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1. Hazzell, L.D. Commonsense Childbirth. Berkeley Medallion Books, New York, 1976 (1969).

2. Arms, S. Immaculate Deception. Bantam Books, New York, 1979 (1975).

3. Harrison, M. A Woman in Residence. Random House, New York, 1982.

4. Cohen, N. and Estner, L. Silent Knife. Bergin and Garvey Publishers, South Hadley, MA. 1983.

5. Peterson, G. and Mehl, L. Pregnancy as Healing: A Holistic Philosophy for Pre-Natal Care, Vols. 1, 2. Mindbody Press, Berkeley, 1984.

6. Goldsmith, J. Childbirth Wisdom. Congdon and Weed, New York, 1984.

7. Caldeyro-Barcia, JR., Supine called the worst position for labor and delivery. Family Practice News 5:11, 1975.

8. Banta, H.D. and Thacker, S.B. Costs and Benefits of Electronic Fetal Monitoring: A Review of the Literature. U.S. Dept. of Health, Education, and Welfare, National Center for Health Services Research, DHEW Pub. No. (PHS)79-3245, Washington, D.C.: U.S. Government Printing Office, 1979.

9. Tew, M. The Place of Birth and Perinatal Mortality. Journal of the Royal College of General Practitioners, 35, Pp. 390-394, Aug. 1985.

10. Stewart, D. and Stewart, L., eds. Safe Alternatives in Childbirth. National Association of Parents and Professionals for Safe Alternatives in Childbirth, Marble Hill, MO, 1976.

11. Stewart, D. And Stewart, L., eds. 21st Century Obstetrics Now! Vols. 1, 2. National Association of Parents and Professionals for Safe Alternatives in Childbirth, Marble Hill, MO, 1977.

12. Stewart, D. and Stewart, L. Compulsory Hospitalization or Freedom of Choice in Childbirth? Vols. 1, 2, 3. National Association of Parents and Professionals for Safe Alternatives in Childbirth, Marble Hill, MO, 1979.

13. Stewart, D. and Stewart, L. The Five Standards of Safe Childbearing. National Association of Parents and Professionals for Safe Alternatives in Childbirth, Marble Hill, MO 1981.

14. Young, D. Changing Childbirth. Chilbirth Graphics, Rochester, NY, 1982.

15. Young D. Obstetrical Intervention and Technology in the 1980s, The Haworth Press, New York, 1983.

16. Brackbill, Y., Rice, J. and Young, D. Birth Trap: The Legal Low-Down on High-Tech Obstetrics. Mosby, St. Louis, 1984.

17. Inch, S. Birth-Rights: What Every Parent Should Know About Childbirth in Hospitals. Pantheon Books, New York, 1984.

18. In the lithotomy position, the woman lies on her back on a narrow delivery table with her feet up in stirrups and her buttocks at the table's edge. Use of the lithotomy position tends to make pushing the baby out more difficult and injurious than necessary, as this position 1.) focuses most of the woman's body weight squarely on her tailbone, forcing it forward and thereby narrowing the pelvic outlet, which both increases the length of labor and makes delivery more difficult8S:8; 2.) "compresses major blood vessels, interfering with circulation and decreasing blood pressure, which in turn lowers oxygen supply to the fetus"16:13; 3.) "increases the need for episiotomy [and the likelihood of tears] because of disproportionate tension on the pelvic floor and stretching of the perineal tissue"16113; 4.) "because the baby's passage through the birth canal must work against gravity, forceps extraction is more frequently required and physical injuries to the baby are more numerous."16113

19. An episiotomy is a surgical incision of the vagina to widen the birth outlet:

The doctor has a sincere belief that an episiotomy protects the fetal skull and brain, shortens the second stage of labor and thus reduces the chance of minimal brain damage from hypoxia [oxygen deprivation]. . .. prevents later prolapse of the uterus, and also protects against third degree tears of the perineum."17112

That birth without episiotomy will result in prolapse of the uterus, or in weakened support of the bladder for excessively stretched muscles has never been proven, nor has the assumption that it will protect the fetus from damage.3:98 However, in a scientifically controlled study of the outcomes of planned home vs. planned hospital birth, in which the couples participating were matched for age, risk factors, and socioeconomic status,86 there were nine times as many episiotomies (supposed to prevent tearing) in the hospital group and nine times as many severe third- and fourth-degree) tears in the hospital group. Explains Michelle Harrison:

Think of the episiotomy this way: If you hold a piece of cloth at two corners and attempt to tear it by pulling at the two ends, it will rarely rip. However, if a small cut is made in the center, then pulling at the ends easily rips the cloth. Doing an episiotomy is analogous, and sometimes results in tears that extend into the rectum. Physicians argue that this "clean" tear is more easily repaired than the ragged one that occurs when a woman tears without a cut. My experience has been that the small tears that sometimes occur without episiotomy are easy to stitch and less bothersome to the woman. Episiotomies, once repaired, are often debilitating and are the source of much pain in the post-partum period.3:97

20. In 1970 the national Cesarean section rate was around 4%. By 1986 it had jumped to 24.1%, according to the most recent statistics available from the National Bureau of Vital Statistics, Washington, D.C. This dramatic increase in the number of Cesareans performed in the United States has produced no subsequent improvement in infant or maternal mortality rates.

21. These interviews have been conducted between 1981 and 1988 in Austin, Texas, San Antonio, Texas, Chattanooga, Tennessee, and elsewhere in the United States. The majority of people interviewed were middle-class, mainstream American citizens, as I was seeking to understand the processes at work in childbirth as it is experienced, not by any particular minority, but by the majority of American women. Quotations from these interviews will be used throughout this article. A more detailed discussion of this research appears in 22.

22. Davis-Floyd, R.E. Birth as an American Rite of Passage. Ph.D. dissertation, Department of Anthropology/Folklore, University of Texas at Austin. University Microfilms Publication No. 86-18448, 1986.

23. Davis-Floyd, R.E. The Technological Model of Birth. Journal of American Folklore 100, 398, Pp. 479-495, 1987.

24. Davis-Floyd, R.E. Birth as an American of Passage. In Childbirth in Americcu-Anthropological Perspectives (Edited by Michaelson, K.), Pp. 153-172. Bergin and Garvey Publishers, South Hadley, MA, 1988.

25. Douglas, M. Purity and Danger. Routledge and Kegan Paul, London, 1966.

26. Douglas, M. Natural Symbols: Explorations in Cosmology. Vintage Books, New York, 1973.

27. Merchant, C, The Death of Nature- Women, Ecology, and the Scientific Revolution. Harper & Row, San Francisco, 1983.

28. Duffy, J. The Healers: A History of American Medicine, U. of Illinois Press, Urbana, Illinois, 1979.

29. Ehrenreich, B., and English, D. Witches, Midwives, and Nurses: A History of Women Healers. Old Westbury, New York: The Feminist Press, 1973.

30. Davis-Floyd, R.E. Obstetric Training as a Rite of Passage. In Woman, Physician and Society. Special Issue of the Medical Anthropology Quarterly. 1:3, Pp. 288-318,1987.

31. Kramer, H. and Sprenger, J. (Excerpts from the ) Malleus Malleficarum, 1486. In Witchcraft in Europe 1100-1700: A Documentary History (Edited by Kors, A.C., and Peters, E.), Pp. 113-189. University of Pennsylvania Press, Philadelphia, 1972.

32. Rothman, B.K., In Labor: Women and Power in the Birthplace, p. 37. W.W. Norton and Co., New York, 1982. (Reprinted in paperback under the title Giving Birth: Alternatives in Childbirth. Penguin Books, New York, 1985).

33. Webster's New Collegiate Dictionary, p. 317. G.C. Merriam Co., Springfield, MA, 1979.

34. Turner, V. Betwixt and Between: The Liminal Period in Rites de Passage. In Reader in Comparative Religion, 4th edition (Edited by William A. Lessa and Evon Z. Vogt) Pp. 234-243. Harper and Row, New York, 1979 [1964].

35. Freeley-Harnik, Gillian, The Lord's Table: Eucharist and Passover in Early Christianity. University of Pennsylvania Press, Philadelphia, 1981.

36. Vogt, E.Z. Tortillas for the Gods: A Symbolic Analysis of Zinacanteco Rituals. Harvard University Press, Cambridge, MA, 1976.

37. Miner, H. Body Ritual among the Nacirema. In The Nacirema: Readings on American Culture (Edited by Spradley, J.P. and Rynkiewich, M.A.), Pp. 10-13. Little, Brown & Co., Boston, 1975 [1956].

38. Kearl, M. Endings: A Sociology of the Dying and the Dead Oxford U. Press, New York, 1989.

39. Much of the following summary of "standard procedures for normal birth" can also be found in 23 and 30. A more detailed and analytical symbolic analysis of these obstetrical rituals is provided in 22 and 24.

40. Thacker, S.B. and Banta, H.D. Benefits and Risks of Episiotomy. In Obstetrical Intervention and Technology in the 1980s (Edited by Diony Young), Pp. 161-178. The Haworth Press, New York, 1983.

41. Malinowski, B. Magic, Science, and Religion. In Magic, Science and Religion and Other Essays Pp. 17-87. Doubleday/Anchor, New York, 1954 [1925].

42. McManus, J. Ritual and Ontogenetic Development. In The Spectrum of Ritual (Edited by d'Aquili, E., Laughlin, CD. and McManus, J.) p. 199. Columbia University Press, New York, 1979.

43. McManus, J. Ritual and Human Social Cognition. In The Spectrum of Ritual A Biogenetic Structural Analysis. (Edited by d'Aquili, E., Laughlin, CD. and McManus, J.) p. 226. Columbia University Press, New York, 1979.

44. Moore, S.F. and Myerhoff, B., eds. secular Ritual p. 8. Van Gorcum, Assen, The Netherlands, 1977.

45. Pritchard, J.A., and MacDonald, P.C, Williams Obstetrics. 16th edition, p. 430. Appleton-Century-Crofts, New York, 1980.

46. The strength of this belief in birth's inherent danger among early obstetricians is evidenced in the following comments by one of their most prominent members, Dr. Joseph B. DeLee:

So frequent are the bad effects of birth, that I have often wondered whether Nature did not deliberately intend women to be used up in the process of reproduction, in a manner analogous to that of the salmon, which dies after spawning. [The Phrophylactic Forceps Operation, American Journal of Obstetrics and Gynecology I, 34-44, 1920]

47. This tendency for the performance of one obstetrical procedure to mechanically follow another is frequently referred to in the lay literature as the "cascade of interventions," since often the performance of one procedure (e.g. the administration of pitocin) necessitates several others (e.g. electronic monitoring, Cesarean section). Following is an example of how this process often works:

Dr. Roberto Caldeyro-Barcia has demonstrated that uterine contractions stimulated with pitocin reach over 40 mm Hg pressure on the fetal head. The quantity and quality of uterine contractions are greatly affected when oxytocin is infused. The contractions tend to be longer, stronger, and with shorter relaxation periods in-between. As a result, the fetus is compromised. . . . With each uterine contraction, blood supply to the uterus is temporarily cut off. . . . [which can lead to] oxygen deprivation and cerebral ischemia causing the grave possibility of neurological sequellae. Truly the fetus has been challenged, and the EFM [electronic fetal monitor] dutifully records the stressed fetal heart rate. With suspicions confirmed, a diagnosis of fetal distress is noted and elective Cesarean section is the treatment of choice. [87, p. 153]

48. Fiske, S. Pigskin Review: An American Initiation. In The Nacirema: Readings on American Culture (Edited by Spradley, J.R. and Rynkiewich, M.), Pp. 55-68. Little, Brown and Co., New York, 1975.

49. Cafferata, J. The Marines: An Initiation into Manhood. In Rites (Edited by Cafferata, J.), Pp. 234-239. McGraw Hill, New York, 1975.

50. Carver, C. The Deliverers: A Woman Doctor's Reflections on Medical Socialization. In Childbirth: Alternatives to Medical Control (Edited by Shelly Romalis.) Pp. 122-149. Austin: University of Texas Press, 1981.

51. Konner, M. Becoming a Doctor: A Journey of Initiation in Medical School. Viking, New York, 1987.

52. Chappie, E. and Coon, C. Principles of Anthropology. Holt, Rinehart and Winston, New York, 1942.

53. Turner, V. The Ritual Process: Structure and Anti-Structure. Aldine, Chicago, 1969.

54. Abrahams, R.D. Ritual for Fun and Profit (or The Ends and Outs of Celebration). Paper delivered at the Burg Wartenstein Symposium No. 59, on "Ritual: Reconciliation in Change," Wenner-Gren Foundation for Anthropological Research, New York, 1973.

55. Jordan, B. Birth in Four Cultures: A Cross-Cultural Investigation of Childbirth in Yucatan, Holland Sweden and the United States, p. 50. Eden Press, Montreal, Canada, 1980.

56. Ashford, J.I., Ed. Birth Stories: The Experience Remembered, p. 80. The Crossing Press, Trumansburg, New York, 1984.

57. Vitamin K is routinely injected into all newborn babies. The rationale for this is that newborns are born without Vitamin K in their systems, because they have "inadequate intestinal flora." Lack of Vitamin K can lead to hemorrhage in the newborn after several days.[45:186) However, breastfeeding the baby will quickly establish adequate intestinal flora without the need for Vitamin K or the pain of an unnecessary shot. Too early injection of Vitamin K in newborns has been implicated as a possible cause of neonatal jaundice.

58. Silver nitrate or an antibiotic substitute is placed in the eyes of almost every hospital-born baby in the United States to prevent the development of blindness in case the mother should have gonorrhea. Its administration, or that of a substitute, is required under state law in all 50 states, on the theory that it is impossible to know which ones need it and which ones do not. Silver nitrate binds with the membranes of the baby's eyes, causing redness, irritation, swelling, and blurred vision in the first few days of her life, thus interfering with visual learning and adjustment to the new environment.

59. More dramatic examples of society's claim to ultimate ownership of the baby are provided by Irwin and Jordan in their recent article "Knowledge, Practice, and Power: Court-Ordered Cesarean sections" [Medical Anthropology Quarterly 1, 3, Pp. 319-332]. The authors document and analyze various recent cases in which a pregnant mother was forced or nearly forced to have a Cesarean against her will, on the grounds that the state had the baby's best interests in mind, while the mother did not. In one case, in Denver, Colorado, attorneys and a judge were called into labor room of an obese woman who was refusing a Cesarean which had been ordered by her obstetrician on the basis of meconium staining in the amniotic fluid and signs of fetal distress as read by both external and internal monitors. Declaring the fetus "dependent and neglected," the judge pronounced the baby a ward of the state until birth and ordered the Cesarean, which was performed against the mother's will. The baby was born healthy, which surprised the physicians, but the mother suffered from delayed healing of her incision.

60. Mendelsohn, R. Confessions of a Medical Heretic. Warner Brothers, New York, 1979.

61. Corea, G. The Mother Machine: Reproductive Technologies from Artificial Insemination to Artificial Wombs. Harper and Row, New York, 1985.

62. Arditti, R., Klein, R.D., and Minden, S., eds. Test-Tube Women: What Future for Motherhood? Pandora Press, Boston, 1985.

63. Wall Street Journal p. 1. Obstetrics and Gynecology. 26 January, 1987.

64. Lichtmann, R. Medical Models and Midwifery: The Cultural Experience of Birth. In Childbirth in America: Anthropological Perspectives, (Edited by Michaelson, K.L.), Pp. 130-141. Bergin and Garvey Publishers, South Hadley, MA 1988.

65. Davis-Floyd, R.E. Right and Left, Male and Female: Childbirth and the Power of Symbolic Oppositions. Paper delivered at the Annual Meetings of the American Folklore Society, San Antonio, Texas, 1981.

66. Freud, S. The Basic Writings of Sigmund Modern Library, New York, 1938.

67. Jones, A.R. "Writing the Body": Towards an Understanding of L'ECriture Feminine. In The New Feminist Criticism: Essays in Women, Literature and Theory (Edited by Showalter, E.). New York, Pantheon Books.

68. Ehrenreich, B., and English, D. Complaints and Disorders: The Sexual Politics of Sickness. The Feminist Press, SUNY College, Old Westbury, NY, 1973.

69. Wertz, R.W. and Wertz, D.C. Lying-in: A History of Childbirth in America. The Free Press, New York, 1977.

70. Oakley, A. The Captured Womb: A History of the Medical Care of Pregnant Women. Basil Blackwell, New York, 1984.

71. Oakley, A. Becoming a Mother. Schocken Books, New York, 1979.

72. Oakley, A. Women Confined- Towards a Sociology of Childbirth. Schocken Books, New York, 1980.

73. Oakley, A. The Captured Womb: A History of the Medical Care of Pregnant Women, Basil Blackwell, New York and Oxford, 1984.

74. Romalis, S. Childbirth: Alternatives to Medical Control. University of Texas Press, Austin, Texas, 1981.

75. Leavitt, J. Brought to Bed: Childbearing in American 1750-1950. Oxford University Press, New York, 1986.

76. Mendelsohn, R. MaKe) Practice: How Doctors Manipulate Women. Contemporary Books, Inc., Chicago, 1981.

77. Kitzinger, S. The Sexuality of Birth. In Women's Experience of Sex, by Sheila Kitzinger, Pp. 209-218. Penguin Books, New York, 1972 (1962).

78. Field, M., The Jewel in the Crown: Clitoral Massage as an Analgesia for Labor. Childbirth Alternatives Quarterly 6:4. Pp. 4-5,1985. (First published in the Newsletter of the Association of Radical Midwives, Winter 84/85, Great Britain.).

79. Parvati-Baker, J. The Dolphin Midwife. Newsletter of the Pre- and Peri-natal Psychology Association of North America, p. 7, Spring 1988.

80. Most of the women in this group seemed comfortable with their technological births, as these experiences often served to strengthen and confirm the technological belief systems they held before entering the hospital. A small minority (9% of the overall sample of 100) of women in my study had entered the hospital with belief systems centering around the power of women as birth givers and the ideal of natural childbirth. They, like Elizabeth, were forced into unwilling internalization of the technological model, with subsequent severe damage to their self-images. (The remaining 12% of the women in my study chose to give birth at home.)

81. Star, R.B. The Healing Power of Birth, p. 54. Star Publishing, Austin, Texas, 1986.

82. Dossey, L. Space, Time and Medicine Boulder and London: Shambala Press.

83. Carver, C. Patient, Beware Prentice Hall Canada, Inc. Scarborough, Ontario, 1984.

84. Siegel, B. Love, Medicine and Miracles. New York, Harper and Row, 1986.

85. Balaskas, J. and A. Active Birth. McGraw-Hill, New York and London, 1983.

86. Mehl, L., Peterson, G., Whitt, M. et al. 1977. Outcomes of Elective Home Births: A Series of 1146 cases. Journal of Reproductive Medicine 19:281-290.

87. Ettner, F. Hospital Obstetrics: Do the Benefits Outweigh the Risks? In 21st Century Obstetrics Now! (Edited by Stewart, D. and Stewart, L.), Vol. 1, Pp. 147-162, National Association of Parents and Professionals for Safe Alternatives in Childbirth, Marble Hill, MO, 1977.

Robbie E. Davis-Floyd, Ph.D.

JOURNAL OF PRENATAL AND PERINATAL PSYCHOLOGY AND HEALTH publishes research and clinical articles from the cutting edge of the science of prenatal and perinatal psychology and health. The journal, published quarterly since 1986, is dedicated to the in-depth exploration human reproduction and pregnancy and the mental and emotional development of the unborn and newborn child.

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