Technological ≠ Scientific

There was a really excellent article by Alice Dreger in The Atlantic that made the rounds a couple of weeks ago. The article, entitled The Most Scientific Birth is Often the Least Technological Birth was rightfully celebrated by birth advocates who believe in evidence-based practice as the best way to improve obstetrical outcomes AND maximize satisfaction for individual women with regards to their birth experiences.

A lot of the time – and not just when it comes to birth, though I will be coming back to that topic (of course) shortly – we have a tendency to see things in terms of conflicting pairs, what semioticians call binary opposition. For example Light//Dark, New//Old, Good//Evil, Presence//Absence, Male//Female, Science//Nature, etc. Contemporary communication theory explores the way that these pairings in language are embroiled in how we see and construct our world (i.e. culture). Essentially, we can only understand ‘good’ in the context of its pairing with ‘evil’ for example, or ‘light’ in terms of its relationship to ‘dark’. Without the opposing term we are unable to define either. Driven by the psychological urge to categorize and order our world, we find comfort and satisfaction in these constructs. Unfortunately, as post-structuralist theory demonstrates, in every pair one of the two terms tends to assume dominance (culturally speaking) over the other. Quite often this privileging is determined by prejudicial assumptions of the larger culture (that is, it is often imbued with values that are tainted by ethnocentric or gender-biased perceptions of reality).

So, how is my nerdy fascination with language and culture connected to birth, you ask? Well, in this case, when considering the Dreger article, we can explore a variety of terms that are often paired in binary oppositions that lead to value judgements of various kinds and these value judgements affect our preferences for birth, often to the extent that we impose those preferences on others in the name of ‘safety’. These assumptions may seem logical when glanced at superficially, but they are often defied by evidence when examined up-close. For example, Science and Nature are often positioned in opposition to one another, seen as contrary notions or concepts, despite the fact that it is Science that permits us to see (and ideally encourages us to respect) the wonders of Nature. This is not understanding through opposition or by virtue of ‘what it is not’, but rather a truly complimentary relationship (this might be compared to the relationship between Science and Divinity, also often seen in opposition, but easily understood as complimentary to one another as in this Ted talk). With Science and Technology generally understood as being not only interconnected, complimentary and often indistinguishable from one another we can see how the Dreger article effectively unpacks assumptions about Science and its relationship to birth and the ways in which this relationship is perceived in the popular sphere, particularly with regard to the deployment of Technology.

When the word “natural” is invoked in relation to birth, a common set of associations might include notions of hippies giving birth in a dirty or outdoor place, images of the apocryphal ‘witch-y’ midwife with gnarled hands and mysterious potions and, most significantly, an aversion to medicine (the sacred intersection of Science and Health) or medical tools.The word “scientific” on the other hand may call to mind white, clean rooms with bright lights and white coated experts or sharp, shiny metal tools designed to precisely control or even improve upon the natural body. Of course, these connotations have nothing innately to do with either Science or Nature and, as Dreger points out, the two concepts, when it comes to birth, are actually not only closer than most may think, but actually directly dependent on one another – it is Science that allows us to ‘see’ how Nature works most effectively and ideally, instructs us as to how to allow it to function without interventions that have the potential to derail the entire process. Likewise it is Nature that provided us with brains capable of abstract thought, which led us to develop scientific methods.

When we consider Science (from the Latin for knowledge) as the development of tools, methods and organizational systems for the purpose of understanding our bodies, our world and our universe, we can begin to perceive it, not as a way of improving upon Nature or creating something that is superior to and distinct from Nature, but as a means of discovering the secrets of Nature in order to allow it to do what it has been doing since the dawn of time. Through scientific study of the processes of birth, we have learned what Dreger so expertly explains in her article – Nature works best when it is unimpeded by technological interventions. While the scientific development of those technologies have been beneficial for the small number of women and babies who are truly not able to make it through the natural process on their own (because of existing conditions or illnesses most often), they do not improve upon the natural system in the vast majority of cases. This has been borne out by scientific study time and time again. What Science has taught us, very clearly (though some refuse to hear the lesson), is that intervening with technologies like Pitocin, electronic monitors, vacuum extractors and surgery causes more problems than it solves for most women and most babies (for a related discussion re safety and birth in context of place of birth, see my earlier post on home birth).

I consider education and the sharing of knowledge and evidence-backed information to be the cornerstone of my practice. When we truly understand how our bodies and the process of labour work it becomes much less frightening and potentially empowering to entertain the notion of letting go and allowing Nature to take its course. Sadly, in North America the standard approach to medical training emphasizes the Science of Birth Technology over the Science of Nature. It is shocking and unacceptable to me that most obstetrics students graduating from med school in this country and in the US have never seen (and likely will never see) a natural birth (particularly if you consider simply going to the hospital as an intervention, which evidence shows us we should). I think that its marvellous that Western medicine has reached a point where it can facilitate birth for women and babies who have problems that might have been severely injurious or fatal at one time. There is no doubt that in the proper contexts Caesareans, for example, can save lives. You know what though? The jaws of life might save the life of someone trapped in a car wreck, but that doesn’t mean that we out to use them every time we need to exit a vehicle.

Science, Nature, Technology – none of these things are necessarily ‘good’, nor necessarily ‘evil’. Likewise, none of them are necessarily identical and none of them are necessarily mutually exclusive. Science has shown us in no uncertain terms that birth, as Nature designed it, is safe and efficient as a general rule. If we could trust the evidence we have, as procured through careful scientific study, and nature as it has been since before we had words to describe it, as much as we seem to trust the technologies we have made, I believe that we would be seeing a lot more natural births and far fewer labour complications.

***

Post-script: The notion of binary opposition and the problems that arise from constructing our world in this way could be applied to concepts surrounding birth in a huge number of additional ways. For instance, the privileging of the New over the Old is an area rife with concern for those interested in natural birth practices. When it comes to health-care practice and the treatment of individuals within a system, the hierarchy that is assigned to binary pairs like Masculine//Feminine, White//Black or Rich//Poor is also of great socio-political concern. Obviously there are many different ways of exploring our culture of birth using a post-structuralist framework, but that seems a bit much for one post. If you have comments on what I’ve said above, I’d love to read them and if you’re interested in expanding the discussion outward away from the Science//Nature pairing that I’ve focused on here I’m all for it!

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