Often when the discussion is on unassisted childbirth (UC), the question becomes, “How do you know what to do when?” This type of question can come from women contemplating a UC, in which case they are asking a legitimate question; or it can come from skeptics or people completely opposed to UC, in which case they are asking the question rhetorically, implying that women can’t or won’t know what is happening to them in labor and birth, either at all, or until it is too late to prevent the “it” from happening [shoulder dystocia, cord prolapse, placenta previa, fetal distress, etc.], or the “it” from having serious or even deadly consequences.
The typical response from UCers is that women will “just know” via intuition what is going on — that when women are completely in charge of their own bodies and labors and births (as can only happen in a UC, since even a very hands-off midwife will intrude at least somewhat simply by her presence) — that they will “tune in” to their bodies in such a way as to know or be aware of what is going on that no external machine or person can even approach to knowing. I’ve read several stories along these lines — one that sticks out was not a UC, but rather a woman who “just knew” that something was going wrong, although the EFM didn’t show any problems, and the nurse didn’t think anything was wrong. She actually had a hidden partial placental abruption, which was ignored because the nurse believed the machines instead of the woman. Often, the reverse case is told in UC circles — women who are showing clinical signs of something being not quite right, but intuition saying that everything is fine and no steps need to be taken.
This section of the dissertation made me think of the difference between “authoritative” and “authoritarian.”
First, the quick definitions (taken from OneLook dictionary):
Authoritative — ▸ adjective: sanctioned by established authority; having authority or ascendancy or influence; of recognized authority or excellence
Authoritarian –▸ noun: a person behaves in an tyrannical manner▸ adjective: likened to a dictator in severity; characteristic of an absolute ruler or absolute rule; having absolute sovereignty; expecting unquestioning obedience.
A person can be both authoritative and authoritarian, but these are not the same in meaning. As an example, Rixa may be an authority on the subject of UC, having not only had one herself, but having studied the topic extensively and written this extremely long thesis on it; yet she would only become authoritarian if she insisted that everyone have unassisted births as she did.
Quoting from the dissertation:
Anthropologist Brigitte Jordan, best known for 1978 book Birth in Four Cultures, explained that authoritative knowledge is “the knowledge that within a community is considered legitimate, consequential, official, worthy of discussion, and appropriate.” It is not simply the knowledge of those in authority positions, as the term might suggest, but rather a “state that is collaboratively achieved within a community of practice.” Whether or not the knowledge system is “right” or “truthful” is irrelevant; “the power of authoritative knowledge is not that it is correct but that it counts.”
So, in OB circles, only such information as may be presented in journals and textbooks is considered authoritative; whereas in UC circles, this information is considered less important (or even unimportant altogether) compared to intuition, or a woman’s innate knowledge. This is larger than just birth — “authority” exists in every circle — religion, education, politics, etc. Dr. Amy may be authoritative — she’s got a whole bunch of school and book-learning, and practiced as an obstetrician for years; but she’s also authoritarian in her insistence of no home births. But what she needs to learn is that her “authoritative knowledge” means nothing to women who disagree with her, because she comes across as authoritarian, and nobody likes to be told what they can and cannot do — especially by someone they disagree with, and who insists on “my way or the highway.”
Further on in the dissertation comes this quote:
Dr. D. Ashley Hill wrote: “Women who choose to have an unassisted birth are at best uneducated about the potential complications of giving birth. At worst, they allow negative feelings towards hospitals, physicians, or midwives to place their babies in danger.”
This makes me wonder — why should/do these women have negative feelings in the first place? What can these people and institutions do to reduce or eliminate said negative feelings so that women will want to give birth there or with the people? Rather than legislating away a woman’s choice to give birth in the manner and place of her choosing, they can make the choice become a positive one — she can still choose a home birth alone or with a midwife, but why when the hospital is so much better? The problem for those who promote hospital birth is that we home-birthers don’t think that a hospital is better, after considering all the pros and cons. If these people want us to think the pros outweigh the cons, they need to see what we consider to be things against hospital birth and change those things — much as they did in the late 70s and early 80s when they made birth rooms more home-like and began allowing fathers in to see the birth of the baby, in response to pressure from mothers — rather than just insist in an authoritarian manner (which typically only serves to increase our stubbornness and resolve to continue in our path and ignore and flout them) that birth at home is dangerous and shouldn’t be attempted and should be outlawed.
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