I think the most troubling aspect of the current state of affairs concerning birth in the US is the total loss of a cultural memory or understanding of the normalcy of birth in the life of a human female. While increasing numbers of American women are seeking safer, more natural alternatives to the typical highly-medicalized and managed birth, it remains within the context of a medical procedure. Even those women who seek out midwives and home birth do so with the caveats of “safety,” “technology,” and “professionalism.” The end result is that the natural childbirth movement is making a lot of noise, but not a lot of progress.
In the 1970s, the natural childbirth movement first began to catch on. However, the focus of the movement was on the reduction of intervention and the humanizing of the birth management process. Having been removed from the natural biology of labor and childbirth by a couple of generations at that point, women were not able to conceive of labor and childbirth outside the scope of medicine. So, even though many women began advocating for home births and midwives, the movement was still very much dependent on the medical establishment for information, support, and legitimization. In her book, Spiritual Midwifery, Ina May Gaskin, perhaps the movement’s biggest and most successful midwife, describes how she began learning to attend women outside of the hospital setting by studying from an obstetrics manual. She heavily relied on the book and the advice and support she received from a close obstetrician friend, and throughout her own accounts, speaks of doing several procedures which we now know to be at best unreliable, and at worst, physically harmful (such as measuring dilation through the anus, and routine episiotomy for breech presentation). The result of this skewed paradigm was that the natural childbirth movement of the 1970s did not accomplish its intended goal of returning childbirth to the mother. Because the focus of the movement was so limited, childbirth remained within the bounds of medical knowledge, only succeeding in forcing the medical establishment to respond to women’s demands by changing medical protocols, and introducing more “humane” procedures and medicines. The majority of American women continued to flock to the hospital to give birth, now more than ever attracted by the “natural” focus, while the medical profession worked to eliminate midwifery as a profession, thereby eliminating any competition.
Thirty years later, the natural childbirth movement has regained some steam. After thirty years of advancement in medical technology, the medical profession continues to dominate in labor and delivery, under the guise of safety and the illusion of choice. With the advent of the information age and the internet, women are now able to network, research, and study, and are learning exactly what each procedure and medication means and what its risks are. Once again, women are clamoring for the reduction of intervention and the humanizing of the birth management process, and yet still, women are unable to conceive of childbirth outside of the medical model. The focus is still on medical management of birth, and the current midwifery licensure movement reflects this. Mothers, midwives, and doctors alike, rather than trying to re-examine the childbirth model as a natural process, are seeking to legitimize midwifery as a medical profession. Now, medical organizations are bowing to outside pressure to legitimize midwifery, but with the stipulation that they can state the terms of licensure. Midwives are now being allowed to practice, but only under such restriction that most women will still be subject to medical testing and interventions, both at home and in the hospital. In addition, the movement for licensure is reinforcing the cultural identification of birth as a medical process which requires a licensed medical professional. Ultimately, no real or lasting changes will be made in the natural childbirth movement following this model.
As long as American culture continues to view childbirth as a process which belongs within the scope of medicine, no meaningful changes will be made. Some small, piecemeal concessions may occur along the way, some new forms of technology or less-invasive procedures will be developed, but birth will still be firmly in the realm of pathology. Women must shift their paradigm, and come to an understanding of childbirth as a normal part of human biology. They must take their understanding of the physiology of childbirth and remove it from its medical setting, and place it back where it once was, as a rite of passage and social event for women. Medical professionals, including midwives, must be relegated to the position of consultant, and their role in childbirth should be considered as an adjunct to the natural process of labor. Once women can re-frame birth, and birth professionals, in this light, they can begin to heal from the loss of generations of valuable knowledge. Once our culture begins to remember the true, unhindered physiology of labor and birth, they can then regain their autonomy, and be able to take advantage of medical technology in its proper sphere, rather than the other way around.