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E-raamat: Birth as an American Rite of Passage [Taylor & Francis e-raamat]

(Rice University)
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This book reexamines the "standard" procedures used to "manage" American childbirth, identifying non-evidence-based obstetric interventions as rituals enacting core values of the American technocracy. This new edition brings together new data with Davis-Floyd's insights into the ritualization and models of labor and birth.



This classic book, first published in 1992 and again in 2003, has inspired three generations of childbearing people, birth activists and researchers, and birth practitioners—midwives, doulas, nurses, and obstetricians—to take a fresh look at the "standard procedures" that are routinely used to "manage" American childbirth. It was the first book to identify these non-evidence-based obstetric interventions as rituals that enact and transmit the core values of the American technocracy, thereby answering the pressing question of why these interventions continue to be performed despite all evidence to the contrary. This third edition brings together Davis-Floyd's insights into the intense ritualization of labor and birth and the technocratic, humanistic, and holistic models of birth with new data collected in recent years.

List of Illustrations
xiv
About the Author xv
Author's Note about the Cover Images xvii
Acknowledgments xviii
Preface to the Third Edition xix
Introduction: Birth as a Rite of Passage 1(7)
Research Methods and Theoretical Issues
2(4)
A Brief Overview of This Book
6(2)
1 Ritual and Rite
8(19)
The Characteristics and Effects of Ritual
8(7)
Symbolism
9(1)
A Cognitive Matrix
10(1)
Repetition, Rhythm, and Redundancy: Ritual Drivers
11(1)
Ritual Tools, Techniques, and Technologies
12(1)
Ritual Frames
12(1)
Order, Formality, and a Sense of Inevitability
13(1)
Acting, Stylization, and Staging: Ritual Performance
14(1)
Affectivity and Intensification
14(1)
The Possible Effects of Ritual
15(8)
Cognitive Simplification
15(3)
Cognitive Stabilization and Fear Reduction
18(3)
Cognitive Transformation
21(1)
Preservation of the Status Quo
22(1)
Effecting Social Change
23(1)
Rites of Passage
23(4)
2 The Stages of Matrescence: The Pregnancy/Childbirth/Postpartum Rite of Passage
27(28)
Separation: "Oh My God, I Think I'm Pregnant!"
27(1)
Transition: Pregnancy as Transformation
28(21)
Transformation in the Personal Domain
29(3)
Transformation in the Public Domain
32(5)
Transformation in the Medical Domain
37(3)
Transformation in the Midwifery Domain
40(1)
Transformation in the Formally Educative Domain: Pregnancy as a Quest for Knowledge
41(4)
Transformation in the Peer Domain
45(4)
Transition: Birth as Transformation
49(2)
Transition: The Immediate Postpartum Period
51(1)
Integration: "Swimming Up on the Other Side"
52(3)
3 The Industrial and Technocratic Models of Birth and Health Care
55(22)
Medicine as a Microcosm of American Society
57(2)
The Industrial Model of Birth
59(1)
The Body as Machine and the Female Body as a Defective Machine
59(5)
The Technocracy
64(1)
The Technocratic Model of Birth and Health Care
65(5)
The Myth of Technological Transcendence
67(1)
The 1--2 Punch and the Technological Imperative
68(2)
The 12 Tenets of the Technocratic Model of Birth and Health Care
70(7)
(1) Mind-Body Separation and (2) the Body as Machine
70(1)
(3) The Patient as Object; and (4) Alienation of Practitioner from Patient
70(1)
(5) Diagnosis and Treatment from the Outside In
71(1)
(6) Hierarchical Organization and (7) Standardization of Care
72(1)
(7) Authority and Responsibility Inherent in Practitioner, Not Patient
73(1)
(8) Supervaluation of Science and Technology
73(1)
(9) Aggressive Intervention with Emphasis on Short-Term Results, and (10) Death as Defeat
74(1)
Technomedical Hegemony: (11) A Profit-Driven System; and (12) Intolerance of Other Modalities
75(2)
4 The Humanistic Model of Birth and Health Care
77(13)
The 12 Tenets of the Humanistic Model of Birth and Health Care
78(12)
Mind-Body Connection
78(1)
The Body as an Organism
79(1)
The Patient as Relational Subject
80(1)
Connection and Caring between Practitioner and Patient
81(1)
Diagnosis and Healing from the Outside In and from the Inside Out
82(1)
Balance between the Needs of the Institution and the Individual: Superficial vs. Deep Humanism
83(1)
Information, Decision Making, and Responsibility Shared between Patient and Practitioner
84(1)
Science and Technology Counterbalanced with Humanism
85(1)
Focus on Disease Prevention: A Public Health Approach
85(1)
Death as an Acceptable Outcome
86(2)
Compassion-Driven Care
88(1)
Open-Mindedness toward Other Modalities
89(1)
5 Birth Messages in the Hospital
90(97)
A Symbolic Analysis of Standard Obstetric Procedures
90(3)
Technocratic Rituals and Humanistic Ritual Changes
90(2)
The Wheelchair
92(1)
The "Prep"
93(20)
Replacement of Clothes with Hospital Gown
94(1)
Pubic Shaving and Enemas: Humanistic Ritual Change
95(1)
Separation from Partner and Other Support People during the Prep
96(3)
The Presence of a Doula: Humanistic Ritual Change
99(2)
Fasting
101(3)
Ritual Purposes
104(1)
Intravenous Feeding (IV)
105(3)
Artificial Rupture of the Membranes (Amniotomy)
108(1)
The "Pit Drip"
109(4)
Friedman's Curve vs. Zhang's Curve: Humanistic Ritual Change?
113(4)
An Argument for a Re-Classification of the "Three Stages of Labor"
117(1)
Types of Obstetric Analgesia
117(26)
Epidurals, Demerol, Fentanyl, Stadol, Morphine, and Nitrous Oxide
117(9)
Cervical Checks
126(3)
External Electronic Fetal Monitor and Tocometer
129(6)
Internal Electronic Fetal Monitor
135(2)
Bed and the Lithotomy and Semi-Sitting Positions for Labor and Birth
137(6)
The Influence of Labor and Delivery Nurses: A Brief Note
143(1)
You're 10 Centimeters: Now Push!/Don't Push!
144(4)
The Labor-Delivery-Recovery Room: Humanistic Ritual Change
148(1)
Water Immersion during Labor: Humanistic Ritual Change
148(28)
Episiotomy: Humanistic Ritual Change
149(3)
Cesarean Births and Vaginal Births after Cesarean (VBACs)
152(10)
Maintaining the Same Cesarean Rate Despite Attempts to Lower It: Techno-Maternity Care as a Self-Organizing, Self-Stabilizing System?
162(2)
Apgar Scoring
164(1)
Umbilical Cord Clamping and Cutting
165(1)
(Not) Washing the Newborn
166(2)
Prophylactic Eye Treatment
168(1)
Vitamin K Injection
169(1)
Humanistic Ritual Change: Keeping Mother and Baby Together, and Bonding
170(6)
The Hospital Bassinet as Cultural Symbol
176(1)
Breastfeeding: Humanistic Ritual Change
177(1)
Wheelchair
177(1)
From Nature to Culture
178(1)
The Obstetric Re-Structuring of Accidental Out-of-Hospital Births
178(1)
Summary: Birth Rituals and Society
179(2)
The Alternative Birth Center in the Hospital
181(6)
A Humanistic Middle Ground?
181(6)
6 How The Messages Are Received: The Spectrum of Response
187(65)
Full Acceptance of the Technocratic Model of Birth
190(13)
Full Acceptance of the Technocratic Model of Birth: Rejecting Biology in Favor of Technology (9%)
190(2)
Full Acceptance of the Technocratic Model of Birth: Entering the Hospital with No Expectations (9%)
192(6)
Full Acceptance of the Technocratic Model of Birth: Women on Medicaid Who Had "No Choice" (6%) and the Racialized Maltreatment of Marginalized Women
198(4)
Comparative Analysis. Full Acceptance of the Technocratic Model of Birth: "Rejecting Biology in Favor of Technology," "Entering the Hospital with No Expectations," and "No Choice for Marginalized Women" (24%)
202(1)
Conceptual Fusion with the Technocratic Model during Labor and Birth
203(19)
Conceptual Fusion with the Technocratic Model: With Cognitive Ease (40%)
203(6)
Conceptual Fusion with the Technocratic Model: With Cognitive Dissonance (15%)
209(10)
Comparative Analysis. Conceptual Fusion with the Technocratic Model, with Cognitive Ease vs. with Cognitive Dissonance (55%)
219(3)
Maintaining Conceptual Distance from the Technocratic Model via Humanism in Birth (21%)
222(25)
Maintaining Conceptual Distance from the Technocratic Model: Counterbalancing Technology with Humanism to Achieve One's Own Choices (8%)
222(6)
Maintaining Conceptual Distance from the Technocratic Model: Achieving Humanized Childbirth in the Hospital with Obstetricians as Primary Birth Attendants (5%)
228(8)
Maintaining Conceptual Distance from the Technocratic Model: Achieving Natural Childbirth in the Hospital with Midwives as Primary Attendants (8%)
236(10)
Comparative Analysis: Maintaining Conceptual Distance from the Technocratic Model via Humanism in Birth
246(1)
A Note on Hospital Birth with Certified Nurse-Midwives (CNMs)
247(2)
The Spectrum of Women's Conceptual Responses to Their Birth Experiences
249(1)
The National Scene: "Listening to Mothers III"
250(2)
7 Scars into Stars: The Reinterpretation of the Childbirth Experience
252(15)
Compartmentalization
253(11)
"Further Epistemic Exploration": "Teilhard de Chardin" versus "Sartre"
254(1)
"Further Epistemic Exploration" through Narrative
255(2)
"Further Epistemic Exploration" through Subsequent Births
257(2)
"Further Epistemic Exploration" through Subsequent Births and through Involvement with Childbirth
259(5)
Scars into Stars: A Brief Note on Hospital Birth Attendants' Reinterpretations of Their Birth Attendance Experiences
264(3)
8 The Holistic Model of Birth and Health Care
267(17)
The 12 Tenets of the Holistic Model
268(12)
Oneness of BodyMindSpirit
268(2)
The Body as an Energy System Interlinked with Other Energy Systems
270(2)
Healing the Whole Person in Whole Life Context
272(1)
Essential Unity of Practitioner and Client
273(1)
Diagnosis and Healing from the Inside Out
273(1)
Individualization of Care
274(1)
Authority and Responsibility Inherent in the Individual
275(1)
Science and Technology Placed at the Service of the Individual
275(2)
A Long-Term Focus on Creating and Maintaining Health and Well-Being
277(1)
Death as a Step in a Process
277(1)
Healing as the Focus
278(1)
Embrace of Multiple Healing Modalities
279(1)
Stratification in Holism and Technomedicine
280(2)
The Limitations of a Focus on the Individual
280(2)
Functional Medicine: A Brief Note
282(2)
9 Birth Messages at Home: Homebirth as Holistic Ideology in Action
284(42)
The Background and Context of Homebirth in the United States
284(3)
Motivations for Choosing Homebirth
287(9)
Birth as a Natural Aspect of Womanhood
288(2)
Birth as a Spiritual Process of Growth
290(4)
Choosing a Homebirth for Pragmatic Reasons
294(2)
Similarities among the Homebirth Interlocutors
296(2)
Birth Messages at Home: The Rituals of Homebirth
298(8)
The Postmodern Midwife
298(8)
The Hospital/Technocratic and Homebirth/Midwifery Models of Care Compared
306(3)
When Planned Homebirth Requires Hospital Transfer
309(3)
Obstetricians Who Support Homebirths
312(2)
Why Do Some Obstetricians Support Midwives and Community Birth?
313(1)
The Politics of Homebirth Rituals
314(1)
Safety: Ideologies and Realities
315(5)
Breeches and VBACs at Home and the "Renegade" Midwives Who Attend Them
320(2)
Freestanding Birth Centers: A Mediating Ground
322(4)
10 Technocracy in Birth and Life: Some Ritual and Political Implications for the Future
326(15)
The Cultural Consensus
326(3)
Why Most American Women Accept Technocratic Birth
326(3)
Women's Rites: The Politics of Birth
329(4)
The Technocratic Model of Birth: Futuristic Extremes
333(5)
Kiri the Cyborg: Human-Technology Co-Evolution
338(3)
11 Holism in Birth and Life: Some Ritual and Political Implications for the Future
341(15)
The Need for the Growth of Community Birth
341(2)
The Possibility of Creating the World's Best Knowledge System about Birth
343(1)
Holism in Birth and Life: Social Movements and Futuristic Extremes Based on Systems Theory
343(7)
The Technocratic Birth, and Birth as the Biodance
350(6)
Envisioning the Richness of Diversity
350(2)
My Futuristic Visions
352(4)
Conclusion: Birth as an American Rite of Passage 356(5)
References 361(34)
Index 395
Robbie Davis-Floyd, PhD, is an Adjunct Professor in the Department of Anthropology at Rice University, Houston, Texas, USA, and a Fellow of the Society for Applied Anthropology. She is a well-known medical/interpretive/reproductive anthropologist, international speaker, and researcher in transformational models in childbirth, midwifery, obstetrics, and reproduction.