Dynamics of Family Interaction: The Labor of Birth

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These are notes I'm taking for Professor Varenne's class on the Dynamics of Family Interaction. I'm using it as an opportunity to play around with wikis and shared community knowledge. Please feel free to contribute to these notes or share your ideas about how it can be expanded, changed, improved.

Aaron Hung

Contents

The Labor of Birth: The social construction of biological processes

Readings

  • Jordan, Brigitte. Birth in Four Cultures. Prospect Heights, IL: Waveland Press, 1993. (Chapters 1, 2, 3, 6, 7)

Reading notes

Jordan, Brigitte. Birth in Four Cultures. Prospect Heights, IL: Waveland Press, 1993. (Chapters 1, 2, 3, 6, 7)

Chapter 1 - A Biosocial Framework for the Crosscultural Comparison of Childbirth Practices

  • topic/content and language/organization are never available one without the other
  • hence biosocial framework: produced jointly and reflexively by universal (biology) and particular (society)
  • no known society where birth is treated as merely a physiological function
  • childbirth often a time of danger for family or community
  • people produce practices to manange this crisis
  • whatever the method, practioners will see it as the "best" way, or "only" way
  • leads to ritualized, morally required routine
  • more variation across different systems; less variation within
  • crosscultural investigation interesting because:
    • given that birth is universal, investigating biosocial organization allows us to better understand range of physiological and behavioral variations
    • better understand of women's networks, practices
    • figuring out what kinds of problems such research would address
  • traditional birthing practices being influenced by Western medicine, while Western model also evolving
  • practices exported to developing countries beign challenged at home
  • tampering with the "correct" way is difficult and considered unethical
  • challenges to crosscultural studies
    • lack of data: male anthrologists tend not to study child labor, focus on puberty rites, economics, etc.; difficult for outsiders to access, esp. for male anthropologists
    • bias of available data: medical personnel tend to focus on physiological instead of interactional aspects
    • difficulty of organizing data: not clear what the categories for crosscultural comparisons should be
  • people often know how to do without necessarily knowing how to talk about it
  • uses participation as a way to accessing know how of birth
  • participants include all the persons that are engaged in producing the event
  • repair work provides access to what is considered normal

Chapter 2 - Buscando La Forma: An Ethnography of Contemporary Maya Childbirth in Yucatan

  • midwife began treating anthropologists as if they were learning to become midwives
  • researchers took notes, helped during labor; tape- and video-recorded births
  • participants accomodated researchers, often offering suggestions on where to put equipment, letting notetakers catch up
  • women in Yucatan (as in US, Holland, Swedan) not resistant to video record
  • midwife keeps a notebook of due dates and births, but not used consistently
  • midwife is able to recall births with great accuracy
  • midwife also gets to know expectant mother and reproductive history during prenatal visits
  • all "business" takes place during massage; unlike US where there is separation between physical exam and the talk/advice
  • during massage, midwife may perform procedures to switch baby into a more favorable position
  • difficult births prove the most instructive
  • talk during labor tend to be filled with chatting about everyday concerns
  • Mayan women would talk about death when labor is in process, while Americans address it more indirectly (e.g. through jokes)
  • explanations and directions given during labor, when they are relevant
  • sometimes midwife will demonstrate labor by sitting in a hammock herself, or showing the couple how to position or support themselves
  • often other women will advise on their favorite positions to give birth; midwife notes that every women must find their own style
  • husband asked to be present in order to see how the woman suffers; can be blamed for being absent if childbirth goes wrong
  • woman's mother also expected to be there, often traveling long distances
  • other women may appear if labor takes a long time
  • if woman appears to be losing strength, other women engage in "birth talk", which is matched to the rhythm of the contractions
  • researchers feel that Mayan women push too early, and that they have to endure more pain than necessary (p. 38)
  • midwife announces gender of child
  • if baby is a girl, her ears will be pierced (before she is 60 mins. old)
  • after baby announced as normal, household resumes its atmosphere of "ordinary concerns"
  • mother and child considered vulnerable to the spirits from the bush; doors kept shut and cracked filled with rugs to keep them out
  • midwife does not give practical advice for first-time mother
  • baby not put down unless they are sleeping; when they wake up they are picked up immediately
  • bottlefeeding increasing; an indication of "progessive attitude" of mothers
  • researchers asked to deliver information midwife learned in a class; midwife might have been unsure on how to transfer this information, but eventually found ways of using it as a resource (p. 43, ff)

Chapter 3 - The Crosscultural Comparison of Birthing Systems: Towards a Biosocial Analysis

  • stable systems are seen as appropriate from within
  • practitioners within each system have not experienced other forms of practice and would not likely try to experiment with them
  • gain better crosscultural comparison if we include social-ecological aspects of birthing
  • in US, 99% babies born in hospitals (how many go undocumented though?)
  • women treated as a patient; decision transferred to physician
  • in Sweden, all births take place in hospitals and managed by trained midwives; medication often used
  • in Holland, 55% births take place at home; medication avoided
  • The cultural definition of birth
    • cultural definition of birth informs participants on who, where, and how of birth
    • local definition makes them consistent: medical procedures (USA), stressful part of normal, family life (Yucatan), natural process (Holland), and personal, fulfilling (Sweden)
    • local definition determines the types of "troubles" that can occur and what can be done
    • in US, many factors, such as nutrition, mood swings, weight, etc. part of medical attention
    • pain becomes different objects in different systems, whether it is viewed in medical or natural terms
    • in US women have to convince attendant how much pain she is in; orients them both towards pain
    • in Sweden, women decide how much medication to administer
    • US: medical personnel oriented to "high drama of surgery"
  • Preparation for birth
    • beginning and end points of birth are arbitrary
    • all systems have formal and informal ways of transmitting information the women needs to know
    • in Yucatan, children have been around where childbirth happens
    • in Western societies, most instruction on childbirth comes from specialized publications or clinics
    • (OMG, her incessant use of footnotes is annoying me)
    • in US, painful aspects of childbirth seen as taboo in women's talk
    • A: although I've seen a friend (relatively new mother) inform another friend (who is fearing labor) about pain and medication
    • experiences that deviate from what they have been led to believe cause American women to view it more as a personal failure (e.g. low pain threshold)
    • prenatal care in US variable
    • Holland & Sweden: health care is free and universal; pregnancy not regarded as pathological
    • in Sweden, women have access to their records and information chronicling her pregnancy
    • Sweden & Holland: Not having prenatal care "unthinkable"
    • Yucatan: instructions given during formal birth, in collaborative manner
    • technologically developed societies based on professional medicine but in different ways
    • no differentiated treatment for the poor
    • local definition of birth determines who has authority
  • Attendants and support systems
    • rare that women give birth alone
    • in US, non-specialists were not allowed in until the 1970s
    • in US, no way to separate normal from complicated births; all must follow the same procedures; but bias towards interference
    • more patience in Dutch and Yucatan systems
    • in Holland, Sweden and Yucatan, 2-3 day labors considered normal; not so in US
    • in US, infant mortality dropped when midwives were used, increased when doctors tok over
    • importance of human companionship during labor underestimated in Western societies
  • Birth territory
    • birth locations can be marked and specialized, or unmarked, in familiar surroundings
    • American practice of moving women to special delivery room and table not followed in Europe
    • location of birth determines responsibility and credit of outcome
    • location also determines when and for how long mother and child are separated
    • in US, mother and child given short time to bond before baby is taken to nursery for observation; this practice doesn't occur in Europe
  • The use of medication in childbirth
    • researcher considers any substance introduced to the woman's body to affect course of labor or provide pain relief as medication
    • different ways of deciding when trouble occurs and requires intervention
    • in US, often difficult to find unmedicated births
    • A: I wonder how much of the ways medicine is used in labor is affected by the broader societal views of medicine, pain, health coverage, and so on; the US has often been seen as "over medicated"; does this affect what happens in birth situations?
  • The technology of birth
    • birth a product of its technology
    • artifacts are visible and available for researcher to ask questions
    • this is beginning to sound a lot like Latour's actor-network-theory
    • Mayan midwife has a lot of Western medicine/tools that she doesn't use (or use in other ways - bricolage?)
    • technologies embedded in practices makes those practices available in context
    • technology tells local definition of event; if simple and replaceable it may remain in the realm of the home
    • forceps common in American births, while it is not used in Holland and Sweden
    • Sweden uses vacuum extractors, which require woman giving birth to actively participate; researchers believe that American women cannot do this because they are semi-conscious
  • The locus of decision-making
    • who "owns" the birth, who decides whether things are going well, who is responsible
    • in Yucatan, decisions are made jointly; midwife is the locus of decision-making but doesn't do so authoritatively
    • in Holland, birth seen as natural process so best to let nature take its course
    • in US woman takes no part in decision-making process
    • researcher notes the need to consider herself as an integral part of the research

Chapter 6 - The Achievement of Authoritative Knowledge in an American Hospital Birth

  • ownership of artifacts determines who has authoritative knowledge
  • where there is different social organization and distribution of resources, different characteristics will prevail
  • authoratative knowledge gets hierarchically distributed
  • Authoritative knowledge
    • several knowledge systems exist, some carrying more weight than others, depending on their relationship with the purpose at hand and the power base
    • A: Is this akin to communities of practice, and different power relations between different members?
    • sometimes parallel knowledge systems exist that allow people to move back and forth between them
    • legitimizing one way of knowing often means devaluing others
    • A: Oh, haha, they cite Lave and Wenger, okay
    • previously, midwives, folk medicine and others were considered authoritative by different people, until the Flexner Report established professional knowledge as dominant form
    • "misrecognition" (from Bourdieu and Passeron): when a particular knowledge is perceived not as socially constructed but natural and legitimate
    • Linde: best way to avoid change is to make change unthinkable
    • people not only accept authoritative knowledge but actively and unconsciously produce it
    • A: As much as I hate to agree with this, I see it happening as a doctoral student, whether it's consciously or unconsciously
    • "the power of authoritative knowledge is not that it is correct but that it counts" (p. 154)
    • "authoritative knowledge" is what participants agree counts in a certain context, that they see as important
    • "authoritative knowledge" not necessarily having to do with knowledge of people in authority positions
    • focus on how people in work environments make visible to themselves and each other the grounds for their proceedings
  • The data
    • birth taking place in a western city; videotaped hour before and after
    • use of transcripts
    • woman asked not to push even though body wants to
    • nurses have to wait for doctor to come to give order to push
    • woman's needs counts for nothing
    • technologies and equipment help create and maintain the authoritative knowledge as the domain of the doctor's
    • A: it's interesting to compare this with similar settings, where, for example, a graduate student who has more knowledge about computers and a professor who has little; here, who has knowledge and who has power is different whereas in the birthing situation, the doctor has both (his space, his equipment - or I guess technically the hospital's); being familiar with this situation, I never feel "power" or "authoritative knowledge" in any way, though; maybe I defer it too soon
    • information has to be produced by the right person for it to be authoritative knowledge
    • orders to push marks the second stage of labor
    • researcher feels that the use of a singsong voice emphasizes childlike status of women
    • A: this seems to be reading too much into it; using a voice that is supposed to be gentle and calming is not the same as reducing status
    • staff wait on the doctor instead of on the labor (which midwives do)
    • doctor sometimes interacts throw the nurses or medical staff
    • students of interaction look at how social "work" is done through participation frameworks - fluid structures of mutual engagement, bodily alignment, etc.
    • laboring woman has limited access to participation structures
  • Some thoughts about the design of labor ecologies
    • is there a way of accomodating divergent views into a single knowledge structure
      • suggests using low instead of high technology
      • machine outputs might be made comprehensible to woman and non-specialist attendants, e.g. displays on walls
      • taking account different perspectives of participants in the labor room
    • A: I wonder how much of the procedures (e.g. waiting for the doctor) have to do with law; e.g. to prevent lawsuits, they must verify certain steps were taken, etc. It's still about power but not in the same way

Chapter 7 - Modes of Teaching and Learning: Pedagogy and the Construction of Authoritative Knowledge

  • learning and teaching always involves multiple agendas, power relations, etc.
  • detailed analysis of training courses for village midwives in Mexico
  • wants to show what counts as authoritative knowledge within domain of birth
  • implications for the distribution of authority in the social system
  • development in Third World countries focus on family planning and upgrading prenatal care
  • often about training programs for traditional midwives; but these have not been successful
  • researcher asked to be consultant on training programs in Mexico
  • each community sent a literate, younger midwife who attended the program
  • researcher noticed that midwives in her fieldwork were aware of biomedical knowledge and wanted to demonstrate knowledge of it
  • Generic problems in training courses
    • midwives adopt a "waiting out" posture when lectures go on
    • sometimes they don't understand Spanish, or the technical language used
    • lectures often focus on definitions instead of practical skills
    • courses did not seem to realize the relevance of content to midwives
    • misconceptions about fertility not addressed
    • midwives may not follow Western visual literacy practices
    • Western tradition often decontextualizes, changes colors, etc.
    • problem of using verbal language instead of watching and imitating; problem of transferring knowledge to real-life situation
    • midwives might know how to talk about medical situations without really it impacting their actual practice
    • teaching needs to be translated into expert teacher who can model and provide practice opportunities
    • local relevance not taken seriously; midwives often don't have the equipment or resources to do what they are taught to do
    • at the end, participating midwives get official status and the training enters into statistics
  • Differing worldviews
    • curriculum ignores different worldviews of trainers and trainees
    • trainers say trainees are ignorant; but the trainers are themselves unaware of the ethno-anatomy and ethno-physiology
    • teaching should be more reciprocal; midwives beliefs and ideas should be taken into account and not dismissed outright
  • Differing modes of knowledge acquisition: Experiential and didactic
    • differing ways of knowledge acquisition: didactic (Western) vs. experiential
    • experiential learning rooted in our evolutionary history
    • all childhood learning depends on imitation and behavioral matching
    • didactic teaching is abstracted from occasions of use
    • apprenticeships happen as a way of life; not recognized as a teaching effort
    • by living in the surroundings of the birth, young girls are already part of the apprenticeship
    • she rarely asks questions, only observes and takes over the work slowly
    • activities often hard to differentiate from play
    • in apprenticeships, there is often little difference between work and play (p. 190)
    • Lave: much of learning looks like play
    • didactic activities specially marked and separated from everyday life
    • progressive mastering of tasks not just a step towards symbolic goal but for immediate use
    • they might not consider themselves as "apprentices", merely fulfilling practical tasks
    • in didactic tasks, information is presented in order instead of from peripheral to center
    • more than just ability to talk about something, but includes ability to do
    • work of talk in apprenticeships are more minor; punctuates flow of bodily performance; rarely is anything taught verbally
    • evaluation of learner more implicit
    • little is said about the apprentice's performance
    • teaching did not occur as an identifiable activity (p. 194)
    • Lave: assumption that teaching can only occur with teachers has biased research on learning
    • stories
      • requests for abstract formuations produce stories
      • stories play role in decision-making
      • stories function to legitimate practitioner, e.g. experience with Western medicine
      • apprentice needs to learn what and when to tell stories

Class notes

Link to Professor Varenne's notes

  • Labor and child birth
    • what is "natural"?
    • taking something natural and start making rules about it
    • Jordan: how rules, even those of your culture, can make things difficult
    • the greater it gets to home the more it hurts when someone mistreats you
    • V: "culture", which used to be studied only in anthropology, seeped into other fields
    • J had a bone to pick with American birthing model
    • no "best way" to use painkillers
    • classical view is to emphasize arbitrariness of cultural rules
    • V: most people in social sciences find crosscultural comparisons a waste of time
    • methodological issues:
      • can't do experimental comparisons; unethical
      • is it experimental if you can't control variables?
      • problem of comparability
      • ethnographic method used because variables cannot be controlled; no other methods possible
      • what they say they do is not the same as what they do
      • problem of bodily displays and functions; asking questions can be inexact
      • audio- and video-recording can capture level of detail that researchers' notetaking cannot record
    • women had more access to men than vice versa
    • body going through a process; peoeple around create what the situation is
    • someone has to pronounces the baby "normal"
    • Mayan birth a very public event; many people invite themselves over
    • when does birth take place; who decides?
    • machines change social relations, e.g. contraction monitor, because now everyone can see the contraction
    • when does labor begin? what counts as a contraction?
    • technologies: foreceps, hygiene, painkillers
    • "Twilight's sleep": medicine that makes you lose control and memory of the childbirth; childbirth began to shift from home to hospital
    • "dangers" of childbirth being "culturally-appropriate"
    • history of childbirth shifting from midwife to doctors; always under the authority of the medical professional
    • political question: who can speak for the woman's body?
    • asking for painkillers creates an asymmetrical relationship
    • issue of trust: is the painkiller working? is the woman complaining too much?
    • Cotter's dissertation: women never invoked her status as a physician during labor
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