Performing birth in a culture of fear: an embodied crisis of late modernity.

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.

KEY WORDS

Childbirth, feminist theory, embodiment, creative performance, late modern culture

Health professionals, activists and social scientists familiar with contemporary maternity care provision now report an emerging sense of crisis around childbirth. Recurrent controversies over medical intervention rates, and over workforce, litigation and insurance issues are the tip of the iceberg. While the medical management of birth remains firmly entrenched in advanced western societies, concerns are also expressed about a decline in even the expectation of normal or physiological childbirth. These issues are linked in complex ways to problems of maternal and perinatal mortality and morbidity in developing countries. In the dominant obstetric frame of reference that shapes western cultural perceptions, the latter stand as the feared 'Other'--the crucial evidence which supports medical claims about the inherent danger of childbirth. Indeed in conditions of poverty, poor health and inadequate care provision, birth and many other aspects of life are indeed dangerous. Yet it is from within the comfort of western civilisation that the press reports 'battleground birth', noting that amongst women, 'trust in the birth process is disappearing', and that rising intervention rates have 'midwives and obstetricians at loggerheads' (The Age, Good Weekend, 9/ 11/03:39). Although many policy makers are seeking to reinstate or maintain 'normal birth' within the mainstream health system, the clash of cultures around childbirth is a significant obstacle (Hirst 2005). Anecdotal evidence from those working closely with childbearing women, such as on professional e-lists, suggests that physiological birth is increasingly defined as too difficult personally and institutionally. Thus we face the paradox that a decline in cultural and individual confidence in women's birthing capacity is apparent in spite of western women's increased social power and achievement and improved health and living conditions. To explain and respond to challenges resulting from this paradox, requires understanding the intersection of culture and embodiment. To that end, this paper draws both on feminist theories and on arguments from physiologists to advance an interpretation of women as 'performers' of birth, a process that is simultaneously a matter of mammalian sexual functioning, deeply cultural and psychically significant.