First I have to catch my breath from laughing so hard. I try not to spend large amounts of time wading through complete bullshit, but as a service to my readers, I bought and read Melissa Cheyney’s latest attempt at academic relevance. I ought to try it more often; it’s really funny.
And I did learn something important. Anyone who believes the oft repeated claims that homebirth midwifery is about scientific evidence is at best naive, and at worst a fool.
Melissa Cheyney makes clear, in her new paper published yesterday in the Medical Anthropology Quarterly, Reinscribing the Birthing Body: Homebirth as Ritual Performance, that homebirth is about anything but the scientific evidence.
Cheyney’s paper is a celebration of the crap that passes for “research” among homebirth advocates:
… As a socially performed act of differentiation, homebirths are constructed in opposition to dominant ways of giving birth, although just where the lines between consent and resistance lie are not always clear, shifting with each provider and each mother, over time and in the retellings.
Now don’t you feel silly; homebirth is not about birth or babies. Melissa Cheyney confirms what I have been saying for years. Homebirth is about defiance of authority. Of course that begs the question of what Melissa Cheyney is doing as Head of the Oregon Board of Direct Entry Midwifery. How trustworthy is a regulator whose stated aim is to create ritual performances in opposition to standard practice?
You might have thought that prenatal and intrapartum care was about delivering healthy babies to healthy mothers. How tragically naive; it’s all about peeling away fictions:
Midwives describe the desire to peel away these fictions of medicalized prenatal care, exposing strong and capable women who “grow” and birth babies outside the regulatory and self-regulatory processes naturalized by modern, technocratic obstetrics…
In other words, homebirth midwifery is not about what is actually happening, it’s all about pretending that women are strong and capable even when they are ill or their babies are dying.
Indeed:
The midwives who participated in this study openly reject the messages of danger, uncertainty, fear, “tentative pregnancy,” doctor-as-ultimate-authority, strangemaking, and even, to some extent, the separation they believe are communicated by the rituals of medicalized prenatal care…
But if homebirth midwifery is all about banishing messages of danger, uncertainty or fear (even when they are justified), why do homebirth midwives ape the practices of real medical professionals? Cheyney attempt to dazzle us with BS:
The use of prenatal artifacts—equipment for taking blood pressure or for urinalysis, for example—are thus, embedded in the larger power/knowledge matrices of midwifery–obstetric practices. The context, artifacts, and symbolic actions associated with prenatal care function to stack or layer meanings for participants by providing a text and subtext that are simultaneously both literal and metaphorical.
Uh-huh. Evidently that means that homebirth midwives monitor pregnant women NOT because such monitoring provides valuable information to be acted upon as necessary, but simply because it is a ritual that women expect. For homebirth midwives, pretending is far more important than reality.
… Repeated restylizations of the strong, capable, healthy pregnant body in the home communicate connection, safety, and well-being. These reconstructed “natural facts,” while equally socially embedded relative to more medicalized perspectives, are seen by midwives as essential components of the foundation needed for “trusting birth outside the hospital” once labor begins.
In case anyone is confused about what’s really important, Cheyney approvingly quotes a homebirth midwife:
I hope no doctors or midwives are running around thinking all we want is a live baby and mother…
Believe me, I’m not confused on that point!
There’s so much nonsense in this paper that, in the interest of brevity, I’ll offer a few more representative quotes.
On active labor:
… The physiological processes of labor transport women into an inherently liminal space—called “laborland” by mothers and midwives in this study—that carries its own affectivity. During labor, midwives can capitalize on this affectivity to transmit transgressive values about pregnant and birthing bodies, socializing participants into accepting the powerful and life-giving properties of the female body and the unity of mother and baby.
On upright pushing:
… It co-opts and restructures what Babcock has called “symbolic inversion,” where the gradual psychological opening to new messages characteristic of the liminal or transitional period of ritual is intensified by metaphorically turning elements of the normal belief system upside-down or inside-out.
On delayed cord clamping:
Midwives tend to feel very strongly about how the immediate postpartum period should unfold and argue that it is cruel to sever the cord too early.
On neonatal resuscitation:
… [M]idwives advocate for some practices that differ from mainstream hospital resuscitation rituals. For example, midwife participants argued that resuscitation is not simply the physiological process of assisting ventilation. Infants are seen as active participants in the process and, like adults who can be called back to consciousness after fainting by stimulation and speaking of their names, respond quickly to maternal touch and voice. Midwives, thus, encourage mothers to “call their babies back,” to caress and to speak to them as they are resuscitated.
Homebirth advocates routinely complain about the centrality of the doctor in “technocratic” births. Curiously, in homebirth midwifery the mother is not the central actor, the homebirth midwife is. A woman can’t simply be pregnant, labor, give birth or welcome her new baby. Every aspect of the process must be mediated by midwives whose primary purpose appears to be to transmit transgressional messages.
One aspect of birth — safety — is almost entirely absent from Cheyney’s discussion. Homebirth is not about birth and it is not about babies, so safety is irrelevant. It’s all about counter hegemonic empowering values!
… the rituals of homebirth midwifery care are not simply about assuring personal transformation via the transmission of counter hegemonic–empowering value —although many women certainly described their experiences this way. Midwifery rituals, as I have argued, are also self-consciously political in their intent. As the popular bumper sticker “Midwives: Changing the World One Birth at a Time” suggests, homebirth is a performative medium for the promotion of social change.
Actually, what it is really about is self-proclaimed midwives making themselves stars of the ritual “performance”:
… Capitalizing on the semiotic potential, heightened emotion, and the liminality of the birth itself, midwives seek to overturn mechanistic views of the faulty female body in need of medical management, replacing them with the language of connection, celebration, power, transformation, and mothers and babies as inseparable units. Homebirth practices, thus, are not simply evidence based care strategies. They are intentionally manipulated rituals of technocratic subversion designed to reinscribe pregnant bodies and to reterritorialize childbirth spaces and authorities. For many, choosing to deliver at home is a ritualized act of “thick” resistance where participants actively appropriate, modify, and cocreate new meanings in childbirth.
This paper is Exhibit A in why Melissa Cheyney is grossly unqualified to head the Oregon Board of Direct Entry Midwifery. For her, homebirth is all about three things: the midwife, the midwife’s beliefs and the midwife’s “performance.” Birth, babies and safety have little or nothing to with homebirth.
