Power and Resistance in Biomedical and Midwifery Models of Birth

“BECAUSE IT IS MY BODY, AND I OWN IT, AND I AM IN CHARGE”: POWER AND RESISTANCE IN BIOMEDICAL AND MIDWIFERY MODELS OF BIRTH By KATHRYN WORMAN ROSS Bachelor of Science in Sociology and Psychology Jacksonville State University Jacksonville, Alabama 2004 Master of Arts in Sociology Middle Tennessee State University Murfreesboro, Tennessee 2007 Submitted to the Faculty of the Graduate College of the Oklahoma State University in partial fulfillment of the requirements for the Degree of DOCTOR OF PHILOSOPHY May, 2013 “BECAUSE IT IS MY BODY, AND I OWN IT, AND I AM IN CHARGE”: POWER AND RESISTANCE IN BIOMEDICAL AND MIDWIFERY MODELS OF BIRTH Dissertation Approved: Dr. Stephen M. Perkins Dissertation Adviser Dr. Tamara L. Mix Dissertation Adviser Dr. J. David Knottnerus Dr. Virginia A. Worley ii Name: KATHRYN WORMAN ROSS Date of Degree: MAY, 2013 Title of Study: “BECAUSE IT IS MY BODY, AND I OWN IT, AND I AM IN CHARGE”: POWER AND RESISTANCE IN BIOMEDICAL AND MIDWIFERY MODELS OF BIRTH Major Field: SOCIOLOGY Abstract: I utilize participant observation, autoethnography and in-depth interviews with women who have given birth at home and homebirth midwives in Oklahoma to understand perceptions and responses to society’s hegemonic birth system, its power, ideology, and practices. Employing Foucauldian, Foucauldian feminist, and Social Constructivist frameworks, I illuminate issues of reality construction, knowledge, and power related to the homebirth experience. Participants expressed distinctions between biomedical and midwifery models. They described complex processes whereby women’s bodies are transformed into docile bodies through disciplinary technologies, including control of ideology and panopticonic domination of time, space, and movements of the body. This process involved technocratic constructions of women’s bodies and birth as pathological and women’s bodies as defective machines that require application of technology and expert action to birth. Homebirth mothers and midwives articulated narratives of empowerment, knowledge, and control in the philosophy and practice of the midwifery model and homebirth, and subscribed to a holistic paradigm that involved constructing women’s bodies and birth as healthy and normal, understanding women as social beings, and valuing nature over technology. Homebirth was directly and indirectly presented as resistance to normalizing medical hegemony whereby respondents claimed ownership of their bodies, births, and babies, pursuing this aim through active creation of agency, empowerment, and practice of alternative birth models. iii TABLE OF CONTENTS Chapter Page PART ONE: INTRODUCTION I. INTRODUCTION......................................................................................................1 II. BUILDING A FRAMEWORK FOR UNDERSTANDING HOMEBIRTH............6 Social Constructivism: Meaning, Reality, and Power .............................................7 Foucauldian Feminism: Political Economy, Biopower, and Subjectivity ...............9 Biopower, Governmentality, and Panopticon...................................................10 Power/Knowledge.............................................................................................13 Subjectivity, Freedom, and Resistance .............................................................15 Analytical Framework ...........................................................................................17 Power and Legitimation of the Biomedical and Midwifery Models ................17 Docile (Female) Bodies ....................................................................................19 Subjectivity and (Embodied) Feminist Resistance ...........................................20 III. CONTEXTUALIZING HOMEBIRTH: A CRITICAL HISTORY ......................22 The History of Birth in the United States: The Rise of the Biomedical Model.....23 Lens of Pathology .............................................................................................25 Body-As-Machine.............................................................................................26 Favoring of Technology and For-Profit Intrusion ............................................28 Power and Agency in the Biomedical Model ...................................................31 The Midwifery Model............................................................................................36 Birth in Oklahoma..................................................................................................39 IV. METHODOLOGY ................................................................................................42 iv PART TWO: WHY WOMEN BIRTH AT HOME V. THE JOURNEY TO HOMEBIRTH: WHY WOMEN BIRTH AT HOME ..........52 The Journey to Homebirth .....................................................................................53 Why Women Birth at Home: Safety and Control..................................................63 Safety ................................................................................................................63 Chapter Page Control ..............................................................................................................77 PART THREE: POWER IN BIOMEDICAL AND MIDWIFERY MODELS VI. THE BIOMEDICAL/TECHNOCRATIC MODEL VS. THE MIDWIFERY/HOLISTIC MODEL......................................................................84 VII. WOMEN’S BODIES AND BIRTH AS PATHOLOGICAL VS. NORMAL .....89 Pregnancy as Disease and Inherently Abnormal vs. Pregnancy as Normal and Safe ................................................................................................................................90 Detecting Disease vs. Achieving and Maintaining Health and Wellness..............96 Fear Promoted vs. Fear Combated.......................................................................101 Pain as Problematic vs. Pain as Normal...............................................................109 VIII. FEMALE BODY-AS-MACHINE VS. WOMAN AS SOCIAL BEING.........114 Mind-Body Separation vs. Mind-Body Connection ............................................116 Relationships...................................................................................................119 Support............................................................................................................122 Education ........................................................................................................124 Mother-Baby Separation vs. Mother-Baby Unit..................................................125 Individualistic Approach vs. Social Approach ....................................................127 The Importance of Family ..............................................................................128 A Social Approach..........................................................................................132 Standardization vs. Personalized Care.................................................................133 v IX. THE SUPREMACY OF TECHNOLOGY VS. THE SUFFICIENCY OF NATURE ..............................................................................................................................140 Medical Management and Intervention vs. Wisdom and Watchful Waiting.......141 Machines vs. People.............................................................................................156 IV. POWER AND RESISTANCE IN BIOMEDICAL AND MIDWIFERY MODELS OF BIRTH..................................................................................................................163 Power and Agency in the Biomedical and Midwifery Models............................164 Power and Agency in the Biomedical Model .................................................165 Chapter Page Power and Agency in the Midwifery Model...................................................168 Control and Empowerment.............................................................................170 Agency: Action and Authority........................................................................173 Medical Hegemony vs. Homebirth as Resistance................................................178 Homebirth as a Response to Medical Hegemony...........................................178 Homebirth as Resistance to Medical Hegemony............................................182 Impacts of Resistance .....................................................................................188 V. CONCLUSION: POLITICAL ECONOMY OF BIRTH......................................193 REFERENCES ..........................................................................................................199 APPENDICES ...........................................................................................................212 vi LIST OF TABLES Table Page Homebirth Mother Demographics…………………………………………………….46 vii PART ONE INTRODUCTION viii CHAPTER I INTRODUCTION Birth is an event that happens every day in every place around the world, and it is an event that has occurred for all of human history. Despite its ubiquitous nature, very few people view birth as mundane or insignificant. Birth has the potential to transform women into mothers, men into fathers, children into siblings. It has the profound ability to create deep and complex relationships, evoke pleasure and pain, happiness and grief. From a sociological and anthropological perspective, the ways in which women give birth tell us a great deal about the cultural and social context within which birth occurs. Birth reflects and has the ability to shape

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