the competetive dynamic is still there in some ways, but it's shifted. When you tell people you did natural childbirth they act as if it was some feat you accomplished in order to prove how tough you are. One acquaintance even referred to me as "having the balls to do it without anesthesia," which seemed deeply ironic to me at the time.

Also, I could not agree more with Jill's last comment about science being on midwifery's side.

Birthhistorian,

The fact of the matter remains that those who have identified themselves as feminists to me IRL, are completely willing to maintain a misogynist, male-driven society, most especially in the very issue of their own womanhood. They tell me they fight for rights and choice, and whatever that might mean to them, it does not even begin to touch the full power and respect for their femininity. In fact, they seem bent on reducing WOmen to woMEN.

Not sure about the last part you took offense to...I do not recall implying feminists are lesser women. Perhaps you misunderstood my final sentence, where I was trying to point out that true feminism will embrace and empower women for ALL our capabilities, which most especially includes our unique and inherent ability to conceive and bear other humans.

Guggie
you misread. my post is above my name. You are responding to something Emjaybee said. I have experienced much as you have and if you read MY piece you will see history supports it. Fifteen+ years ago i voiced--why is it feminist will walk their feet off for abortions rights yet when keeping the pregnancy, turn into helpless girls clinging to male deliverance. For this you have to look to the history of recent feminism. As for "spread their legs" tis tart--and the point is made and women in the birth movement need to to get thicker skin. The lack of maturity--and there was a time I included myself in that and can relapse; tis a process, people--is huge with too many locked and loaded to take offense. Emjaybee, I'm not referring so much to this moment as near 30 years in the birth movement watching women eating other women. Feminism not getting birth is not anything new. Tis the norm and there are a lot of women who experienced abandonment by a high profile movement that claimed to the women's voice. Let's acknowledge that and start growing up together.

Guggie, that was me, not birthhistorian.

I have no problems with criticism of feminist actions, so long as those criticisms have to do with political efforts or actions. "Spreading their legs" is a slut-shaming slang term, which is what I objected to. Shaming causes harm and is not effective; education and institutional change are.

Rachael in WY
you wrote:
the "approval" of men is a very different thing than it is in our context. Then there's the fact that we think of ourselves as intelligent autonomous beings now, largely because of cultural changes that allow/encourage this.

You maybe so blessed but a nearing 40% section rate suggest too many don't. I know a painful number of women who have shattered the glass ceiling pulling down insane amounts of money and prestige yet in their private lives they still translate themselves through the men in their lives. The more things change the more they stay the same. The ideas of women's autonomy and agency have been introduced but implementation is a process and there is still much to do. I find your characterization of women's autonomy really oversimplified.
I was at a conference this past autumn where the Female head of Women's medicine at the university got all holier-than-thou-incredulous when Judy Norsigian promoted the licensing (CPM) of direct entry midwives--then she assured this doc, "Don't worry, we'll make them get advanced degrees later but for now we need to get them in the system." No, not word for word but damn near. When I challenged her on this and added that birth, and women's bodies have historically been reliable she voiced doubts about that. Women are still co-opting and subjugating each other thru the male paradigm.

As for the article on Hunter and Smellie--having gone through 300 years of documents i have little doubt that they didn't "burk" their way into history.

Birthhistorian,

Of course women still have huge issues with autonomy and self-confidence. My point remains that the historical period to which you refer was vastly different from the one we live in, and judging women then based on our standards now is a bit unfair. It's apples and oranges, in many ways.

Rachel
I think you misread me. i totally understand and do not 'judge' women back then--what else were they to do? What I submitted was NOW we know, when are we going to stop? The thought of a female paradigm is a Third wave, Womanist, metaphysical, slightly crunchy phenomenon and is still, in practice, fairly obscure. i am encouraged that things i'm reading on birth blogs are going places that in the even recent past were discouraged because--we want to be nice and engage the system--ie male paradigm. Don't shake things up too much or talk about women's empowerment because we want to get into the system.
I'm with Jill on the being afraid what others thinks--bad mother, stupid/ignorant, associating w/granola types, feminists, etc--who gives a shite? I've birthed those babes and pushed em out the door. Not my paradigm.

@ Birthstorian-
Can you just clarify who was the subjugator in this- I was a little confused:

"I was at a conference this past autumn where the Female head of Women's medicine at the university got all holier-than-thou-incredulous when Judy Norsigian promoted the licensing (CPM) of direct entry midwives--then she assured this doc, "Don't worry, we'll make them get advanced degrees later but for now we need to get them in the system." No, not word for word but damn near. When I challenged her on this and added that birth, and women's bodies have historically been reliable she voiced doubts about that. Women are still co-opting and subjugating each other thru the male paradigm."

Just wondering - Is Judy who you meant- that she doubted the validity of women's inherent power to give birth or that the doc subjugated Judy's point about women who deliver babies to be graced in- and be required to have advanced degrees later... and that somehow it is more important to make sure they "tow the line" (patriarchal- medical model) by being part of the system rather than functioning autonomously as a midwifery community.

Birthistorian,

I apologize if I'm coming across as more contrary or confrontational than I intended. My point is just that people are products of their time period, and the systems from which they emerge. Women have been, and still are, constructed as passive objects. They are socialized to conform, defer to patriarchal authority, try their best to be pleasing and cooperative (and note that these are all the things that the western medical establishment requires of women in childbirth). A lifetime of implicit training is difficult to overcome, so the standard picture of the totally autonomous, independent agent who questions the system and shakes things up is a bit problematic here, and it seems like an awfully high expectation to have. It's true that throughout history there are examples of women gaining power in patriarchal systems by subjugating other women (Sarah Palin, anyone?). It's also true that there still are many women who try to appease the medical establishment and gain legitimacy that way. But they are simply working within the system that determines what legitimacy is and how it is obtained. So the problem is still the system itself.

And at the same time there are many women who are standing up and questioning this system and working to weaken the stranglehold it has. Many women I know refused to just mindlessly submit to the dictates of doctors during pregnancy and childbirth, and it seems to me that this willingness to defy convention tracks with education level and access to information. I realize that this is anecdotal and may not reflect a wider trend (my social circle is disproportionately academic, and feminist), but it does seem to indicate that better education and accessible info can bring about change.

And this is one of those times where I feel like I don't fit into any of the neat boxes. I am a feminist. I am a scientist. I am not anti-modern medicine, in general. I am pro-evidence-based care.

For me, that adds up to being in favor of natural childbirth, breastfeeding, and vaccinations. The evidence has shown that natural childbirth is healthiest for most mothers and children. Likewise, vaccines have eradicated many diseases, and produced herd immunity to prevent outbreaks of many other diseases.

On a related note, when it comes to discussions of nursing in public (which I am in favor of -- I do it all the time, sans trendy nursing cover), I like to add a feminist argument for it -- it increases the autonomy of women with children.

Finally, I've never been a fan of Amanda Marcotte, for many reasons. Her history of dismissing the concerns and needs of mothers in the feminist movement is one of them.

What I find ironic is that I homebirthed *precisely because* of

1) My background in science. I read the studies showing mortality rates were the same for homebirth and hospital birth, but that mother and baby were more likely to be injured or suffer complications in hospital birth. I read about rates of interventions and their risks. I saw that the ACOG itself says only 23% of obstetric recommendations are evidence based. I want evidence based care - and the midwifery model of care provides that.

And 2) the fact that I am a feminist. As a woman, my body is strong and powerful, and can deliver my baby safely into the world. I know that it doesn't always happen, and it doesn't make the woman less powerful and strong. It just shouldn't be the default assumption that a woman is weak, that her body is inherently flawed, that it is a danger to her baby, that she needs someone standing by at all times to "save" her, or the baby, or deliver her. I find hospital birth to be (usually) all about disempowering the woman, stripping her of her autonomy, circumventing her right to informed consent, doubting her body's natural ability, and reducing her to a strapped-down, drugged-up, passive vessel through which a doctor "delivers" the baby.

Emjaybee
i got over to the pandagon.net discussion. Most of it was quite disheartening. Want to say your post was BRILLIANT! I love it when someone writes so well I don't feel the need to write. I am an older women who has nearly raised my children out the door-4 down, one to go-and have returned to school to finish my degree. The young women I have worked with at my university and the response of those when I have spoken has been extremely positive. They do not see a dissonance in being pro-choice and questioning the medical paradigm, so the women on pandagon--well, I was gobsmacked a few times.
Fairplay to ya

Barbara-Jean
Let me see if i can do a better job
they both did--1st Wendy--the doc was appalled, got all drama queen, that Judy suggested women should be allowed to have non-hospital births. Judy explained that CNMs were hospital based practitioners and some women were going to give birth at home and needed to have practitioners with some credentialing--good for her--but Judy then assured Wendy not to worry that we'll make them to get advanced degrees later let's just get them in the system. When I challenged Judy on her 'we'll make them get advanced degrees', she criticized and questioned the validity of aspects of the CPM process. Along the way i pointed out birth/ women's bodies historical reliability and that birth became dangerous when men (read male model of medicine) entered the room. She expressed disbelief and something to the effect of needing the medical within shouting distance.
Is that better?

Rachel
LOL you're killing me! I don't know how many times I've seen this happen--women going back and forth only to finally realize they've been saying the same thing and agree with each other. What a hoot. I agree with what you are saying AND the only thing holding us back is ourselves. When i left lobbying/activism a big part of it was I came to realize that we oppressed each other far more than those against us and that women would not gain autonomy until we stop wanting social acceptance more than our own agency. Marsden has often said the oppressed, or maybe the subjugated, oppress each other. so true, so true.
Thankx for hanging in there with me. that's how tis done. Wish you weren't so far, I think we'd do well together.
warmest regards~
D'

I’m going to drag this a bit further off-topic, but there is no feminist way to give birth or raise babies. How could there be? The whole topic is so nuanced and I don’t believe that anyone can lay claim to a right way. Ever. I know what works for me. If there is a sweeping ideal, it probably lies somewhere between Choice with a capital “c” and public health concerns (i.e., 100% of women choosing to feed their infants formula would not be good from an epidemiological perspective).

One reason I don’t react with confusion or disbelief anymore when people talk about how their doctor is their personal hero and they would do anything that person says without hesitation is because, like Rachel said, people are largely products of their culture. Allan Berger wrote an interesting article in 2002 that talked about arrogance in physicians, noting that ill and suffering patients sometimes regress psychologically and attach omnipotent parent-like qualities to the physician who will save them from their suffering. His article talks about how it creates something of a cycle of deification that the patient and ultimately society demands. I guess if someone really operates hardcore from this construct, there would be no reason that they wouldn’t apply it to their view of prenatal/labor care.

I suppose it does relate to the original post in that people trust who they trust until they have reason not to trust them. It’s just not worth my energy to judge it, but it doesn’t mean that cultural scripts are not worthy of discussion.