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Performing Birth in a Culture of Fear
An embodied crisis of late modernity
Kerreen Reiger
La Trobe University
Rhea Dempsey
'Birthing Wisdom', Victoria, Australia
Abstract
Drawing on recent multidisciplinary work, this paper considers the emerging sense of a crisis around childbirth in late or post-modern western culture. Not only are many health professionals and birth activists expressing concern about rising rates of medical intervention in birth but physiological birth is increasingly defined as difficult and even unattainable. A decline in cultural and individual confidence in women's birthing capacity seems paradoxical in view of women's increased social power and achievement in the modern west, along with their improved health and living conditions. Many feminist theorists are ambivalent about childbirth developments though, seeing natural birth advocates' critiques of technological birthing as essentialist, moralising and patronising towards women's choices.
The paper argues for a theoretical framework that overcomes the tensions between these positions, one which focuses on the interplay between the physiological processes and the internalisation of cultural norms. The paper draws on seemingly disparate work from feminist cultural analysis and philosophy, and from physiology and neuropsychology, to argue that childbirth is collectively and individually performed. It is best seen as an active embodied practice, as a 'biopsychocultural' activity.
The final section of the paper then uses this framework to examine parallels between the challenges of birthgiving and those of intense creative effort in fields such as sport and the arts. It identifies the importance of embodied interactions in managing the crisis of confidence commonly experienced by performers struggling with emotionally challenging tasks. Cultural norms of anxiety and fear of birth can be materialised in the body through social processes that instil or diminish women's confidence of 'doing' childbirth, thus limiting women's capacity to experience the agency of their lived bodies in the performance of birthing.
Keywords
childbirth, feminist theory, embodiment, creative performance, late modern culture
Article Text
Conceptualising birth as social and physiological practice
The cultural diversity of symbolic associations and of birthing practices shows the inadequacy of considering birth as an essential 'biological' phenomenon that just automatically happens to female human beings. Yet the intense emotional and physical processes, including various levels of pain, which are commonly involved in giving birth, are hardly only a matter of cultural ideas. While we do not see birth as the romanticised, naturalised or universal ideal of which some feminist critics accuse the 'natural birth' movement (e.g., Annandale and Clark, 1996), we do argue for a materialist understanding that does not over-privilege culture or discourse. As Susan Bordo (1993) argues, bodies are neither biological automatons nor simply cultural 'texts'. Rather, bodies are the site of the interaction of 'nature' and 'culture', especially through material practices, things that get done to and by bodies. In her analysis of how the contradictions of managing affluence and control in contemporary western culture became 'embodied' as eating disorders, Bordo offers a useful model with which to consider childbirth as involving cultural processes that have material, bodily effect. She considers the body as 'a carrier of culture', arguing that while all embodied experience is mediated by language and symbols, this does not mean that the materiality itself does not matter - embodiment involves constraints as well as potentials (Bordo 1993: 288-9). Birth can be seen therefore primarily in terms of various levels of activity - from broad cultural discourses to local practices and embodied, psychological realities, all of which intersect and over-determine each other in complex ways.
As taking either cultural or biological levels of activity as the starting point privileges one or the other, our analysis commences with Iris Young's (1990a,b,c; 2002) emphasis on the body as a lived, experienced reality, a 'body-in-situation', in which culture and physiology meet. In her essays, 'Throwing like a girl', 'Pregnant embodiment', and 'Breasted experience', and in later work, Young draws on existentialist philosophy to conceptualise our subjective reality as embodied beings. She explores the ways in which feeling conscious of being 'in' one's body involves certain ways of relating to both the body and environment - ways of moving in time and space in order to carry out one's intentions as a human subject. Young argues that we interpret 'the facts of embodiment, social and physical environment... in light of the projects' we seek to accomplish (Young 2002: 415). While recognising diversity of women's reproductive experience, she notes that a sense of being grounded and solid, multiple and changing is a distinctive aspect of the creative process of 'pregnant embodiment'. When it comes to birthing, Young points to the alienation women experience in modern medical settings as their embodied reality is not what authorities consider to be authoritative knowledge (Davis-Floyd and Sargent 1997). In this context, Young's stress on the significance of agency or intentionality diminishes and she offers an image of the birthing woman as largely passive: 'During labor, there is no sense of growth and change, but the cessation of time. There is no intention, no activity, only a will to endure' (Young 1990b: 168). Although Young recognises that western institutional practices limit women in childbirth, she fails here to analyse the actual ways in which they become inscribed in bodily being.
Feminist analyses of the complexity of cultural inscription of the body can be enriched by recent biological work as well as that from cultural studies and philosophy. In particular Fausto-Sterling's ground-breaking account of 'sexing the body' argues that the 'social becomes material', that social arrangements and personal experience become 'written on the body' or rather into the body through establishing neurophysiological patterns (Fausto-Sterling 2000). She points out that 'nature /nurture are indivisible' and that there is no fixed 'biology' as human organisms are always in process. Recent research now shows brains to be surprisingly plastic, capable of developing new cells even in adulthood. The body is thus a dynamic developmental system, always in interaction with its environment. Emotions too are not internal to the individual psyche but flow between people. As Fausto-Sterling comments, understanding 'the social nature of physiological function' requires multiple disciplinary perspectives, ranging from 'feminist critical theorists to molecular biologists' (2002: 235).
What is directly relevant to birthing is the research evidence concerning the crucial role played by oxytocin in the somatisation of emotions. The work of Swedish physiologist, Kerstin Uvnas Moberg (2003), in particular demonstrates how significant biochemical reactions are intrinsically relational. Psychological responses to pleasure and pain, to love and fear, are made manifest in quite specific ways through the role of oxytocin in the neural pathways of the brain, in hormonal responses and through the entire nervous system (Uvnas Moberg 2003). Most importantly, oxytocin develops the mechanisms through which human interactions actually enter the body through touch and other senses. Warmth, security and emotional connection to others produce heightened release of oxytocin (Uvnas Moberg 2003: 21-26). The implications for maternity care of recognising what Uvnas Moberg argues is a complex neural system of connection to others, a parallel one to the recognised 'fight or flight' one, remains to be further explored. If, as it now appears, social processes have direct material effects, not only on the psyche but on all aspects of physiological functioning, the social construction of childbirth is intrinsically and simultaneously embodied. In contemporary late modern or postmodern culture, widespread anxiety and loss of confidence can be seen as producing a normative frame of reference that becomes internalised and, most importantly, enacted by individual women.
Just how this process occurs can be further considered at the theoretical level by extending the concept of 'performativity' which has been developed in the work of Judith Butler (Butler 1990, 1993). Like Jackson's (1999) materialist account of the construction of heterosexuality through everyday practices and interactions, Butler's analysis encourages attention to recurrent processes of repetition or reiteration of norms. For Butler, sex/gender is neither merely biological nor only cultural but a material effect of power systems which both make some bodies matter more than others and shape bodily matter itself (Butler 1993). Some possibilities are opened up, others foreclosed by cultural interpretations of being in a sexed psyche and material body, interpretations which then take material form in the operation of such minds/bodies. Although childbirth has certainly not been Butler's concern, other feminist philosophers have contributed more specific insights into 'conceiving birth' (Ruddick 1994) which are compatible with this analysis. The philosophical distinction between the inert material body and the lived, experienced body (Welton 1998) is essential to distinguishing between the processes of being delivered and giving birth. As already mentioned, Iris Young (1990b) draws attention to the ways in which modern western medical systems tend to produce an experience of bodily alienation in birthing. Her focus on women's 'being in the body', and on patterns of movement and intentionality, points to investigating birthing as an active embodied practice rather than just a passive state of being 'done to' or delivered, though that indeed is often how it is experienced in current medical regimes.
Women share many aspects of their sexual and reproductive processes with other mammals, but their consciousness and hence embeddedness in cultural meanings also shapes their physiological functioning in complex ways. Even seemingly autonomous physiological processes such as contractions that open the cervical sphincter and govern the baby's descent in the birth canal are directly affected by social interactions. These not only enter the body through the senses but also involve unconscious emotional responses. It is not possible here to explore the management of the self through an ego system that is simultaneously psychological/physiological, but as the discussion of the complex role of oxytocin indicates, mind and body operate together. As the ego mediates social influences and physiological processes, embodied subjectivity is indeed fluid and multiple, as post-structuralist theorists such as Grosz (1994), Flax (1993) and others have argued. It is also inescapably social. In birthing for example, as Gaskin (2003) points out, dilatation of the cervix is so highly sensitive to emotion and environment that rough handling by a caregiver can rudely disrupt the finely tuned physiological processes. Gaskin's advice to women and to their caregivers therefore is not to disturb the activity of the primitive brain-stem that manages instinctual behaviours. In telling women to 'let your monkey do it' in birth, the operative term is the first one - the 'doing' of birth is a process of actively surrendering. Women's subjective agency is critical to 'letting' processes develop over which conscious control is impossible, but for which agency in managing contractions, moving the body and responding to action initiated by the baby is still required. As in other forms of sensuous activity such as music or dance, a moving, living, conscious body enacts 'biopsychocultural' processes. In sexual behaviour, which of course includes birth and breastfeeding then, the locus of subjectivity cannot remain in the head, although this is its usual location in western culture (Young 1990b: 165, Flax 1993). It appears that many women in late modern societies increasingly find this displacement difficult to attain and some struggle to integrate mind/body processes.
On the basis of this analysis, we argue then that giving birth needs to be seen as a form of women's agency as sexed subjects, albeit performed more or less willingly and with different levels of emotional investment according to circumstances. Birthgiving, as Sarah Ruddick (1994) argues in extending her account of maternal practice, is something that women in particular do as a process - the term labour of course is not accidental. Their doing or performing though is never unmediated by cultural meanings and practices: at both collective and individual level birth is thus 'done'. However neither hegemonic medical discourse nor its infiltration into contemporary risk culture recognise or value women's agency in performing birth. Rather, both 'cite' or reiterate norms that quite literally construct or materialise the reproductive body as pathological and as the inevitable recipient of professional cure/care. Rather than supporting women to be fully present in their bodies and actively 'birthgiving', many practices hinder the complex mind/body processes involved. Furthermore, their cultural context makes it difficult for contemporary women to overcome the body-mind split and 'go with' processes which are not amenable to rational control (Akirch and Pasveer 2004). Conceiving birth then, or 'reconceiving' it in terms of how social practices become materialised in bodily performance, provides a way of reading contemporary cultural and personal dilemmas of birthing that does not essentialise or moralise, but does give due recognition to women's agency and embodied reality as well as their embeddedness in culture and social relationships. Culture is mediated not only through discourses such as those of medicine, but reiterated in practices and interactions such as those between a woman and her caregivers.
Doing creative performances: body and culture intertwined
If, as we argue, the crisis of normal birthing now being discussed in contemporary western societies is a 'biopsychosocial' problem concerned with a changes in how we are now 'doing' or performing birth, collectively as well as individually, the question of agency in and support for intense creative effort becomes central. Evidence from other forms of creative and peak physical effort, we suggest, can throw light on what is involved. This final section of the paper draws on a series of 12 interviews with people who work intensively in their 'lived bodies' as creative artists, athletes or theatre performers as well as work with a variety of birthing women. This data demonstrates the intense effort of undertaking challenging embodied processes and its relevance to birthing. In conceiving and producing a creative work of theatre, or achieving peak bodily performance in sport, the psychological/ physiological processes encountered are highly individual but also involve others. As the self is social, the role of support becomes critical to sustaining self-direction and to maintaining confidence in the capacity to accomplish the task. The parallels in maternity care emerge in stories of women who report the value of intimate support in labour (Oakley and Houd 1990, Anderson 2000, Reiger 2004, Edwards 2005).
Endnote
1.The interviews of performers were carried out by Rhea Dempsey in the late 1990s as a part of work for presentations in her role as childbirth educator. The discussion also draws on the many births attended by Rhea Dempsey and on 4 focus groups with women who had recently given birth in a rural area of Victoria in 2004. These formed part of a project on the introduction of a team model of midwifery care in a rural hospital carried out by Kerreen Reiger as part of a La Trobe University collaborative grant with industry. LTU financial support and that of Wonthaggi and District Hospital in acknowledged.
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