sara wickham
It
is my belief that an understanding of where
we have come from can help put into perspective
some of the issues facing women today.
When asked to present a paper in an area of
clinical midwifery, I often start by outlining the
history of this area in order to put the issues
into perspective. For instance, the
history of
perineal care makes enlightening reading.
Historically, manual interference in physiological
birth was not only unknown but ‘deplored’ by
those attending women (Floud 1994). It
would
appear that the perineum was not even ‘discovered’
until Louis XIV of France decided he wanted
to watch his mistress give birth. The
attending
doctors realised it gave them a bird’s eye view
of the woman’s perineum and started expecting
all women to adopt this position to give birth.
The impact of this both on women’s perception
of birth and the outcomes of their labours is immeasurable.
Once
in view, the perineum then became a
target for all manner of manoeuvres and interventions,
the efficacy of which still remain a hot topic
of debate today. Such a hot topic,
in fact,
that a large trial has recently been conducted in
the UK to see whether it is better to have
“hands on” the perineum, or “hands poised”
and nearby as the baby is born. (McCandlish
et al
1998) In the face of such rigorous
scientific testing,
it is easy to forget to question why we face the
situation we do today. Would this
practice
be in question if not for the so-called “Sun King”
and another gentleman by the name of Pomeray,
who coined the concept of the fetus as
'battering ram’, therefore subjecting millions
of women to unnecessary episiotomy and months
or years of perineal trauma, incontinence and
sex-life disruption? Once we
understand why
the perineum is in focus at all, does our
perception of what might “need” to be done
to this part of a woman’s body change?
The
same kind of situation exists for many
of the procedures carried out in the name of
midwifery and obstetrics. Prenatal
care began
in the UK as a direct result of the Boer War;
the authorities conscripting men for service at
this time were shocked at the ill-health of the
population and began a program which included
care for pregnant women. Only in
the last few
years has the frequency and purpose of the
visits women make to their midwife or doctor
been brought into question in the midwifery
literature; the Boer War ended in 1902.
Antenatal screening owes part of its history
to the concept of eugenics, which was a philosophical
tool favoured by certain prominent Nazis and
focal to the ideal of ethnic cleansing.
And amniocentesis only became common to
women in the UK after the Abortion Act was passed;
how many more women would question their
need for this kind of intervention if they
understood how this system had developed and
that its main purpose was to persuade them to
abort their child if found to be defective?
On
a cross-cultural basis, history may also be
an important tool for learning and for
planning for the future. I would
like to hope
that some of the issues surrounding the professionalisation
of midwifery in the UK during the latter part of the
last century and the early part of this one might
be useful to American midwives who are facing
some of the same questions. And one
of the most
interesting aspects about the history of birth
for me is that it is often difficult to pin ‘blame’
for negative changes on one person, group or
conspiracy; often, it appears that societal reaction,
peer pressure or ‘pack mentality’ have a part to
play in the sweeping changes which have
affected women and birth over the last few decades.
What could this tell us about the way things
might need to move today?
History
may also have an important part to play
in shattering some of the myths surrounding
childbirth. While I am very keen
not to
throw out evidence which has derived from experience,
some of the beliefs held by women and professionals
today are clearly based in historical misconceptions.
The concept of timing and regulating the
frequency of breastfeeds derived from observation
of how often baby calves fed from their mothers;
because they tended to suckle every four hours,
it was assumed that human babies needed to
feed this often as well. And why
not, as it was
concurrently perceived that the milk made
for baby calves could somehow be “nearly” as
good for babies as the milk which nature
had already designed for them?!
The
concept of time as we understand it today
only entered daily life during the Industrial
Revolution, as clocks became important tools
in the smooth running of factories and other
industries. Yet clocks feature very prominently
in the majority of hospital delivery rooms,
often placed at the end of the bed (most probably
so that women and their partners can assist
professionals by timing their contractions and
ensuring they are adhering to the ‘normal limits’
of the partogram!) The concept of
‘normality’
itself is also relatively new in the scale of time and,
some would argue, has a tenuous philosophical
basis in the way it is used in relation to birthing women today.
The
history of religion also has an impact on childbirth.
Not until some groups offered their own
translation of the Bible were women expected to
experience “pain” in childbirth. I am not suggesting
that the experience of labour is not intense,
or that it doesn’t require hard work, but, along
with Ina May (Gaskin 1990), I would question
the impact this negative terminology has on the
woman’s perception and expectations of labour.
At the same time, other groups emphasised the need
for women to suffer in childbirth and, in previously Pagan
- and therefore Goddess-worshipping - societies,
the impact of certain forms of Christian teaching
could be seen to be detrimental to women’s needs
and interests in general.
Historical
examples and situations might also be
a tool through which women could be brought together,
radicalised and united in their objectives.
One of the most powerful paragraphs I have ever read
was written by Sjoo and Mor (1987, p309)
and is a stark reminder of the situation women and
midwives faced during the Renaissance period:
“While
Michaelangelo was sculpting and
Shakespeare writing, witches were burning…
Renaissance
men were celebrating naked female
beauty in their art, while women’s bodies were
being tortured and burned by the hundreds
and thousands all around them.”
There
are countless examples of ways that women
today are affected by events which occurred tens,
hundreds or thousands of years ago, and this article
offers no more than a few of them.
I would like to raise the question of whether more women
- and men - might benefit from gaining an understanding
of ‘where we have come from’, in order to decide
how we can best influence ‘where we are going’.
References
Floud
E (1994) Protecting the
perineum in
childbirth 1: a retrospective view.
British Journal of Midwifery,
Vol 2, No 6, June 1994, pp 258-263.
Gaskin
I M (1990)
Spiritual Midwifery.
The Book Publishing Company, Summertown, TN.
McCandlish
R, Bowler U, van Asten H, and others (1998)
A randomised controlled trial of care of the
perineum during second stage of normal labour.
British Journal of Obstetrics and Gynaecology,
Vol 105, No 12, pp 1262-1272.
Sjoo
M and Mor B (1987)
The great cosmic mother -
rediscovering the religion of the earth.
HarperCollins, San Fransisco.