It is about a journey, called labor, that
delivers mother and child into each others' arms.
The definition of "normalcy"
in birth has given rise to a surprising level of controversy, resulting
from a confusion as to the reference point for normal. Is normal
birth that which is socially "usual," and if so, are not
Cesarean births (or other complications) usual and therefore "normal"
in our society? From a social definition and use of the word "normal"
as the "norm" (the "typical," "usual"
or "average") naturally this would appear to be true.
However it is not in a social context, but a biological context
that the definition of "normal" birth is presented within
these pages. Normal in a biological or physiological sense does
not presume a social judgment, but is rather a purely functional
term in biomedical usage. In medical charts and at medical conferences,
the terms "unremarkable, N.S.V.D." (normal, spontaneous,
vaginal delivery), and "normal" are used interchangeably.
My intent in using the biological "normal"
is to keep biological normalcy in birth alive in the medical field
as well as in our general society. The definition of normal birth
in medical terms simply means the natural resolution of labor which
does not require medical intervention and in which neither the life
of the mother or child is threatened or compromised without such
intervention. The fact of increased complication in birth in present
society should not obscure our understanding of the normal process.
We must not lose sight of normalcy in the face of our recent need
for increased technological support in birth. But what contributes
to this rise in complications?
Women are struggling, as are the men
of our culture, in times of changing values which affect family
cohesion and durability. The age of the nuclear family reached its
peak and decline in the 1950's. A mother's rebellion from the powerless
isolation of suburbia continues to reverberate throughout the 20th
century. The fact that children and motherhood are naturally and
biologically a part of womanhood inevitably renders childbearing
susceptible to an increasing degree of unsettlement as women struggle
for identity in economic as well as emotional terms. There is no
question as to the absolute necessity for these changes, yet pregnancy
and childbirth will be more conflicted for the average woman until
the whole of' society has adopted and adjusted to support the changing
identity of women in the second half of our century. In a more general
sense, the women's movement has indeed catalyzed needed changes
for men and children as well. But as a culture we are only beginning
to assimilate these changes.
Pregnancy has always been a time of
stress, the natural and healthy stress of transformation to motherhood.
Pregnancy, labor, and birth have always served as nature's bridge
to mothering. It is a natural state of self-reflection and a time
when a slight increase in anxiety may be generated and useful to
fuel the psychological integration needed in becoming a mother.
The psychological task of pregnancy
has been identified as the work of integrating the psyche to include
the emotional construct of mothering (Holistic Prenatal Care,
Chapter 2, Mindbody Press). Is it any surprise that complications
in labor and birth increase with the difficulty of this task?
Society has been reduced to the smallest
biological unit possible in childbearing-the single parent and child
family. Never before has this smallest of family units been so prevalent.
The fact that more women are choosing single motherhood than ever
before, in a time when procreation is a choice, reflects the obvious
increase in the stress of the role and identity of mother in our
culture within a larger family context.
Though by no means attaining a majority,
there has been an increase in women choosing single motherhood over
traditional shared parenthood. Some women report the stress of both
relationship and mothering as overwhelming and markedly prefer to
adapt to the adjustments of motherhood on their own (The Finer Report
on One-Parent Families and The Journal of Family Practice,
14(3): 581-586, 1982). In the course of history, single motherhood
has never before emerged as a viable alternative. The fact that
it is being chosen as such echoes the stress that has enveloped
women as we quest for change on a societal and cultural level. The
changing times of our society are a needed and creative stress born
of the energy and potential for personal and cultural evolution.
But our times are not without reflection upon the perinatal period,
a period which already stimulates a natural increase of anxiety
for integration of motherhood.
Our society is in flux, and is not
yet supporting the woman of our times sufficiently in the mothering
role. Yet women will continue to birth -- to bring forth the needed
children of humanity. The human race cannot wait for society to
change in order to procreate with greater ease. As women, we are
members of our society and will naturally strive to integrate the
role of mother on an individual level. Our belief in motherhood
is the beauty of our striving, and represents the lifespring of
human existence today. However, the rise in obstetrical technology
and intervention has confused the definition of "normal"
birth. Confusion has occurred as a result of two very divergent
but interdependent phenomena: the very real rise in need for technological
support in birth in a transitional society, and the very real rise
in complications resulting directly from unnecessary and/or
dehumanized obstetrical intervention.
In response to distress the medical
model has responded with more technological intervention. In a model
in which bodies are viewed as machines, naturally intervention is
aimed solely at the mechanical manipulation for resolving points
of cumulative stress that may peak in the full force of a woman's
labor. The medical model offers women the only support it knows-
mechanical resolution. Medical intervention has served not only
necessarily for physical manipulation of outcome, but in some cases
unnecessarily for socialization to the cultural norm of "good
patient." Physicians, in some cases, perform Cesareans as a
means of quick relief from the normal pain of labor when the woman
in labor does not "deal well" with the pain (i.e. in our
culture, quietly and without complaining). An increase in technology
beyond that already necessary in stressful times has resulted in
a backlash of angry women who feel cheated of the opportunity for
a normal birth (Cohen, N.W. and Estner, L. J Silent Knife: Cesarean
Prevention and Vaginal Birth After Cesarean, 1983). Women have
reclaimed their rights to nature, to their bodies in a manner necessary
for society to remain alive and healthy. Yet, times remain transitional
in the 20th century, and having alternatives in childbirth available
may not ensure a woman an easy transition into motherhood or an
uncomplicated birth. Support of both a technological, in some
circumstances, and an emotional nature, are needed. The need
for increasing awareness of counseling as a natural part to prenatal
care cries out to us. Availability of counseling services to support
a woman's integration of mothering in a transitional society must
be given if we are to use other than medical technology to reduce
risk and to mitigate the stresses of the average modern woman entering
How do we support women through the
emotional integrative work to pregnancy without "blaming"
ourselves or the pregnant woman for birthing outcome? What part
of ourselves creates the potential to "blame" in order
to recognize the impact of psychoemotional variables in the birthing
process? Perhaps a social value judgment on "normal" delivery
outcome is not necessary, but merely a byproduct to a competitive
society. The competitive society places judgment on "performance"
in all areas to our lives, invading even the privacy of our most
intimate experience-birth and sexuality.
Perhaps it is the belief in competition,
the erroneous interpretation of Darwin's theory of "survival
of the fittest" which gives birth to the intention to blame
a woman or a society for birthing outcome. And it is blame itself
that tightens and restricts our capacities to help ourselves and
Birthing Normally addresses
the need to keep sight of our biological definition of "normal."
It does not serve women to be dissuaded from the biological "norm"
in the name of unnecessary obstetrical technology. A 50% Cesarean
rate should not replace a social normative for a biological definition
of the normal (Cohen and Estner, Silent Knife ). For, if
we are to stray too far, how will we return to that which is natural?
How will our daughters return to a belief in their bodies to give
birth? Nature may reflect a temporary stress of our times, however
we must be clear in our knowledge of what is defined as "normal"
biologically, so that the average woman now and eventually can return
to biologically normal birth.
There is no success, no failure in
birthing outcome within a holistic model. Blame becomes an anachronism...
Birthing Normally is about the individual and creative way
women adapt to the labor process, and about the natural and healthy
stress a woman deals with in pregnancy as she adjusts to her baby
to come. It is also about a woman's inevitable transformation as
she hibernates that aspect of herself that will become mother. And
it is about a journey, called labor, that delivers mother and child
into each others' arms.
Copyright 1995 by Gayle Peterson.
All rights reserved under international copyright conventions. This
excerpt has been reprinted with permission from Shadow and Light
Publishers. This article may be printed out for personal use but
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