Birth Culture
September 6, 2014 10:05 AM   Subscribe

Since 2006, Alice Proujansky has photographed childbirths around the world for a project entitled 'Birth Culture.' Her intent is to highlight 'the universal aspects of childbirth, elements that are culturally-specific and the struggle to provide women with safe, respectful maternity care.' Images: Photographer's site. NYTimes Gallery. Agnostica. Slate. Some photos may be NSFW.
posted by zarq (21 comments total) 13 users marked this as a favorite
 
Nonsense. Industrial Birth Culture maybe. If a woman is physically and mentally stable, there is no need for all that meddling. In fact, that fiddling can be the cause of many things going horribly wrong. An attendant is nice but certainly not necessary. "GET OUT OF MY HOUSE, WE'RE HAVING A BABY!"
posted by Emor at 11:55 AM on September 6, 2014


This might be a more interesting view. Skip to ~8 min mark if the labor is too boring.

And abortion can certainly be considered part of birth culture.
posted by Emor at 12:19 PM on September 6, 2014


Here are some facts about maternal mortality from WHO, including prevalence and causes.

Women are unquestionably safer when a skilled attendant is present at the birth. What's nonsense is dismissing all of the wonderful gains we've made in preventing maternal mortality because there are some problems with "industrial birth culture." Right now, women are dying because of lack of access to skilled care. Not just sick women -- healthy women too.

An attendant is only unnecessary until they become necessary.
posted by Kutsuwamushi at 12:48 PM on September 6, 2014 [23 favorites]


And really, really, we don't have to pit the idea of less interventionistic and more emotionally supported style birth AGAINST the idea of being near and having access to emergency services and skilled medical practitioners.

We can want people giving birth to have access to both!
posted by xarnop at 1:39 PM on September 6, 2014 [12 favorites]


Of course, but the word culture is a very broad one...and the op included only one very narrow view of what birth culture encompasses. Just looking to broaden the discussion beyond medical intervention being necessary to give birth 100%. And optimally, we want all women included in a birth culture that has options, each with pros and cons, to give birth or terminate a pregnancy however they feel is necessary.

If the argument is better nutrition/education to increase survival rates for mother and baby...and father for that matter...pre, during, and post pregnancy (like my caveat stated "If a woman is physically and mentally stable..."), then I must have read it wrong.
posted by Emor at 2:18 PM on September 6, 2014


Thanks for the post, zarq.

The first NPR link shows a series of photos from one particular birth, which was attended by midwives and included an epidural. Other links (especially the Slate blog post) include photos from home births, clinic births, and hospital births and give a much more varied picture. She mentions that she also photographed abortions, and stresses that the US has a higher infant mortality rate than other wealthy western countries.

If you read all of the links and visit the artist's website I think you'll find that her point of view isn't far off from yours, Emor
posted by twoporedomain at 3:06 PM on September 6, 2014


Yes, you're right twoporedomain. I let my emotions get the better of me and I apologize. I have witnessed many births in my family from hospital to birth center to home even unattended and I am not exactly sure what upset me. I am sure my thoughts will get more clear as I watch my gazillionth kids' game this afternoon and I will come back more level headed. Thanks for the post, zarq.
posted by Emor at 3:37 PM on September 6, 2014


I actually think that even the sets of pictures that show primarily medical settings still represent an interesting range of cultural norms. I know that's something I've observed myself. I'm American, so most of my friends have had their babies within that system, but I spent the first half of my pregnancy in the UK and am in Australia for the second half and while all the care in all three countries is nominally through medical professionals and does involve hospitals, what that genuinely translates to is very, very different. My friends in the US have to seek out (and often pay a premium for) less interventionist care, whereas in the UK and Australia I've been on the publicly funded system where midwives provide at least half the pre-natal care, and the delivery/post delivery care, for anything that's a "normal", uncomplicated pregnancy and you're unlikely to ever have to see an obstetrician. The public hospitals in Australia have the lowest rates of caesarean sections compared to the private hospitals (at least the ones I looked into) and the one I'm going to deliver at has the same facilities in the labor rooms that are standard only at midwife-run birth centers in the US; my hospital also provides an option that does make a home birth possible. The UK and Australia also offer a much broader range of non-epidural pain relief and encourage not laying on your back for labor. So I've found it really fascinating, the differences in the standard "medical" version of birth in three countries that I think most people would paint with the same broad "industrialized medicalized healthcare" brush.

The picture showing the male relatives waiting for births in the DR, not allowed in, is really interesting to me.
posted by olinerd at 4:16 PM on September 6, 2014 [4 favorites]


Childbirth is now over-problematized. What other medical event would have us talking about the "culture"? What about "heart bypass culture"? "Influenza culture"? Focusing on "culture" is fiddling while Rome burns. What the world needs is safe, effective maternity care. It's only very rich people who are so secure in their high level of medical care and infrastructure who can start to see it as something other than a medical event.
posted by yarly at 5:45 PM on September 6, 2014 [1 favorite]


The Slate link includes a photo taken at the hospital where I gave birth, in Massachusetts. There the standard is to have all prenatal care and deliveries done with midwives, and OBs available at all times if necessary. I was able to have a completely unmedicated birth with the same midwife and nurse through my whole labor, and my friend was able to have the emergency c-section she needed. I feel so lucky to live where that kind of care is available.

I completely agree with Xarnop! There is a false dichotomy between medicalized birth and non-medicalized, and it doesn't have to be that way.
posted by apricot at 5:47 PM on September 6, 2014 [1 favorite]


From the author's website: "And the U.S. has the highest first-day infant mortality rate of any industrialized nation, in part due to excessively high rates of intervention and difficulty accessing prenatal care."

There is no evidence whatsoever that medical interventions cause infant mortality! Perinatal & neonatal deaths have steadily fallen over the years as interventions are introduced.
posted by yarly at 5:49 PM on September 6, 2014 [9 favorites]


The first link has photos of a labor in the same room I gave birth in!
posted by apricot at 5:51 PM on September 6, 2014


Oh wow....

So I clicked on the NYTimes gallery first. It goes to a picture in the middle of the set. The next picture features Liza Ramlow, a midwife, checking a newborn. Guess what - she delivered ME 28 years ago in Greenfield, MA! I've been told my whole life what a wonderful midwife she was; my mom really loved her. Such a trip to suddenly find her here. My mom actually wondered when I was pregnant last year whether Liza Ramlow could deliver my baby. I guess not; looks like she was in South Sudan!
posted by Cygnet at 6:43 AM on September 7, 2014 [8 favorites]


And the U.S. has the highest first-day infant mortality rate of any industrialized nation, in part due to excessively high rates of intervention and difficulty accessing prenatal care.

I think I've seen it claimed on MeFi that the US defines infant mortality differently than most other countries, including some deaths that in other countries would be classified as "stillbirths." (And perhaps more very premature babies also have a chance to be born in the US, who would be miscarried in places with less sophisticated NICUs and interventionist OBGYNs?)

But I don't have a cite and don't have time to research it at the moment, so maybe someone who isn't relying on vague memories of second-hand information can confirm?
posted by OnceUponATime at 7:15 AM on September 7, 2014


Nonsense. Industrial Birth Culture maybe. If a woman is physically and mentally stable, there is no need for all that meddling. In fact, that fiddling can be the cause of many things going horribly wrong. An attendant is nice but certainly not necessary. "GET OUT OF MY HOUSE, WE'RE HAVING A BABY!"

I gave birth at home, and this is crazy. Women in most cultures have traditionally given birth surrounded by other women, not alone, and any good birth plan will acknowledge the possibility of complications for both mother and child.
posted by PhoBWanKenobi at 8:11 AM on September 7, 2014 [5 favorites]


I personally was very happy to give birth in a hospital, with plenty of doctors at hand, and with a wonderful epidural. But what do I know, I guess I would have been safer alone in my bathtub.
posted by lydhre at 12:09 PM on September 7, 2014 [3 favorites]


As we have evolved to stand upright and use our hands, birth has gotten complicated. Heads are bigger to accommodate brains, but there's a limit to how much a woman's pelvis can expand. As a result, human babies are born helpless. But head size vs. pelvis size isn't always winnable.

Women die from having big babies that they can't deliver. Women die from all sorts of complications of pregnancy, delivery, post-partum. The last 30 years of research and resistance to over-managed birth have made a big difference for the better, but I'd still recommend a well-attended birth. (I had a surgical delivery after trying very hard not to. For various reasons, it saved my son's life. My son's wife just delivered a lovely boy, and with good midwives, plus a doctor with suction, delivered a healthy boy. Intervention isn't always bad.)
posted by theora55 at 9:09 PM on September 7, 2014 [1 favorite]


Childbirth is now over-problematized. What other medical event would have us talking about the "culture"? What about "heart bypass culture"? "Influenza culture"? Focusing on "culture" is fiddling while Rome burns. What the world needs is safe, effective maternity care. It's only very rich people who are so secure in their high level of medical care and infrastructure who can start to see it as something other than a medical event.

I disagree. Childbirth is different from influenza or a heart bypass in that it is not a disease. Families do need safe and effective medical care, but if you are speaking of the problems of giving birth in third world countries, considering all births a "medical event" isn't actually beneficial. There are places where it is difficult to dangerous to travel to the hospital and the hospitals lack basic supplies and sanitation.

That said, having access to good prenatal care and qualified, trained attendants is huge. This doesn't need to happen in a hospital, but yes, people need to have access to test and screens to determine their risk of not being there. Resuscitation equipment matters, but that doesn't need to be confined to one type of setting.

Finally, this is an aside, but I've seen a lot of photography projects about "cancer culture," which is totally a thing.
posted by ohisee at 11:00 PM on September 7, 2014


I was talking with my wife (a doula) about this sort of thing yesterday. There's a clear anti-intervention movement in the birth community, but I think this is problematic because it places blame (at least in part) on birthing mothers if they end up having a birth in which interventions were involved. These mothers then either feel guilty for having had interventions, or angry at those who suggest that a no-intervention birth is "better".

Instead, we said, it would be better to be pro-maternal-agency and pro-informed-consent. That is, mothers should be provided with all important information about their birth choices, and allowed to make the decision that is right for them. Yes, there are issues in which OBs schedule c-sections on a Friday because they don't feel like working on the weekend, and that is a problem that should be addressed. But at the same time, women should not be demonized or criticized for choosing to have an epidural or an inducement if that is the right decision for her at that time.
posted by Ben Trismegistus at 11:08 AM on September 8, 2014 [2 favorites]


Instead, we said, it would be better to be pro-maternal-agency and pro-informed-consent.

I could not agree more. I'm currently pregnant and really annoyed at all the resistance I'm getting to making my own choices on what I do. I don't think one way is best in all situations, and it would be great to have more widespread support for families being informed and making their own decisions.
posted by ohisee at 12:18 PM on September 8, 2014 [3 favorites]


Instead, we said, it would be better to be pro-maternal-agency and pro-informed-consent.


I agree. The culture-at-large is wrought with inherent ways of using this most delicate time to rob families of their innate power.

Obviously, there are women and families in the world who are struggling to even survive on a nutritional level. I'm not sure the best course of action is to introduce the idea that they will not have a healthy future if they don't accept one certain way of delivery.

And, ohisee, trust your instincts.
posted by Emor at 7:22 PM on September 9, 2014


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