sociology

This month’s guest column* by Christine H. Morton, PhD, a research sociologist at the California Maternal Quality Care Collaborative, draws on her research and publications on women’s reproductive experiences and maternity care advocacy roles, including the doula and childbirth educator. She is the founder of ReproNetwork.org, an online listserv for social scientists studying reproduction.

The ever-evolving history of the childbirth reform movement has new developments, which need to be incorporated into the older story which documents the shift from home to hospital birth; and the paradigm clash of midwifery and medical models of birth reflecting holistic and technocratic values, respectively. We need to incorporate the story of the doula, which I argue, is one of many efforts to bridge the divide – to provide, as Robbie Davis-Floyd has called it, humanistic care in birth, which is what most women desire.

History is happening now. In addition to the emergence of the doula in the past thirty years, more recently, we see efforts underway in maternal health policy (Childbirth Connections’ Transforming Maternity Care), among physician and nursing professionals (most especially around maternal quality measures, and maternity quality improvement) and resurgence among, for lack of a better word, ‘consumers’ or childbearing women, who seek greater access to vaginal birth after cesarean (VBAC). What are the goals of each stakeholder; how do they intersect and overlap, and come into conflict with one another? This is a big story, and we need to tell it!

I take a small slice of this larger historical backdrop to consider the interconnected history of childbirth educators and doulas, which will be the subject of my research presentation at the Lamaze-ICEA Mega Conference in Milwaukee.

To back up a bit, when I embarked on my sociological investigation of the doula role, I was interested in many aspects of this innovative approach to childbirth advocacy and support. What strategies and mechanisms enabled women with no medical training to insert themselves at the site where medical care is delivered to a patient in a hospital, and enact their self-defined role? Why did women become doulas and what did the work mean for those who were able to sustain a regular practice over time? How were doulas utilizing and leveraging the corpus of evidence based research which suggested their impact was as great, if not greater, than that of the physician, the culture of the obstetric unit, or the labor and delivery nurse? Where did doulas come from? What, in the history of childbirth reform, or childbirth education, or labor/delivery nursing, could help me understand how doulas emerged at this point in time in U.S. history?

Later, after learning that there were limited histories of childbirth education (by non-childbirth educators), and little research on the history of obstetric nursing, I had to take a step back and consider these factors as well. Why was the work and perspectives of women who support other women during childbirth an overlooked piece of historical research? Why did histories of women’s health reform efforts largely exclude childbirth reform? Why had there been no history of the women who were involved in childbirth education; in labor and delivery nursing; in the mainstream arena of birth care in the US? So as not to be accused of ignoring the scholarship that does exist in this area, I acknowledge my debt to Margot Edwards and Mary Waldorf; to Judith Walzer Leavitt, to Barbara Katz Rothman, Robbie Davis-Floyd, Margarete Sandelowski, Deborah Sullivan and Rose Weitz, Judith Rooks and Richard and Dorothy Wertz (I can make my full bibliography available to those interested). I have been inspired by these histories, but they focused less on the women (childbirth educators) who were making history and more on the larger cultural shifts in beliefs about medicine, technology, women’s bodies and reproduction.

When childbirth education per se was a topic of inquiry, the research focus tended to be on the primary sources of the male physician champions – Grantly Dick-Read, whose work informed the natural birth movement, and Ferdinand Lamaze (and his US counterparts – Thank you Dr. Lamaze author Marjorie Karmel and Elisabeth Bing) who formulated a method for accomplishing unmedicated, awake and aware childbirth. However, most of this scholarship makes unsubstantiated generalizations about what particular childbirth educators (of various philosophies /organizations) believed, and how they taught. There is surprisingly little in the way of empirical research – few scholars interviewed childbirth educators or conducted systematic observation of their classes over time.

So after completing my dissertation on the emergence of the doula role, I had the great opportunity to continue with my research interest through a research grant from Lamaze International to conduct an ethnographic investigation of childbirth education, with my colleague, medical anthropologist Clarissa Hsu. We talked to educators, observed their classes and analyzed our data.

We found that educators who were actively practicing doulas drew heavily on their direct labor support experiences as authoritative resources for stories and examples that supplemented the material they taught. Actively practicing doulas also included more curricular content on early labor than educators without such experience. Having real births to draw upon provided doula-educators a different type of credibility and authority than educators without such current labor support experience. These educators relied on other mechanisms to establish their authority, such as knowledge of the latest research on birth and use of more authoritarian teaching styles.

We found that the intersection of doula practice and childbirth education has significantly affected how childbirth preparation classes are taught, and this new infusion of practice and ideology is worth exploring. I encourage you to explore this with us, and welcome your thoughts.

*Note: this column was originally posted on the Science & Sensibility blog.

For this month’s column, I had the pleasure of emailing with Chris Bobel, Ph.D. about her new book which deftly tackles a taboo topic.

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You explore new feminist activism that focuses on menstruation. Historically, how have feminists viewed menstruation, and why menstrual activism now?

The issue of menstruation has not been a top feminist priority, though, since at least the 1970s, a few bold feminists have recknoned with socio-cultural and political dimensions of the menstrual cycle. I argue that the menstrual taboo–which impacts us all, even feminists–often puts the issue off-limits. In mainstream culture, the only menstrual discourse that gets any play is making fun of women with PMS. I studied menstrual activists who want to widen and complicate the conversation. Menstrual activism is part of an enduring project of loosening the social control of women’s bodies, moving women’s bodies from object to subject status–something absolutely foundational to addressing a range of feminist issues, from human trafficking to eating disorders to sexual assault.

What do you think of Kotex’s new ad campaign “Break the Cycle,” which lampoons traditional menstrual product ads?

The new campaign could be a game change, but I’m doubtful. First, the campaign only works as long as the menstrual taboo persists; otherwise, their frank talk doesn’t stand out, does it? While I can join in the joke of the industry poking fun at itself–and I love the message of “no more shame”–in the end, it’s the same, just repackaged.

Second, I resent this campaign for exploiting shame to sell product for nearly a centuray and then exploiting THEIR overdue pronouncement–“enough with the euphemisms, and get over it”–to sell product.

Also, you’ve got to wonder if not only Kotex but their whole industry is now pulling out all the stops to try to hold onto its market share as menstrual suppression drugs–like Seasonique and Lybrel–are gaining interest.

So, what do you think of pharmaceutical industry arguments that support these menstrual suppressants?

Their quasi-feminist arguments co-opt feminism to push drugs. Big Pharma is marketing suppression as a ‘lifestyle choice’, but what most don’t realize is that “menstrual suppression” is actually cycle-stopping contraception that does not only reduce or eliminate menstrual bleeding but also suppresses the complex hormonal interplay of the menstrual cycle. We don’t yet have adequate data to really show if this is a safe long-term practice for otherwise healthy women. Check out this position statement.

Furthermore, ad campaigns represent the menstrual cycle as abnormal, obsolete, and even unhealthy. These messages underscore that women’s natural functions are defective, dysfunctional and need medical intervention. This can lead to negative body image, especially in young women. How is this feminist? ‘Choice’ without good, fact-based information based on thorough medical studies isn’t real choice, and a campaign that exploits women’s negative attitudes about their bodies isn’t feminist either.

Your work uses menstrual activism as an analytical lens through which to view continuity and change in the women’s movement, from what some call the “second wave” of feminism through the “third wave.” So, given that the ‘wave’ distinctions are not without controversy among feminists, what do you see as setting third wave feminism apart? Is it truly unique, or is it merely a label that recognizes the next generation?

There’s a lot of continuity between the waves–mostsly in the tactical sense. Today’s feminist blogs are yesterday’s zines, which reflect earlier mimeographed manifestos; radical cheerleading recalls street theater and public protests, like early second-wavers at the 1969 Miss America pageant. Second-wavers practiced what third-wavers call DIY (Do It Yourself) healthcare when they modeled pelvic self exams. But, most third-wavers depart from most (but not all) second-wavers by troubling the gender binary. For example, the radical wing of menstrual activism movements reers to “menstruators”, instead of assuming that everyone who menstruates gender-identifies as a woman.

Tell me more about that!

Most assume that a female-bodied person, with breasts and a vulva, is a woman, and usually that’s true. We also assume that menstruation is a near-universal experience for women. Radical menstruation activists question these assumptions. Menstruation is not and has never been EVERY woman’s experience. Women don’t menstruate for lots of reasons, and they don’t menstruate their whole lives. Also, some transmen and intersex people DO menstruate. So, equating menstruation with womanhood is problematic. Saying “menstruators” makes room for more people, more experiences. This linguistic move is boundary smashing, inclusion-in-action and bodes well for feminism’s future.

But, you’ve written that menstrual activists are not successful at all attempts at inclusion.

The first face of the feminist movement may have been white and middle class, but poor white women and women of color across the class spectrum have always been there, often toiling in relative obscurity. This could be the case with menstrual activism, too. However, I’m a white, privileged academic, and this biases my world view. I looked for women of color doing this work and found a few. But, was I looking in the right places? Was I using the right language? One activists of color said that I was likely missing Black women because I wasn’t clarifying how race and gender intersect in menstrual health. Also, menstrual activism is risky business for all, and especially for women of color, whose bodies have been denigrated throughout history. Taking on the menstrual taboo can make others see you as nasty, gross, improper…and if you’re already struggling to be accepted and taken seriously, then why go “there”?

Well, I and many other women’s health activists appreciate that you ‘went there’!

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For more on this topic and her research, check out Chris’s new book — New Blood: Third-Wave Feminism and the Politics of Menstruation (Rutgers University Press, 2010), previewed in the Our Bodies, Ourselves blog and in a provocative article in the Guardian last fall.