If "natural" childbirth is so natural, why must it be taught?
Becky Mansfield, in the paper The social nature of natural childbirth in the December 2007 issue of Social Science and Medicine, claims that rather than representing a return to nature, "natural" childbirth posits a specific set of social and cultural practices. Mansfield's paper is an excellent and comprehensive overview of the presciptive emphasis of natural childbirth literature.... If childbirth is so natural, how can there be strategies to facilitate it? If it is instinctive, why does it need to be learned? ...Mansfield reviews a variety of natural childbirth publications written for lay people, and identifies 3 groups of social practices that appear to be required for "natural" childbirth to be natural.
1. Activities during birth
The first theme is the variety of activities during labor and delivery that the books represent as necessary for making a non-medicalized birth possible. This theme is "social" because the books represent natural childbirth as something women must do; according to these books they cannot do nothing or just anything.The specific prescribed activities include stress reduction techniques, movement, and management of the environment. For example:
These books represent the right kind of environment, both physical and emotional, as a necessity for labor. Books promote having a range of props to help a woman be active (e.g., squat bars or birth balls) ... The books place even greater emphasis on using the environment to help women be emotionally comfortable, on the premise that the wrong environment increases fear and anxiety (thereby inhibiting labor)while the right one reduces them...2. Preparation
Authors represent hospital rooms as unfamiliar and intimidating, and say they emphasize the patient role and risk of birth. In contrast, they assert that birth goes more smoothly in a familiar environment, such as home, and in a quiet and dimly lit room.
The second theme of these books - preparation - emerges from this emphasis on activities and learning. According to these books, women wanting birth without intervention must prepare themselves by doing a variety of things in advance...Other prescribed forms of preparation include physical preparation "as for an athletic event", emotional preparation and establishing choices in advance.
... What is unique is that the basic information the books promote and provide is not just about birth in general but is also about the natural approach...
Another unique form of information is evidence against standard medical practices. O’Mara claims to base her book on scientific evidence as presented in Oxford University’s Effective Care in Pregnancy and Childbirth, which summarizes current results of evidence-based research. Similarly, Goer’s book claims to translate for the non-expert scientific evidence regarding birth practices, with each chapter devoted to a different procedure. Other books are less explicit in their use of scientific evidence, but as they discuss common problems and procedures, they point out evidence against usual medical approaches and provide tips for how to avoid them.
3. Social support
The emphasis on choice of caregiver and place of birth is one indication that social support ... is considered an integral part of natural childbirth. Overall, these books assert that activity, environment, and preparation are important but are secondary to the proper social setting, which they claim must be fostered over time. The books contend that social support makes natural childbirth possible by helping women build "trust" in themselves, their bodies, and the "natural" process of childbirth...Mansfield concludes:
The role of the caregiver as presented in these books is a complicated one... According to these books, caregivers treat "normal" as a range (rather than an average); they use this expanded benchmark to assess problems and reassure women; and they have a different skill set to help a woman through the birth experience without medical intervention. As a result (and despite their emphasis on instinct), books imply that women need not be responsible for always knowing what to do; they can rely on someone with knowledge, training, and experience to help figure out what is happening and what to do...
Additionally, all the books describe multiple "natural interventions", which include a whole host of "non-pharmacological" practices meant to change the course of labor. Examples include herbal remedies, homeopathy, acupuncture, ... massaging the perineum to prevent tearing, and transcutaneous electronic nerve stimulation (TENs machines) for pain relief. While books represent such interventions as "gentle" or "natural," the message they send is that natural childbirth often does involve actively intervening in the birth process...
... What these books imply is that even unassisted birth (with no birth attendant) requires this kind of social support to help the woman develop her trust in birth. In sum, these books suggest that "letting nature take its course" requires a complex sociocultural milieu that must be fostered through a range of social interactions.
... the medical model sees society as improving on nature, while the natural model rejects ... intervention and aims to return to nature. The results presented here, however, suggest a different way of understanding natural childbirth. The books analyzed in this study represent natural childbirth as requiring social practice to make it successful... Thus, although the central theme first appears to be about letting nature take its course and doing what comes naturally, the books communicate that accomplishing this requires two kinds of social practice, one to remove any barriers that might prevent this from happening and the other to teach women just what it is that might come naturally...
The central finding of this study is that proponents represent natural childbirth as a set of very specific social practices that are seen as facilitating nature, and in so doing, they also present a vision in which nature depends on social practice...
<< Home