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"Hospitals are Put Off by Waves:" The Complexity of Feminine and Feminist Interests in the Childbirth Education Association of Erie, PennsylvaniaBy:Amy Schriefer |
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My mother delivered me in 1977 at an Erie, Pennsylvania hospital. It was her first pregnancy and she was looking forward to the childbirth experience, so in order to prepare herself, she read everything she could and attended Childbirth Education classes with my father. Unfortunately, she was not prepared for hospital experience. Her doctor chastised her denial of pain medications but he respected her wishes even as he administered pitocin and attached an internal and external fetal monitor, preventing her from walking around. As she was wheeled into the delivery room, she was shocked at being strapped down to the table while the doctor cut a large and bruising episiotomy and pulled me out quickly with forceps. My mother intuitively went to reach for me, but the straps held her hands back. She was left feeling disappointed in herself for not being informed of what she later found to be unnecessary invasive procedures and for not being more assertive in standing up for her self and me. My mother and I both (remember, I was there, too) came out of this attack on our bodily autonomy with a desire to help other women gain control of their experience of reproduction. Mom went on to be an instructor with the Childbirth Education Association (CEA) of Erie and I eventually went to college to study the history of reproduction and childbirth in the United States and became a reproductive rights activist working at Planned Parenthood of Metropolitan Washington, D.C. As a self-proclaimed feminist activist, I was interested in my mother's work with CEA, but disappointed with what I perceived to be a lack of feminist action. They didn't advocate home births or midwives or organize marches in the street to protest hospital policies and doctors' attitudes. This paper is an attempt to squash the impulse to categorize movements and examine the complex and multiple meanings and means of performing reproductive rights activism. I will explore the divisive definitions of childbirth movements in feminist academia and chart the historical developments and conflicts in "natural" and "prepared" childbirth. I will then focus on the microcosm of my mother's CEA and how their organization and teachings deconstruct and complicate our ideas of women's movements. My information on Erie's CEA was gathered from interviews with my mother and her former colleagues, as well as newspaper articles about the organization from the local paper. At the time my mother gave birth to me, there were already established movements created to resist technological intervention during labor and the male-dominated hospital delivery room. Robbie Pfeufer Kahn argues that there has always been a childbirth movement "in the sense that women gather together to help each other in childbirth, "(Kahn 1995: 305) but the United States childbirth movement came at distinct times and in several factions. In the late 1950s and early 1960s, American women turned to new European methods of childbirth, such as Grantely Dick-Read's "Childbirth Without Fear" philosophy in which he advocated for women to understand the birthing process so they could feel safer during labor (Dick-Read 1944) and Ferdinand Lamaze's psycho-prophylactic method where women were told they could be awake, aware, and pain-free during labor by using a series of breathing and relaxation techniques (Lamaze 1956). These methods were thought to be natural because they rejected a need for medications to control pain, but since they necessitated that women practice and prepare their minds and bodies to undergo childbirth this type of childbirth was called "prepared" childbirth. To educate women about these new techniques, childbirth education classes took shape to train women to have a prepared childbirth. Dick-Read's wife, Jessica Dick-Read Bennett is credited as being the first to establish childbirth education classes in an effort to bring her husband's ideas to more women (Dick-Read 1944). The most appealing aspect of the early prepared childbirth programs was the opportunity for women to have their husbands with them during the early stages of labor. Husbands could serve as "coaches" during labor to offer support and guide their wives through the breathing exercises. The prepared childbirth movement gave not only women, but also their husbands, the opportunity to actively learn about and participate in the birth process. Though doctors were skeptical of these methods at first and feared a husband's presence could disrupt their authority, Lamaze methods were soon incorporated the American birth ritual, particularly among white, middle-class women (Wertz and Wertz 1989). Prepared childbirth was hailed as a step forward in the attempt to reclaim childbirth for women until a more radical sect of the childbirth movement came forward with scathing criticisms of this new trend. The social movements of the late 1960s and early 1970s, particularly the feminist movement, brought new challenges to the hospital delivery method as well as challenges to the effectiveness of prepared childbirth. Medical technology was increasingly used during childbirth and some women wanted to fight for their right to deliver their children without any medical intervention, or rather undergo what they called natural childbirth. These activists observed that even though a prepared woman may not receive any pain medication, doctors still used medical technology such as fetal monitors and forceps during labor. They also noticed that even though doctors were more willing to accept requests for this kind of natural birth, these medical professionals ultimately had the power to control how and when the birth proceeded (Wertz and Wertz 1989, Rotham 1982). Even though women were educated through childbirth education classes, gaining knowledge did not gain them power and despite all their preparations, they were willing to submit to medical authority and technology (Lazarus 1997, Michaelson and Alvin 1988). Because the majority of doctors were men, these uneven power structures were attributed to a gendered analysis of hospital birth. Many in the natural childbirth movement believed the only way for a woman to truly be in control of her labor and have a birth free of medical intervention was to refuse the doctor and the hospital and seek a midwife-attended birth at home. They set out to remove the legal restrictions that prevented them from fulfilling their wishes. Several feminist scholars, agreeing with the natural childbirth movement, also criticized the prepared childbirth philosophy for reinforcing the patriarchal status quo. They challenge that the Lamaze methods touted in prepared childbirth classes encourage women to be silent and complacent during labor while discouraging them to speak up to complain or take charge of their experience (Lazarus 1997, Wertz and Wertz 1989). According to Barbara Katz Rotham, "the only thing 'prepared childbirth' has done is change the patient who comes in [to one who] knows what to expect and how to act" (Rotham 1982: 80). The husband's role in a prepared childbirth is also argued to be merely a play on men's traditional patriarchal role (Rotham 1982) and advocating for presence of the husband/father was a means of reinforcing the heterosexual nuclear family unit (Wertz and Wertz 1989, Davis-Floyd 1992). The prepared childbirth movement itself has been rejected for failing to attack the prevailing gender roles and power structures, causing researchers and activists to refrain from giving the movement a feminist label. Academia has attempted to categorize women's movements as either feminine or feminist or, as Maxine Molyneux (a feminist researcher of Latin American women in revolutionary movements) theorizes, women's movements can either promote practical gender interests, which are based on accepted cultural constructions of gender roles and focus on obtaining rights based on these roles, or strategic gender interests, which instead seek to question and challenge the power structures that create and promote these gender roles (Molyneux 1985). This binary construction is problematic because it sets up an either/or dichotomy that is not exempt from becoming hierarchical (usually valuing feminist movements over the feminine), thus emulating the very structure it attempts to criticize. It also ignores the complexity and multiplicity of the views expressed by movement women themselves (Stephen 1995). Looking closely at the prepared and natural childbirth movements, it is difficult to simply label them as respectively feminine and feminist because of the many individual voices that express varying opinions and feminist viewpoints. The prepared childbirth movement includes radical feminists, the natural childbirth movement includes right-wing Christians, and not everyone agrees on a single definition of "prepared," "natural," or "feminist," so it is important to look beyond labels and listen to how the women involved describe their own actions and the cultural context in which they act (Stephen 1995). The following description of Erie's CEA may seem to fit the idea of a traditional feminine movement that promoted practical gender interests, but simply writing it off as such (as I did when I began this project) misses the unique way they worked within and outside of the system and the rich lessons their successes and failures hold for future childbirth movements. The Erie, Pennsylvania chapter of CEA began in 1971 with six couples at the home of Judy Inman (a local labor and delivery room nurse) and by the late 1980s, over 10,000 people had graduated from CEA classes. These numbers continued to grow until the organization ended in 1995. For almost thirty-five years they provided childbirth education classes for pregnant women and their partners, teaching them to manage their physical experience through Lamaze exercises and to negotiate doctor-controlled hospital care in an effort to create their emotional experience. The instructors and students were predominantly white, middle-class, heterosexual, and educated, articulate people. All of the instructors were women who had already given birth (so you knew of what you spoke) and many of them came from Christian beliefs and professed birth to be a special gift from God. In the beginning, all instructors were required to also be nurses because doctors would not take them seriously otherwise, but in the mid-eighties, CEA opened up to lay instructors, many of them educators who fine-tuned the previously loose and awkward teaching outlines. The original purpose of the organization was to lobby for a change hospital policy that would allow husbands to join their wives during the labor and delivery. They were met with quick success and soon it was seen as unusual for a woman to go through labor without a male partner. A big part of the curriculum focused on the husband's coaching role during labor, which my mother admits was sometimes difficult because most men immediately tried to take charge and dominate the situation. Inman believes watching a husband support his wife during labor was one of the most beautiful and rewarding aspects of teaching CEA classes because she was able to be present at the birth of a family. CEA's logo reflected the concept of the nuclear family (and the traditional gender roles that accompanied it) with a drawing of a man, woman, and baby (the man towering over the woman and the woman holding the baby). Though they went on to address other issues, the commitment to couple oriented childbirth remained the same. CEA in Erie prided itself
on remaining independent of hospital affiliation, allowing them to be
frank with their students about the realities of hospital care, which
they believed often needlessly intervened with medical treatment, such
as pitocin or episiotomies, that caused more harm than good and robbed
women of an empowering birth experience. Instead of encouraging their
students to rebel against and protest hospital procedures, they taught
them how to work within the system to receive treatment when and how
they wanted. They taught their student how to clearly explain their
desires (no pain medications, the ability to walk around, etc.), in
an assertive, yet unconfrontational manner that did not appear to challenge
or undermine the doctor's authority, which could greatly upset a doctor,
causing them to ignore the patient's requests out of spite. The couples
were shown how to present a comprehensive birth plan that would satisfy
their needs and the hospital's litigious atmosphere. Women were told
to manipulate their performance in order to get their way by not acting
too hysterical or dramatic. But CEA was able to change doctor's practices for the better, even if they had to go around them. They worked through their students' insider status to implement changes they were unable to achieve working with doctors and hospital management from the outside. An example of this was their campaign to eliminate the unnecessary use of silver nitrate to disinfect a newborn's eyes immediately after birth. They felt it prevented the newborn from seeing her/his parents for the first time and potentially disrupted the initial bonding process. Doctors were not swayed by their letters, phone calls, and meetings, so CEA instructors turned to their students, educating them about the effects of this chemical and encouraging them to request that their doctor refrain from using it. Soon, doctors were bombarded with so many requests against the use of silver nitrate that, to please their paying patients, they stopped using it all together. Doctors and the hospitals eventually caught on to the benefits of having a patient prepared by CEA classes, but instead of supporting CEA, they stole their teaching outlines and some instructors (which they could afford to pay more) and began their own classes. Doctors used their influence to refer their patients to these new hospital classes. People felt they were receiving better education because is was from the perceived medical authority of the hospital, where they would eventually give birth, but in reality, the classes were shorter and covered less information. Also, because they were in the hospital they had to adhere to hospital policies that were dictated by insurance companies who usually cared more about the bottom line than the patients. Inman argues that hospital classes only "indoctrinate women into hospital procedure and procedures" instead of teaching them to ask questions and assert themselves. As the 1990s approached, CEA saw a large drop in their enrollment as hospital classes skyrocketed, particularly as more working families experienced time constraints and a growing interest in epidurals left women feeling they no longer needed to learn Lamaze techniques. CEA eventually lost to the hospitals and the Erie chapter ended in 1995. They may not have taken to the streets in protest or directly challenged the inherent gender inequalities of the doctor/patient relationship in the labor room, but as Inman says, "Hospitals are put off by waves." Since women in Erie were giving birth in hospitals and they believed it was the safest environment, CEA had to develop a subversive method of helping women gain control of their childbirth experience without rocking the boat too much and possibly causing more problems. The CEA instructors and their students were influenced by a specific race, class, religion, and, most importantly, a relatively small conservative city that often responds to progressive movements with skepticism and hostility. Most of these women do not identify themselves as feminists, even though they may express feminist thought. Though I wish they had been more radical and more inclusive, they were successful in implementing changes and attitudes that still echo in the labor and delivery rooms of Erie hospitals. They may have been too successful, for their ideas were co-opted by the very powers they were struggling to change (a sure sign that you're doing something right) and used to disband their organization. My mother loved and learned
from her experiences as a CEA instructor and feels that her work had
an impact on the families of Erie (although I try to convince her that
it also had an impact on women as individuals), but she was left with
a cynical taste in her mouth after hospital classes became more popular
than CEA classes. She thinks I'm too aggressive in my activist thinking
and I aim too high and too broad. I've come to realize, though, that
we are not speaking to each other on opposite sides of a feminine/feminist
divide, but as women intertwined in a web of a movement and we intersect
at many points. Alice Walker believes that "mothers and daughters
are meant to give birth to each other, over and over" (1996, 172).
I believe that if we look past the labels to communicate and share our
experiences, I will honor and possibly renew and radicalize my mother's
activism and she will encourage and force me to focus my activism, giving
birth to a new kind of reproductive rights movement that honors all
women and their differences. Dick-Read, Grantley International Childbirth
Education Web Page Jordan, Brigitte Kahn, Robbie Pfeufer Lamaze, Fernand Lazarus, Ellen Molyneux, Maxine Rotham, Barbara Katz Stephen, Lynn Walker, Alice Wertz, Richard W. and Doroty
C. Wertz
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