Many know first hand just how traumatic and violating a hospital birth can be. Doctors and other hospital staff attend births day in and day out--and can become desensitized in the process. Women sometimes feel they are treated as a mere compartment for a child to emerge from. Here are a few excerpts from the article that sum this up nicely:
The rising science of obstetrics ultimately accomplished this goal by adopting the model of the assembly-line production of goods as its template for hospital birth. Accordingly, a woman's reproductive tract came to be treated like a birthing machine by skilled technicians working under semiflexible timetables to meet production and quality control demands. As one fourth-year resident observed:
We shave 'em, we prep 'em, we hook 'em up to the IV and administer sedation. We deliver the baby, it goes to the nursery and the mother goes to her room. There's no room for niceties around here. We just move 'em right on through. It's hard not to see it like an assembly line.
The hospital itself is a highly sophisticated technocratic factory; the more technology the hospital has to offer, the better it is considered to be. Because it is an institution, the hospital constitutes a more significant social unit than an individual or a family. Therefore it can require that the birth process conform more to institutional than personal needs. As one resident explained,
There is a set, established routine for doing things, usually for the convenience of the doctors and the nurses, and the laboring woman is someone you work around, rather than with.
The most desirable end-product of the birth process is the new social member, the baby; the new mother is a secondary by-product. One obstetrician commented,
It was what we were all trained to always go after--the perfect baby. That's what we were trained to produce. The quality of the mother's experience--we rarely thought about that.
Many women report feeling a lack of control once they are in the hospital--I know I did.
Routine obstetric procedures are highly symbolic. For example, to be seated in a wheelchair upon entering the hospital, as many laboring women are, is to receive through their bodies the symbolic message that they are disabled; to then be put to bed is to receive the symbolic message that they are sick. Although no one pronounces, "You are disabled; you are sick," such graphic demonstrations of disability and illness can be far more powerful than words. One woman told me:
I can remember just almost being in tears by the way they would wheel you in. I would come into the hospital, on top of this, breathing, you know, all in control. And they slap you in a wheelchair! It made me suddenly feel like maybe I wasn't in control any more.
The intravenous drips commonly attached to the hands or arms of birthing women make a powerful symbolic statement: they are umbilical cords to the hospital. The cord connecting her body to the fluid-filled bottle places the woman in the same relation to the hospital as the baby in her womb is to her. By making her dependent on the institution for her life, the IV conveys to her one of the most profound messages of her initiation experience: in American society, we are all dependent on institutions for our lives. The message is even more compelling in her case, for she is the real giver of life. Society and its institutions cannot exist unless women give birth, yet the birthing woman in the hospital is shown, not that she gives life, but rather that the institution does.
The article talks about how women are repetitively being told--without words--that they are dependent on the hospital: the often awkward and exposing hospital gown, the ID bracelet, IV, the bed, etc.
The message that she is "defective" is also conveyed to her, that her body needs help to birth a baby.
She is also reminded in myriad ways of the potential defectiveness of her birthing machine. These include periodic and sometimes continuous electronic monitoring of that machine, frequent manual examinations of her cervix to make sure that it is dilating on schedule, and, if it isn't, administration of the synthetic hormone pitocin to speed up labor so that birth can take place within the required 26 hours. All three of these procedures convey the same messages over and over: time is important, you must produce on time, and you cannot do that without technological assistance because your machine is defective.
...Consider the visual and kinesthetic images that the laboring woman experiences--herself in bed, in a hospital gown, staring up at an IV pole, bag, and cord, and down at a steel bed and a huge belt encircling her waist. Her entire sensory field conveys one overwhelm-ing message about our culture's deepest values and beliefs: technology is supreme, and the individual is utterly dependent upon it.
...Internalizing the technocratic model, women come to accept the notion that the female body is inherently defective. This notion then shapes their perceptions of the labor experience, as exemplified by one woman's story:
It seemed as though my uterus had suddenly tired! When the nurses in attendance noted a contraction building on the recorder, they instructed me to begin pushing, not waiting for the urge to push, so that by the time the urge pervaded, I invariably had no strength remaining but was left gasping and dizzy....I felt suddenly depressed by the fact that labor, which had progressed so uneventfully up to this point, had now become unproductive.
Note that she does not say "The nurses had me pushing too soon," but "My uterus had tired," and labor had "become unproductive." These responses reflect her internalization of the technocratic tenet that when something goes wrong, it is her body's fault.
Many families seem comforted by hospital rituals. They welcome the interventions, feel safer with them and put more faith in the machines than their own bodies. Some women opt for elective cesarean sections or prefer them to vaginal birth because of the "control" factor, fear of the pain from a vaginal birth or countless other reasons. Others may find this hard to understand--a major surgery is not scary? How and why would anyone ever choose that over a vaginal birth--a natural process? The article explains this well, how people tend to conform to rituals--no matter how absurd it may seem--in times of stress.
When humans are subjected to extremes of stress and pain, they may become unreasonable and out of touch with reality. Ritual assuages this condition by giving people a conceptual handle-hold to keep them from "falling apart" or "losing it." When the airplane starts to falter, even passengers who don't go to church are likely to pray! Ritual mediates between cognition and chaos by making reality appear to conform to accepted cognitive categories. In other words, to perform a ritual in the face of chaos is to restore order to the world.
Labor subjects most women to extremes of pain, which are often intensified by the alien and often unsupportive hospital environment. They look to hospital rituals to relieve the distress resulting from their pain and fear. They utilize breathing rituals taught in hospital-sponsored childbirth education classes for cognitive stabilization. They turn to drugs for pain relief, and to the reassuring presence of medical technology for relief from fear. One woman expressed it this way:
I was terrified when my daughter was born. I just knew I was going to split open and bleed to death right there on the table, but she was coming so fast, they didn't have any time to do anything to me...I like Caesarean sections, because you don't have to be afraid.
When you come from within a belief system, its rituals will comfort and calm you. Accordingly, those women in my study who were in basic agreement with the technocratic model of birth before going into the hospital (70%) expressed general satisfaction with their hospital births.
The institution that is the hospital is overwhelming. If women who want to birth there, who find a hospital birth inviting or optimal give themselves over in such a huge way upon arrival--imagine what it does to women that don't feel that way.
Unfortunately, many of us know that all too well.
