The
ConsIrueIIon BlFlll
Soelal Of
&l&ng
heart beat. puke a;espir-
ation.Bvl:lOhebonh&wartathe
nmgue: Also
BY
al
Barbara Katz Rothman, M.A.
m-J I”
Ill; afta-
noon. and convark”dy near a has-
z4bbwt
Pital, a three vom-db b4o”deared, blue-eyed child cries ca “ino”n”y? +wsDsa”dfalkover.Atlzl%hetook
inti,~~~~-wilh~d~. cemable puke, heatbeat 01 respSa-
pwple
hare of what k bnlng. Thelr behavior and Interactions dopond on these t”teqwtatkms. I” thk paper, intendto bok at the way we &fine, u”der%tend and mganke the birth oxpedn:ce. and, I” p&u.hr, the importance of the hospital in the eockl canstrwtlon of bkth. Hwnsl beings live I” a ecckl es well es a physkd world. We do not simply see, hex, feel, emeli e”d teete: we Inteqnet what OUTsensestake in, and ov Lnterpretatlonrare bawd on whd we have k,amed from other psople.’ Whs, we tdk to one enothez, we do “ct hear Justwunde, we actually hear words. As you read thk page. you do “ot see the t&we or dae@r of Ink on papor, but reag. “ke UIeie as syymbob,M words. Thk aockl procpo of i”teIpmtethns goes w1 not only for highly atawted thhw Ike lenguega. but for phyekal 0bje.c~ s well. A chair, for L”ete”ce,
I
Barbara Katz Rothman k o doctoml candidate k sociofcxw oh New York Unlversig, and leaches medical soa’ologv al Emoklyn Coflege and other colkgea In the New York orea, in. cfuding the Docunstat.9 Con1inldng Education Proqr”” for Nurses. Her andyak of the rocki consmrdion of birth led to her decklo” to have II home birth three yesn ago. JOURNAL OF NURSE-MIDWIFERY
l
IS SWBI end rewg”ked es e chair, its Purpase reem1ngly otvtous. Yet if om Is there for good (i.e. bringing e chips) or evil (i.e. doing a painful hyskel examination). The sounds of big cart coming down the hell may e mtended for her or may be just “ens for a linen doset next door. he is not famihar enough with the ituatlon to sort out the legitimate mxkty provoking cues horn those hat would not produce anxiety if she understoodthem. And it k particulev Y hnoatent to re&e that one’! he * lmle fueq whenin labor to :itert wcth.and thex P justso much one can keep track of nterprettng her envkonment is a )est en added stress.et worst a con inuing SollIce of ianxlety.
imsp orreality may
o the wonmn laboring at home the sounds heard are :hingsl& T the refrigelator opening. chil hen playing. somebdy calling thei iog. The sounds are not threatenin hey have nothing to do with her II )or and she can make that distinc ,on. She smells chicken cooking. nc medklne and disinfectants.Far her being antiety provooldng.her had ground stimuli ere actually reew ing. providing messagesof normality The cues available to u%in a situ tion include not only phyrcel object but perceived behevi&. &d even th way we see ourselvesacting. Huma beings ten and do take objective zu count of themselves,see themselvc in the seme ways they %e others.h instance. we’ve probably all had th experience of not realizing ho nel”ollS we were until we notice oursdves dammerlng, or behavir awkwardly. The cues we get fro OUT own -behavior are en importa part of how we understand whet happening to us. This has interestir implicationrforchlldbiah. Mergewt Myles speang et ti Metemity Center Assoc&tion of NO Vol. XXII, No. 2, SummerfP77
I workeiThe &?-exp!~matfon sdt heeffectiveneeeoftheeemahodrr hd the concentr&on on tmahhg docks~o~tbesenmtfonrdpetn iolwer, it is lntere3tkwba women xwtke their br&hkg uhtt ddvin!& or wetd?tng teiawm. >rreading.dladMtie.th&them&es require some kvet of atenkXl.Cellitbeth~tbebXe&ngk it&&g enough to teke you mtnd L4fpain,bUttidiSkeLiklg~oghto fake your mind off the med? He& likely. I beueve that th reamn thet Dreathing ex?rdses wa)rsoveltin the control of pain in dlik?hmh ietha theyerepwentingthewnenu+th posnh!ecws regardbIg beI ewdion. ffshewerenotdotnghab shemigl-dveryweUbeayhg~~ ing. Her ebikty to obfecth& ovduate her own situatkm, kddng cues fmm hero~behavtoreswlleethaof others, hecomes very impxt&. The womenwhohesjustgottendmxgb 8 contmction witboU a@w out has presented herself with evtdexe thzJ it is bearable, b333u.w if it wolp not bearable. she knows she u&d be ayingWhdIamsugg&iwirthd this works as e m(Re stmctu4 version of whenowr I M &ad, I whistle a happy tune” Whena-crinhsoan home, perhaps with her ca on her lap or watching her older d-&d play. some nice recordsInthebxkgmwd, thesoundrofsomeowfixingfoodin the kitchen, end she is mnceo on her breathing pettem. dl cues aveilabk to her ere that eJl is ~ell.it~U!dhdiffkUkto-ie althatnorm&tywiththei&athet
bed,withenNinherean,heetng strangsn cwning in and o cues available to ha em no different then the ewe she coetd f-~onp4212) t1
[email protected] hrd to me&et” e sense of heatlh @ oomwltty when the cues around ~rendsI&ap.Ailyouce”wk for h conud ovex pab and the oxmofpsir. The meswges thd the bIrthha wommpkhsup6mnthecwsav~l. Me to h= b the hospital are not ln2ted to the wm&ty, he&h and rrldtvc p&n of .ter s2utJbn The d&2b” of the ah&on goes “n&h deepr than the& to the very he& of tiz2 k heppenba end who contmb whet k happenbg. l’hk k hw rw”@nedbythelwolthewofd “?hdivtu’ Both mothers and bkth et. teadads em said to deliver babkt. When the mother is seen es d&s tna. thw the ettondmt la -a, eldlng, lttemlly &en&g. But when the doctor a nuse-nttdunfe ts dellv. ettrg the baby, the” the mother Is I” the ~e%ve position of being ddlv emd. The words uwT?d are, of course, the feart of the CUOIthet the l&&g woman receives regarding the tmjxxtmce of hez contrlbtuon to the adh%y bldrg pbw, the delivery of hs b&y. t has tee” suggestedthat there are thwe baskmodek of I tdationshbs! Lel us conidaexh with reasi to cht!dbl 1. The fkst ki the Acttve.Pesslw rebtb”ship, pr&ubrly appEz.¶t&to the u”con&os petlent In M e”x,g. eocy sltuatbn The doctor makes dl de&b”* end thepaknt k”worked on” b much the same way one doss mechat repairs.In the chlldtetth e&b” this rolanonhb is Qptfkd kV the doctor wing folcetM to pull the baby oul of an uncon~bos mothor. The doctm not only has fomplete control, all pawar and ectivity once the ntothet is unoonscKm%but 2 k the physicb” who ha the autbtiy to &flne normal, “MaUons fromnormal. ar.d otxt&kal emorg~nda, es well es the ‘Mete” of the patk~t. The physkzk” hw powor not oi-dy when the reletbnahip is Actbe.P&w. but holds the txwer to cxew tha mletb”sh~ hy MOSthethkigthamolher.
Dndiuun0
12
patipnt-
Mknt rebtbnhb Is Ctukim,coZootxxMo”. Th6 pncnaonS auldu
2wcibn ewlly. En&Ibmh, I bdkv.3 ha this ts krt typtfwd by the I”. vxpitat “wspmtd” chthibitth The aboring M”m” * there to be aeched. AU the txe”w2bn she hsl lad bra taught h& to work wtthinthe ienwwotk of the h-d ruleas. be loams. for ex?mde, tedmbws or breathby through-an “ncomim. tblo tmdez fmmbed to tablo. end inernotlean to questbn the r&es5iy of such e tmnskr. She Ie.x”a uheretopbcetihadssothathey till not be &r-d dam on the klively table. She leans what the ules zue, end how to avotd hreekina hem.
b&
The hospital patient is in no gosition to be an equal participant her birthing
in YY
lhe thkd posalhle rebtbnrhip Is tiutunl Pwtklpdbn, t” whbh pmt. itbntr snd p&lent work tog.zthe nowards II wmnmn goz.L En child. birth, it is pmbsbly pose&lo, thotut. ve?y&fftcult, to echkve thtw&bn rhb in a” lnstibtbnd settIne It flows ntimlly. howevet. in a ho;,e td& whsre the ettvndant k cleaiv hired ty end guest d the mother. 6e ho+ pltd prlient k II no podtbn equal twHcipa~t In her bkthbg. Shr is out~wmhered end oUpowered She m*y bs allowd to ad es tf shy were *R equal pmtkipti even Mnf e patknt edwcete (h&d, coach] with her, but should she stop pkyinf by the rule end become dlmee able, dlffkult or dkruptive, e, defbc by the bttih attendmts .md hosp2e Mf, hu tiue powerbs”~ is rnad~ clear. Her advocate k thsre only I bng a8 the hospttal attendantr chow to ellowhhn there. It is perhaps for thb t-” that N much empharls ts put o” con& o
tobean
both p.dn end the exprwion of pal” In prepzez2b” for Ch2dkMh C’bmer Aaordbgtother&softhegan4Lf the Iwomen chooser to dez4 withhapeinbyayingorcddlngout, the bar fo&ted hs tit to dodsion making. t&h is madi b childbirth preperetb” d&s of Wng I” control dulng labor, while till tha Is moat by thet k bebg I” Cntml ova expwmbno of pain. A woma wtro maintains a ftxed,tf wnwvhat +d cheerful -on. and conttnuer txedhbaptdtemsreguledy,ksaIdm he ‘in control” as she IS eated from one mom to an&s end l~terelly eimpped tint on ha back with her logSt”thealr.
Cettidnly a womm who was u”. mnscbus. roml4Uperow, amnedac or s”nply nunb from the waist doum crmnot hew ~erknced ha blrthbg es an scmmplirhment, something over whkh he had control But what of the viv”tm who k e”muqed to to see hers& es L member of II “team” delfwna the beby? Though she may help, and wach h e minor, she k not the pimay bun of action. Po+itbnhs and drepbe her b soch e WY the4 &e can&tdirectly see the bkth, end not ellw4ng ha to touch her genti and the forthcoming babvt&themotherthstLebhth!a
that
soidhhg Is hagpenbg to he& or hbq done to ha, end not somethlna she Is dobg. The Mrth Is msneged by the othu mamlxrs of the teem, the oned who are telling her what to do, end us&g the& hmds on h.xendthoheby.
A t&th IS en excmna a th,ilUnrr thing to see. But It Is aneven “Ior0 ~xcitlna cod thrtlllr~gthbg to do. En. co:meaI”a e woman to watch herself alve hkth In u mtmx moves her from to okerver of the bhth. I em not sug@i”g that wlxne” be de”kd mtmxstf they wont them. But I am sugeos4lvyl th& the emphscison “‘welng” the ldrth comes out of the conteti of pnpered In-hospital, dottordirected hi&r. The womm ,L awke, encoueged to see he&f as pal of the tezen and help the doctor hy folloM”a Hyl(Wltlonr and dtrae.
Ptltlklpant
JOURNAL OF NURSE-MIDWIFERY
l
Vol. IMU, No. 2, SU”vn.rl277
t*on*. But
the hospital
members
of
that team have had most of their expe%ie”ce delivermg babiss without the active ~artkl”atio” and helo of the mother: Th&know that they’& get that baby delivered with or without the woman’s coopaat~o”. If she wants to be awake. “be thae” for the bkth, then the only mle that they have to offer hex is as &sewer. She can watch the birth like anyone else. Her head is there and her genitals are there; but a.5 I” the gynecological examination, it is hard for doctors to see them as both belon9ing to the same person at the same time. The lmpiications of an Active. Passive or Guidance-Cwperatfon model for birth extends bevond the Mtthing experience and intd the rela. tlonshlp w”h the babv. When the hospit& staff, whethn doctor or nurse-midwife, perceived as having delivered the baby, then It is the re. sponslMlity and privilege of the staff to present the baby to the mother. The mother thus becomes the reclp,. ent rather than the producer of the child. The less acttvethe mother was In the birth and the more time that has elapsed between the birth and the presentatlo”, the more clearly the baby is a product of the hospital. The very miracle of birth Is that the baby is at the same “me part of the mother’s body and yet a separate person. There are others who are better quaiifled than I to discussthe psycholag& cal effects on maternal infant bonding‘. and the physiological effects o” iaclation, of alternative treatments of the newborn. But I ask you to consider the implications for whose baby It really ir I” the various ways new. boms are processed.
is
A mother unmnxiousfor the birth and presented six or twelve or twen. ty-four hourslater with a baby under. standably has a hard time grasping and dealIn9 with what has happensd t.a her. Her pregnancy terminated. She has a baby. Those two facts are clear enough, but the relation betwoen them is submerged. Even w”wn who are cons~lous for the birth, but who do not perceive It as smnething which they have JOURNAL OF NURSE-MIDWIFERY
l
done by their own efforts,may have some difficulty in assimilattng what
has happened. As one mother, awake but unable to feel the bi,th. has said, “It’s like seeing a rabbit pulledodofah~“Boingthehatisafar cry from being the magfda”. It is the riciSht of hand that makes a magic hick. things done that the audience cannot see. Similarly, continuity Is lacking in a bMh I” which the babe is held up for the mother to me but not towh and then taken out of her sight for pmce%ing. r,ecording. and pmphylaaic treatment. When the baby is returned, wiped off and waddled, in hospital “uniform” it or one step further removed from the immediate product of birth. The! newborn 1sabruptly changed from being part of its moth& body to a standard issue hospital baby. But when the motha fe& herself giving birth to her baby by t er own
efforts, with whatever h& she needs, when she holds the baby while the cord still physically mm nects It to her, the full reality of bbih Is before her. Nancy MUk. a lay midwife who has done hundreds oi home births. now encouragea women to touch the baby’s head when It is cmwnin9, to feel it emerge with their hands. One woman late told her, ‘1 felt I was 9ivln9 birth tc my&+ and my baby.“’ The baby i! part of the mother. The acceptance of the baby as a separate perao” can follow slowly, during a period of psy chological weanin9. and not as a fail acccmpli. The issue of control over the bab) continues I” the days after birth. A baby in a hospital nursery is controlled by that nwse~y. The m&he! has accessto it only with the apprw .I of the nursery staff. The baby ir brought to the mother but returned to the nursery. Consider the ci.sslc scenario of the mother being wheeled to the front door of the hos pital and handed her baby to take horn, In more or less subtle forms the message is that the baby is L produd of the hospital which the parents bring home with them. Afta three or five days or more of beins Vol. XXII, No. 2, Sum”w1977
cared for by the ~ofes&n& a”d experts,thebabyisentmstedtotf,e paents. It pnters the mother’s Me nat as a co”u”uatf0” of the pmgM”cy and birthing experience. still more or lesspat of her, but as a stranger. has been the 9.~4 of this peper to paint old the ways in which the bbth experience is socfaib consbucted. from the acknowledwnent of labor the care of the newborn. Pahaps the most i”lpata”t “lessage tha can bedrawnfmmaliofthisbmthow the hospital sbwhtres the b4xthexp&ace, but simp$ that a does that outside the how it is the birthing worm who doRneswhat is * pening and what it means, and in the ho@4 insmutiand deff”f&ms take precedence. Demmtbxg home-!&e labor mans, designing more cornfortable labordelivery beds and atlowing roomi”@ 9v a lamg way toward making biih in hospital a more pleasant experience. But they do not change the fundanontd balance of power betwee” the individual and the insiftutfo”. In ou so& ety the stmggie for in&k&d control against institutional dem;n& ir MI a problem unique to childlath
It
to
ConsIrueIIon BlFlll
Soelal Of
&l&ng
heart beat. puke a;espir-
ation.Bvl:lOhebonh&wartathe
nmgue: Also
BY
al
Barbara Katz Rothman, M.A.
m-J I”
Ill; afta-
noon. and convark”dy near a has-
z4bbwt
Pital, a three vom-db b4o”deared, blue-eyed child cries ca “ino”n”y? +wsDsa”dfalkover.Atlzl%hetook
inti,~~~~-wilh~d~. cemable puke, heatbeat 01 respSa-
pwple
hare of what k bnlng. Thelr behavior and Interactions dopond on these t”teqwtatkms. I” thk paper, intendto bok at the way we &fine, u”der%tend and mganke the birth oxpedn:ce. and, I” p&u.hr, the importance of the hospital in the eockl canstrwtlon of bkth. Hwnsl beings live I” a ecckl es well es a physkd world. We do not simply see, hex, feel, emeli e”d teete: we Inteqnet what OUTsensestake in, and ov Lnterpretatlonrare bawd on whd we have k,amed from other psople.’ Whs, we tdk to one enothez, we do “ct hear Justwunde, we actually hear words. As you read thk page. you do “ot see the t&we or dae@r of Ink on papor, but reag. “ke UIeie as syymbob,M words. Thk aockl procpo of i”teIpmtethns goes w1 not only for highly atawted thhw Ike lenguega. but for phyekal 0bje.c~ s well. A chair, for L”ete”ce,
I
Barbara Katz Rothman k o doctoml candidate k sociofcxw oh New York Unlversig, and leaches medical soa’ologv al Emoklyn Coflege and other colkgea In the New York orea, in. cfuding the Docunstat.9 Con1inldng Education Proqr”” for Nurses. Her andyak of the rocki consmrdion of birth led to her decklo” to have II home birth three yesn ago. JOURNAL OF NURSE-MIDWIFERY
l
IS SWBI end rewg”ked es e chair, its Purpase reem1ngly otvtous. Yet if om Is there for good (i.e. bringing e chips) or evil (i.e. doing a painful hyskel examination). The sounds of big cart coming down the hell may e mtended for her or may be just “ens for a linen doset next door. he is not famihar enough with the ituatlon to sort out the legitimate mxkty provoking cues horn those hat would not produce anxiety if she understoodthem. And it k particulev Y hnoatent to re&e that one’! he * lmle fueq whenin labor to :itert wcth.and thex P justso much one can keep track of nterprettng her envkonment is a )est en added stress.et worst a con inuing SollIce of ianxlety.
imsp orreality may
o the wonmn laboring at home the sounds heard are :hingsl& T the refrigelator opening. chil hen playing. somebdy calling thei iog. The sounds are not threatenin hey have nothing to do with her II )or and she can make that distinc ,on. She smells chicken cooking. nc medklne and disinfectants.Far her being antiety provooldng.her had ground stimuli ere actually reew ing. providing messagesof normality The cues available to u%in a situ tion include not only phyrcel object but perceived behevi&. &d even th way we see ourselvesacting. Huma beings ten and do take objective zu count of themselves,see themselvc in the seme ways they %e others.h instance. we’ve probably all had th experience of not realizing ho nel”ollS we were until we notice oursdves dammerlng, or behavir awkwardly. The cues we get fro OUT own -behavior are en importa part of how we understand whet happening to us. This has interestir implicationrforchlldbiah. Mergewt Myles speang et ti Metemity Center Assoc&tion of NO Vol. XXII, No. 2, SummerfP77
I workeiThe &?-exp!~matfon sdt heeffectiveneeeoftheeemahodrr hd the concentr&on on tmahhg docks~o~tbesenmtfonrdpetn iolwer, it is lntere3tkwba women xwtke their br&hkg uhtt ddvin!& or wetd?tng teiawm. >rreading.dladMtie.th&them&es require some kvet of atenkXl.Cellitbeth~tbebXe&ngk it&&g enough to teke you mtnd L4fpain,bUttidiSkeLiklg~oghto fake your mind off the med? He& likely. I beueve that th reamn thet Dreathing ex?rdses wa)rsoveltin the control of pain in dlik?hmh ietha theyerepwentingthewnenu+th posnh!ecws regardbIg beI ewdion. ffshewerenotdotnghab shemigl-dveryweUbeayhg~~ ing. Her ebikty to obfecth& ovduate her own situatkm, kddng cues fmm hero~behavtoreswlleethaof others, hecomes very impxt&. The womenwhohesjustgottendmxgb 8 contmction witboU a@w out has presented herself with evtdexe thzJ it is bearable, b333u.w if it wolp not bearable. she knows she u&d be ayingWhdIamsugg&iwirthd this works as e m(Re stmctu4 version of whenowr I M &ad, I whistle a happy tune” Whena-crinhsoan home, perhaps with her ca on her lap or watching her older d-&d play. some nice recordsInthebxkgmwd, thesoundrofsomeowfixingfoodin the kitchen, end she is mnceo on her breathing pettem. dl cues aveilabk to her ere that eJl is ~ell.it~U!dhdiffkUkto-ie althatnorm&tywiththei&athet
bed,withenNinherean,heetng strangsn cwning in and o cues available to ha em no different then the ewe she coetd f-~onp4212) t1
[email protected] hrd to me&et” e sense of heatlh @ oomwltty when the cues around ~rendsI&ap.Ailyouce”wk for h conud ovex pab and the oxmofpsir. The meswges thd the bIrthha wommpkhsup6mnthecwsav~l. Me to h= b the hospital are not ln2ted to the wm&ty, he&h and rrldtvc p&n of .ter s2utJbn The d&2b” of the ah&on goes “n&h deepr than the& to the very he& of tiz2 k heppenba end who contmb whet k happenbg. l’hk k hw rw”@nedbythelwolthewofd “?hdivtu’ Both mothers and bkth et. teadads em said to deliver babkt. When the mother is seen es d&s tna. thw the ettondmt la -a, eldlng, lttemlly &en&g. But when the doctor a nuse-nttdunfe ts dellv. ettrg the baby, the” the mother Is I” the ~e%ve position of being ddlv emd. The words uwT?d are, of course, the feart of the CUOIthet the l&&g woman receives regarding the tmjxxtmce of hez contrlbtuon to the adh%y bldrg pbw, the delivery of hs b&y. t has tee” suggestedthat there are thwe baskmodek of I tdationshbs! Lel us conidaexh with reasi to cht!dbl 1. The fkst ki the Acttve.Pesslw rebtb”ship, pr&ubrly appEz.¶t&to the u”con&os petlent In M e”x,g. eocy sltuatbn The doctor makes dl de&b”* end thepaknt k”worked on” b much the same way one doss mechat repairs.In the chlldtetth e&b” this rolanonhb is Qptfkd kV the doctor wing folcetM to pull the baby oul of an uncon~bos mothor. The doctm not only has fomplete control, all pawar and ectivity once the ntothet is unoonscKm%but 2 k the physicb” who ha the autbtiy to &flne normal, “MaUons fromnormal. ar.d otxt&kal emorg~nda, es well es the ‘Mete” of the patk~t. The physkzk” hw powor not oi-dy when the reletbnahip is Actbe.P&w. but holds the txwer to cxew tha mletb”sh~ hy MOSthethkigthamolher.
Dndiuun0
12
patipnt-
Mknt rebtbnhb Is Ctukim,coZootxxMo”. Th6 pncnaonS auldu
2wcibn ewlly. En&Ibmh, I bdkv.3 ha this ts krt typtfwd by the I”. vxpitat “wspmtd” chthibitth The aboring M”m” * there to be aeched. AU the txe”w2bn she hsl lad bra taught h& to work wtthinthe ienwwotk of the h-d ruleas. be loams. for ex?mde, tedmbws or breathby through-an “ncomim. tblo tmdez fmmbed to tablo. end inernotlean to questbn the r&es5iy of such e tmnskr. She Ie.x”a uheretopbcetihadssothathey till not be &r-d dam on the klively table. She leans what the ules zue, end how to avotd hreekina hem.
b&
The hospital patient is in no gosition to be an equal participant her birthing
in YY
lhe thkd posalhle rebtbnrhip Is tiutunl Pwtklpdbn, t” whbh pmt. itbntr snd p&lent work tog.zthe nowards II wmnmn goz.L En child. birth, it is pmbsbly pose&lo, thotut. ve?y&fftcult, to echkve thtw&bn rhb in a” lnstibtbnd settIne It flows ntimlly. howevet. in a ho;,e td& whsre the ettvndant k cleaiv hired ty end guest d the mother. 6e ho+ pltd prlient k II no podtbn equal twHcipa~t In her bkthbg. Shr is out~wmhered end oUpowered She m*y bs allowd to ad es tf shy were *R equal pmtkipti even Mnf e patknt edwcete (h&d, coach] with her, but should she stop pkyinf by the rule end become dlmee able, dlffkult or dkruptive, e, defbc by the bttih attendmts .md hosp2e Mf, hu tiue powerbs”~ is rnad~ clear. Her advocate k thsre only I bng a8 the hospttal attendantr chow to ellowhhn there. It is perhaps for thb t-” that N much empharls ts put o” con& o
tobean
both p.dn end the exprwion of pal” In prepzez2b” for Ch2dkMh C’bmer Aaordbgtother&softhegan4Lf the Iwomen chooser to dez4 withhapeinbyayingorcddlngout, the bar fo&ted hs tit to dodsion making. t&h is madi b childbirth preperetb” d&s of Wng I” control dulng labor, while till tha Is moat by thet k bebg I” Cntml ova expwmbno of pain. A woma wtro maintains a ftxed,tf wnwvhat +d cheerful -on. and conttnuer txedhbaptdtemsreguledy,ksaIdm he ‘in control” as she IS eated from one mom to an&s end l~terelly eimpped tint on ha back with her logSt”thealr.
Cettidnly a womm who was u”. mnscbus. roml4Uperow, amnedac or s”nply nunb from the waist doum crmnot hew ~erknced ha blrthbg es an scmmplirhment, something over whkh he had control But what of the viv”tm who k e”muqed to to see hers& es L member of II “team” delfwna the beby? Though she may help, and wach h e minor, she k not the pimay bun of action. Po+itbnhs and drepbe her b soch e WY the4 &e can&tdirectly see the bkth, end not ellw4ng ha to touch her genti and the forthcoming babvt&themotherthstLebhth!a
that
soidhhg Is hagpenbg to he& or hbq done to ha, end not somethlna she Is dobg. The Mrth Is msneged by the othu mamlxrs of the teem, the oned who are telling her what to do, end us&g the& hmds on h.xendthoheby.
A t&th IS en excmna a th,ilUnrr thing to see. But It Is aneven “Ior0 ~xcitlna cod thrtlllr~gthbg to do. En. co:meaI”a e woman to watch herself alve hkth In u mtmx moves her from to okerver of the bhth. I em not sug@i”g that wlxne” be de”kd mtmxstf they wont them. But I am sugeos4lvyl th& the emphscison “‘welng” the ldrth comes out of the conteti of pnpered In-hospital, dottordirected hi&r. The womm ,L awke, encoueged to see he&f as pal of the tezen and help the doctor hy folloM”a Hyl(Wltlonr and dtrae.
Ptltlklpant
JOURNAL OF NURSE-MIDWIFERY
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Vol. IMU, No. 2, SU”vn.rl277
t*on*. But
the hospital
members
of
that team have had most of their expe%ie”ce delivermg babiss without the active ~artkl”atio” and helo of the mother: Th&know that they’& get that baby delivered with or without the woman’s coopaat~o”. If she wants to be awake. “be thae” for the bkth, then the only mle that they have to offer hex is as &sewer. She can watch the birth like anyone else. Her head is there and her genitals are there; but a.5 I” the gynecological examination, it is hard for doctors to see them as both belon9ing to the same person at the same time. The lmpiications of an Active. Passive or Guidance-Cwperatfon model for birth extends bevond the Mtthing experience and intd the rela. tlonshlp w”h the babv. When the hospit& staff, whethn doctor or nurse-midwife, perceived as having delivered the baby, then It is the re. sponslMlity and privilege of the staff to present the baby to the mother. The mother thus becomes the reclp,. ent rather than the producer of the child. The less acttvethe mother was In the birth and the more time that has elapsed between the birth and the presentatlo”, the more clearly the baby is a product of the hospital. The very miracle of birth Is that the baby is at the same “me part of the mother’s body and yet a separate person. There are others who are better quaiifled than I to discussthe psycholag& cal effects on maternal infant bonding‘. and the physiological effects o” iaclation, of alternative treatments of the newborn. But I ask you to consider the implications for whose baby It really ir I” the various ways new. boms are processed.
is
A mother unmnxiousfor the birth and presented six or twelve or twen. ty-four hourslater with a baby under. standably has a hard time grasping and dealIn9 with what has happensd t.a her. Her pregnancy terminated. She has a baby. Those two facts are clear enough, but the relation betwoen them is submerged. Even w”wn who are cons~lous for the birth, but who do not perceive It as smnething which they have JOURNAL OF NURSE-MIDWIFERY
l
done by their own efforts,may have some difficulty in assimilattng what
has happened. As one mother, awake but unable to feel the bi,th. has said, “It’s like seeing a rabbit pulledodofah~“Boingthehatisafar cry from being the magfda”. It is the riciSht of hand that makes a magic hick. things done that the audience cannot see. Similarly, continuity Is lacking in a bMh I” which the babe is held up for the mother to me but not towh and then taken out of her sight for pmce%ing. r,ecording. and pmphylaaic treatment. When the baby is returned, wiped off and waddled, in hospital “uniform” it or one step further removed from the immediate product of birth. The! newborn 1sabruptly changed from being part of its moth& body to a standard issue hospital baby. But when the motha fe& herself giving birth to her baby by t er own
efforts, with whatever h& she needs, when she holds the baby while the cord still physically mm nects It to her, the full reality of bbih Is before her. Nancy MUk. a lay midwife who has done hundreds oi home births. now encouragea women to touch the baby’s head when It is cmwnin9, to feel it emerge with their hands. One woman late told her, ‘1 felt I was 9ivln9 birth tc my&+ and my baby.“’ The baby i! part of the mother. The acceptance of the baby as a separate perao” can follow slowly, during a period of psy chological weanin9. and not as a fail acccmpli. The issue of control over the bab) continues I” the days after birth. A baby in a hospital nursery is controlled by that nwse~y. The m&he! has accessto it only with the apprw .I of the nursery staff. The baby ir brought to the mother but returned to the nursery. Consider the ci.sslc scenario of the mother being wheeled to the front door of the hos pital and handed her baby to take horn, In more or less subtle forms the message is that the baby is L produd of the hospital which the parents bring home with them. Afta three or five days or more of beins Vol. XXII, No. 2, Sum”w1977
cared for by the ~ofes&n& a”d experts,thebabyisentmstedtotf,e paents. It pnters the mother’s Me nat as a co”u”uatf0” of the pmgM”cy and birthing experience. still more or lesspat of her, but as a stranger. has been the 9.~4 of this peper to paint old the ways in which the bbth experience is socfaib consbucted. from the acknowledwnent of labor the care of the newborn. Pahaps the most i”lpata”t “lessage tha can bedrawnfmmaliofthisbmthow the hospital sbwhtres the b4xthexp&ace, but simp$ that a does that outside the how it is the birthing worm who doRneswhat is * pening and what it means, and in the ho@4 insmutiand deff”f&ms take precedence. Demmtbxg home-!&e labor mans, designing more cornfortable labordelivery beds and atlowing roomi”@ 9v a lamg way toward making biih in hospital a more pleasant experience. But they do not change the fundanontd balance of power betwee” the individual and the insiftutfo”. In ou so& ety the stmggie for in&k&d control against institutional dem;n& ir MI a problem unique to childlath
It
to
