Pregnancy and Birth: My Biomedical Experience
Sita Venkateswar has written that “events which occur in the present often appear intrinsically different from events which occurred in the past” (2014). Looking back a year later, I can recognize that my memories of giving birth have undergone considerable change, to the point where they have become hazy with time. What has not been diminished, however, are the conflicting emotions which I felt. These alternated between feelings of =trength and fear, and interestingly, each one resulted in my viewing of the pregnancy in a different manner. These differing viewpoints are also visible within the field of Biomedicine, the West’s dominant form of medicine. Its success at understanding biology has lead to its treatment of many illnesses, however this has come at the price of extended suffering and the general fearing of our bodies. On the other hand, its evolution has been a process which has today come full circle to include more humane practices which thus promote empathy and strength. I experienced being pregnant and giving birth under the latter form of Biomedicine, of which shall be detailed at length in the essay below.
I fell pregnant in late 2012. It came as a shock considering that I did not menstruate often, and after a number of tests doctors had told me I was likely to be infertile. I was also taking a contraceptive pill on the off chance that I might fall pregnant while living and studying in South America. I have taken this pill throughout my life despite it causing me a number of side effects including dizziness and anxiety, of which my childhood doctor had assured me were the results of vertigo and depression. His lack of interest in these symptoms caused me a great amount of distress in the past as I felt conflicted between trusting my body and trusting my doctor. In a nutshell, I was left wary of my own reality because of my doctor’s refusal to validate my words (Cassell, 1982: 641). This was not a personal fault of my doctor – instead it highlights the very issue with Biomedicine in its original form. It is a philosophy that separates the mind from the body and then the body into distinct pieces that can be observed and classified (Gaines & Davis-Floyd, 2003: 40). This segregating of the body continues until at its simplest it is a form of diagnostics at a biological level (Gaines & Davis-Floyd, 2003: 1). This bears more than a passing resemblance to the industrialization period in which it flourished; it removed any possibility of a connection between mind, body and spirit until Biomedicine had effectively reduced “the patient to a silent sum of mechanistic parts” (Mantri 2008, 4). However, when I became pregnant it grew more and more clear to me just how intertwined these components actually were, and that it was paramount to have them working together in a successful partnership. If not, then the notion of suffering on a number of levels would not be an uncommon outcome of my medical care (Cassell, 1982: 639). It was therefore necessary for me to find the right type of prenatal care for both myself and the developing baby.
First and foremost it was necessary for me to visit a general practitioner in Chile to confirm the pregnancy. I was not a regular patient of this doctor and the surgery was a busy, private one. He informed me that to do this an interior ultrasound would be performed then and there. I agreed for two reasons. The first being that I recognised that whatever prejudices I may have towards the field of Biomedicine, I could not escape the fact that I have grown up in a society which values the “scientifically supported explanations … grounded in science” (Mantri, 2008: 1). It is precisely this which lead me to my second reason: my inherited dependence upon modern medicine, its specialists and technologies which had resulted in my alienation from my own body. This is the cornerstone of Foucaldian medical anthropology which concerns itself with the dilemma of the body being “an object to know rather than a knowing object” (Venkateswar, 2014: 6). In other words, my ability to hear and then to understand the messages my body may have been telling me had become defunct after a lifetime of being silenced by Biomedicine. I had effectively spent twenty-five years learning that how my body felt was not as relevant as how my body looked on the internal level, of which the only people qualified to see were the medical establishment (Venkateswar, 2014: 7). As my ability to ‘know’ my body had became silenced, “power over the body had been transferred from the patient to the physician” (Mantri, 2008: 2). There are numerous repercussions that such power transferences have and as such Foucalt has defined us as living “in a biopolitical age” (Rose, 2001: 9). One prominent issue is that medical science has become an “inegoliterian social organization through which a very small number of people have acquired tremendous power over the bodies and minds of a very large number” (Venkateswar, 2014: 1). This is especially worrying given that much of Biomedicine “has not been based upon scientific evidence but on medical habits and tendencies, ingrained popular beliefs” (Gaines & Davis-Floyd, 2003: 4). At the time of my vaginal ultrasound, I felt strongly uncomfortable as though my body was being invaded (in a manner of speaking it was) and I felt this way because I had not mentally accepted my pregnancy. I inwardly struggled against the doctor and as a result found the experience painful and conflicting. For this reason, I made up my mind to return to New Zealand in the hope that I would feel stronger and thus better equipped to deal with situations of this kind.
This was not to be the final time I had to relinquish control of my body. Once in New Zealand I was told by my childhood doctor to take folic acid supplements and a number of other vitamins. I declined the vitamins but acquiesced to the folic acid. I decided on a popular midwife known for her natural, empowering homebirths. My doctor turned outspoken and borderline nasty at this decision because firstly a natural birth would be doubtful for my first baby, and secondly because this particular midwife was known for not vaccinating her own children. This was a confronting experience because I felt as though decisions were being taken from me on multiple levels. Although we have the freedom to make many choices in New Zealand, this does not infer that such choices can be made quietly or independently. Paul Starr explains this is because Biomedicine “spills over its clinical boundaries into arenas of moral and political action of which medical judgement is only partially relevant and often incompletely equipped” (1982: 5). At every stage in my pregnancy my unborn child and I were to be examined and documented. My family history was to be dissected, numerous bloodtests would be taken, diabetes checks would be done and ultrasounds would be performed. At this early stage of my pregnancy, the health of the foetus was paramount to all. Nikolas Rose writes that pregnant women are subject to strict surveillance in order to gauge what risk group they and their child may fall into (2001: 9). The second ultrasound was especially important, as it is “used to detect anomalies … associated with a disorder” (Rose, 2001: 12). I found this to be a worrying test ethically, as anything other than ‘normal’ was likely to be warranted a candidate for abortion. However, Rose writes that these tests are themselves inconclusive and therefore raise the issue of “biopolitics [that] becomes ethopolitics” (2001: 12). For this reason, I declined these tests.
The appointments with my midwife started mid-pregnancy. She was a midwife operating enough within the sphere to be considered Biomedicine, but enough without it to be labelled alternative and humane. In other words, she did “not reject biomedicine but enlarged its scope to incorporate the patients psychological and social aspects” (Marcum, 2008: 393). Within my town she is (mostly) well-respected, and has in fact been a university teacher of midwifery. Her popularity comes from “the combined effects of growing consumer demand … [which have] provided the conditions for the entry of alternative practitioners” (Mizrachi et al, 2005: 38). What I remember most distinctly about these meetings with her is that she encouraged me to embrace the numerous changes in my body as necessary to prepare me for birth. These changes also meant that I felt I was being well-equipped to do what nature had intended me to do. As such, I felt increasingly safe and strong in her presence and never once did I feel that my transference of power to her was invasive. However, despite her efforts all around me I was given ample opportunities to be fearful. Many friends had difficult pregnancies with many medical interventions – some even had problems exacerbated by physicians. The general talk around pregnancy was fearful. On the television each week screened a hospital birthing programme that began to terrify me and cause me to doubt my abilities. As time neared my due date I was torn between these two polarising emotions of fear and strength and as such veered among empowerment and despair. Eric Cassell has written that this trend towards fear is typical of Biomedicine, as physicians fail to acknowledge that suffering can occur in a myriad of forms and as such Biomedicine treatments become “a source of suffering itself” (1982: 639).
Thomas R. Egnew writes that the humane physician evolves “from expert problem-solver and fixer to servant and companion” and nowhere was this clearer than during my labour experience (2009: 3). I laboured at home and was close to breaking point when my midwife appeared. She was instantly my pillar of strength and calmed me down. She drove me to a one-room provincial hospital where I alternated between a warm pool and the bed. I felt scared but at no point did I feel that I was not capable. Perhaps the strongest sensation I had was that of my body overpowering my mind. Suddenly, my mind was quiet and my body was working of its own accord, which was challenging given that I had lived distrusting any signals my body had previously given me. This is a common conundrum during labour when women “feel out of control, when the pain is overwhelming, when the source of the pain is unknown” (Cassell, 1982: 641). However this is not to say that my mind was redundant during labour because as the feelings intensified it became increasingly important for me to unite my mind with my body by focusing on each sensation within the moment. I believe in hindsight that this is what enabled me to achieve a drug-free labour. My midwife encouraged the strengthening of this bond by always encouraging, listening, supporting and validating the words I said, effectively creating “antibodies against illness and pain” (Egnew, 2009: 4). My experience therefore was healthy because this connection was allowed to flourish intact without being separated into “barely connected domains” (Mantri, 2008: 3).
I had a healthy, strong baby in September 2013, in a darkened room and in the pool. I pulled him out of the water myself and lay with him for many minutes on my chest, before moving to the bed and feeding him. I look back to this surreal moment and can barely believe that it happened, let alone that I achieved it. After this experience with a holistic-leaning midwife I feel stronger than ever that when pregnancies are healthy the resulting birth can be equally as healthy without the need for constant intervention. Biomedicine in its traditional form seeks to discern the cause of problems at its smallest level and to achieve this it often pushes away all of its connecting pieces. Pregnancy and birth, in my view, cannot be judged solely on this level because it requires much more than just a functioning body to be achieved: it also requires a functioning mind. Xavier Bichat said that “what is observation if we are ignorant of the place where the evil is seated?” and this quote sums up the fundamental flaw of Biomedicine with regards to pregnancy and birth (Mantri, 2008: 3). They are not evil and regarding them as evil only births fear and then suffering. Biomedicine is necessary, yes, but my experience has shown that positive results on behalf of all are possible when it does not exclude the fact that human beings at their core are holistic in nature.
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Rose, Nikolas (2001). “The politics of life itself”. Theory Culture Society. 18 (1). Print.
Starr, Paul D. (1982). The Social Transformation of American Medicine. New York: Basic Books. Pages 3-29, 420-449. Print.
Venkateswar, Sita (2014). Medical Systems of China, India and the West Study Guide. Topic Seven. Massey University. Palmerston North: New Zealand. Print.