Thursday, July 27, 2006

Experience vs. Knowledge

Responding to my comment that so much of what natural childbirth advocates have been told about childbirth and midwifery simply isn't true, Danielle says:
"I would say the majority of people debating here are here because of what they have *experienced*, not because of what they have been *told*!!!"
I know that many natural childbirth advocates would passionately agree with that statement, but let's take a closer look. There are two different questions that are raised by this statement. How have advocates experiences been mediated by what they have read? How much of what advocates claim as a knowledge base is actually true?

I would not think of disputing any woman's experiences, but I would ask whether the experience came before exposure to the natural childbirth advocacy literature or after. Certainly some women have bad experiences and then read the literature and find that it resonates with them. But those women seem to be few.

I would suggest that in most cases, advocates read the natural childbirth literature (or the homebirth literature, or the waterbirth literature) and that shapes their experiences. If the experiences came first, then we would find that these experiences throughout time, and across cultures. However, the descriptions of labor pain as "empowering", the reports of "orgasmic" birth, etc. seem to be restricted to white, Western, well-educated and relatively well off women who have given birth within the past 100 years.

Take waterbirth as an example. Essentially no one gave birth in water until Michel Odent told them that they should. If waterbirth represents an aspect of natural childbirth, it most certainly would have been practiced in other times and in other cultures. If the urge to labor in water were inherent, we should be able to find women who labored in water before Michel Odent made his pronouncements, and in places where people have never heard about Michel Odent or his colleagues. Yet that is not what we find at all. The urge to labor in water, indeed the entire practice of laboring in water, basically did not exist until a man made it up.

The second aspect of this issue is what natural childbirth advocates claim to "know" about childbirth that has nothing to do with what they personally experienced. A lot of the claims about the benefits of natural childbirth are knowledge claims, not experience claims. Natural childbirth advocates do not say: Natural childbirth was healthier for me and my baby. They say: Natural childbirth is healthier for mothers and for babies. A substantial portion of these knowledge claims are simply untrue.

For example:

"Birth is inherently safe because it is natural."

"The neonatal and maternal mortality rates in nature are relatively low."

"The neonatal and maternal mortality rates dropped dramatically in the last century because of better hand washing and cleaner water."

"Modern midwifery recreates childbirth as it existed in nature."

"The pain of childbirth is a result of the medicalization of childbirth."

"Epidural anesthesia is harmful to babies."

"If you blunt or eliminate labor pain, you will impair the mother-infant bond."

"Scientific research shows homebirth to be as safe as or safer than hospital birth."

These are all knowledge claims and none of them are true. A woman would only learn about them from reading the natural childbirth advocacy literature, because that is the only place that these claims appear. They do not appear in the medical literature and they are not things that can be directly experienced, or generalized from the experience of an individual woman.

I don't doubt that many natural childbirth advocates had bad experiences in the hospital or that they had better experiences with midwives. That's not surprising because, in most places, midwives are a lot nicer than doctors. However, I would claim that the interpretation of these experiences are mediated in large part by the natural childbirth literature (since nothing similar happened before the literature existed and nothing similar happens in places without access to the literature). Furthermore, since the natural childbirth literature is filled with myths, falsehoods, and outright lies, a good deal of the knowledge claimed by natural childbirth advocates is simply not true.


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