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transcending silence... 2008 Issue

Birth: Eight Women Tell the Truth about Birth in America

Elizabeth A. Becker

Abstract

Every year during the month of September, community groups throughout the US present Birth, A Play by Karen Brody to honor BOLD (Birth on Labor Day). BOLD is a critical theatre project that Brody created in 2006 that is committed to consciousness-raising about birth as a woman’s reproductive right. This essay is the revised version of a sociological/anthropological fieldwork report, originally written for the Women’s Studies capstone course entitled, WSS490Z: "Research Seminar in Women's Studies," at the University at Albany. The purpose of this essay is: 1) to critically analyze BirthNet’s production of Karen Brody’s play, Birth, through a close "reading" of the event(s) and 2) to act as a reflection on the process of participant-observation. For these reasons, descriptive and analytical notes gathered during the field experience are provided in order to offer perspective on the process of data collection and analysis. This essay examines the audience, the content of the play, a silent auction, and a talkback panel, analyzing how consciousness-raising about birth politics "plays itself out" through live media. In many ways, this essay functions as an entrée to a much larger body of work and a growing advocacy project.

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Sections

Field Notes: Observations
Field Notes: Analytical Notes
Analytical Essay

The Setting
Gaining Access
My Role as Researcher
Data Collection
Data Analysis

Endnotes
Bibliography

Field Notes: Observations

Birth, "Eight Women Tell the Truth about Birth in America" -- September 30, 2007
- play written by Karen Brody
- sponsored performances in 30 US cities and Amsterdam
- trying to raise awareness about mother-friendly maternity care
- donation of a section of Safe Motherhood Quilt by Ina May and Steven Gaskin
- event sponsored by BirthNet, local consumer/midwifery advocacy organization
- performance space donated by Russell Sage College in Troy, NY
- silent auction featuring local artists and giveaways held during intermission
- discussion with cast and BirthNet organizers to follow performance

Performance setting & notes:
- dimly lit, cozy theatre.
- well-attended evening performance; there are a few women alone, no men alone.
- boisterous chatter, good audience energy, positive vibes.
- snacks and drinks served; baby-friendly environment.

Memorable character anecdotes:
- "Can I really get what my dog got?"
- (Amanda) "My Body Rocks!"
- "Empowering Epidural"
- "A woman doesn't have to be rescued from pain."
- "I had never been a part of women caring for each other before this."
- "My body is not a lemon."
- "Butt Pain."
- "Nooo! Don't cut me!" -- forced, in-hospital episiotomy.
- "Planned C-section."
- (Lisa) "Don't I matter?"

Intermission:
- silent auction with local artists and businesses auctioning off goods and services.
- natural and organic foods and beverages offered for purchase.

Panel discussion:
- sensitivity issues surrounding childlessness and motherhood; alternative forms of mothering/nurturing/care-work.
- evidence, science, data as opposed to the "cultural pendulum"; choice based in real information, evidence-based practice.
- a mother is born, when her baby is born. ("A father is born -- if there’s a father," said a panelist.)
- "The oldest profession is not prostitution, it’s midwifery!" -- Anonymous panelist.

Nurse from Germany speaks about midwives in the "old country"; points to irony of the state of American healthcare -- highly medicalized, technological birthing practices do not protect against (and often lead to) higher infant and maternal mortality than in other industrialized nations that utilize midwifery care.

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Field Notes: Analytical Notes

performance setting:
- theatre was well-heated and dimly-lit, giving the audience a sense of coziness, a womb-like atmosphere.
- 80+ member-audience made up almost entirely of women with friends and children, some men in attendance (8 or 9) who look like partners, husbands, fathers and one or two friends; men are attached to the women, implicitly understood as a "women's event."

"Can I really get what my dog got?" -- All eight women ask this question in conjunction with a story told by one about her dog giving birth in a very warm, calm environment. Her dog is able to keep her pups with her as soon as she gives birth to them and it is understood by all that one should not "intervene" in this natural process. These women ask why humans (particularly women) must settle for less.

(Amanda) "My Body Rocks!" -- Amanda, played by a good friend of mine, is a character who recognizes her self-worth through motherhood and the process of giving birth. She repeats her mantra, encouraging the audience to participate as she acts out giving birth on stage.

"Empowering Epidural" -- This character, a second wave feminist, recounts her experiences with the birth of her first child. Originally she plans to give birth in a birthing center by a group of "granola" midwives, but ultimately she cannot endure the pain of the labor and she transfers to a hospital where she begs for an epidural, which she later names her "empowering epidural." She implies that she felt empowered because she was able to "overcome" the pain of the event.
- "A woman doesn't have to be rescued from pain." -- a realization during a subsequent pregnancy: a refusal to live in fear of pain; to allow others to control reproduction through pain management.
- "I had never been a part of women caring for each other before this." -- a remark after attending a home birth for the first time; feeling connected to womanhood and motherhood in a powerful, primal way.
- "My body is not a lemon." -- to be squeezed and poked; it is not a broken thing, a sour thing.

"Butt Pain" -- A memorable remark about the way that giving birth really feels. The character said that it's "a pain that you don't forget," "not even with an epidural." According to her, it feels like the baby is "coming out of your butt" and "you don't forget that!"

"Nooo! Don't cut me! -- forced, in-hospital episiotomy; this is a particularly poignant line because it resonated with the entire audience and spoke to the importance of a mother’s agency in birth, addressing the systemic neglect of women and mothers within American medicine. Speaks clearly to issues of reproductive control; e.g. socially accepted forms of female genital mutilation.

"Planned C-section" -- a take-charge, urban businesswoman opts for a planned c-section because she does not want the birth to interfere with her busy schedule and she wants to make certain that everything goes according to plan; she wants it to run like an elective surgical procedure. The ability to choose this as an option can feel empowering for some economically privileged women because, while they surrender control of their bodily functions to their physicians, they feel that they retain the ability to plan the event (everything from choosing the date and time to electing for cosmetic surgery), thereby remaining in control of their own destinies.

(Lisa) "Don't I matter?" -- another emergent theme throughout the eight narratives; Lisa’s plaintive cry speaks to the powerlessness often felt by laboring mothers in highly medicalized settings, while at the height of labor.

Additional emergent themes:
-Empowerment, privilege, womanhood, identity.
-Abortion: "dissociation" -- the baby-mother split -- technological intervention; medical "gaze" -- Medicalized birth
-Facing issues of modernity, familial/societal expectations of birthing decisions/practices.
-Further questions of the "empowered consumer": What are the social and political implications of using the term "consumer" to frame agency and choice within public discourses on reproductive justice issues?

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Analytical Essay

The Setting

I chose to review a local performance of the play Birth, written by Karen Brody and presented by BirthNet at Russell Sage College in Troy, NY. [1] The event took place all day Sunday, September 30th with an afternoon and evening performance, a "Red Tent,"[2] a silent auction, and a talkback panel following each performance. While I would have liked to capture the entire day’s events, I was only able to attend the evening performance, the silent auction and the panel discussion. As it turned out, these three parts of the event provided a wide range of data to analyze. The play is performed annually during the month of September in 30 U.S. cities as well as in Amsterdam, The Netherlands. The popularity of this play is due in large part to the continued organizing and mobilization of community theatre groups and activists through Brody’s organization Birth on Labor Day (BOLD). [3] The performance that I attended was put on by BirthNet, a local reproductive rights advocacy group, and the cast was made up primarily of local birth professionals and activists. The performance space was donated to BirthNet by the Theatre Department at Russell Sage and the profits earned through the performance will be used to benefit BirthNet's future education and advocacy efforts within the community. Additionally, donations were collected to benefit the family of a mother who recently died in childbirth in the Capital District.

I chose to analyze this particular event because it represents a bridge between theorizing and community action, between practice and community education within the reproductive rights movement in the United States. By performing and attending this play about birth in America, these women (and men) came together to discuss and raise awareness about reproductive rights issues and to support one another in their continued efforts through a variety of methods. The play addresses the paucity of contemporary accounts of American women's birthing experiences and offers many different perspectives on natural birth and reproductive rights. The event provided a relaxed and enjoyable space in which to discuss these important issues.

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Gaining Access

Gaining access was not difficult. Since the event was open to the public and designed to inform as well as facilitate discussion of the issues, it was very easy to collect information without disturbing the ambiance. I was able to observe and participate seamlessly. I had the added benefit of being a friend of one of the cast members as well as an avid supporter of BirthNet. Also, the cost of attendance ($5-10) was very reasonable, with a sliding scale for seniors, students and adults. Being a single woman in college, I am a member of one of BirthNet's target audiences, as they intend to involve young women--who have not yet decided to have children--in discussing American birthing practices. By including women like me, they are opening the discussion to proactive solutions for the future of American birth, in addition to recounting personal histories and analyzing past and present circumstances.

At this event, women outnumbered men by about ten to one. Perhaps the topic itself is an implicit gatekeeper? The men played supportive roles, as friends, partners, husbands, or (sometimes) fathers, whereas the overwhelming majority of the women were mothers themselves. Consequently, women played a particularly active and dynamic role in this space.

Interestingly, the issue of childlessness was a source of conflict during the panel discussion. A woman in the audience pointed out how discourses on childbirth and motherhood have tended to marginalize those women who either choose not to or are unable to have children themselves, often altogether discounting their mothering capacities and relevant carework within their communities. Panelists and other members of the audience were receptive to her critique, but quickly pointed out that this event was created to celebrate carework in many forms. One of the panelists even encouraged her to write a play addressing these issues herself. I felt the tension between these women as they earnestly tried to find a middle ground and respect one another’s points of view. However, I think that they eventually lost confidence in each other as the critiques and suggestions that they traded appeared to fall on deaf ears.

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Data Collection

I took notes openly and freely over the course of the three hours that I was there. I also recorded the first half of the performance with a digital voice recorder. It was a useful tool for jogging my memory about details and identifying poignant moments such as laughter, applause and silence during the performance.

Despite the ease of access and because I went to the event alone, I felt somewhat isolated in a particular way: nearly all of the women and men at the event had arrived as part of a group or a couple. Even the other students had come with friends or partners; so I did appear different from the rest of the group. I also kept to myself more than if I had come with a friend, as we likely would have mingled and discussed things with others. In retrospect, I wish that I had used the opportunity to interview more of the event-goers, participants, and organizers; like a cultural anthropologist, I had wanted to keep a low profile and keep from disturbing the flow of the event with my questions. I kept my participation to a minimum and only discussed my research with people who asked me directly. Otherwise, I went about just like everyone else. Yet again, I feel in retrospect that this may have been an opportunity wasted to compile even more valuable qualitative data about the demographic of the participants and the event itself.

I did receive, however, a wealth of information from analyzing the critical issues and power relations that I was able to perceive at the event. In addition to the playbill, each of the audience members received a small parting gift for attending the performance. Each was wrapped in a shimmering lavender satchel and tied with a violet satin ribbon. Each one included a compact rolling back massager, three packets of "mother-and-baby-friendly" tea (chamomile, mint, etc.) and a vanilla-scented candle. While none of these objects were specifically gendered--other than the tea which proclaimed its mother-friendliness right on the label--I think it is safe to assume that the gift was intended to tap into the feminine.

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Data Analysis

This event was structured entirely around the performance of Birth, A Play by Karen Brody. Great attention to detail was taken to create both an event and a space that was warm, inviting and comfortable for participants to share their ideas, their emotions and their stories about being women and being mothers. For this reason, the event was designed to put women at the center of the discussion. The organizers have been able to bridge differences between diverse groups of women by focusing on and organizing from perspectives on motherhood and carework, in which arguably, women everywhere on earth are at some time and in some way involved.

This is, however, a contentious point from which to form an analysis--especially a feminist analysis--of women’s lives. There is deep disagreement surrounding the history and liberating potential of motherhood, due in large part to extensive evidence that societies worldwide do not value motherhood and carework very highly, despite the fact that they pay and have paid them lip service when it suits the status quo to do so. In fact, both motherhood and carework are marginalized forms of labor because of their reproductive qualities and the difficulty of accounting for this labor in our current economic systems. [4] Many scholars and activists have been deeply invested in arguing and acting from this theoretical position, while many others have been deeply critical of the liberating potential of this argument, acknowledging that not all women choose or want to choose motherhood. Still other women are unable to become mothers for health or environmental reasons, which was a topic of particular interest (as I have noted above) during the panel discussion after the performance. For me, the conflict that arose between the audience member and the panelists was particularly poignant because it demonstrated how women who are actively engaged in educating the public about issues of equity and visibility can be insensitive to alternative or conflicting viewpoints of other women. The most disheartening effect of this insensitivity occurs when potential bridges between activists (and everyday people) are not realized. This is a kind of tunnel vision, a deadly blindness. Despite these and other limitations, the organizers of this event were working from a good information base and a solid theoretical framework on the issues at hand and I would like to discuss the outcomes here.

I noted earlier that I was struck by the small number of men (roughly 10%) at this event. I observed that these few (brave) men were in attendance to support their wives, partners and friends who were experiencing something cathartic and energizing. However, I believe that the men present did, in fact, get something significant out of the experience themselves. The friend of mine who invited me to the event, and was incidentally a leading lady in the performance, told me that her partner had attended the day-time event, but was now home watching their two-year old son. She related that he had cried during the performance as it was the first opportunity that he got to see her in this stage role and her performance sent him back to the birth of their own child—in all of its beauty and intensity. When she recounted this anecdote to me, I recognized again how personal and transformative this event was for those in attendance. The organizers were committed to sharing and consciousness-raising, something that I think the performance communicated best.

Out of all of the anecdotes and experiences that I collected during the event, I was most impressed by the collection of semi-fictional, semi-biographical stories that made up the basis for the performance. Several themes emerged from the data that I collected, dealing with fundamental feminist concerns and concepts like empowerment, privilege, womanhood and identity. Through their dialogues and soliloquies, the women on stage grappled with these issues, making sense (and making fun) of the hard facts and harder choices about American birthing practices. Through their diary-like entries, they each communicated vastly complex identities and decisions, struggling with personal feelings, familial expectations and societal norms, as well as the medical establishment, and often doing so without any support. Something that is often overlooked about birth in American hospitals is that women make many so-called "informed decisions" during the course of labor, while either heavily sedated or in excruciating pain. Combined with societal expectations and the pressures physicians face to assist in a "flawless" birth, laboring women are often coerced into making decisions about their health and well-being that they would not normally have made under less intense, high-pressure circumstances. This is due in large part to mainstream medicine's construction of birth as "disease" or "temporary disorder," instead of as a normal physiological process that the female body is naturally equipped to handle. The parts of the performance that speak most greatly to these issues dealt in large part with the characters' perceptions and experiences of medical intervention practices during the course of labor--whether elective or not. I found the language and expressions that they used to describe these processes and their resulting responses to be most interesting and illustrative of the concepts mentioned above.

Perhaps the most illuminating character of all was played by a woman in her mid-late fifties or early sixties who went through one of the greatest transformation stories of any of the characters. I coded her story, "The Empowering Epidural," after the name that she gave to her first birthing experience in the hospital. The phrase carries quite a lot of pain, humor and irony, which she expressed throughout the course of her monologue. As a product of the late-1960s' counter-culture, when she and her partner decided to have children, she opted to give birth "the natural way" in a clinic staffed by "granola" midwives. [5] Unfortunately, this was her first birth and the labor was not an easy one. She was transferred to a hospital and as soon as she arrived, she begged the head obstetrician to give her an epidural. "Please, please! I need one; I need an epidural! Give me an epidural! Or else… Just kill me, take the baby and give it to my husband!" At which point, the physician conceded and she was finally able to relax.

At the time, she considered the epidural drugs a god-send to her, a true relief and an absolute necessity for birth. Her polemical endorsement of the epidural seemed similar to many first wave feminist arguments for women’s liberation through birth control. She felt empowered and privileged; she felt like the modern American woman and mother. As her story unfolded, she gave birth two more times and became increasingly unhappy with her recollection of the experience, particulary with her inability to connect with her body and with other women whom she knew to have had less intervention during their labors.

She began to do research on midwifery and shadow midwives. Later, she attended her first homebirth and felt its innate power, the feelings that the women shared together and the satisfaction that the birthing woman felt. When she was pregnant with her fourth child, she decided that she had to give birth at home in order ultimately to make peace with herself. Because of her high risk, she gave birth not at home but in a clinic staffed by midwives.

As she performed the monlogue, the tension in the audience was palpable. She ended with the story of the birth of her fifth and last child. She was ultimately able to give birth at home, surrounded and coached by her family and friends. She had come a long way out of fear and mistrust of her body and she found a way to lay claim to her own experiences through birth. The most important message from this piece was not that every woman should give birth at home; but like in the other women’s stories, she should be able to choose where and how she births her children. We should acknowledge that "a woman doesn't have to be rescued from pain." She should be encouraged to work through "her darkest hour" and overcome fear in any environment.

At the end of the evening and toward the panelists' final wrap-up, a German nurse raised her hand and spoke about her earliest experiences of nursing practice in this country. She had left Germany many years ago and came to the U.S. to work as an advanced practice nurse. She quickly discovered that for the vast majority of women, only obstetricians attended births in hospitals and clinics. She was surprised by the complete absence of midwives in major medical centers; whereas in Germany, birthing women were seen almost exclusively by trained midwives, except in the minority of cases that required some kind of surgical intervention to protect their life or the life of their child. In those cases, they were attended by an obstetrician. This comment initiated a full panel discussion of the rapid changes that had occurred in American medicine over the past hundred years. The majority of these changes took effect over the earlier part of the 20th Century, precipitating an extensive takeover of birthing practices by American physicians and resulting in the marginalization and near extinction of American midwives. Panelists raised the issues of racial and gender discrimination in the field of medicine in conjunction to the ousting of American midwifery, and showed how institutionalized forms of oppression and popular prejudices were used to sway public opinion against practicing midwives. As the audience members reflected on how images of women (especially women of color) have been used throughout history to silence and marginalize, one of the panelists noted wryly, "Despite popular opinion, the oldest profession is not prostitution, it's midwifery." (And guess which profession gets more publicity these days?) At this, everyone laughed.

There is an implicit awareness and fear at gatherings of this sort that the sacred rites and practices of midwifery--of women and partners participating in and supporting women through birth--are in constant jeopardy today with over-reliance on medical technologies and widespread mistrust of women's bodies and power. In spite of this, I am not without hope. Life, giving it and supporting those throughout that process are very ancient rites; they predate every institution and run across cultures, even across species. Even as we contest teleological "master" narratives and reinvent notions of progress, we continue to find ways to preserve our most sacred, not simply from fear of loss, but because they are necessary to our survival.

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Endnotes

[1] Although the play's title is officially Birth, A Play by Karen Brody, I chose to emphasize the event’s tagline ("Eight Women Tell the Truth about Birth in America") in my own title in order to reflect the multi-layered critical analysis within the performance narrative. [Return]

[2] The Red Tent was designed to provide a safe space for women to share their own mothering and birthing experiences, whether discussing fertility issues, loss of a child, birth experiences in different settings, the political and legal issues surrounding midwifery practice, or anything else that bridges the personal and political. The concept of the "Red Tent" is based on the book by the same title, written by Anita Diamant. [Return]

[3] Additional information about Birth on Labor Day (BOLD) can be found at: http://www.birthonlaborday.com/. [Return]

[4] These concepts were derived from the work of Marilyn Waring on national income accounting, "Who's Counting?: Marilyn Waring on Sex, Lies, and Global Economics," directed by Terre Nash. [Return]

[5] The term "granola" is used to describe people who live (or appear to live) a socially liberal, environmentally-sustainable lifestyle, that is most often associated with hippies. It comes from the stereotypic image--a granola-crunching, Birkenstock-clad, dreadlock-bedecked, tree-hugging, peace-loving flower child. It can be used in both a negative or a positive context, but is intended to connote humorous undertones in either case. [Return]


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Bibliography

Brody, K. (2004). Birth, A Play by Karen Brody. Organized by BirthNet, performed at Russell Sage College. September 30, 2007.

National Film Board of Canada, The. (1995). "Who's counting?: Marilyn Waring on Sex, Lies, and Global Economics." (Video). Directed by Terre Nash.

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Edited by Robin Morris and Sabrina Tabarovsky