Mamas on Bedrest: Is childbirth really OB vs Midwife or Men vs. Women?

January 6th, 2012

We are 6 days into 2012 and the battle over “who is the better birth provider” and “Where is the best place to give birth” continues.

On December 30, 2011, The Feministing blog posted an interesting interview with Ina May Gaskin as part of a series on birth professionals. Ina May Gaskin is one of the world’s most recognized midwives, authors and teachers of childbirth. For those of you unfamiliar with Ina May’s work, here is a very brief summary, shortened from the biography provided in the blog post.

Ina May is the famed “midwife of modern midwifery” and has revolutionized the way the world views this ancient practice since the emergence of her seminal book “Spiritual Midwifery.” …A pioneer in the natural birth movement, Ina May firmly places control back into women’s hands from what she calls “male-centered, misogynistic birthing processes” which views women’s bodies as defective designs and allows for profit to be made from women’s fears of their own bodies….

She and her husband Stephen Gaskin established The Farm, a 1,750-acre commune in Tennessee, with a population once at its highest of 1500 residents, where Ina May runs The Farm Midwifery Center. The cesarean rate at The Farm’s clinic is less than 2% and people from all over the world come to receive their home birth services.

The post continues on with the inteview of Ms. Gaskin. As with any blog post, there will be those who like the information provided and those who oppose it. I personally am for opposing viewpoints as we’re all entitled to our opinions, it makes for interesting conversation and I tend to learn something from the other person’s viewpoint-even if I’ll never agree with them. But when the viewpoints become venomous and attack the author and/or the content of the blog rather than convey a viewpoint backed by solid evidence, then the conversation degenerates. I think that the commentors on this blog post did fairly well in that many cited specific articles and studies to back their opinions.

I had no sooner read this back and forth on “the dangers of home births” when I received an e-mail notifying me that there was a comment on a post I had written for Science and Sensibility, the Lamaze International Blog, back in November. While my post was addressing racial disparities in health care delivery, in maternity care in particular, the comment was coming from a mother/grandmother who lost both her daughter and granddaughter during childbirth following (an unwanted) labor induction. While all the details of the birth were not provided, I am gathering (and again, I don’t have all the facts) that the induction was not medically necessary. The delivering mama tried to refuse the induction but in the end succumbed. The events that transpired are unknown to us, but the end result was tragic-a mother and a baby both lost their lives.

I am always struck by physicians who scream from the mountain tops, “Home births are unsafe!”. Who do you think delivered your grand parents? And their parents? And their parents and so on??? Midwifery is mentioned way back in the book of Exodus (The second book of the bible) and existed well before that. Yet we also know that throughout time, millions of women have died during childbirth. Those of us in the childbirth arena well know, childbirth is risky business. As one of my mentor’s Dr. Linda Burke Galloway says, “Obstetrics is the specialty of the unexpected”.

But I’d like to think that we’ve come a long time since the bondage of the Israelites in Egypt, and truly we have. An article that I found in the Postgraduate Medical Journal gives a historical recount of the genesis of obstetrics. From this article and several others that I have read, obstetrics originally came to pass as a way to deal with breech birth presentations and save the mother’s life (if not the baby’s as well). Instrumentation was orginally frowned upon in childbirth and was typicaly only used for stillbirths. Interestingly, forceps, anesthesia and antisepsis, all were introduced by men and increasingly used when “accoucheurs” (male midwives)” became fashionable in the 17th century in France. Modern obstetrics as we know it became a medical specialty, taught in medical schools, in the 19th century in Europe and later towards the end of the 19th century in the United States.

As I look at the history of childbirth attendance, there is an interesting shift that takes place. When you look at the early records, the bible, documents from early civilizations, and up until about the 16th century in western civilizations women were the birth attendants. Women cared for women and did the best that they could, with information handed down from generation to generation, to take care of themselves and eachother (Remember, women weren’t allowed to be educated in many cultures-they could not read or write or conduct any sort of scientific experiment.). Child bearing and childrearing was considered “women’s work” and men took no part.

But in other areas of medicine and science, men were studying and discovering ways to ward off disease and improve longevity. However, they were not attending births and women were not allowed to be educated so these advances were slow to reach childbirth and women continued to die. As men began to slowly infiltrate and attend childbirths, they brought with them instrumentation, anesthetics and techniques of antisepsis which we know improved outcomes. Midwives, female attendants, began to be marginalized.  Regarded as ignorant, their services were increasingly less sought after for childbirth delivery.

During the 19th century in Europe and most certainly by the 20th century in the United States, childbirth increasingly took place in hospitals, mortality rates improved and midwifery (by women attendants) was relegated to poor women unable to afford the services of a doctor or hospital .The modern obstetrical model of the male educated and authorative figure dictating what and how things will take place during childbirth had been widely accepted and was the primary model of childbirth and healthcare delivery-until very recently.

From my perspective, this is the origin, the very core of this “OB vs. Midwife” debate. While both sides are very adept at going tit for tat as to who has the most untoward outcomes, the core argument stems from these simple facts,

  • Women used to care for women and babies before, during and after childbirth.
  • Men began studying ways to improve outcomes and prevent death during childbirth.
  • When men began implementing what they learned, they pushed the women attendants aside, labeled them as igorant and uneducated (which they were because they were not allowed to attend medical school!) and ousted them from the birth arena.
  • Childbirth and women’s health went from an intimate community (I’m thinking of the book The Red Tent by Anita Diamante) in which women cared for one another and shared wisdom from one woman to another to an austere, more academic environment in which little beyond the immediate health issue was considered.
  • Women (those giving birth and those women who attend births) are rallying against the academic environments and are demanding that they be given equal access in women’s health, bringing in the more intimate interpersonal relationship between provider and patient/client and allowing women patients more authority in the treatment process. Those that can, opt out and choose birthing centers or home births with (female) midwives.

For me, the question isn’t OB vs Midwife (especially now that there are female OB’s and male midwives). It really isn’t entirely about mode of care, more interventional (obstetrics) vs. more attendant (midwifery). At its core, the fight being waged over childbearing is between men and women and who (should) call the shots. From this perspective, it’s a completely different argument, one I’ll continue in the next post.

Who do you think should direct a woman’s care before and during childbirth? What is your experience? Share your thoughts below. We’ll be chatting about this on Twitter (@mamasonbedrest) and on our Facebook Page. To follow this topic, sign up for our RSS Feed at the upper right hand corner of this page.

One response to “Mamas on Bedrest: Is childbirth really OB vs Midwife or Men vs. Women?”

  1. I loved your article post.Thanks Again. Fantastic.

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