Childbirth between places and ex

labrys, études féministes/ estudos feministas
julho/ 2016- junho 2017 /juillet 2016-juin 2017

Childbirth between places and expertise, wish and choice

Sandra Morano

Abstract

Only 60 years after birth hospitalization, it looks as though in Italy an anthropological mutation has taken place. More and more often in Maternity wards, we meet women who say, with a smile, that they had a Cesarean section because they wanted so. Who takes care about normal birth? Who promotes it ? In an ever fiercer and more powerful reproduction market , from a feminist perspective we need to address without delay the redefining of the aims of Midwifery both for women and (female )specialists . Childbirth between places and expertise, wish and choice : a woman personal and professional journey through the last century authoritative “Medicine for women” that nowadays reign supreme over the entire healthy female population. We need to reconsidering culture, and even birthplaces structures, helping women to discover and understand the strongest and strangest of abilities, the transformation of body and mind, that’s a form of pure creativity.

Key words :midwifes, birthplaces, expertise, cesarean

Only 60 years after birth hospitalization, it looks as though in Italy an anthropological mutation has taken place. Today, women who are pushed away from basic body functions, weakened by the comparison with technology, forced to reduce, evermore often, spaces and time dedicated to the changes of pregnancy and maternity, put off and reduce to basic their reproductive function, an unusual and surely inconvenient break in the obstacle course of metropolitan life. More and more often in Maternity wards, we meet women who say, with a smile, that they had a Cesarean section because they wanted so. Women with an average education, who are able to design complex buildings as engineers, judge serial killers as magistrates, play extreme sports. In the name of an ongoing process of “decorporization”( Duden Barbara , 1994,Il corpo della donna come luogo pubblico, Bollati Boringhieri ) ,the labour is identified only by the pain, the phenomenon of the delivery is considered useless, a waste of time (it only takes half an hour for a Caesarean section!) and above all, it is taken for granted that it is only one option for delivery, nowadays outdated by more modern variations.

There are couples that conceive only one child later and later and that split up often and soon, because they aren’t able to put up with conflicts and also financial difficulties, due to the commitment to the family after the delivery. All conditionings about safety and pregnancy, which is often over treated, all the clamor over the need of super-experts of (normal) delivery that should preferably take place in an operating theatre, fall to pieces in the loneliness of going home, where the more complicated task has to begin: welcome and raise the newborn in their family. The first and one of the most important signs of civilization of a country is to support women’s childbearing competence, easing maternity choice. All this isn’t expensive. Paradoxically, the continuation of life on earth needs an appropriate culture more than expensive devices. The commonly sensed atmosphere of fear and risk of labour, which has lead us to the sad record of Caesarean sections, only needs a re-education project which, starting from schools, is addressed to women and is woman centered, and can reach media and decisional headquarters of perinatal politics.

I belong to a generation of women who wanted to crash the current authority, and brought on their own shoulders the burden of difference and persistence to state it. This happened in places, times and traditional settings, without supporting mentors. The contact with other women, sometimes a casual meeting, sometimes magic, often attempted, made feasible some achievements. A kind of visionary and an unconscious call towards what we guessed suitable and attainable led us. It was very hard for me to follow this way in a male based Medicine, in an ostensibly sexless environment such as the Hospital, to deal with the childbirth knowledge. Nowadays, even though this field belongs to the female gender, and despite a large amount of women working as caregivers, it’s still featured by a neutral/male feeling, teaching and learning. This is the reason why all that deals with giving birth is not considered.

The enormous feminine power derived from conception till childbirth, during centuries was hidden by an alleged authority that instead managed to picture it as fragility and inferiority(Rich, Adrienne 1977, Of woman born, Garzanti, Milan). The childbirth care “narrative” is humiliating, and the most important hindrance is the incompetence for women to take care of other women with feminine voices and hearths. Women: once solely devoted to reproduction, and now convinced that the only way to become a mother is by a CS. Therefore, the most worrying fact is the absence of political acknowledgement that the reproductive competence is the problem of problems, that should be the first government issue defining a women friendly agenda. A world governed without our bodies authority, without knowledge and proposals about our experiences and needs : we can’t risk to go out of us without an in(sight) that can make us fulfilled and strong. We can’t be politically engaged in whatever (feminist) target without experiencing wellbeing through/in our relationships, in particular regarding our feelings related to the commitment to support the planet life. My observatory is my medical profession, foremost provided to women. Today, as yesterday, the risk is to ignore their needs, confusing shame with hush,considering humiliations as a rule. Labor and childbirth currently happen in an authoritative and trivial frame: naked women, unfamiliar people attending, useless and ineffective routine practices, and the cesarean section publicized as freedom and choice, actually being the twenty-century snatching of the women biggest competence. Our need to fight comes from here.

In Europe in 70’s many associations struggled to reach the so-called “birth humanization”. Looking at Leboyer’s philosophy (Leboyer Frederyck, 1973, A birth without violence, Garzanti), at the Maternity ward in Pithivier, built by Michel Odent(Odent, Michel 1981, Nascita dell’uomo ecologico, RED edizioni, Milano), the first Birth Centres were born. The first great challenge undertaken was the birthplaces transformation, and a subsequent reconsideration about the whole process ways and times. Rebuilding the memory of female bodies’ original functions we sought for more appropriate visions and evidences, so that nowadays the majority of routine practices reserved to laboring women are considered ineffective and/or harmful. Also in Italy we succeeded to build “Homelike maternity centres are changing and developing centres”, ex: (Odent, 1981:67) in which there’s the opportunity to let pregnant women and clinicians (especially midwives) live the full birth experience supporting competence and promoting choice. The clinicians, mainly midwives, involved in changing some practices or birthplaces structures experienced directly how much the mission is hard. It requires an empathic relationship with the labor time through a specific training obtained during long days and nights spent with laboring mothers.

Coming back to 70’s, also thanks to feminist movements, many women made their professional choices in order to take care of other women supporting their sexual and procreative competences. Actually, the young women residents attending Obstetrics and Gynaecology Departments, could have a direct and plane look of what nowadays, from other perspectives, is called Obstetric Violence. A terrible sense of impotence was felt by residents who didn’t agree with routine practices and teaching principles in order to which women were isolated from husbands and parents, laying-in beds with continuous fetal hearth monitoring, and weren’t allowed to drink, eat, walk during labor. Residents were expected to learn and agree with those causes and those practices. The impotence was often felt as well by midwives, involved more actively in practices.

All of us know that at least for two centuries women everywhere used to undergo blameworthy practices, sometimes criminal, when” helping in childbirth” became a shared “dominion” between two professionals, midwives and specialists. In Italy Midwifery is still featured on an old and ineffective hospital centered model, between an authoritative medical perspective and a not well defined midwives autonomy. What about women? They are thought as needing always protection, and so depicted in every sexual and reproductive parliamentary act. However, are Italian women so fragile? Perhaps not, if we look at their reaction to the web campaign #bastatacere (http://www.facebook.com/bastatacere).

An enormous amount of testimonials invaded the web, telling about their great or little oppression experiences in giving birth, usually with specialists showed as the main accountable. However, the same healthy women, roughly the majority (85.5%) ,do prefer to be cured by specialists, and not by midwives. Are women really fragile? Or isn’t it a matter of changing the childbirth culture as a whole? The true target is very crucial : leaking the Italian European record of CSs rate, a raising trend who nobody had actually resisted, also due to the above hospital centered model and lack of appropriate politics. Perhaps the question is more complicated than looking for a “Mc Carthy like” obstetric violence campaign addressed specifically to professionals.

And, finally, what about our old and future battles? Acknowledging the women’s difference and, moreover, choosing to become a helper in childbirth with feminine voice and hearth is a privilege, dealing with the unexpected, the blood, the pain, the compassion and joy sounds as an incomparable opportunity(Morano, Sandra , 2013,“Chi ha paura della Maternità?Parole Immagni Affetti Per una narrazione, Aracne, Roma) . However, in order to meet such a paramount issue, we also need policies and educational investments towards a culture made of more cultures, which may return dignity and competences to women, and new perspectives to the whole society.

Biography

Sandra Morano is graduated in Medicine and postgraduated qualifications in Obstetrics and Gynaecology, Reproductive Pathophysiology, and in Sexual Medicine. She is professor in Obstetrics and Gynaecology at Genoa University and was consultant obstetrician in IRCCS S.Martino –IST Istituto Scientifico Tumori University Hospital, Genoa, Italy since 2015. In 2000 she created the first Italian Birth Centre, aiming to promote continuity of care and satisfaction in childbirth. She currently teaches Obstetrics and Gynaecology at the Medical and Midwifery School of Genoa University. Her fields of interest are promotion of psychodynamic health and normality in pregnancy and childbirth, the prevention of perineum disorders and postpartum depression. She is PI for Italy of the project Optibirth, whose aim is to reduce the CS rate through raising of vaginal birhs after Cesrean section. She has published peer-reviewed research papers and books.

labrys, études féministes/ estudos feministas
julho/ 2016- junho 2017 /juillet 2016-juin 2017