22. Book Review: Birth As An American Rite of Passage
Have you ever questioned the necessity of certain hospital procedures during childbirth? Wondered if your induction or cesarean was truly essential? Or pondered the impact of your birth experience on the early postpartum period? In "Birth as an American Rite of Passage," Robbie Davis-Floyd delves into these very questions, exploring the origins and implications of routine obstetric practices.
Birth as a Rite of Passage
Davis-Floyd opens the book by challenging the continued prevalence of standard obstetric procedures despite substantial evidence questioning their necessity. She argues that these practices are deeply rooted in our technocratic society’s fear of natural processes, positioning them as rational ritual responses rather than purely medical necessities.
“Why, given the large and growing body of evidence against their routine use, do standard obstetric procedures still shape and define American birth—just as they do in many other countries? I demonstrate that these obstetric procedures are, in fact, rational ritual responses to our technocratic society’s extreme fear of the natural processes in which it still depends for its continued existence.”
Chapter 1: Ritual and Rite
In the first chapter, Davis-Floyd examines the characteristics and effects of rituals, defining a rite of passage as a series of rituals that transition individuals from one social state to another, transforming societal and self-perceptions.
“Even highly humanistic practitioners who normally function at a Stage 4 (open, fluid) level can regress into Stage 1 or Substage when stress becomes extreme. Such cognitive regression accounts for a great deal of the overt obstetric violence, disrespect, and abuse that is daily perpetrated around the world by birth practitioners as they take out their stress on other practitioners below them in the facility hierarchy, and on the lowest of the low in that hierarchy—the laboring person.”
Davis-Floyd shares a personal anecdote reflecting on the significance of mindset in shaping birth experiences:
“I began to envision my upcoming birth. I wrote a detailed birth plan—things to resolve, changes to make, and an experience to embrace ... I remained positive about my body’s natural ability to birth my baby. I began a process of undoing some of the fearful thinking that had prevented me from experiencing motherhood on a more blissful level. I also began internalizing the belief that birth—as with other aspects of life—is very much a self-fulfilling prophecy. My state of mind will determine its outcome.”
Chapter 2: The Stages of Matrescence
Chapter two introduces the concept of matrescence—the transition into motherhood. This journey involves a profound transformation from one’s former self to a new identity as a mother, encompassing physical, emotional, hormonal, and social changes.
Davis-Floyd discusses how this transformation manifests across various domains, including personal, public, medical, and midwifery spheres, highlighting the ongoing journey of knowledge and adaptation.
“Birth and early parenting activists around the world have called us to think through the implications of the decline in continuous contact in early childrearing that characterized parenting practices until ‘plastic babysitter’ technologies like monitors, swings, cribs and car seats began to replace physical contact. Midwives and holistic pediatricians who value the external gestation period described by McKenna and others argue that more high-touch (sometimes called ‘attachment’) parenting practices often produce babies who are healthier (emotionally and physically) than bottle-fed, solitary-crib-sleeping, and stroller-carried infants who constitute the norm in technocratic societies. However, pressure to return to work outside the home soon after birth, unpaid maternity leave, and the breakdown of extended families create enormous barriers for new parents who would like to engage in exclusive breastfeeding, co-sleeping and ‘baby-wearing’ facilitated by slings and wraps.”
Chapter 3: The Industrial and Technocratic Models of Birth and Health Care
In chapter three, Davis-Floyd traces the history of the industrialization of birth, illustrating how the medical model has traditionally viewed the body as a defective machine. She discusses the origins of the technocratic model and its progression over time, revealing how deeply embedded these practices have become in modern health care.
The 12 Tenets of the Technocratic Model of Birth and Health Care:
Mind-Body Separation
The Body as Machine
The Patient as Object
Alienation of Practitioner from Patient
Diagnosis and Treatment from the Outside In
Hierarchical Organization and Standardization of Care
Authority and Responsibility Inherent in Practitioner, Not Patient
Supervaluation of Science and Technology
Aggressive Intervention with Emphasis on Short-Term Results
Death as Defeat
A Profit-Driven System
Intolerance of Other Modalities
One striking passage exemplifies the problematic nature of this model:
“If the product is perfect, the responsibility and the credit go to the ob; if flawed, any blame will be categorically assigned to the inherent defectiveness of the mother’s birthing machine, as obstetrician Michelle Harrison described:
‘Yesterday on rounds I saw a baby with a cut on its face and the mother said, “My uterus was so thinned that when they cut into it for the section, the baby’s face got cut.” The patient is always blamed in medicine. The doctors don’t make mistakes. “Your uterus is too thin,” not “We cut too deeply.” “We had to take the baby” (meaning forceps or cesarean), instead of “the drugs we gave you interfered with your ability to give birth.”
Reading this, one cannot help but feel a surge of anger and frustration. The concept of medical gaslighting—blaming the patient's body for medical errors—is both unacceptable and infuriating. No mother should be made to feel that her body is defective due to medical mistakes.
Chapter 4: The Humanistic Model of Birth and Health Care
The Shift to Humanism
Chapter four introduces the humanistic model of birth and health care, which contrasts starkly with the technocratic approach. Davis-Floyd outlines the principles of this model, emphasizing the interconnectedness of mind and body and the importance of treating the patient as a relational subject.
The 12 Tenets of the Humanistic Model of Birth and Health Care:
Mind-Body Connection
The Body as an Organism
The Patient as Relational Subject
Connection and Caring between Practitioner and Patient
Diagnosis and Healing from the Outside In and From the Inside Out
Balance Between the Needs of the Institution and the Individual: Superficial vs Deep Humanism
Information, Decision Making, and Responsibility Shared between Patient and Practitioner
Science and Technology Counterbalanced with Humanism
Focus on Disease Prevention: A Public Health Approach
Death as an Acceptable Outcome
Compassion-Driven Care
Open-Mindedness toward Other Modalities
One particularly impactful excerpt underscores the profound implications of the mind-body connection in childbirth:
“The implications for childbirth of the knowledge that the mind affects what happens in the body and vice versa-are obvious and profound. Far from seeing the uterus as an involuntary muscle that operates in machine-like ways, humanism in childbirth allows for the possibility that the laboring woman’s emotions can affect the progress of her labor, and that problems in labor may be more effectively dealt with through emotional support than through technological intervention. For example, if a woman’s labor stalls at 8 cm, it might be because she had been raped, and the feeling of the baby’s descending head is invoking those cellular memories, causing her to freeze. Another laboring woman may freeze because she is suddenly seized with doubt about her ability to raise this child, and another because she fears that her partner will leave her after the baby is born, or that she might lose her job. Ideally, such issues are dealt with before labor begins, but often they just suddenly arise in the moment. In such cases, asking the laboring person what they are feeling and supporting them to express those feelings and perhaps cry them out, as nurse-midwives often do, will be far more effective than forcing their labor to proceed with Pitocin.”
Unmasking Hospital Birth Rituals: A Deep Dive into Chapter 5
This chapter, "Birth Messages in the Hospital," lays bare the often overlooked and distressing rituals that dominate hospital births in the United States. As I read through this section, my adrenaline spiked, and I felt a surge of discomfort and anger. The normalization of these practices, which in other contexts would be seen as abusive or violent, is both shocking and heartbreaking.
Standard Obstetric Procedures: Rituals Over Evidence
Davis-Floyd critically examines the Standard Obstetric Procedures that are widespread in hospitals today, despite a lack of supportive evidence and studies that highlight their potential harm. She states:
“Cases where evidence indicates that obstetric procedures either fail to accomplish their stated purpose or actually cause harm, lead to the obvious conclusion that the only possible reasons for the continued performance of such procedures are ritual and symbolic.”
This perspective challenges us to question the very foundation of these practices and their true purpose.
Hospital Rituals: Questioning the Norm
Have you ever wondered why certain hospital procedures and protocols exist? When you explore the psychology behind these rituals, it starts to make sense. From the seemingly innocent use of hospital gowns and wheelchairs to the more invasive practices like cervical checks and IV lines without consent, each ritual conveys a powerful message: the hospital system owns your body and knows what’s best for you.
The Wheelchair: Symbolizing Disability
A striking example is the use of a wheelchair for healthy women entering labor. Davis-Floyd explains:
“To place a healthy woman in a wheelchair is to associate her body with a powerful symbol of disability. Although she may reject this message on a conscious intellectual level, its passage through her body and into the right hemisphere of her brain will guarantee that, on an unconscious level, she will receive the message, ‘you are disabled’; in other words, she may receive a ‘felt sense’ of her body as suddenly weak and dependent.”
This initiatory rite begins the process of undermining the woman’s sense of control and independence.
The "Prep" and Loss of Autonomy
The "prep" process in hospitals further strips women of their autonomy. This multistep procedure includes:
Separation from partners or support persons
Replacement of personal clothes with a hospital gown
Shaving of the pubic hair
Administration of an enema
Cervical checks
Insertion of an IV
Electronic fetal monitoring
Each step communicates the woman’s dependency on the institution and diminishes her sense of individuality and control.
The Hospital Gown: A Symbol of Dependence
The act of replacing a woman’s clothes with a hospital gown is particularly symbolic:
“A woman’s clothes are her markers of individual identity; removing them effectively communicates the message that she is no longer autonomous, but dependent on the institution.”
The gown exposes her intimate parts to institutional control, reinforcing her perceived vulnerability and dependency.
Separation and the Authority of the Hospital
Separating women from their support networks during labor heightens their vulnerability:
“Those women who were ‘prepped’ during heavy labor reported that the pain of their contractions increased during the separation period and their ability to ‘maintain control’ decreased.”
This practice sends a clear message: the hospital holds authority over the family, and the laboring woman now belongs to the institution.
The Doula Effect: Humanizing Birth
The presence of a doula can dramatically improve birth outcomes by reducing medical interventions and enhancing maternal satisfaction. However, many hospitals devalue doulas, viewing them as a threat to standard procedures:
“ If somebody invented a machine that could generate the doula effect, every hospital would buy them.”
The Misguided Practices of Fasting and IV Fluids
Fasting during labor, a common practice in many hospitals, can lead to ketosis and weakened muscle cells, which slows labor and often results in the use of synthetic hormones like Pitocin. Current research suggests there are no downsides to allowing women to eat and drink during labor, yet this outdated practice persists.
The Cascade of Interventions
The use of interventions like Pitocin sets off a cascade of further medical procedures, each with its own risks and complications. This series of interventions often reflects a cultural mindset that prioritizes technological control over natural processes.
Challenging Cultural Norms
Davis-Floyd’s exploration reveals how deeply ingrained cultural beliefs about birth and technology shape hospital practices. These rituals reflect a broader societal mistrust of natural processes and a belief in the superiority of technology and institutional control.
Chapter 6: How The Messages Are Received
In this chapter, Davis-Floyd categorizes the birth stories of women she interviewed, highlighting their varied responses to the technocratic model of childbirth.
Full Acceptance of the Technocratic Model
Some women fully embrace the technocratic model, believing the hospital is the only safe place for childbirth. Davis-Floyd notes:
“What we believe is what can come true for us ... If a woman believes on the deepest emotional level that the hospital is the only safe place to birth, then if she tries to deliver at home, she won’t be successful.”
Conceptual Fusion and Distance
Other women experience a conceptual fusion with the technocratic model, while some maintain a conceptual distance, struggling with hospital interventions and feeling distressed when they can't avoid them:
“On the other hand, if a woman believes on the deepest emotional level that home is the only safe place to birth, yet goes to the hospital... she may experience a stressful, traumatic labor.”
This chapter underscores the complex interplay between beliefs, behaviors, and birth outcomes, emphasizing the significant impact of ideology on childbirth experiences.
A Note on Hospital Birth with Certified Nurse-Midwives (CNMs)
Davis-Floyd also discusses the role of Certified Nurse-Midwives (CNMs) in hospital births. An obstetrician she interviewed highlighted the ideal division of roles:
“The obstetrician should be the hero of the hospital, swooping in when help is needed. But the normal births—those should be solely under the purview of midwives, as all we do is mess them up, because we don’t know how not to intervene!”
This perspective points to a growing recognition of the benefits of midwife-led care for normal births, while reserving obstetricians for complications.
Chapter 7: Scars Into Stars
In Chapter 7, Davis-Floyd explores how women reflect on their childbirth experiences, particularly those that were traumatic. Many women revisit their birth stories during subsequent pregnancies or through deeper epistemic exploration, seeking meaning and coherence:
“The body keeps the score when it comes to trauma and unresolved trauma will always resurface in the future.”
By sharing their stories, women can process their trauma, turning "scars into stars" as they find healing and empowerment through their narratives.
Chapter 8: The Holistic Model of Birth and Health Care
Chapter 8 introduces the holistic model of birth, advocating for a shift away from the technocratic system towards a more humanistic and holistic approach:
“I am not alone in wishing that we could scrap the whole system and start over... We are moving towards a more humanistic future. And as long as we are moving in that direction, birth activists will keep pushing for a more holistic future.”
Davis-Floyd outlines the 12 Tenets of the Holistic Model, which include:
Oneness of BodyMindSpirit
The Body as an Energy System Interlinked with Other Energy Systems
Healing the Whole Person in Whole Life Context
Essential Unity of Practitioner and Client
Diagnosis and Healing from the Inside Out
Authority and Responsibility Inherent in the Individual
Science and Technology Placed at the Service of the Individual
A Long-Term Focus on Creating and Maintaining Health and Well-Being
Death as a Step in a Process
Healing as the Focus
Embrace of Multiple Modalities
Stratification in Holism and Technomedicine
These principles emphasize the importance of treating individuals holistically, respecting their autonomy, and integrating various healing modalities to promote overall well-being.
Chapter 9: Birth Messages at Home
Homebirth as Holistic Ideology in Action
In Chapter 9, Davis-Floyd provides a comprehensive look at the background and context of homebirth in the United States, highlighting various motivations for choosing homebirth. She recounts stories of women who view birth as a natural aspect of womanhood and a process for spiritual growth. Davis-Floyd also explores the different rituals of homebirth and their underlying messages.
What stands out in this chapter are the comparisons between the hospital technocratic model and the homebirth midwifery model. The discussion about homebirth transfers to hospitals offers significant insights into the importance of building respectful community relationships. When obstetricians support midwives attending community births and vice versa, it fosters mutual respect and better outcomes.
Motivations for Choosing Homebirth
Sharing a personal story, I chose homebirth after two hospital births to avoid fighting for the birth I knew my body could achieve. Leaving the technocratic system was the best decision for my pregnancies and births. Davis-Floyd captures this sentiment:
“ The mother’s body knows how to grow a baby and how to give birth. The uterus, much more than an involuntary muscle, is a responsive part of the whole; the mother’s mental and emotional attitudes affect its performance during labor, as do the beliefs and actions of the partner and the birth attendants.”
Safety: Ideologies and Realities
For those questioning the safety of homebirth, numerous studies confirm its safety. The CPM2000 Study found:
“...the perinatal mortality rate was around 2/1,000 – almost exactly the same as the rate for nurse-midwives attending birth at home and for physicians attending low-risk birth in hospitals. … This study therefore showed that homebirth with a CPM in the United States was safe; it carried no additional risks over hospital birth.”
Davis-Floyd emphasizes that intensified technocratization does not equal intensified safety and that planned homebirth can minimize risks.
Chapter 10: Technocracy in Birth and Life
Ritual and Political Implications for the Future
In Chapter 10, Davis-Floyd discusses why most American women accept technocratic birth. She delves into the politics of birth, comparing hospital birth to male initiation rites. She proposes various future scenarios for childbirth.
A particularly striking idea is the comparison of the Birth Crisis to the Climate Crisis:
“... prevent the Climate Crisis from turning into a Climate Catastrophe. Can we do the same for birth? Can we prevent the Birth Crisis with its obstetric paradox (intervene in birth to make it safe, thereby causing harm) from turning into a Birth Catastrophe, with cesarean rates rising even higher around the world, until vaginal birth becomes ‘alternative’ to cesareans?”
As someone who experienced an unnecessary c-section and obstetric violence, this thought is terrifying. If we don't change, the primary birth experience for society could become one of excessive intervention, causing harm rather than ensuring safety.
Chapter 11: Holism in Birth and Life
Ritual and Political Implications for the Future
Chapter 11 discusses the need for community birth and increasing the number of midwives across the country. Davis-Floyd highlights the importance of holistic and community-centered approaches to childbirth.
Susan Frye beautifully summarizes the essence of homebirth:
“ Homebirth brings us back to basics. It’s just simply better for moms and babies. So women who want that should be able to choose it. I want to see a society in which it is more and more acceptable to choose homebirth. Insurance companies even now are starting to cover it… Thinking that homebirth is dangerous is a societal thing, built into us before we were born. In this society, we are just not comfortable with our bodies. We expect others to take control, we let legislators and total strangers tell us what to do with our bodies. Homebirth matters on a very personal level. When you yourself realize that you gave birth, not someone or something else—they didn’t grow that baby, they didn’t bring it down into the birth canal—you have a much more intense and personal relationship with that baby, and that’s a basic feature of growing up as a whole healthy person, not to be born in a drug-induced stupor. The first arms that baby should feel are those of his family.”
Conclusion: Birth As an American Rite of Passage by Robbie Davis-Floyd
Robbie Davis-Floyd's "Birth As an American Rite of Passage" is a profound exploration of childbirth practices and their deep cultural, ideological, and political implications in the United States. By dissecting the technocratic, holistic, and homebirth models, Davis-Floyd reveals the complex interplay between beliefs, behaviors, and birth outcomes. Her detailed analysis highlights how these models reflect broader societal values and impact women's experiences and autonomy in childbirth.
Chapters 6 through 11 provide a comprehensive examination of the current state of childbirth practices, from the spectrum of responses to the technocratic model, to the reinterpretation of traumatic birth experiences, to the promise of holistic and homebirth approaches. Davis-Floyd emphasizes the importance of respecting and supporting midwives and community births, challenging the dominant technocratic system that often prioritizes intervention over natural processes.
The book underscores the need for a cultural shift towards more humanistic and holistic childbirth practices. Davis-Floyd's call to action is clear: we must question the entrenched technocratic model, advocate for evidence-based practices, and support women's right to choose the birth experience that best suits their needs and beliefs. The future of childbirth, as Davis-Floyd envisions, is one where respect, autonomy, and holistic care are at the forefront, leading to healthier and more fulfilling birth experiences for all.
"Birth As an American Rite of Passage" is not just a critique of current practices but a hopeful vision for the future of childbirth. It is an essential read for anyone interested in the sociology of birth, women's health, and the transformative power of respecting and honoring the natural birth process.
Stay Wild & Free,
-Brandy
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