our culture sees women’s bodies as faulty machines, but there are other birthing possibilities
- Written by Holly High, Associate Professor, Anthropology, Deakin University
I did not think particularly deeply about birth until the prospect of my own labour was on the horizon. I asked my grandmother, then in her eighties, what to expect.
It was a family gathering in June 2013. We were sitting side-by-side at the long, polished dining table that fills almost the entire dining room of a wooden farmhouse outside a town in the Great Dividing Range of New South Wales, where we’d spent many Christmas lunches.
I was leaning toward Joan across my new and strange belly, and her smile seemed to say: no judgement that your pregnancy preceded any sort of marriage or even a plan for one. No bad words. No painful memories. Around us, the hubbub of her children, her children’s children, and their partners: the joy of the crowd seemed to set a limit on what we could say.
When I asked what birth was like, she laughed and told me not to think too much about it: “The doctor will give you something and you will go to sleep. When you wake up, there will be a baby. The doctor will do it all for you.” I didn’t press her.
Rites of passage
Anthropology, my profession, is my other family. By reading and (much more rarely) meeting anthropologists whose work I admire, I have found people willing to have the kind of conversations that might be too difficult in one’s real family, but who still have that family-like ability to shape who you are.
In pregnancy, I dug out old readings given to me when I was an undergraduate studying anthropology at the Australian National University. I remembered Robbie Davis-Floyd’s 1994 article on birth in the United States[1]. I had given that article to my sister when she was pregnant, but it had not clicked for her. For me, though, it provided a searing warning about the implications of the “technocratic” turn taken by biomedical approaches to birth in the 20th century.
Davis-Floyd used Arnold Van Gennep’s 1909 concept of rites of passage[2] to interpret the otherwise unnecessary interventions that riddle hospital births, like the use of wheelchairs, monitors, and bizarrely designed delivery beds. Davis-Floyd understood these as symbolic, part of a deeply sexist set of rituals that repeated the cultural messaging that women are faulty birthing machines and that technology provides the only sure means of regenerating life.
Van Gennep’s interpretation of rites of passage was quite conservative, in so much as he did not seek out the seeds of cultural change in his study, or even really consider the possibility of social change at all. Instead, his emphasis was on how these rites effectively reproduce existing social roles.
But if we can recognise a rite of passage for what it is, we do have some measure of freedom: a freedom to accept, or work with, or jam the symbols we live in these times of our lives.
Cascade of intervention
On my first consultation with a doctor about the pregnancy, I was told explicitly to worry. “It is a very inefficient process,” the GP said, meaning that I would likely miscarry.
She prescribed me low dose aspirin. After a conversation with my partner, I decided not to take it. The GP prescribed an ultrasound at nine weeks to assess if the pregnancy even had a heartbeat. It did. The ultrasound technician seemed as puzzled as I was as to why the ultrasound had been necessary.
At 12 weeks, my doctor prescribed a nuchal translucency test to assess risk for Down’s Syndrome. This again involved an ultrasound. It was quite pleasurable seeing the outline of the little future-person in my belly, but the technician went quiet and left the room to fetch the obstetrician. On arrival, with great gravity, the obstetrician reported that my son’s nasal bone did not look normal. In words that are branded into my memory, she said “If you were Asian, we would not be worried. But as you are Caucasian, we would expect a different nose.”
On that basis, which to me seemed entirely spurious, along with statistical formulas (largely based on my age), I was given a result of one in 17. This represented their assessment of the chance my son had Down’s.
The obstetrician requested that I consent to an invasive procedure that had a one in 100 chance of aborting the fetus. All my instincts told me not to do the procedure. But my partner and the obstetrician persuaded me. With such forceful cultural messaging prodding me into seeing my pregnancy through the eyes of science, my pregnancy looked risky, unsure, full of worry.
I had the test. It revealed that the obstetrician’s fear had been misplaced.
To this point, my pregnancy conformed to the kind of rites of passage Robbie Davis-Floyd described: the messages were that women’s bodies are faulty and inadequate for efficient birthing, that my own ability to reproduce was very questionable in itself: for a successful outcome, I ought to rely on medical technology.
Yet this was not the whole story. The debacle with the nuchal translucency test was a wake-up call. We hired a private midwife, Sheryl, and started planning a home birth. Unfortunately, due to an early rupture of membranes with no labour at 36 weeks (which I will forever link to the unnecessary invasive procedure inflicted by the obstetrician during the nuchal translucency test), I birthed in hospital under induction at 37 weeks.
Induction is notorious for sparking what Davis-Floyd called a “cascade of intervention”, because the synthetic oxytocin used does not cross the blood-brain barrier, meaning that contractions occur without the usual accompanying benefits of feel-good hormones. The contractions can easily build up too fast and too hard, creating unbearable pain and pressure on the baby.
Knowing these risks, we opted for induction anyway. The hospital midwife attached a monitor to my belly to track the baby’s heart rate and to look for signs of distress. I took it off.
I requested a bath. The hospital midwife left to ask the obstetrician on duty if it was permissible for a woman who was being induced to birth in a bath. Sheryl went to fetch some warm water to top up the bath, in a quiet defiance that this question had even been raised. While they were both out of the room, I entered the bath and experienced a “fetus ejection reflex”: the baby was born in a single spasm.
It was a moment of great clarity. I want to say that it felt powerful, but not in the sense of being in control: I was completely out of control. My normal self was gone. I was overwhelmed.
But something of me was in control: something not me exactly, but of me. It was a part of myself I had not encountered so consciously before. I felt that a me much more powerful than my conscious self had snatched birth back from the grips of the less-than-perfect circumstances around us and done it simply, gloriously and rebelliously without asking anyone’s permission.
Sheryl came back in just after the baby’s head was born: she was so sure that we were hours away from crowning that she almost tipped a steaming bucket of boiling water right in, but luckily saw the emerging baby just in time. Instead, she instructed us on how to pass the baby safely through the water, and then snapped a photo of the three of us, my partner, our baby and me, jubilant.
It was a very affirming note on which to begin my journey as a mother, and also for my partner who was commencing his new role as a father.
It seems to me that this is the key point. It is true that rites of passage can have conservative meanings. All the rituals of birth that Davis-Floyd described happened to me: the almost obsessive concerns with dilation, the bright lights, and the monitoring devices all repeating the cultural messaging that my body was a faulty birthing machine and that could only be made to work through medical technology.
But birth is not always reducible to the rituals constructed around it. Even in conditions of intense ritualisation, such as a hospital birth, one finds seeds of other meanings.
Read more: Obstetric and gynecological violence: Empowering patients to recognize and prevent it[3]
Birth as carnival
The first birth I remember attending was on island in the Mekong River where I lived for 16 months for ethnographic fieldwork in 2002 and 2003. The village was a string of 50-odd houses on stilts, spaced out between gardens, bamboo, and coconut palms along the riverbank. The houses, which were made of teak and bamboo, faced the river and backed onto rice fields. A gilt Buddhist temple gleamed in the higher patch of ground in the village centre.
One day, I noticed a house downstream preparing a screened off area under the house: an area, my hosts told me, for the coming birth. I walked by, curious and ever the diligent fieldworker, but too shy to intrude on what I assumed was a private event.
I was pleased and surprised, then, when a lean young man, perspiring from the heat and a long walk through the dark of the evening, came to my house to invite me. He was inviting every household, using a headlamp to follow the footpaths between houses and across rice fields. Birth was one of the occasions (along with deaths, severe illnesses, marriages and feeding the dead) that required at least one member of each house to attend for an all-night vigil.
By the time I got there, though, the birth itself was over. While the woman who had just birthed rested in the screened-off space under the house drinking hot liquids and “toasting” over hot coals (really, just sitting close by or over the coals, in a ritual seclusion where heat is thought to help the body dry and close after birth), we congregated upstairs listening to music, dancing, drinking alcohol, and eating delicious morsels.
It is compulsory at such events that men gamble with playing cards. Gambling is usually illegal in Laos, but these rules are informally suspended at birth parties. In Luang Prabang, where people are much more prosperous than in the rural village, these parties can go on for a month, with the regularity and length of any given guest’s involvement in the party taken as a sign of their closeness to the couple who had birthed.
In my field site, these events were typically referred to as wiak (labour, in the sense of work). Labour, in the sense of birth itself, is instead referred to by the direct word cep (pain).
If birth labour in Australia implies the labour of faulty bodies at producing a product (much like a factory worker might labour on a production line), in Laos the meaning of birth labour is the sociability around the birthing woman. Birth labour here is the work of revelry, the effort it takes to suspend everyday rules, and the contributions we all made by simply being there, adding to the creative, out-of-the-ordinary spark generated by gatherings.
Birth was a carnival, in the sense of the term developed in anthropology: a moment of inversion of everyday life. No wonder so many women prefer to birth at home in Laos.
A woman recovering from birth under her home by drinking warm water and sitting over burning coals, Sekong Province, Laos.
Photo: Holly High, Author provided (no reuse)
Imagining birth
Since having my own children, I have paid more attention to birth in Laos. One of the characteristics of the births that I have followed in the southern provinces of Champassak and Sekong is that, even though most women broadly respect medical science, in general the preference and practice is to birth outside of medical facilities, even when doing so means that medical assistance may be too distant to access in the case of an emergency.
In explaining this, women cite lack of transport, “shyness” of (and sometimes outright shaming by) medical staff, the convenience of a village birth for the friends and family who may wish to attend, and cost (even though mother-and-child health care is free in Laos).
I have seen women plan a hospital birth, but when the time came they ended up birthing in the village, saying that it never felt like the right time to go. Women also say that if they are not sick, they do not see the need for medical care. Many do not see pregnancy and birth as an illness, and when I probed them on this, I heard about the reassuring messages they received from the people closest to them.
In village Laos, much cultural messaging affirms that birth is nothing to fear. And indeed, the births I knew of seemed to be usually trouble-free and over in an hour or two. All this, despite statistics suggesting that Laos has the highest maternal death rates outside Africa[4] (although this rate is falling quickly).
By contrast, in Australia the cultural messaging around birth seemed to dwell on its uncertainties and dangers. The few births I had close knowledge of before having my own children seemed drawn out and vexed, typically beset by high drama, angst, and epic time scales (by Lao standards at least). This, despite maternal deaths being, statistically speaking, rare in Australia[5].
Clearly, these statistics – while no doubt indicating something true about birth – failed to capture something else: how birth is imagined in each context.
Read more: 'Free birthing' and planned home births might sound similar but the risks are very different[6]
Women who rebelled
When I was pregnant for the second time, I interviewed my mother about my own birth. In a telephone call I made from my back veranda, while surrounded by piles of laundry in various stages of hanging, drying, and folding, I asked and she answered. We were sometimes halting, sometimes fluent, feeling our way around shame, reserve and anger.
I was her second child. Her first birth was in a hospital where she had experienced what birth activists now call “obstetric violence”: without her consent, she was given an unnecessary and painful episiotomy while her husband was forced to remain outside.
When the pair were pregnant for a second time, she again enrolled at a hospital and went for regular check-ups. What she didn’t tell these medical providers was that she had also hired two “healers”, Carole and Norman, who agreed to attend her in birthing at home.
Despite some misgivings about Carole and Norman’s commitment to homeopathy and anti-vaccination stance, she did birth at home. During the labour, they offered her drops of Rescue Remedy on her tongue and “Tibetan pills” – hand-rolled by lamas – said to open her birth canal.
This was the mid-1970s and my parents were then living on an MO (a multiple occupancy, a “commune”, if you will) in the hinterlands around Nimbin, the centre of Australia’s counterculture. My father told me that, in the movement in those days, birthing at home was considered a key aspect of building community, a key affirmation of countercultural values.
After I was born, my mother met weekly with other women in a “Pregnancy, birth and beyond” group in Nimbin. I grew up with the photographs taken at my own birth: my mother prone on a bed, sunlight streaming in on her glasses and her long blonde hair, me a bloody blob just visible between her legs, and around the bed, people unknown to me looking on. These were nothing like the stylised birth photography so common today. These were raw.
During our interview, some of the pauses in my mother’s retelling seemed to be around shame, fear and anger. Looking back now, she wondered: had it been safe? Had she taken too many risks? When I was a child, she had often said that I was born with the umbilical cord around my neck, as if she was haunted by an horrific “what if” scenario of strangulation at birth.
Birth specialists today no longer speak of the umbilical cord as potentially life threatening for infants at birth, although the idea of tangled umbilical cords did have some currency in the 1980s. The idea of the umbilical cord – that link between us – choking me before my first breath seemed to have come to stand for all the reservations and compromises my mother had faced in planning her home birth in circumstances where there was so little in the way of medical support available for it, and a nightmare possibility that haunted those choices.
Nevertheless, I grew up telling people that I was born at home: I was a home birth. I had some childish sense that this difference was special, a bit like being left-handed. It was only as an adult that I realised that my story had been wrong.
In fact, the birth was what people these days call a “free birth”: a birth that is planned and intended to occur with no attendance by anyone qualified in biomedicine.
A home birth, by contrast, is a birth that takes place at a woman’s home while attended by a qualified midwife or equivalent. But such births were not an option in 1970s New South Wales. If they are an option today, it is due in large part to women like my mother. Women who rebelled.
Birth choices rally, Melbourne, May 2018.
David Crosling/AAP
Birth as possibility
My second birth was a home birth, a true home birth, attended by a qualified midwife, Rachele.
The build-up of contractions was slow. Five days out from the due date, there was some cramping, blood and gushes. Rachele encouraged us to go about life as usual, so we did. Without my noticing it very much at first, I found that these cramps became the tempo of my life: I could stand up easily, but I’d wait for the cramp to finish first. If I lingered by the warmth of the oven, it was to ease the cramp that was passing then. If I spoke, it was because there was no cramp, and if I hummed softly, it was because there was.
Mostly I was my normal self, but when the pain came, I paused, became more inward. Things became more intense at about nine o’clock on the night before our due date. Now when the pain came it would take all of my attention. For what seemed like hours, I leaned on a chair in the dark of my bedroom in solitude, feeling waves build and subside.
It was hard work, but it felt pleasant and possible. I loved the TENS[7] (Transcutaneous Electrical Nerve Stimulation) machine: a non-invasive, drug-free method of pain relief.
Who knows if these things really work? Part of the pleasure of it no doubt was the mindless, repetitive action of turning it up at the start of each contraction and down at the end, both done with the press of a button. It marked the passing of each contraction and put me in charge (it was my finger on the button!).
I enjoyed the breaks between the contractions. I was entering what philosopher Orli Dahan has tentatively called “birth consciousness[8]”, which she defines as “an altered state of focus and retreat” which may feel spaceless, timeless and nonverbal.
Sometimes when my partner came to check on me, I could not muster any words. At one point I gathered myself so I could explain to him that if I was not speaking, it wasn’t because there was any problem. I was just too ecstatic. I asked him if he’d ever felt so high that he imagined entire conversations with people, but when he went to speak realised that none of it mattered because it was all beyond words? Well, that was how I felt at the time. Ridiculously happy, truly gone.
Through all this I heard Gadsby (my first-born) crying: it was hours past his bedtime. From the bedroom I commanded: “Bring him here.”
Gadsby curled up in my arms as I sat on the floor in the candlelight, humming through contractions while rocking him. He looked up at me, curious but mostly sleepy. I relished letting the deliciousness of his gentle, drowsy presence, his blonde curls and angelic face, sink in, aware that this would be the last time for a while that it would be just the two of us. Gadsby slept. I laid him on the bed and rested next to him for a while.
The contractions ceased, and I must have fallen asleep or into some kind of doze. Perhaps 20 minutes passed. My partner came in to check, and I got up in that way you do when you are half asleep and for some unknown reason you try to act more awake than you are.
Immediately, I felt a big contraction that grabbed me before I’d even left the bed. I tried to find my rhythm there again, but it was not as easy or pleasant. The spell was broken. I tried the birth pool, but I didn’t feel dreamy and content. It was harder now. I felt very alert. A catch in my breath and I was floored by the pain.
I remember saying “I don’t know where I am”, meaning I had lost my thread, that sense of “having the finger on the button” that had carried me through the early part of the labour. Now it felt not so much that I was having labour but that labour was having me. I was being taken over, I was roaring until I was hoarse but the pain was still more than I could express. I felt the “ring of fire” that I had read about, but not registered in my last birth. I felt extreme pain in my lower back. But still there was no sign of the head. In a pause between contractions, I gave myself an internal pep talk:
I don’t want to feel this pain anymore and there is only one way out of it: forward. Are you holding back? Are you scared? These contractions are going to keep on happening unless you go with them to the end. You need to push with everything you have got, and then this will be over. Are you scared you will break? It’s fine. They will stitch you up. They will take you to the hospital to put you back together again if that is what it takes. You are not going to die from this. It is time to let go and end it.
The contraction started and I pushed. “There’s the head,” I said, hoping I’d catch my own baby this time. Another push. “And there’s the body,” I said as I felt it slide past my hand behind me, towards my partner Ed. The midwife told him to pick up the baby, and the touch of concern in her voice was enough to trigger all my adrenalin-soaked hyper-worry. I hurried to lift the baby from his hands and out of the water and into my arms.
He was perfect, wonderful. We retired to our big yellow sofa and watched in amazement as he did the “birth crawl” up my chest to latch on himself for his first feed.
Rachele later told me that my contractions never took on the kind of consistency or length that would have been considered an established labour by a hospital. If I’d chosen a hospital birth, I would likely have been given synthetic oxytocin again. As it was, with my home birth, the love, respect, privacy, familiarity and support enabled a journey that was pleasurable (at times), profound (throughout) and intricately suited for my particular needs.
Looking back, I was struck by how very different my own experiences of birth had been to my grandmother’s. I felt profoundly grateful for all those who made it possible for me to make the choices I did: anthropologists like Robbie Davis-Floyd[9] and Sheila Kitzinger[10], and activists like my mother and my midwives.
In Australia, at least one in three women who give birth experience ‘birth trauma’.
Rebekah Vos/Unsplash
Birth under possessive individualism
In Australia, at least one in three women who give birth experience birth trauma[11]. One in ten develop signs of post-traumatic stress[12].
People rarely speak plainly of birth, and even more rarely spell out the details in positive terms. When I have spoken in public forums about birth, it is usual for at least a couple of people in the audience to use the question time to share their own birth traumas, or even to speak of traumatic births that they have only seen depicted in Hollywood movies, as a critique of my presentation of birth as possibility: it is almost if they want to say “What right do you have to speak of births so positively – your own or anyone’s – when there is so much trauma in birth?”
This trauma is real. And this trauma is cultural. Birth is, in anthropological parlance, “biocultural”. Cultural meanings and physiological processes are mutually entangled in feedback loops.
For instance, people approaching their first birth who have received cultural messaging about birth as trauma, perhaps through the rituals of worry that are so common during pregnancy, or perhaps through the Hollywood movies that dwell on birth trauma, may then be predisposed during labour to pull the trigger on the “cascade of interventions”, one leading to the next. This stream of interventions may itself be traumatising and perhaps life-threatening.
If so, these are more likely to be spoken of and easily heard, because they are affirmed by a surrounding cultural context that already frames birth as dangerous and traumatic.
Yet the statistics suggest that birth does not have to be a horror show. In Australia, women on average have a 60% chance of undergoing an episiotomy[13] or caesarean section[14], while those who plan a home birth experience these at a rate of less than 6%[15]. Yet less than 1%[16] of women who give birth in Australia plan a home birth. More women give birth on the side of the road[17] each year. There are possibilities for better births.
A small but determined and wonderfully committed Australian birth activism scene is campaigning for continuity of care for women who birth in hospital, and for access to home birth for women who want it. By keeping open the possibility of birth outside hospitals, birth activists may (intentionally or not) be throwing open much wider horizons of possibility.
The stock-standard hospital birth promises bright lights, distant professionals, clean surfaces, and sterile tools. Visiting hours and numbers are limited. Birth is set apart from the day-to-day world: a potentially abstract space. Given the preference for possessive individualism in our culture, I have argued that hospitals may appeal because they offer an abstract space where bodies can be imagined through relations of avoidance, even in the extremes presented by birth. This is particularly clear in many Australian women’s aspiration to have an obstetrician attend their births: a stranger who they will most likely barely know, but one of high status.
By contrast, with the continuity of care model proposed by Australian birth activists, even a woman planning to birth at hospital could expect a stable team throughout her antenatal and postnatal care, people with whom she may develop familiarity, even affection. She would also have the right to a home birth if she so chose. The continuity of care model, then, challenges the rituals of avoidance that sustain possessive individualism. It offers women at this key crossroads not abstraction but connection and community. And the home birth offers women a rite of passage tangled in with the comings and goings of everyday life: an inversion of the day-to-day, but not an avoidance of it.
In Australia, comparing death rates among planned hospital births with planned home births is vexed, because higher risk births are usually planned as hospital births. Hospital home birth programs, as well as most private midwives, only take on low risk births. Comparing planned hospital and home births through their existing mortality rates is comparing apples and oranges. Yet major systematic reviews reveal no significant statistical different in infant death rates[18] and lower rates of maternal mortality among non-hospital births[19].
In Laos, cultural messaging affirms that birth is nothing to fear. Mekong River, Don Det, Laos.
Basile Morin, via Wikimedia Commons, CC BY-SA[20][21]
Read more: More than 6,000 women told us what they wanted for their next pregnancy and birth. Here's what they said[22]
To birth as if already free
Birth continues to be an important rite of passage. This means cultural meanings are transmitted but can also, possibly, be transformed.
Birth activism, the choices women make in planning their births, and those who work to support them in those choices, have profound importance not only for the individuals involved, but also for the possibilities of social change and for the future of humanity more broadly.
The idea of a choice-making individual is core to possessive individualism: a person is conceived of as the rightful possessor of their body as if it were one of their belongings. One of the contradictions of birth activism is that so much of it is framed in terms of defending birthing women’s abilities to make choices about their bodies, yet a birthing woman has an opportunity to experience herself precisely as overcome by a force that might temporarily displace her rational, decision-making self.
It is often noted that the more first-time parents plan their births, seemingly the more things go awry. The more we see birthing as something to plan and make informed choices about, the more rates of intervention rise. There is something uncomfortable, then, in defining the goals of birth activism in terms of choices.
One possible way of thinking about this apparent contradiction is in terms of the kinds of choices that are actually at stake. Birth choices are not like the choices made by, say, an architect planning a building. Nor are they like the choices made by an individual who owes nothing to anyone and thinks only of their own self-interest.
Ideally, birth choices would instead be more akin to the choices made by free people. By this, I mean freedom in David Graeber’s sense: not freedom from obligations, but freedom to choose one’s obligations and to live only under those constraints. As he wrote in his book Revolutions in Reverse[23]: “The revolution begins by asking: what sort of promises do free men and women make to one another, and how, by making them, do we begin to make another world?”
Graeber noted that we barely have any experience of being free in this way. We do not live in a free society. We can only work towards making one a possibility.
Even so, Graeber reminds us that we can, in the here and now, insist on living as if we were already free[24]. Birth choices that insist on this kind of freedom have implications not only for satisfaction among new parents, but also for more expansive imaginations of the possibilities for ourselves and our place in the world.
This is an edited excerpt from As if Already Free – edited by Holly High and Joshua O. Reno[25] (Pluto Press).
References^ birth in the United States (www.davis-floyd.com)^ rites of passage (press.uchicago.edu)^ Obstetric and gynecological violence: Empowering patients to recognize and prevent it (theconversation.com)^ the highest maternal death rates outside Africa (www.ncbi.nlm.nih.gov)^ rare in Australia (www.aihw.gov.au)^ 'Free birthing' and planned home births might sound similar but the risks are very different (theconversation.com)^ TENS (www.healthdirect.gov.au)^ birth consciousness (www.academia.edu)^ Robbie Davis-Floyd (www.davis-floyd.com)^ Sheila Kitzinger (en.wikipedia.org)^ experience birth trauma (www.womenandbirth.org)^ signs of post-traumatic stress (pubmed.ncbi.nlm.nih.gov)^ episiotomy (www.aihw.gov.au)^ caesarean section (www.aihw.gov.au)^ less than 6% (bmcpregnancychildbirth.biomedcentral.com)^ less than 1% (bmcpregnancychildbirth.biomedcentral.com)^ give birth on the side of the road (www.aihw.gov.au)^ infant death rates (www.sciencedirect.com)^ lower rates of maternal mortality among non-hospital births (pubmed.ncbi.nlm.nih.gov)^ Basile Morin, via Wikimedia Commons (commons.wikimedia.org)^ CC BY-SA (creativecommons.org)^ More than 6,000 women told us what they wanted for their next pregnancy and birth. Here's what they said (theconversation.com)^ Revolutions in Reverse (www.akpress.org)^ already free (library.oapen.org)^ As if Already Free – edited by Holly High and Joshua O. Reno (www.plutobooks.com)
