The construction of "choice" in childbirth
The natural childbirth movement has historically placed great emphasis on choice in childbirth options. At the inception of the movement, choice was understood to mean the choice to reject the "medical model" and its associated "interventions". However, it was always framed as a right of women to choose for themselves what constitutes a good birth experience and to choose the level of risk that they wished to accept.As the natural childbirth movement evolved from the province of a small group of social and political activists into an industry of courses, publications, websites and trained professionals, natural childbirth advocates increasingly came into contact with women who make very different choices.
Karreen Rieger addresses this issue as the subsequent evolution of "choice" in her article Telling tales: health professionals' and mothers' construction of 'choice' in childbirth (2000).
Women ... have also been active in influencing changes in the health system. They do not speak with a unanimous voice, of course, and in other work I explore attempts to change childbirth management towards a medical model in the interwar years then subsequently away from it, towards ‘natural birth’. Since the 1960s, childbirth reform groups have defined the problems of contemporary birth in terms of over-medicalisation and the lack of women’s power in managing the process...So the natural childbirth movement, after vigorously emphasizing choice, is now confronted with the fact that many women make different choices than the ones they advocate. Rather than embrace choice for every woman, natural childbirth advocates have fallen back on efforts to discredit women who make unapproved choices. These efforts take two primary forms: claiming that these women are "uneducated" or "uninformed", and claiming that these women have been so thoroughly socialized by the dominant culture that they cannot be trusted to make "authentic" choices.
The birth organisations had already encouraged women to question, to learn about pregnancy and birth and to stand up for their rights in sometimes lively and hostile encounters with health professionals... By the 1990s the critique of medical power had already taken a different turn from the intentions of those who sought women’s right to intervention-free childbirth. ... [S]ome women consciously embrace medicalised birthing. It seems they often come from professional backgrounds and thus value planning and control, having accepted medical ideas of safety and the technocratic culture’s esteem for science ...
... [E]conomic rationalism’s advocacy of the free market has made it fashionable to promote ‘choice’ as something to be exercised by individuals ... Whereas the 1970s reformers’ stressed the need for women to organise collectively to change the ‘system’, as well as to seek out individual education for birth, it seems that the focus has moved towards a more consumerist and highly individual interpretation of ‘choice’. Leading birth educators report that, unlike in the 1970s, most women and their partners, come to them seeking a ‘custom-made’ birth ‘experience’, certainly not to try to change the maternity system...
[A]ccording to both Leslie Cannold and Catherine Deveny,writing recently in the Melbourne Age, women’s options are now being curtailed. They claim that advocates of ‘natural’ childbirth are limiting women’s rights to ‘choose’ medical intervention, reiterating the argument levelled at critics of medicalised birth over the last forty years, that they are making women feel ‘guilty’ for wanting drugs for pain relief in labour. They both argue that, in Cannold’s words, ‘pain is not noble’, is too often underplayed and alternative remedies are not enough...
These efforts to delegitimize women who disagree are ugly. They also raise serious questions about the natural childbirth movement's avowed support of choice. The reality is that the natural childbirth movement does NOT support choice, it supports specific CHOICES, and there is a big difference. In a very real sense, the natural childbirth movement has transmogrified into precisely what is specifically opposed: a cultural model of childbirth that posits that women who disagree do not know enough about childbirth to be allowed to decide for themselves.
Labels: philosophy
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