The Social Reconstruction of Birth as "Unassisted Home
Birth:" Challenges to the Modern Medicalization, Deprivatization, and Desexualization
Philip D. Holley
Southwestern Oklahoma State University
Department of Social Sciences
100 Campus Drive
Weatherford, OK 73096
e-mail: firstname.lastname@example.org and email@example.com
home page: http://pholley.home.telepath.com/index.html
University of Oklahoma
Department of Sociology
Norman, OK 73019
Paper Presented at the Annual Meetings of the
Southwestern Sociological Association
San Antonio, TX
April 1, 1999
The Social Reconstruction of Birth as "Unassisted Home Birth:" Challenges to the Modern Medicalization, Deprivatization, and Desexualization of Birth
This paper examines the contemporary social movement advocating "unassisted home birth." Critiquing traditional midwifery and the medical establishment as unnecessarily interventionist, advocates argue that birth should be (1) a private experience, taking place at home, in that (2) as a natural process, any medical intervention detracts from and complicates the process, and (3) birth is sexual, and should be experienced by the woman alone or at most with her partner.
Using constructionist theory, the paper examines the grievances upon which the social movement is based, and the claims made by unassisted home birth (UHB) claimsmakers.
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The Social Reconstruction of Birth as "Unassisted Home Birth:" Challenges to the Modern Medicalization, Deprivatization, and Desexualization of Birth
Considerable controversy exists in the western world regarding the ideal circumstances of birth. For centuries, women, serving as midwives, assisted other women in labor and delivery (Rooks, 1997). This practice relied on the expertise of women having their own babies and attending other births. When the scientific model and medical establishment gained preeminence, birth came to be supervised by mostly male doctors in hospitals and clinics (Mitford, 1992). Justified on the basis of reducing health risks to mother and baby, the medical model continues to dominate prenatal care as well as care for the parturient woman. Today, while midwifery continues to be available to pregnant women in many places in the US, the practice is beset in various states with such regulation that it is arguably on the verge of extinction. Although increasing numbers of women are entering medicine, the medical establishment continues to be male dominated. Despite the safety of midwife-supervised birth, and much lower costs, most US women opt for a physician-controlled, hospital labor and delivery (Rooks, 1997). Although the medical model won the "war" with midwifery, the controversy has not been completely resolved (Arms, 1996).
At the fringe of the controversy between midwifery and medicine is a significantly different view of birth. It is one which asserts the naturalness of birth, a process which requires neither doctors nor midwives in attendance. It argues that birth is a sexual experience, one which should take place in private, outside the view of male medical practitioners as well as midwives who are almost universally female. Advocates include Shanley, (1994), Griesemer, (1998), Moran, (1997, 1986, 1981), and Halfmoon (1996).
"Unassisted home birth" (UHB) refers to planned birth taking place at home--in private, by the woman alone or with a partner, needing neither medical intervention nor medical personnel to attend, oversee, or supervise the experience (see Holley, 1997). It is supported by views that birth is both natural and sexual, and not inevitably painful.
Adherents to unassisted home birth fundamentally challenge birth as it is experienced today, even with the creation of birthing centers, the admission of fathers to delivery, and possibilities of "natural" childbirth. They often arrive at unassisted home birth from unsatisfactory and harmful experiences with the medical and midwifery models. Seeking an acceptable alternative, they discover, embrace, and experience do-it-yourself (DIY) birth.
The "unassisted home birth" movement is defined as the contemporary social movement which asserts that UHB is the ideal birth. Advocates assert that birth is natural, non-medical, private, and sexual. In its infancy, the movement is small at the present time and seeking influence. Yet, the movement is buoyed by accessibility of the Internet and international interest, participation, and membership.
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PURPOSE OF THE PAPER
This paper involves a constructionist examination (e.g., Best; see also Gusfield, 1996, 1963; Scott, 1993; Fine, 1997; Gunter & Holley, 1997) of this emerging, albeit small, social movement. Examining claims and the claimsmakers, the paper includes both a contemporary and historical analysis of the movement and an examination of the values, beliefs, and experiences which serve as a foundation of the movement. Both grievances and assertions are explored in order to consider how contemporary birth practices and beliefs are "reconstructed" as UHB. Specifically examined is the social movement which sets out the critique of contemporary birth as a negative experience and the reconstruction of what is purported to be a more positive one. The use of the term "reconstruction" is intended to call attention to the extent to which UHBers hold grievances against contemporary birth models while highlighting the formation of UHB values.
Within this analysis, some attention will be given to UHB as an emerging social movement, including both the limitations of and challenges of a latter 20th century movement.
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THEORY AND METHODOLOGY
The constructionist perspective provides the foundation for an examination of UHB as a contemporary practice, much in the same way that motherhood has been studied (Hays, 1996). The subjectivist approach "...focuses on the processes by which people designate some social conditions as social problems" (Best, 1989, p. xviii). Special attention will be directed at the claims articulated as grievances and ideology, and the extent to which we are dealing with a "new social movement" (Fine, 1997; Johnston, Larana, & Gusfield, 1994). Attention will be directed at the claimsmakers as well.
Multiple methods were used in the research. Existing documents-books, journal articles, newsletters, web pages, etc.-were examined. Internet message boards and mailing lists were also reviewed. Several movement leaders were contacted, and through the use of open-ended questions, historical and descriptive data were obtained. Contact with movement leaders is ongoing.
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The findings will be organized by considering the (1) a brief movement history, (2) the claimsmakers and (3) their claims.
A Brief History of the Movement
The UHB movement is so new that it is likely that many adherents to its principles do not consider what is taking place as a social movement. Clearly, no social movement organization existed in the past, although UHBers found means of contact. Leaders have found little interest from major publishing firms in publishing their writings as well as very little media interest in UHB.
To the extent interconnected, UHBers contact with each other has been initiated and maintained by publications and newsletters, and informal networks. In 1977, Marilyn Moran began publishing "The New Nativity," a newsletter intended "...to provide a means of communication and support for those couples who wanted to give birth at home in a personal, husband/wife, purebirth [sic] way " (Moran, 1986, p. xii). (This newsletter has been published by others since 1990 as "The New Nativity II.") Moran's Birth and the Dialogue of Love, published in 1981, set out her vision of do-it-yourself birth, experienced at home, with the husband only. Her Happy Birth Days (1986) was a collection of birth accounts previously published in the newsletter. Her final work was published in 1997-Pleasurable Husband/Wife Childbirth.
While Shanley experienced her unassisted births prior to contact with Moran, by the time her 1994 book, Unassisted Childbirth, was published, she had made contact with Moran and become exposed to her writings. In 1995, she and Hygeia Halfmoon began publishing their newsletter, "Letters from Home." (With the Winter, 1998, issue, Laura and her husband David became publishers.) By 1996, Halfmoon had been publishing her works, including Primal Mothering in a Modern World.
Since 1997, the Internet has served as the focal point of the movement. This includes numerous home pages, a web ring, an e-mailing list, and a message board (Gregson, ND/1998; Griesemer, ND/1998; Morgan, ND/1999; Shanley, ND/1998; Bel, 1998; and others as listed in the references). Out of the contact afforded by the web, recent organizational developments have been taking place.
Sponsored by the Griesemer's, the First National Husband/Wife Homebirth Conference was held during the summer of 1998 in Charleston, SC. In attendance were Shanley and Moran, and about 40 others (Griesemer, ND/1998). While a conference was intended for 1999, it apparently has not materialized. The next conference is scheduled to be held in Virginia in the year 2000.
At the present time, Laurie Morgan (ND/1999), with assistance from other UHBers, is launching the "Joyous Birth League International." It is intended to bring together families around the concept of "natural childbirth," which is considered to natural, safe, private, intimate, and a legitimate choice among birth alternatives. The league is intended to provide information, resources and support. Claimsmakers
The movement leaders are overwhelmingly female-Shanley (1994), Moran (1997), Griesemer (1998), Halfmoon (1996), Morgan (ND/1998), etc.--as are essentially all of the movement members. The few men involved in the movement tend to be husbands of women who are movement members, usually playing a non-activist role. One of the few males actively involved is Bob Griesemer, husband of Lynn Griesemer, who has a web page devoted to men's involvement in UHB. UHB advocates have welcomed our presence as researchers into their world as well as readily used the writings of male doctors which are consistent with their views (Dick-Read, 1959; Bradley, 1981).
Movement leaders and members are predominantly in their childbearing years. Moran (now deceased) and Shanley are beyond childbearing. The majority are heterosexual, many of whom are married. However, some of the women define themselves as bisexual, and there is even a minor lesbian presence within the movement.
Those arguing for "unassisted home birth" have experienced at least one, and usually more, births through the medical model or midwifery (e.g., Moran, 1997; Morgan, ND/1999; McCracken, ND/1999). High levels of dissatisfaction with these experiences are apparent, including what is described as unnecessary medical intervention during labor and delivery, especially with regard to caesarean sections (Shanley, 1994). Excessive midwife control represents a parallel criticism. Experiences of victimization by either the medical establishment or midwifery typify these women (see Best, 1989, p. 75).
However, there is considerable diversity among these women in their trajectories toward "unassisted home birth." Some of the women planning or experiencing first pregnancies anticipate their own future contact with either the medical or midwife experiences in negative fashion, motivating them to subsequently seek out UHB. Their motivation is a 'fear" of victimization by either midwives or doctors. In a broad sense, some women rely on information gathered from other women's negative experiences while others have an idealized image of birth which does not include doctors or midwives. The latter is illustrated by Griesemer's (1998) lack of a negative experience in the four births prior to her UHB. Some others simply have unassisted home birth (Shanley, 1994)
Most of the movement leaders are self-educated experts in pregnancy and childbirth Griesemer (1998). Some are midwives or nurses, although none are academics.
Many of the women are stay-at-home moms, while others have full- or part-time careers outside the home. Most appear to be relatively-well educated, and middle class.
Some of the women are countercultural, living outside the dominant culture, maintaining as much simplicity and self-sufficiency as possible, by home-based careers, home schooling of children, etc. (see Holley & Brewster, 1998). Commitment to religious beliefs tend to be high, despite a wide diversity of beliefs within the movement. Some are New Agers and pagans, while others are Catholics and Mormons.
Movement members are drawn from various US states and other countries. Members live in Australia, Canada, France, and Scandinavian countries. While essentially all of the movement leaders to this point in time have been North American, the movement is not and cannot be so confined. The same conditions about which North American UHB women are concerned are found in many other countries.
Movement leaders and members tend to be unified through holding a collection of non-traditional and anti-establishment values and beliefs. These include values connected to simplicity, nature and what is natural, privacy, family, intimacy, sexuality, and health/wellness. Specific beliefs variously include extended breast feeding, home schooling, attachment parenting (i.e., young children sleep with the parent(s) in the family bed), vegetarianism, and opposition to circumcision and immunizations (Holley & Brewster, 1998). It appears that commitment to a multiplicity of "deviant" beliefs and values enables movement members to easily and readily advocate and practice UHB.
Specific references made by those arguing for "unassisted home birth" include (1) strongly worded critiques of the medical establishment, often including personal testimonies, identifying excessive and unnecessary medical examinations, monitoring, drugs, and physician control, (2) less strongly worded, yet forceful, critiques of midwifery, (3) reliance on cross-cultural/cross-national data and anthropological evidence regarding the naturalness of birth, (4) statements of a few physicians and midwives who agree with and approve of "unassisted home birth," (5) testimonials from women indicating unhappiness with doctors, nurses, hospitals and clinics, and even midwives, and (6) evidence drawn from various sources regarding the enhanced sexuality of women during pregnancy and while nursing, as well as parallels between orgasm and birth. Economic arguments-essentially very few costs associated with home births, appear not to be important and are omitted in the rationales. Labor and delivery complications are believed to be rare rather than the norm.
Attention will be directed to an examination of the specific assertions made by UHBers, broken down by grounds, warrants, and claims (see Baumann, 1989).
Grounds include definitions, examples, and statistics. Added to this analysis will be references to anthropological evidence, as well as rare medical and midwifery evidence.
Definitions. Various terms have been used to describe what we refer to as UHB (see Holley, 1999). While a lack of agreement exists today with regard to the term, it is generally agreed that it does not refer to a hospital or clinic birth, nor is it physician managed. The birth is home based, although it might take place outdoors (Griesemer, 1998). It would usually not refer to the attendance of midwives. If the woman does not birth alone she might include a partner, children, and even a few family members and friends (Shanley, 1994). Either implicitly or explicitly the definition emphasizes that the woman is in charge of her labor and delivery .
Unlike some "broad" definitions being used as the basis for some contemporary claims (Baumann, 1989), the same dynamic does not appear to exist here. In fact, the effort of UHB leaders is to narrow the definition.
Examples. UHB material is replete with testimonials which include accounts of awful and horrible experiences with doctors and nurses in hospitals and clinics. These include: (1) failure of medical staff to follow the birthing woman's wishes (i.e., doctors performing an episiotomy in direct violation of a directive of the woman in advance ), (2) litany of monitoring activities described as a sexual violation (Moran, 1997), rape (McCracken, ND/1999), a privacy violation (Griesemer, 1998, Moran, 1997), and medically unnecessary (Shanley, 1994).
Accounts of birth with midwives reflect much the same levels of dissatisfaction (see Morgan, ND/1999).
Also found in the UHB literature are numerous accounts, often given in contrast to the 'atrocity tales," of UHB experienced a joyful, liberating, sexual, and rewarding (Griesemer, 1998; Moran, 1997, 1986, 1981; Shanley, 1994).
Statistics. There is seemingly little exaggeration and distortion of data utilized by UHBers. Data about unnecessary medical procedures tend to be cited, as well as research on midwifery home birth. For example, UHBers tend to cite data from the medical establishment or public health sources regarding the excess of cesarean surgeries (Griesemer, 1998). Shanley (1994) utilized data to demonstrate the "dangers of medication intervention," including induction, drugs and enemas. Research on the safety of midwifery is used to buoy UHB arguments (such as that published by The Farm in Tennessee, ND/1999). In reality, there is a paucity of data with regard to the effects of the various types of birth.
While there might be some arguments between advocates of UHB and others as to the meaning or implications of the statistics, the reality is that UHBers tend to utilize their "adversaries" data.
Anthropological and Rare Medical and Midwifery Evidence. UHBers make extensive use of information about labor and delivery acquired by anthropologists. The data are both historical and cross-cultural, although sketchy. This evidence suggests that birth is "natural," and that even tribal women do not require the "assistance" of a midwife (see Shanley, 1994).
Furthermore, evidence supporting UHB tends to be drawn from both "radicals" and non-radicals within the medical establishment and midwifery. Even though the "radicals" represent a minority voice, their views are highly valued. Medical establishment radicals include Dick-Read, (1959) and Bradley, (1981). Others less radical include Kitzinger (1991), Harper (1994), Arms (1996), and Jones, (1995). At times, UHBers go beyond what was intended by the authors who advocate the presence of an expert at the birth.
Warrants represent rationales for UHB claims. Several are included within the UHB movement. They are: (1) birthing women are entitled to choose the type of birth they want, (2) much of medical technology is invasive and personnel are unnecessarily intrusive, (3) birth is a natural process, (4) birthing women are entitled to be in complete control of the birth experience, (5) birth is a sexual event, (6) birth should be a private experience, (7) UHB is safe for mother and baby, and (8) UHB provides the most rewards for all involved. Warrants also assert that birth complications are rare. Financial considerations are not typically included in the discussion of UHB.
Choice. Fundamentally, UHB relies on the fundamental right of women to choose the type of birth they want. Implicit in the argument is the right of women to know the variety of birthing options available to them (Shanley, 1994).
Anti-medical technology and personnel. UHBers assert that much of medical technology is invasive and harmful. Medical exercises in labor induction, fetal monitoring, drugs, episiotomy, c-sections, pubic hair shaving, enemas, etc. are strongly negatively evaluated (Shanley, 1994). Fundamentally, the benefits of such practices, whatever they might be, do not outweigh the disadvantages. Birth-related medical procedures and obstetric personnel do not represent progress for UHBers.
Natural. Birth is set out as a natural process (Griesemer, 1998). Like cats and kittens, the baby decides when she comes out, as well as the period of gestation, not doctors or midwives.
Control. Control refers to the management of the labor and delivery experience. UHBers insist the rational approach is for the woman to maintain control, rather than to turn it over to doctors or midwives (Shanley, 1994). It is legitimately the woman's choice about induction-related procedures, her activity during labor, and position during birth. Any activities carried out by doctors or midwives and legitimized as being in the best interests of the woman and baby when resting control from the woman represent illusions.
Sexuality. Birth involves a woman's genitals, even though we find ways to "desexualize" them with males and females in medical practice and with females in midwifery. Rather than labor being inherently painful, it is sexual, despite certain Jewish and Christian beliefs (see Pagels, 1988). Sexual arousal and orgasm via intercourse, nipple and clitoral stimulation, serve as a natural means of the induction of labor and speeding labor along (Shanley, 1994). Additionally, labor is experienced as a "series of orgasms" (Shanley, 1994, p. 69). For Moran (1997) and Griesemer (1998), the husband catching the child hearkens back to the conception event of intercourse.
Privacy. Privacy is a corollary of the sexuality argument. Certainly if birth is a sexual experience, it should happen alone, or with a partner (Griesemer, 1998). Only intimates should be present. This excludes "male" doctors as well as "female" doctors and midwives.
Safety. The premise set out is that natural birth is safe birth. Women are creating no undue risks when trusting oneself to birth, while relying on information gained in preparation for the birth (Griesemer, 1998).
Rewards. Hospital or clinic birth while in the supine position, medicated, examined, monitored, being surgically cut, and controlled provides nothing in the way of a meaningful birth experience for the parturient woman (Shanley, 1994). The child arrives, but at great cost to the mother and risk to the child. While creating fewer problems than the medical model, midwifery affords a less than optimal birth experience. The most rewarding and fulfilling birth experience is UHB.
Birth complications. UHBers are well aware of one of the most common arguments made by their detractors-birth complications. It is asserted that the woman lacks the expertise to deal with a crisis during the birth. UHBers tend to have two responses. First, in the same way that some women find sadness and loss but not tragedy in a miscarriage, some UHBers readily deal with a stillbirth or death of a child as an event in the natural process (Shanley, 1994). Second, they believe that complications of birth are rare (Griesemer, 1998). When such complications do exist, the prepared birthing woman is able to deal with the situation, else she calls upon a midwife, or visits an emergency room. It is widely held that medical interventions (drugs, surgeries, etc.) are the sources of many problems that women experience.
Financial considerations. While one might expect that the lack of expense involved in a UHB would be included as a rationale, it is typically not used. Criticism, however, is occasionally directed at the medical establishment for the high cost of care, and to a lesser extent midwives.
Except for minor expenses for some equipment and supplies, UHB involves no cost. When paired with no purchased prenatal care, the expense associated with pregnancy is negligible. Even if women obtain some services from midwives or the medical establishment during pregnancy, the costs of UHB are vastly reduced from the alternatives.
The claims made by UHBers are directly related to the freedoms afforded individual and families in many cultures. The conclusion is that women should have choices with regard to her birth circumstances. While UHB is considered the ideal, UHBers believe women who want doctor or midwife involvement in birth should have that right. They do, however, believe such interference does not afford woman and their significant others the opportunity to fully and deeply experience birth. Thus, they seek to persuade others of the viability and legitimacy of UHB.
Their claims are asserted with the realization that UHB is practiced as a private matter and with the understanding that essentially no laws exist today restricting UHB. However, there is some concern that governments in the future might restrict such a practice, parallel to the legal challenges confronted by midwives in some states. Furthermore, they are specifically concerned about the effects of related issues, including the acquisition of birth certificates, immunizations, etc. Thus, the movement seeks to stave off governmental intervention in UHB and to educate the public with regard to birth options. To this point, gaining attention from sympathetic experts and media has not been achieved.
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UHBers maintain firm displeasure with the medical and midwifery models or paradigms of birth. Based upon ideals associated with birth and experience, they reconstruct a model of birth which is radically different. That model or paradigm of birth asserts the normalcy of pregnancy, labor and delivery, and fundamentally that babies do not require nor benefit from the presence of doctors or midwives at birth.
The UHB movement denotes a type of "new social movement," within which numerous grievances address "dimensions of identity" through segmented social movement organizations (Johnston, Larana, and Gusfield, 1994). The outcome is an emerging social movement of "ideas" rather than "association" (Gusfield, 1994). More research examining the role of the Internet in the formation of UHB is needed.
Other implications of this research include the need for a review of contemporary models or paradigms of childbirth subscribed to by sociologists, family researchers, educators, and practitioners. Might we not be guilty of bias in the adoption of certain models or paradigms and the corresponding exclusion of others? Further, to the extent that we are unaware of or ignore the emerging model or paradigm of "unassisted home birth," we ignore our professional responsibility to those who are advocates of and have experienced such births in the past, and those who might choose such an option in the future.
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