Robbie Davis-Floyd

The technocratic, humanistic, and holistic paradigms of childbirth

This article describes three paradigms of health care that heavily influence contemporary childbirth, most particularly in the west, but increasingly around the world: the technocratic, humanistic, and holistic models of medicine. These models differ fundamentally in their definitions of the body and its relationship to the mind, and thus in the health care approaches they charter. The technocratic model stresses mind–body separation and sees the body as a machine; the humanistic model emphasizes mind–body connection and defines the body as an organism; the holistic model insists on the oneness of body, mind, and spirit and defines the body as an energy field in constant interaction with other energy fields. Based on many years of research into contemporary childbirth, most especially through interviews with physicians, midwives, nurses, and mothers, this article seeks to describe the 12 tenets of each paradigm as they apply to contemporary obstetrical and health care, and to point out their futuristic implications. I suggest that practitioners who combine elements of all three paradigms have a unique opportunity to create the most effective obstetrical system ever known.

The technocratic body: American childbirth as cultural expression

The dominant mythology of a culture is often displayed in the rituals with which it surrounds birth. In contemporary Western society, that mythology--the mythology of the technocracy--is enacted through obstetrical procedures, the rituals of hospital birth. This article explores the links between our cultures mythological technocratic model of birth and the body images, individual belief and value systems, and birth choices of forty middle-class women--32 professional women who accept the technocratic paradigm, and eight homebirthers who reject it. The conceptual separation of mother and child is fundamental to technocratic notions of parenthood, and constitutes a logical corollary of the Cartesian mind-body separation that has been fundamental to the development of both industrial society and post-industrial technocracy. The professionals body images and lifestyles express these principles of separation, while the holistic ideology of the homebirthers stresses mind-body and parent-child integration. The conclusion considers the ideological hegemony of the technocratic paradigm as potential future-shaper.

Birth Models That Work

This groundbreaking book takes us around the world in search of birth models that work in order to improve the standard of care for mothers and families everywhere. The contributors describe examples of maternity services from both developing countries and wealthy industrialized societies that apply the latest scientific evidence to support and facilitate normal physiological birth; deal appropriately with complications; and, generate excellent birth outcomes - including psychological satisfaction for the mother. The book concludes with a description of the ideology that underlies all these working models - known internationally as the midwifery model of care.

The role of obstetrical rituals in the resolution of cultural anomaly

To a technological society like that of the United States, the natural process of childbirth presents special conceptual dilemmas, as it calls into perpetual question any boundaries American culture tries to delineate between itself and nature. The author builds on previous works in which she has argued that the American core value system centers around science and technology, the institutions through which these are disseminated into society, and the patriarchal system through which these institutions are managed. A constant reminder that babies come from women and nature, not from technology and culture, childbirth confronts American society with practical, procedural dilemmas: How to create a sense of cultural control over birth, a natural process resistant to such control? How to make birth, a powerfully female phenomenon, reinforce, instead of undermine, the patriarchal system upon which American society is still based? How to turn the natural and individual birth process into a cultural rite of passage which successfully inculcates the dominant core value system into the initiates? In the absence of universal baptism, how to enculturate a non-cultural baby? Some of the dilemmas discussed in this article are universal problems presented by the birth process to all human societies; others are specific to American culture. Each contains within it a fundamental paradox, an opposition which must be culturally reconciled lest the anomaly of its existence undermine the fragile technology-based conceptual system in terms of which American society organizes itself. After a brief discussion of the history of this technological paradigm, the author analyzes eight of the dilemmas presented by childbirth to American society, demonstrating how they have been neatly resolved by obstetrical rituals specifically designed to removed births conceptual threat to the technological model by making birth appear, through technological means, to confirm instead of challenge the basic tenets of that model. From this perspective, routinely used obstetrical procedures such as electronic fetal monitoring, episiotomies, the lithotomy position, and even the Cesarean section emerge as rational ritual responses to the conflicts between reality as American society has constructed it, and the physiological realities of birth.

La partera profesional: Articulating identity and cultural space for a new kind of midwife in Mexico

This article documents the emergence of a new kind of midwife in Mexico, the thoroughly postmodern portera profesional. It traces the transnational conjunctures that facilitated her creation, illustrates aspects of her philosophy and praxis, and probes her ongoing articulations of identity. These women, who are of diverse sociocultural backgrounds, initially sought training from American direct‐entry midwives in the independent out‐of‐hospital midwifery model; now, they are adapting that model to the situation in Mexico. Through their own practices, through intensive liaison work with traditional midwives, and through organizing national midwifery conferences and meetings, they are creating midwifery as both incipient profession and nascent social movement. Some of them operate outside the medical system while others are carving a niche within it. The mere existence of these self‐consciously activist midwives constitutes a critique of monological Mexican medicine and its high cesarean rates; however, these women face a long struggle to define their identities, legalize their practices, and generate a sustainable space within the emergent Mexican technocracy. To their intense dismay, this struggle must take place within the context of the escalating disappearance of the traditional midwives whom they seek to support. The tension they feel between their desire to preserve traditional midwifery and their desire to create professional midwifery is a recurrent theme. These goals alternately complement and conflict with one another, yet both are central to the partera profesionals ongoing efforts at identity articulation.

Introduction. Daughters of time: The shifting identities of contemporary midwives

Imagine anthropologist Robbie Davis-Hoyds surprise when she rounded a corner in a birth center owned by Dona Facunda, a partera traditional (traditional midwife) who works in Morelos, Mexico, and encountered a flat marble delivery table complete with metal stirrups. Laughing as the anthropologist expressed her amazement (iAy, Dona Facundal ¿que hace una partera traditional con una mesa as [My goodness, Dona Facunda! Whats a traditional midwife doing with a table like that?]), Doña Facunda, with a mischievous glint in her eye, pointed out that the fathers, mothers-in-law, and grandmothers who accompany her clients believe in the efficacy of the hospital and its procedures, including giving birth in the lithotomy position. If they want me to act like a little doctor (mini-médico), she said, holding up her blue hat and booties, I can do that! But when the mother-in-law says, Shouldnt she get up on the table now? I say, Tvlo, if s not time yet, and I encourage her to keep walking around or to rest comfortably in my big double bed. Most of my mothers give birth sitting, kneeling, or squatting. Very few want the table. Its here if they do, but its main use is just for show! She added, If having an IV makes them feel safer, for an extra 100 pesos Im happy to insert it. But I really hate for women to give birth flat on their backs and hooked up to an IV. So I encourage them to wait before they get up on the table, until they are really pushing well, and then they find they like being upright. Grabbing the handles from which the IV bag would be suspended, and using them to support herself in the birth-position

Daughter of time: the postmodern midwife (Part 1)

This article presents the notion of the postmodern midwife, defining her as one who takes a relativistic stance toward biomedicine and other knowledge systems, alternative and indigenous, moving fluidly between them to serve the women she attends. She is locally and globally aware, culturally competent, and politically engaged, working with the resources at hand to preserve midwifery in the interests of women. Her informed relativism is most accessible to professional midwives but is also beginning to characterize some savvy traditional midwives in various countries. Thus the concept of the postmodern midwife can serve as a bridge across the ethnic, racial, and status gaps that divide the professional from the traditional midwife, and as an analytical focal point for understanding how the members of each group negotiate their identities and their roles in a changing world.

Birth and the Big Bad Wolf: An Evolutionary Perspective1

Once upon a time, there were six little pigs who set out to seek their fortunes in the world (okay, we know that in the original story there were only three, but just bear with us here!). Far away from home they journeyed, until the first little pig spied a peaceful meadow with a stream running through it; there he stopped his hot and weary journey. In 2 hours he had built himself a house of straw, then he spent another hour building animal traps, after which he set about to laugh and dance and play all day. It was like that every day – he would spend 3–5 hours hunting wild game, after which he could do as he pleased. The female pigs gathered wild grains, tubers and fruits so that food was available even when the hunt failed. Although the first little pig didn’t always like to admit it, the female pigs brought in 70–80% of the diet from foraging, and often helped with the hunting and trapping as well. He was feeling very content, for he had wished to find an environment that could sustain him and his small band of kin pigs, and he had. Sure, he and his like-minded friends experienced high infant mortality rates and a resulting life expectancy of around 35 years, as well as high death rates from endemic disease and accidental death. However, as they discussed frequently in their abundant leisure time (in between the long stories they loved to tell), these problems were offset by their varied and nutritious diets and high mobility, which made sanitation and infectious disease transmission non-issues. Life was good and gender relationships egalitarian for the most part.

Filha do tempo: a parteira pós-moderna (Parte 1)

This article presents the notion of the postmodern midwife, defining her as one who takes a relativistic stance toward biomedicine and other knowledge systems, alternative and indigenous, moving fluidly between them to serve the women she attends. She is locally and globally aware, culturally competent, and politically engaged, working with the resources at hand to preserve midwifery in the interests of women. Her informed relativism is most accessible to professional midwives but is also beginning to characterize some savvy traditional midwives in various countries. Thus the concept of the postmodern midwife can serve as a bridge across the ethnic, racial, and status gaps that divide the professional from the traditional midwife, and as an analytical focal point for understanding how the members of each group negotiate their identities and their roles in a changing world.

OPEN AND CLOSED KNOWLEDGE SYSTEMS, THE 4 STAGES OF COGNITION, AND THE CULTURAL MANAGEMENT OF BIRTH

This conceptual article looks at levels or Stages of Cognition, equating each of the four stages I examine with an anthropological concept. I equate Stage One--rigid or concrete thinking--with Naive Realism (our way is the only way, Fundamentalism (our way should be the only way and those who do not follow it are doomed), and Fanaticism (our way is so right that everyone who disagrees with it should be either converted or eliminated). I equate Stage Two with ethnocentrism (there are lots of other ways out there, but our way is best). The next two Stages represent more fluid types of thinking--I equate Stage Three with cultural relativism (all ways are equal in value and validity), and Stage Four with global humanism (there must be higher, better ways that can support cultural integrity while also supporting the individual rights of each human being). I then categorize various types of birth practitioners within these Four Stages, while showing how ongoing stress can cause even the most fluid of thinkers to shut down cognitively and operate at a Stage One level that can involve obstetric violence--an example of further degeneration into Substage--a condition of burnout or losing it. I show how ritual can help practitioners ground themselves at least at a Stage One level and offer ways in which they can rejuvenate and re-inspire themselves. I also describe a few of the ongoing battles between fundamentalists and global humanists and the persecution globally humanistic birth practitioners often experience from fundamentalist or fanatical Stage One practitioners and officials, often referred to as the global witch hunt.