Saturday, January 20, 2007

The public face of the alternative childbirth movement

Katherine Beckett's article on maternal choice C-section investigated the theoretical unpinnings of the alternative childbirth movement. In another article, Challenging Medicine: Law, Resistance, and the Cultural Politics of Childbirth (Law & Society Review, Volume 39, Number 1, 2005), she and Bruce Hoffman explore the public face of the alternative childbirth movement. They examine the rhetoric employed in efforts to gain licensure for direct entry midwives. They note that alternative childbirth advocates have crafted their claims for public consumption, modifying them to appeal to legislators, even at the expense of concealing their true beliefs. This article offers us insight into the tactics typically employed by the alternative birth movement in order to generate public sympathy.

Beckett and Hoffman themselves are sympathetic (they agree with the aims of direct entry midwifery) and they are also perceptive analysts. In examining the public rhetoric of the alternative birth movement, they identify particular tactics at work in the claims of the alternative birth movement.
Birth activists located their claims and arguments in a narrative of tradition and continuity, depicting midwifery (like motherhood) as an age-old practice and long-honored profession ...

Birth activists have gone to great lengths to assure lawmakers that their primary concern is maternal - and especially infant- safety... One simply must be concerned about safety in order to be seen as credible. For this reason, many activists have stressed that midwives screen their clients carefully and serve only those deemed ‘‘low-risk.’’ In fact, one of midwives’ main concerns about licensure is that it necessarily limits the kinds of clients they may legally attend and requires them to refuse to serve a ‘‘high-risk’’ client ... In this way, birth activists seeking midwifery licensure have been compelled to adopt a stance that many find objectionable.

Midwives and their supporters have [attempted] to position themselves as the truly scientific ones. Toward this end, birth activists cite a seemingly endless supply of epidemiological studies that conclude that planned home births attended by trained birth attendants are ‘‘as safe or safer’’ than hospital birth for low-risk women. In fact, their lobbying materials consist largely of abstracts of such studies, occasionally accompanied by an article concerning high rates of cesarean section or rising medical costs.

... [F]aith in technology is only part of the cultural story; discourses expressing fear of technology gone awry also abound, and many contemporary social movements -especially the environmental movement- highlight the risks associated with modern technology to great effect. The idiom of ‘‘the natural’’ has proliferated in this context, and the spread of natural foods, natural clothing, and natural medicine suggests that this rhetoric has significant cultural appeal. The importance of living and giving birth ‘‘naturally’’ has likewise been a key theme for the alternative birth movement...

This definition of professional midwifery is quite useful to those seeking licensure. First, it neatly distinguishes midwifery from medicine to bolster the case that midwives are neither medical practitioners nor para-professionals, but rather autonomous health care providers with a distinct area of expertise (i.e., out-of-hospital birth). Second, the inclusion of knowledge of pathology and abnormality in The Midwifery Model of Care legitimates midwives’ efforts to retain the authority to screen and diagnose their clients and to respond to unforeseen, medical emergencies ...

Yet even as they tout their professional qualifications, midwives are (more quietly) modifying what it means to be a professional. Many in the midwifery community have been concerned that the extensive educational requirements associated with professionalization will exclude midwives already trained through apprenticeship, as well as aspiring midwives who are unable to relocate and/or pay for a formal education. In order to include such women, MANA acknowledges ‘‘multiple routes of entry’’ to the profession and allows applicants for the CPM degree to acquire their knowledge and skills through either formal education or apprenticeship; a woman whose education ends with high school can therefore be certified as a CPM. In public and political forums such as state capitol buildings, most midwives do not stress that they may be certified without extensive formal education ...

Midwives and their supporters consistently frame this debate as one centrally about individual choice, arguing vigorously that women have the right to choose where and with whom they will give birth. As the legislative sponsor in California stated, ‘‘At the core of this issue are two simple beliefs: first, that childbirth is a natural process of the human body and not a disease. And second, that a parent has the responsibility and the right to give birth where and with whom the parent chooses . . .’’

Turf Battles
Birth activists further justify their emphasis on choice by arguing that planned home birth with a midwife is a safe choice for most women. As was discussed previously, the claim that midwife attended out-of-hospital birth is relatively safe is supported by references to scientific studies and to midwives’ professional qualifications and expertise. But it is also supported by the suggestion that the doctors who oppose midwife-attended births are engaged in a ‘‘turf battle,’’ and thus that medical claims about lack of safety are suspect...

Through such statements, birth activists invoked a kind of David and Goliath imagery, raising suspicions of opponents’ veracity by highlighting organized medicine’s professional and economic interests in the outcome of these debates.
These claims appear over and over again in publications, public testimony, editorials, and even some scientific papers about natural childbirth and homebirth. In future posts, I plan to examine whether these claims are true, and to look at the way these claims (carefully crafted for public consumption) have been deployed by professional advocates such as Henci Goer and Marsden Wagner.


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