Tuesday, December 20, 2011

Comment Turned Post: Medical Anthropology and Midwife Rituals

Medical anthropologist and midwife Melissa Cheyney published an article in the Medical Anthropology Quartlerly called Reinscribing the Birthing Body: Homebirth as Ritual Performance. Apparently this caught the eye of a writer at Science 2.0, Hank Campbell, who decided to bash anthropology and midwifery in an article called Midwife Rituals: Anti-Science Or Just Symbolism?

Campbell seems to fail to understand certain things about anthropology, like the fact that participant-observation is a dominant method of anthropological research. He also calls her analysis of her research "advocacy" when she says "Just as women and their doctors who deliver in the hospital often feel convinced that their birth was the only safe and 'correct' way, women and midwives who deliver at home feel strongly that they have the solution." This is her analysis statement, not a bashing of obstetricians. Additionally, calling aspects of biomedical care "rituals" is not meant to "create false equivalence for female empowerment rituals," as Cambell states. It is a true anthropological concept and theoretical analysis method which has been studied extensively, not simply made up for Cheyney's convenience.

It is a true concept that the female reproductive body has become medicalized in all aspects - menstruation, pregnancy, birth, breastfeeding, menopause, and so forth. The concept that American medicine has of the birthing body is encompassed in the culture of biomedicine and the beliefs of our society. We like to think that it is objective, evidence-based, and the One Truth, but in fact it is only one reality. Robbie Davis-Floyd explored how medicine, obstetrics, and birth in the U.S. is a ritual; a socially constructed rite of passage. If Campbell had read the article carefully, he would have noted that the reason that Cheyney used ritualization as a lens through which to explore homebirth is because it has been a useful tool for reproductive anthropologists in the past. (Rites of passage and rituals have been studied extensively in other areas of anthropology as well). Davis-Floyd showed that birth is "a reflection of a larger patriarchal and technocratic society." Davis-Floyd examined the rituals associated with hospital birth, and Cheyney examined the rituals associated with home birth midwifery. Both are valid anthropological research and theory.

So while, yes, home birth is partly about a rejection of the dominant biomedical tenants about birth and certain types of authoritative knowledge, it is also about embracing a different point of view regarding the way birth is or should be. Biomedicine is only one example of the way birth is or can be. Differing views are not wrong, they are just different, and exploring them for a deeper understanding is what medical anthropologists do best.

The point of this article is not to add to the "which is better, home birth or hospital" debate. The purpose is to explore the rituals involved in home birth midwifery and what they mean. Cheyney believes that what she calls rituals in home birth are intentionally subverting technocracy, and are meant to "reinscribe pregnant bodies and reterritorialize childbirth spaces and authorities." What this means is that home birth midwives are doing the things they do and saying what they say in order to purposefully go against the hegemony of biomedicine and all it says about bodies and where birth should take place and with whom. She says that midwives are, like obstetricians, taking advantage of this liminality of birth to create a certain meaning of childbirth (in the midwives' case, that nature is sufficient; in the physicians', that technology is supreme).

Many of the rituals (“patterned, repetitive and symbolic enactment of cultural beliefs and values") that Cheyney describes include things like including the woman and her family in prenatal care, repetitive birth mantras and other techniques for a drug-free birth, an inversion of the doctor-up, mother-down hierarchy during pushing, and certain postpartum techniques like delayed cord clamping. Cheyney argues that midwives do all these things in order to intentially be diferent from the biomedical model. Its interesting to read her description of them as their own form of "ritual," and I also would not have thought previously about their being used to intentionally be subversive.
 
Some women do "sidestep obstetric standards of care" and challenge "the hegemony and authoritative knowledge of medicalized birthing care" by choosing birth with a midwive at a center birth or at home. While the idea about which is "better" can be debated until the end of time, the point is that women do make that choice, and have the right to. And though it is not a belief shared by all, it is my belief that women have the right to choose what happens to their bodies and who they hire to provide their health care.

I agree that homebirth is a "medium for the promotion of social change," but I don't think thats the only reason that women choose to birth at home or with a midwife. It has been shown that women who choose home birth are rejecting the technocracy, but this is not always a conscious part of their decision. Furthermore, the reason they do it is not always to be part of political and social change, but simply to make the best choice for themselves and their babies, or because they have no other choice (in the case of the underinsured, for example).

These are my thoughts on the article. Unfortunately, the comments on the Science 2.0 article do not tend to focus on the fact that Campbell's understanding of anthropology is flawed and his analysis of Cheyney's piece is incorrect. Many in the comments section  jump into the home birth vs. hospital and midwife vs. physician debate. So, I am going to weigh-in a bit here:

It is not just mothers, hippies, birth activists, and midwives who are pointing out that the biomedical model of birth is potentially dangerous, it is also physicians and health researchers and scientists. Birth models that include midwives and the midwives' model of care have been shown worldwide to be birth models that work.

So what's the big deal if women are included in all processes, from conception to birth and beyond? Is it such a bad thing if a woman feels empowered, capable, strong and in control? What's the big deal if a woman wants warm water immersion and positive birth statements repeated to her, if it works? Arguments against home birth midwifery tend to call all this "woo woo" or "touchy feely." Women should be able to have this kind of positive care whether or not you're with a physician or a midwife. It has been shown that it matters and that it is a good thing. So why does biomedicine reject it?

I encourage you to put your two cents in over at Campbell's article, even if you're not an anthropologist. The infamous Amy Tuteur has even found it worth her while to do so! Most commenters seem to agree with what he says, and we need to turn the tide.

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