The Rituals of American Hospital Birth

[Epicurus]

This is a few years old but brings to light some very interesting concepts. What do you think?

Collette

The Rituals of American Hospital Birth


This article appears in
Conformity and Conflict: Readings in Cultural Anthropology, 8th ed.,
David McCurdy, ed., HarperCollins, New York, 1994, pp. 323-340.
Permission is hereby granted by the author and copyright holder, Robbie E. Davis-Floyd, to reproduce this article for educational purposes.



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Why is childbirth, which should be such a unique and individual experience for the woman, treated in such a highly standardized way in the United States? No matter how long or short, how easy or hard their labors, the vast majority of American women are hooked up to an electronic fetal monitor and an IV (intravenously administered fluids and/or medication), are encouraged to use pain-relieving drugs, receive an episiotomy (a surgical incision in the vagina to widen the birth outlet in order to prevent tearing) at the moment of birth, and are separated from their babies shortly after birth. Most of them also receive doses of the synthetic hormone pitocin to speed their labors, and give birth flat on their backs. Nearly one quarter of them are delivered by Cesarean section.

Many Americans, including most of the doctors and nurses who attend birth, view these procedures as medical necessities. Yet anthropologists regularly describe other, less technological ways to give birth. For example, the Mayan Indians of Highland Chiapas hold onto a rope while squatting for birth, a position that is far more physiologically efficacious than the flat-on-your-back-with-your-feet-in-stirrups (lithotomy) position. Mothers in many low-technology cultures give birth sitting, squatting, semi-reclining in their hammocks, or on their hands and knees, and are nurtured through the pain of labor by experienced midwives and supportive female relatives. What then might explain the standardization and technical elaboration of the American birthing process?

One answer emerges from the field of symbolic anthropology. Early in this century, Arnold van Gennep noticed that in many societies around the world, major life transitions are ritualized. These cultural rites of passage make it appear that society itself effects the transformation of the individual. Could this explain the standardization of American birth? I believe the answer is yes.

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[mom2burgess]

I don't know, if I had wanted to do any of those postions, all I had to do was say so. They even asked me in the pre registration how I wanted it to go, if I wanted to use the tub/chair/ball/bed. Any medication I had was my choice, as well as the episiotomy. Frankly, IMO I would rather do the hospital birht anyday, rather than a home birth.

[Epicurus]

Things have come a long way even in the little time since this article was written. That is a good thing! The hospitals are modeling after homebirths now in order to stay competitive. ("Homelike atmosphere") Due to the fact that HB statistics are so excellent they have to do this to justify themselves at least in regard to low/normal risk women.
13 years ago I did not have these choices when I birthed my first child in the hospital.
Anyway, there are still lots of places where you don't have the choices you had (where I live for instance). The article talks about rites of passage in these procedures. Even you likely had EFM and and IV, right? These are routine medical procedures that have not been proven at all to improve outcome in low/normal risk women. It gives a sense of security but the proof is in the numbers. The only thing they change is they increase the likelihood of a cesarean.
Just the mass pilgrimage of laboring women into the hospital is part of that rite. Women talk about this journey at women gatherings. I hear about it fairly often. The nice OR mean nurse etc.
What do you think of the rite of passage aspect of what she says?

Collette

[OnederWoman]

I think that l&d has come a long way the US as far as allowing women to participate and dictate what she want her labor to be. I know that the several hospitals here in ABQ no longer do routine episiotimies. Midwifes are now more accessable and there are usually several on staff. Of course, on your back feet in the air is still probably the norm. |

For my first birth, I had no choice as I was severely pre-eclamptic. I had wanted to utilize many different positions and methods of pain control. However, I could not have asked for a better labor. It really was fabulous. This time around, I imagine it's going to be very different, and I will get to utilize the methods I wasn't able to before.

I think as women continue to educate themselves and demand to be a participant in their labor and prenatal care, it will continue moving to the other end of the spectrum.