Childbirth/Breastfeeding Day in Anthropology

I apologize for the slow down in posting... Grad school and doula work is taking up all of my time this semester! But I will be able to catch up on everything during holiday time, so please stay tuned!


So that fabulous reproductive health anthropology class that I mentioned? Well we had our unit on childbirth and breastfeeding - my favorite day! Naturally, this is the day I chose to help facilitate the discussion for, so I have a little more information on this topic for you.


Our readings on Birth were:

Brunson, J. (2010). "Confronting maternal mortality, controlling birth in Nepal: The gendered politics of receiving biomedical care at birth." Social Science & Medicine 71(10): 1719-1727.

Notes:

 "Universal hospital deliver also may be inappropriate given the desires and/or economic  limitations of community members"

"The concept of birth preparedness, like prenatal care, is a part of a biomedical model and risk framework; when birth is considered a natural event, it does not require planning."

"this study's major contribution is a detailed description of the gendered and household politics that determine whether a woman receives biomedical care at birth."

"By using the term 'natural' I do not intend to invoke a romanticized vision of low-tech, 'traditional' birth as the ideal form. Nor do I mean to equate a 'natural' view of birth with a purely biological view of it... Rather I am referring to a worldview involving a cosmic order in which many aspects of life are seen as beyond human control (although efforts or propitiations may be made in an attempt to influence outcomes) as opposed to the mechanistic materialism of modern science that rejects an ordered cosmic totality and instead articulates the world in terms of cause and effect..."

"Women were socialized to keep quiet about their suffering, was usually men who made decisions such as determining at what point situations were dangerous or life-threatening enough to warrant taking them to the hospital."

"More research needs to be done on possible factors that discourage families from delivering in hospitals, in particular the obstacles for impoverished families such as intimidation or cost."

• What are the limitations these women face in having a safe and healthy birth? What factors influence a Nepali woman to birth where she does?
• Would planning for a birth, in any way, mean that birth would no longer be viewed as a natural event? Is a planned-for birth necessarily a biomedical event?
• In order to reduce maternal mortality, Bruson asks, who ought to control birth? Who should be the advocate?

Miller, A. C. (2009)  "Midwife to Myself": Birth Narratives among Women Choosing Unassisted Homebirth. Sociological Inquiry  79,1: 51–74.

Notes:

"Despite this clear reliance on midwifery, use of a midwife is seen as inappropriate. From the UC perspective, midwives and doctors are 'the same'... professionals who interfere with a woman's natural ability to experience completely unhindered birth. When a birth attendant is present, UC advocates argue that women cease to rely on the inner 'primal' knowledge that exists to guide them through the best, safest, and most empowering birth possible."

The authority of the biological construction of pregnancy and birth indeed reflects what Foucault described as 'bio-power.'"

These women already believe that birth isn't medical, dangerous, etc - "A fundamental rejection of the biomedical discourse on birth."

"The assumption, whether accurate or not, is that when a midwife enters the home she becomes 'in charge'"

"the natural role of husbands as decision-makers"

The professional birth attendant has been rejected, but the framework remains, gesturing to the power of the midwifery model as the primary counterdiscourse to the biomedical construction of birth. 

• In what way is choosing unassisted childbirth a privilege?
• Where does the authoritative knowledge lie in unassisted childbirth?

Piperata, B.A. (2008) Forty days and forty nights: A biocultural perspective on postpartum practices in the Amazon. Social Science &Medicine 67: 1094–1103.

 Notes:

"In the eastern Amazon the immediate postpartum period is referred to as resguardo, lasts for 40-41 days and includes food taboos and work restrictions."

"Quantitative and qualitative data on dietary intake and energy expenditure were collected on 3 consecutive days in each of three postpartum periods."

"women responded by saying 'the boy pulls more' meaning the boy places more strain on the mother... a male infant puts more pressure on a woman's body in terms of breastfeeding style and by causing greater pain an hardship during parturition. The implication is that women require more time to recuperate after the birth of a boy."

"The taboo status of foods was not unanimous... what was taboo for one may not be for another."

"The seduction of the river dolphin"

"During resguardo energy expenditure in physical activity was lower, reducing women's energy needs and allowing them to devote more time to infant care. However, energy intakes were also lower. The reduction in dietary intake was impacted more by work restrictions and the loss of women in subsistence tasks during resguardo than by adherence to food taboos."

• Why is the biocultural framework useful in this study?
• Thinking about the three articles on birth, what effects to gender roles have on the experiences of parturient women?

Our readings on Breastfeeding were:

Gribble, K. D., M. McGrath, et al. (2011). "Supporting breastfeeding in emergencies: protecting women's reproductive rights and maternal and infant health." Disasters 35(3): 

Notes:

"Reproductive rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so..."

"Mothers and infants are vulnerable groups that are disproportionately affected by emergencies and the negative ramifications of breaching these rights are enhanced in emergency conditions."

"breastfeeding reduces women's physiological responsiveness to both physical and emotional stress...artificial feeding increases the resources needed and the work associated with caring for an infant."

The undermining of breastfeeding rights in emergencies

"Supplying breast-milk substitutes to women as a precautionary measure, in the event that they produce insufficient milk, also undermines their confidence in their ability to breastfeed."

• Why is breastfeeding a reproductive right?

• In what ways is this right undermined in both emergency situations and non-emergency situations worldwide? What are the results?

Kukla, R. (2006) Ethics and Ideology in Breastfeeding Advocacy Campaigns. Hypatia 21(1): 157-180.

Notes:

"As a result, many of our public health initiatives specifically target mothers' choices, as though these were morally and causally self-contained units of influence; if only we could talk women into making the right choices, these initiatives presume, then children would turn out healthy"

"The fact that mothers are not behaving as they are being called upon to behave is here smoothly interpreted as empirical proof that they are no actually hearing the call. Such an interpretation closes down any interrogation of why women might not behave as they are asked to, even if they hear and understand the request."

"One might have assumed that what makes the United States saliently different from all other developed nations with better breastfeeding rates is not its lackluster advertising campaigns, but rather its abysmal maternity leave policies, privatized daycare system, complete absence of workplace regulations supporting breastfeeding, and so forth."

"It utterly fails to examine or address the reason for this gap between message and behavior, insistently keeping the focus on changing women's choices... We need to question our assumption that improper education is the cause of low breastfeeding rates."

There are many American women, especially women from the socially vulnerable groups least likely to breastfeed, for whom breastfeeding is not in fact a livable choice..."

"Breastfeeding mothers are asked to negotiate an exceptionally complicated set of codes of privacy and publicity."

"...in comparison with mobile, privileged white women whose bodies do not challenge normative conceptions of femininity" 

"As a culture, we expect and demand that breastfeeding be contained within the domestic space..."

In ads, mothers are portrayed as white women, garbed in bedroom clothing, sitting in a nursery or a nonspace, the women look down at their infants, the children are never older than 1, etc.

Really interesting section on the sexual texture of breastfeeding... "position the infants as traditional male sexual conquerors" 

"When we hide the real, deeply culturally embedded barriers to safe, comfortable breastfeeding, we tell mothers who face these barriers that they are unmotherly, shameful, incapable, defective, and morally inadequate/ We then combine this with the message that breastfeeding their child is the only decent choice, the only way of refraining from harming their children, and their responsibility as mothers."

• The U.S. DHHS breastfeeding advocacy campaign fails to take into account societal and policy level issues related to breastfeeding barriers, focusing only on the assumed rational behavior of individual mothers. What effect does this have on breastfeeding rates?
• What do the "Breast is Best" and "Babies were Born to Be Breastfed" campaigns mean for the "good/bad mother" debate?
• Kukla argues that "the reasons women 'fail' to breastfeed go not only well beyond selfishness or lack of education, but even beyond physical and economic barriers such as cracked nipples and long work hours. These reasons lie buried deep within our culture..." How is breastfeeding culturally situated, and how can the cultural context be altered?

Non-normative bodies and various breastfeeding campaigns (click to enlarge):

Breastfeeding outdoors, in work clothing, not looking at baby, as a woman of color, breastfeeding twins, in an airport, in front of family, in front of strangers, with tattoos, breastfeeding toddlers, and other kinds of breastfeeding campaigns

I had been trying to find this image before class and couldn't, but now I have it so I'm sharing it:

We also touched on laws protecting breastfeeding in the U.S.: 

Our professor also invited some perinatal loss doulas to come and speak about the support that they provide for women experiencing fetal loss, choosing to terminate a pregnancy, or giving birth to a stillborn baby or baby that is not expected to live past birth. This was very interesting, as I had heard of Full Spectrum Doulas before providing doula support during abortions, but hearing the accounts from these doulas about how they work with mothers and families experiencing various forms of grief was incredible. They are usually called by the hospital health care workers directly when a family finds out about their baby's condition, and they provide information and psychosocial support, as well as physical labor support, in addition to photography, footprint mementos, and so on for families that desire them. These ladies have very big hearts to work with family after family experiencing the loss of a wanted pregnancy.




Further reading/watching:

• Canar, Ecuador: Birth and Indigenous Identity in the 21st Century - video preview of an anthropologist's documentary that touches on medical pluralism and birth
• Breast-Milk for Haiti: Why Donations are being Discouraged, Jan 29, 2010 - an article about the difficulty of sending breast milk donations to Haiti after the earthquake
• Breastfeeding Legislation and Policy, United States Breastfeeding Committee
• Best for Babes Foundation - dedicated to beating the Booby Traps, the cultural and institutional barriers that prevent moms from achieving their personal breastfeeding goals 
• Born Free: Unassisted Childbirth in North America - Dissertation by Dr. Rixa Freeze, department of American studies (2008) - Rixa herself had a planned homebirth, a planned unassisted birth, and an unplanned unassisted birth
• Birth in Four Cultures: A Cross-Cultural Investigation of Childbirth in Yucatan, Holland, Sweden and the United States by Brigitte Jordan (1992) - the mother of anthropology of reproduction, anthro of birth, and the concept of authoritative knowledge
• Medical Anthropology Quarterly, June 1996 10(2) - a full issue on authoritative knowledge and birth
• Monique and the Mango Rains: Two Years with a Midwife in Mali by Kris Holloway (2006) - a quick read by a young peace corps worker about her experience with reproductive health issues in Mali