Sunday, February 10, 2008

How homebirth indoctrination works

I came across an article that seeks to explain how a woman becomes a homebirth advocate by rejecting the "dominant obstetric care paradigm". The article, Homebirth as Systems-Challenging Praxis: Knowledge, Power, and Intimacy in the Birthplace, written by a DEM who has a PhD in anthropology, is tendentious and laden with jargon. However, if you can wade through it, it does provide insight into the re-education process that is necessary to believing in the safety of homebirth. Or as the author writes in the abstract:
In this article, I examine the processes and motivations involved when women ... choose to circumvent the dominant obstetric care paradigm by delivering at home with ... direct entry midwives. ... I collected and analyzed homebirth narratives from a theoretical sample of women (n = 50) in two research locales. Findings ... suggest that women who choose to birth at home negotiate fears associated with the "just in case something bad happens" argument... through complex individual and social processes. These involve challenging established forms of authoritative knowledge, valuing alternative ... or intuitive ways of knowing ... Adherence to subjugated discourses combined with lived experiences of personal power and the cultivation of intimacy in the birthplace fuel homebirth not only as a minority social movement, but also as a form of systems-challenging praxis.
Translation from jargon to English: Women who choose homebirth are bombarded by relatives, friends and health professionals warning them about the dangers. This article seeks to explain how they learn to pretend that homebirth is not dangerous.

First, the author points out that although women come to the choice of homebirth from many different backgrounds and for many different reasons, the process of learning to believe int he safety and value of homebirth is the same for all of them.
... [A]lthough there was considerable variation in the details of how each pregnancy and birth unfolded and in how each woman and her family arrived at the decision to birth at home, several themes were repeated in many or even most of the narratives. Using in vivo coding, I identified three predominant themes: (a) redefining authoritative knowledge; (b) embodying personal power/agency, and (c) creating connection/intimacy in the birthplace ...
In other words, the process always involved rejecting the authority of medical experts, coming to believe that the choice to give birth at home expressed personal power, and valuing the relationships formed with others around the decision to give birth at home (particularly the midwife) as much or more than the safety of the choice.

I'd like to concentrate on "redefining authoritative knowledge", because it is often the biggest stumbling block. Common sense tells all women that the hospital is the safest place to give birth. You don't need a degree in medicine (or anything else) to know that serious life threatening complications can occur during birth, and that proximity to doctors and emergency equipment are critical to the survival of the baby in those circumstances. Therefore, the key component in homebirth indoctrination is destroying confidence in doctors and hospitals and replacing it with confidence in direct entry midwifery "knowledge". Cheyney describes the factors that are involved in this process:
Unlearning and relearning a new authoritative knowledge. Participants constructed ... homebirth narratives ... as a means of challenging ... "authoritative knowledge" — or the knowledge on the basis of which decisions are made and actions taken "either because they explain the state of the world better (efficacy), or because they are associated with a stronger power base (structural superiority), and usually both."

...[T]he decision to birth at home is embedded in a refutation of a public narrative (the medical model of childbirth) and a challenge to obstetricians as indisputable experts...
As I have said many times before, defiance is an integral part of homebirth advocacy. The first step is to defy what Cheyney would call medical "authority" and what I would call medical knowledge. How do they, as people with limited education and knowledge of childbirth, learn the habit of defying the accepted "authority" (knowledge) of medical experts?
For women to begin to challenge powerful and widely accepted hospital birth metanarratives, and to move into the realm of social action either by giving birth at home or by becoming alternative birth activists, many described ... a long and arduous process of "unlearning and relearning." Women sought a new, authoritative knowledge as they "hungered for new information" ... especially as they attempted to "make sense of what happened the first time" in a previous hospital delivery. Alternative birthing knowledge was acquired though the Internet and books on midwife-attended birth, as well as through more informal knowledge sharing networks ...

All of the women in the sample faced skepticism and accusations of "selfish irresponsibility" and "unnecessary risk-taking" from friends and family members who were not supportive of homebirth. Many noted that although their own process of unlearning and relearning was challenging, it did not compare to the difficulty of convincing their detractors. As one participant lamented,
When I told my doctor I was thinking of having a homebirth, he said “Cool, and while your at it, don’t bother with a car seat.” . . . He totally discounted me even though I had printed out a full bibliography of over 100 studies on the safety of planned homebirth for low-risk mothers."
... [P]articipants narrated ... a "journey" of unlearning and relearning that enabled them to start assembling new narratives that more closely modeled their lived realities [that]commonly value new sources and definitions of knowledge. Two in particular — embodied knowledge and informed consent — were discussed in detail by participants from a variety of social and demographic backgrounds.
Cheyney accurately captures the rejection of medical knowledge, the substitution of homebirth "knowledge", the bewilderment that accompanies the realization that no one else thinks such "knowledge" is accurate, and the eventual rejection of medical knowledge for "new ways of knowing", particularly "embodied knowledge" such as intuition that are integral steps in the indoctrination of homebirth advocacy.


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