Friday, March 19, 2010

Review of Birth as an American Rite of Passage

I just finished reading "Birth as an American Rite of Passage" and I found myself wishing that if I had read just one book to learn about what giving birth in an American hospital would be like, I wish this book written by medical anthropologist Robbie Davis-Floyd. Through the words of women in response to interview questions relating to their birth experience, readers get a very realistic view of what obstetric culture is like and the expected role of women birthing in hospitals. I often said that if someone had told me what giving birth in a hospital is like based on culture, medical ideology, current practices, etc., I would not have believed them because it all sounds so very irrational, paranoid, conspiracy-theorist and unethical. However, after reading "Birth as an American Rite of Passage" I think I would have been convinced through Davis-Floyd's analysis and the selected quotes from women's birth stories. She clearly describes the "technocratic model" that predominates our current culture and how it renders women as objects who malfunction who are not to be trusted and who threaten the very premise that our world can be saved by technology.

In the article I recently wrote for the Exponent, I quoted the author's definition of technocratic birthing rituals and I'll also include it here:

“The term technocracy implies use of an ideology of technological progress as a source of political power. It thus expresses not only the technological but also the hierarchical, bureaucratic and autocratic dimensions of this culturally dominant reality model—dimensions that are immediately visible in many realms of post-industrial American life.”

Davis-Floyd goes on to state:

“According to the technocratic model of birth, the human body is a machine. The medical system [which is inculcated by the technocratic culture] has done a thorough job of convincing women of their defectiveness and dangers in their specifically female functions”—pregnancy and childbirth foremost.

Through reading the book, I've also come to have a greater understanding of why women are so steeped in our culture and why non-technocratic birth is unlikely (as 98% of women in the US give birth to babies in the hospital, and only 1% birth at home). Indeed, when as I became a mother, I too felt the obligation to follow the dominant culture. If only I had know the historical underpinnings of hospital birth and read this book, I may have been able to be convinced that birthing in a hospital was not the way I wanted to welcome my child into my arms.

I was pleased to read that Davis-Floyd recognized and named trauma as a result of birth experiences; however, the symptoms of post-traumatic stress disorder were misidentified as mild postpartum depression. In my research on PTSD resulting from childbirth, the earliest citations I have found declaring the diagnosis of PTSD were from 1995--before the first edition of the book was published. However, I am disappointed that in the revising for the second edition, the author did not update sections on trauma to reflect the new diagnosis.

Also I felt a category of women's experiences was missing. Davis-Floyd stated that of the 100 women she interviewed for the book that women either fully accepted and embraced the technocratic model of childbirth, they rejected it entirely or they were somewhere in between. To give the benefit of the doubt, there is a chance that the reason why my missing category was not included was because none of the women in her sample would have matched it. The in-between categories included:
  • Women who maintained conceptual distance from the technocratic model by achieving "natural" childbirth in the hospital (15%)
  • Women who maintained conceptual distance from the technocratic model by placing technology at the service of the individual (10%)
  • Women who found conceptual fusion with the technocratic model with cognitive ease (42%)
  • Women who found conceptual fusion with the technocratic model during birth by experiencing cognitive distress, e.g. trauma (9%)
And now, because you are wondering what this missing category I am referring is: I feel she left out, or did not have a woman in her study matching the profile, of a women who maintained conceptual distance from the technocratic model by achieving "natural" childbirth in the hospital with cognitive distress.

For this was my experience, I was able to attain the ideal unmedicated, low-intervention birth in a hospital and the detriment of my mental health.

Perhaps it could be argued that my experience would fit into the last category of finding fusion with cognitive distress, but I did not find fusion. And if someone wants to state that I did, because I consented to AROM at 5 cm, I'm not listening...

An interesting correlation can be mentioned however, that the percentage from Davis-Floyd's study of women who experienced cognitive distress is the same commonly cited percentage rate of PTSD after childbirth--9%. Making her omission of PTSD as a sequelae of childbirth, even more disappointing.

So in conclusion, this book is a very persuasive case for birth as a initiation rite for women as they transition to motherhood and current obstetric practice as a vehicle for gaining compliance and reinforcing the dominant cultural view of technology reigns supreme. If I were to create a list of influential, informative books for future mothers, this would be near the top.

To end, a quote from the book that summarizes why birth is so exceptionally profound and important to me:
Her baby constitutes for her a powerful symbol of her motherhood, her individuality, her new family, the beauty and wonder of nature, and the perfection of her own body and her procreative powers.


Jennifer said...

Mild postpartum depression? That is almost insulting. At least most refer to it as "a severe form of postpartum depression", which, though inaccurate, is a bit closer to the truth.

Rixa said...

FYI--the new edition of the book isn't a revised edition, just a reprint of the first edition with a new introduction. So that probably explains why her mentions of PPD aren't updated.