Friday, October 26, 2007

Birth Fantasyland

One of the striking parallels between religious fundamentalism and birth fundamentalism is the longing for a mythic past that never actually occured. In the case of homebirth advocates, that mythic past bears so little resemblence to the real past as to be nothing more than pure fantasy.

Whenever I need goofy quotes, completely out of touch with reality, I can always count on Jan Tritten, the Editor of Midwifery Today, and this time is no exception:
We are mammals. Most mammals birth fine. So what happened to us? We used to birth fine. Women in "primitive" cultures birth fine. What happened to modern women?..

We need to follow the mother's lead in labor. If empowered, she will birth. We need to tell her she can do it, to help counter the cultural garbage that has accumulated in her mind. Birth works. Authentic midwifery care is there to help. Good midwifery care encourages or allows the unfolding of the birth. Good midwifery care empowers the woman in her pregnancy, helping her clear out the obstacles that culture has put in her brain.
Tritten is talking about a birth fantasyland that never existed. In Birth Fantasyland, women were healthy, strong, in meaningful relationships, and had chosen to have a child. There are no unwanted children in Birth Fantasyland, no teenage mothers, no rape or sexual violence. Every pregnancy is desired.

In Birth Fantasyland, maternal mortality was rare and neonatal mortality only slightly more common. There were no eclamptic seizures, no ruptured ectopics, no retained placentae. The few problems that existed could be prevented or treated with "good nutrition".

Since there were only positive experiences in Birth Fantasyland, the midwives and mothers approached birth as a time of joy and had no fear. They viewed labor as safe, enjoyable, and possibly even orgasmic. They planned to be and were empowered by the experience.

Not surprisingly, Birth Fantasyland bears a striking resemblence to childbirth among homebirth advocates. Every baby is a wanted baby. There are few complications (because all the women who have risk factors are directed elsewhere) and birth is viewed as empowering and as an "achievment".

Guess what? Birth Fantasyland never existed, not within the recent past and not within the ancient path.

Let's look at some numbers. We can compare contemporary homebirth practice (supposedly modeled on Birth Fantasyland), with what we know about fertility in ancient populations.

age at first birth3016-18
years since menarche15+less than 1
life expectancy75-80 years35 years
maternal mortality10 per 100,0001,000 per 100,000
lifetime risk of chilbirth death1 in 40001 in 13
neonatal mortality7 per 100070 per 1000
number of children2.28-10

Are we supposed to believe that in nature teenagers who had 1 in 13 lifetime chance of dying in childbirth, who could expect to have 8-10 children, who had no control over their fertility approached birth without fear? Are we supposed to believe that societies with a 1% maternal mortality rate and a 7% neonatal mortality rate "used to birth fine"? Are we supposed to believe that these same teenagers who left no record of any kind indicating that they found birth empowering, painless or ecstatic, actually approached birth in the same way as 30 year old Western, white women in the 20th century? The entire premise is absolutely absurd.

It is quite obvious that the mythic past that homebirth advocates long for never actually existed, and even the most cursory investigation of ancient societies reveals that it never could have existed.


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