Clara's birth.

Abstract

Advocacy for homebirth is based on the strong assumption that birthing is a physiological process and does not require medical interventions unless things turn "wrong." Let us assume that something might always go wrong, for instance during Clara's birth when the placenta was still retained after three hours. What needs to be done? The moment the midwife entered the house she was endowed with a responsibility for any problem caused by her failure to give proper guidance. With this weight on her shoulder, and according to her training and experience, there was no other way for her than to suggest an intervention regarding the placenta. The two midwives, B, and C., might not agree on risk estimations, the nature of the intervention, whether it should be performed at home or in a hospital. The estimation of abnormalities, evaluation of risks and the procedures with which to handle them are the main practical difference between classic obstetrics and non-interventionist midwifery--by analogy, between allopathy and naturopathy. The rest (positive thinking) is basically literature. A delivery will not remain normal just because we decide it "must" be physiological. Dr. Barua, a professor of obstetrics in Pondicherry, pointed out that normal deliveries are rare--fewer than 10 percent in South India. What we have instead is either pathological or "natural" deliveries in which regenerative processes take care of abnormal situations. Unless she has developed sensitive hands, a birth assistant or midwife must rely on monitoring procedures to evaluate deviations from the normal process. Even with the greatest care, these procedures are intrusive in that they disconnect the parturient from her own sensations. While successful unattended homebirth stories emphasise the extraordinary power and sensitivity of a birthing woman, the whole dream seems to collapse in abnormal or pathological cases. It would have collapsed for Sonia as well, had she not discarded negative suggestions. Dependency on medical experts is an alienation by which the patient is forced to tolerate what is not tolerable to her at a precise moment. The trauma of medicalized birth is not surprisingly associated with rape. It remains that the leitmotif in homebirth literature is more "empowerment," self assertion, militancy for the freedom of choice and ownership of her own body, than "self reliance" which involves a long-term sensitisation. Even outstanding essays a advocating non-medicalized birth may contain a sentence with implicit fear talk defusing the argument. For instance: "And if need be, [the midwife] can transport you to the hospital if you truly need the help that only modern obstetrics can provide...."] The sentence may be countereffective to a reader who is insecure about homebirth. The problem lies in the proximity of "truly" and "only." It was indeed the writer's intention to emphasise "truly" with an interrogative connotation: "Are you sure you need it?" However, the effect is overruled by the assertive strength of "only." The reader's unconscious reading may be that, truly, she needs the help that only modern obstetrics can provide. This is an example of negative suggestions conveyed by confidence building talk about health and pregnancy. Another example was Denis and Sonia's obsession with the placenta retention problem that had been causally exposed by midwife B. Why should her empowerment end suddenly when there is a life threatening complication during the delivery? If the pregnant woman claims a fundamental right to choose her way of birthing in uncomplicated cases, she needs even more self determination when she is in real danger. This paradox is striking evidence that the common sense attitude toward danger is affected by the "allopathic mind." It sets up an insurmountable barrier between the physiological and the pathological, whereby symptoms are failures of the normal regenerative processes. Hence, testimonies of women feeling that their bodies "b