Kristi Rines
Queer Mobilities, Queer Citizenship
Dr. Cathy Hannabach
15 June 2011
A Look at Birthing Narratives and Practices in the United States:
Challenging the Hegemony of Hospitalized Birth
The documentary Orgasmic Birth (2008), directed by Debra Pascali-Bonaro, calls
for action: “women of earth, take back your birth!” (Pascali-Bonaro). But, what is it
exactly that women are taking supposed to be taking back? Are females not the beings
birthing? Who is taking their birth from them? No, this is not referring to the
transgender female, birthing under a physical guise of masculinity. Delving into the
history of birthing practices and narratives in the United States, Barbara Ehrenreich and
Dierde English discuss how “at the turn of the twentieth century, Western medicine took
away power, authority, and a livelihood from midwives and women healers in favor of
mostly male physicians” (77). They define the midwife as “historically, a female who
assists women during childbirth” (79). Though, today there are varying calibers of
midwifery, direct entry midwifery outlawed in many states.
For instance in 1992, “[t]he governor of New York signed a new Professional
Midwifery Practice Act into law in July. The act defined midwifery as a profession with a
specific scope of practice and called for a board of midwifery to regulate the profession”
(Feldhusen). However, the regulation, both legally and socially, of midwifery began long
before this. Mary Phillips sites 17th-century midwife Elizabeth Cellier:
In her Scheme For the Foundations of a Royal Hospital (1687)…she
argued that the lives of women and children were being placed at risk by
untrained and unskilled midwives. She therefore proposed that they be
incorporated by Royal Charter. Her subsequent defense of the midwifery
profession against male incursion To Dr. --, An Answer to His Queries,
Concerning the Celledg of Midwives was published in 1688 (Phillips 28).
Phillips argues “that Cellier’s work was, in Foulcauldian terms, an act of resistance
against male incursion,” albeit not without restrictions placed on midwives that required
their inclusion within the framework of the medical profession, the arena dominated by
and most accessible to the heteronormative male figure, in hopes of legitimizing the
midwife.
Next, Ehrenreich and English site in “Exorcising the Midwives” how contagious
narratives spread to limit the legitimacy and mobility of midwives, in turn illegitimating
mothers who birth with the assistance of the midwife:
In the rhetoric of the medical profession, the midwife was no more human
than her clientele. She was a foreign “micrococcus” brought over, as was
supposedly the case with other germs, in the holds of ships bearing
immigrant workers. The elimination of the midwife was presented as a
necessary part of the general campaign to uplift and Americanize the
immigrants—a mere sanitary measure, beyond debate (Ehrenreich 78).
These narratives became so pervasive and influential that “between 1900 and 1930,
midwives were almost totally eliminated from the land—outlawed in many states,
harassed by local medical authorities in other places” (79).
In this paper, I would like to “explore the ways that legal and cultural citizenship
practices [of birth] are predicated upon certain notions of mobility and privilege, and
consistently rely upon norms of sexuality, gender, race, and class” (Hannabach 1).
Midwifery Today sites “[b]y 1900, physicians were attending about half the
nation’s births, including nearly all births to middle- and upper-class women. Midwives
took care of women who could not afford a doctor.” However, in 1900 “less than 5
percent of women gave birth in hospitals” (Felhusen). Next, “[t]here was one last matter
to clean up before the triumph of (male) scientific medicine would be complete, and that
was the ‘midwife problem’” (Ehrenreich 77). Ehrenreich and English continue, “[w]hat
made the midwives into a ‘problem’ was then not so much the matter of direct
competition…; from the point of view of medical leaders, was that the midwife was in
the way of the development of modern institutional medicine” (77). Because it was the
“‘lower’ half of society which clung to the midwife and her services: the rural poor and
the immigrant working class in the cities,” in correcting the so-called “midwife problem,”
“the medical school offered its medical trainees as staff for the hospital; the hospital in
turn provided the raw ‘material’ [poor and immigrant bodies] for medical education”
(Ehrenreich 77-8). This move all at once allowed new, inexperienced doctors to practice
obstetrics and served to eliminate the role of the midwife, forcing nearly all U.S. pregnant
bodies to participate in the expansion of institutionalized and medicalized birthing
practices.
This move to institutionalized medical practices and discourses of birth did not
come without costs, costs specifically to the illegitimated, pregnant female body and her
child. “Teaching hospitals had an additional bias toward surgical intervention since the
students did have to practice something more challenging than normal deliveries”
(Ehrenreich 79). In response to this unequal treatment of birthing and birthed bodies:
[A] doctor on the staff of Cornell Medical College put it:…the homeless,
friendless, degraded, and possibly criminal sick poor [are] in the wards of
charity hospital, receiving aid and comfort in their extremity and
contributing each one his modest share to the advancement of medical
science, render even greater service to humanity (Ehrenreich 78).
I wonder if this doctor used the term “extremity” to refer to the pregnant females’ state of
labour, treating it as an emergency as contemporary medical discourse does. Or, are
these bodies in extreme states by the inherent nature of their deviance from norms,
whether marked through class, race, sexuality, or likely a combination of those qualities.
It seems my latter posed theory is most fitting, as it not only marks the of extremity
certain bodies, but does so in a way that fulfills the “even greater service to humanity”
this doctor speaks of. It marked out some bodies as less important than others, as merely
test subjects, so that the normative pregnant female may birth under the conditions
deemed most safe by the medical professional institution. Sadly, in 1912 a “study by [a]
Johns Hopkins professor found that most American doctors at the time were less
competent than the midwives they were replacing” (Ehrenreich 79).
The United States’ birthing narrative that began to emerge, most dominantly and
affectively at the turn of the twentieth century, required this existence of racialized and
classed bodies to produce bodies that were more or less worthy of mobility and privilege
than others. In racializing and classing bodies, ideological understandings of gender and
sexuality rooted in our patriarchal liberal history informed how different bodies would be
legitimized, illegitimatized, mobilized, and immobilized in relation to modes and
surveillance of birth. This applied to birthing mothers, their children, and those who
cared for them at the time of birth.
Connecting new institutionalized, professional medical discourses of birthing to
the concept of the contagious narrative, I would like to quote Nayan Shah in “Perversity,
Contamination, and the Dangers of Queer Domesticity”:
In the prevailing nineteenth-century ideology, respectable domesticity
enabled the proper moral and biological cultivation of citizen-subjects
necessary for American public life to flourish. The formation of
respectable domesticity connected practices of individual health and
sexuality to collective social well-being (77).
Here, “respectable domesticity” in relation to birthing discourse may refer to rising
medical professional involvement in birth, something that has only strengthened,
becoming increasingly institutionalized by situating itself in the hospital. Pointing to
Judith Butler’s “theories of recognition to interrogate how human value is constituted
through the terms of intelligibility” Rodriguez explains:
Legally and socially, all of those interpellated as parents own the
racialized and gendered body of another and live the consequences of
performing ‘parent’ in ways that are more or less intelligible to others,
under the moralizing gaze of a state and society that demands our
conformity to normativizing dictates of what constitutes familial love, care
and support (19-20).
As part of my of my media text coinciding with and sharing the goal of this paper,
I site Ricki Lake’s interview on the television show The Doctors. Ricki Lake’s
appearance takes place shortly after the release of the documentary film she co-produced,
The Business of Being Born (2008), a text in which she shared the footage of her own
homebirth with a midwife. Dr. Lisa M. Masterson, M.D.’s response to homebirth as “a
specialist in obstetrics, gynecology, infertility, adolescent gynecology and family
planning” serves to reveal the hegemonic value placed on a medicalized and scientific
practice and understanding of birth (The Doctors). Dr. Masterson’s rhetoric is quick to
queer and illegitimate the practice of birth outside the professional, medical institution,
casting out the mother who practices birth in such a way as uncaring and unintelligible.
Her blatant disregard for other modes of birth portrays and reinforces the immobility of
the acceptable birthing narrative in the U.S., placing it strictly and solely within the
hospital, wielding a medical educational background as evidence of its absolute
correctness.
Juana Maria Rodriguez discusses the historical link of the queer, nonnormative
subject to that of the perverse. Ehrenreich states that “[c]ertainly no decent woman in
1900 [a white, middle-upper-class, domestically normative female] would want her
delivery witnessed by any unnecessary young males. The only choice was the people
who had the least choice—the poor (77). This phenomenon marks out the poor and
immigrant birthing body as less decent than the normative birthing body, situating her in
the rhetoric of the perverse. She is a body who it is okay to impose excessive
intervention upon, who it is acceptable to gaze openly upon while in a submissive
position where multiple medical trainees may practice how to properly treat the real,
legitimate bodies later. Rodriguez states:
Queer scholarship has productively pushed on these vectors of analysis to
consider how queer baby-making in its myriad forms plays into the social
mandate to reproduce as the means through which to enter the realm of
full citizenship by participating in the state’s investment in discourses of
familial and national reproduction (12).
I feel this statement relates to turn-of-the-twentieth century narratives of birth in many
ways, one being that socially constructed queer, pregnant bodies were pushed into
institutionalized birthing practices, likely as a form of legitimating, or assimilating. The
child born in the hospital is born into the normative, national discourse and practice of
birth, legitimizing that newborn child while illegitimating the child born outside this
framework. Furthermore, dominant twentieth century society’s emphasis on the midwife
as foreign and filthy works in contrast to construct birthing within the institutionalized
medical profession as a site where “the realm of full citizenship” may be accessed.
Tracing the genealogy of U.S. birthing narratives, it is not difficult to reveal the
detrimental effects of the institutionalized, professional, medical discourses that
historically permeate the national body when facing birth and health statistics. Wendy
Budin returns to Doris Haire’s seminal text published in 1972 that “used comparative
analyses of birthing practices in developed countries around the world to illustrate how
childbirth in the United States had become overmedicalized, relying on the supposedly
‘common sense’ practices of doctors rather than on scientific fact” in “Cultural Warping
of Childbirth, Revisited” (Budin 1). Budin states, “Haire’s analysis in 1972 reminded us
that many of our accepted practices at the time were not supported by scientific research
and appeared to be rooted more in hospital and medical tradition than in human
physiology.” (1). She continues, “[o]ver the past 30 years, a vast body of evidence has
accumulated that casts doubt on the benefits of many currently performed obstetrical
practices; however, at the same time, care practices that support and promote normal
birth are underutilized” (Budin 2). According to 2005 studies Budin sites,
Although the infant mortality rate has continued to steadily decline over
the past several decades—from 26.0 per 1,000 live births in 1960 to 6.9
per 1,000 live births in 2000—the preterm birth rate…and the percentage
of babies born at low birth-weight continue to rise, reaching rates of 12.7
and 8.2 respectively…The incidence of cesarean birth continues to
increase, reaching a record high of 30.2% of all live births in the United
States in 2005. The routine use of technology and interventions—unheard
of in the 1970s—has skyrocketed…Seventy-six percent had epidural or
spinal anesthesia. [And], almost 40% of infants were separated from
mothers for routine care immediately after birth (Budin 2).
Today, “[t]he United States provides the world's most expensive maternity care but has
worse pregnancy outcomes than almost every other industrialized country. Midwives are
attending more births—5.5 percent in 1994, compared with 1.1 percent in 1980,”
although this is a relatively insignificant fraction of births (Felhusen).
In conclusion, tactics of queering pregnant bodies and birthing practices works by
recognizing them as intelligent or unintelligent through narratives that “are predicated
upon certain notions of mobility and privilege, and consistently rely upon norms of
sexuality, gender, race, and class,” (Hannabach 1) Ehrenreich and English state:
With the elimination of midwifery, all women—not just those of the upper
class—fell under the biological hegemony of the medical profession. In
the same stroke, women lost their last autonomous role as healers. The
only roles left for women in the medical system were [and are] as
employers, customers, or “material” (79).
In calling for change, I would like to utilize a statement released from the National Latina
Health Organization in 1993:
Women’s health depends on the availability of information about
women’s bodies, on economic and cultural conditions that women live
under, and on laws and social forces that limit or enhance women’s
abilities to make choices about nutrition, reproduction, sexuality, and the
like…women’s health in different parts of the world must be understood
within the context of a globalized world, where development policies,
multinational corporations, the dominance of Western medicine, and local
and national health care systems all combine in complex ways….[T]he
politics of the availability of information and the power of mainstream
media representations limit the kinds of choices that women make about
their health. It is…important to understand that access to health care and
technology alone does not ensure that women will be able to develop
agency and knowledge about their bodies and health issues (NLHO 147).
Works Cited
Budin, Wendy C. “Cultural Warping of Childbirth, Revisited.” Journal of Perinatal
Education. 16.2. 2007 Spring. 1-3. Print.
“The Doctors.” 2011. 12 June 2011. Web.
Ehrenreich, Barbara and Dierde English. “Exorcising the Midwives.” Eds. Inderpal
Grewal and Caren Kaplan. An Introduction to Women’s Studies: Gender in a
Transnational World. 2nd ed. New York, NY: McGraw-Hill. 2006. 84-88.
Print.
Feldhusen, Adrian E. “The History of Midwifery and Childbirth in America: A Time
Line.” Midwifery Today. 2000. 10 June 2011. Web.
Hannabach, Cathy. “Queer Mobilities, Queer Citizenship.” Syllabus. 1-7. 2011. Print.
National Latina Health Organization, “Norplant Information Sheet.” Eds. Inderpal
Grewal and Caren Kaplan. An Introduction to Women’s Studies: Gender in a
Transnational World. 2nd ed. New York, NY: McGraw-Hill. 2006. 145-147.
Print.
Pascali-Bonaro, Debra, dir. Orgasmic Birth: The Best Kept Secret. Sunken Treasure.
2008.
Phillips, Mary. “Midwives versus medics: A 17th-century professional turf war.”
Management & Organizational History. 2.1. Sage: 2007. 27-44. Print.
Rodriguez, Juana Maria. “Queer Kinship and the Quandaries of Domestic Affection
(DRAFT).” Sexual Subjects, Queer Gestures. 1-37. Print.
Shah, Nayan. “Perversity, Contamination, and the Dangers of Queer Domesticity.”
Contagious Divides: Epidemics & Race in San Francisco’s Chinatown.
Berkeley: University of California Press, 2001. 77-104. Print.