Midwifery of Birth and Death
*New Course*
In ancient times, midwives traditionally worked with families from ‘womb to tomb,’ bringing in new life and laying out the dead. They saw living and dying as opposing aspects of the same cycle. The two were of equal importance, as two passages through the same door: one coming in, the other going out. Midwives were as intimately involved in every manifestation of death as they were in those of life. Midwives traditionally supported and taught the dying, and cradled the corpse as well as the infant, each to its own particular new life.--Carol Leonard
We often think of birth and death as “natural” events that take place outside of any politics or ideology. This class argues that the processes of birth and death are managed by several competing institutions, and that most of the practices overlook what have been thought of as traditionally women’s roles. These institutions—science, medicine, and religion—do not intend to usurp women’s work; they are simply fulfilling their mandate: goals of progress, cleanliness, and modernity, inadvertently (?) hide the power of these institutions from public view. Thus, at the beginning of the 21st century, we know very little about what actually happens during these two important life events, birth and death.
Nowhere is this dilemma more salient than in the questions of birth and maternal-infant health. Despite the fact that prenatal care and birth are well covered by public and private funds, the United States ranks among the lowest of industrialized nations in terms of mother/child health. Lack of adequate prenatal care, coupled with overuse of medical interventions, have doubled the rate of maternal death over the last 20 years. In the face of these problems, many health care professionals are turning to a midwifery model of care in order to try to reduce maternal death and increase infant health. The first section of the course covers the changes in birth practices over the last sixty years. Once we moved to a hospital setting, it became much harder for birth practitioners to view birth as something “normal.” In this section we will review the many reasons why this is the case. We will also investigate the question of whether or not the medical model should dominate or even influence the birth process. Many midwives believe that medicine has developed important interventions to help birth along; these interventions, they argue, should be “at the ready” and used whenever things even look like they could potentially go wrong. Midwives in this tradition are called Certified Nurse Midwives (CNM); they are trained nurses who specialize in birth. Conversely, Certified Professional Midwives (CPM) do not require a nursing degree and do not follow a medical model for the birthing process. Helping a woman give birth, they argue, is a matter of offering comfort, support, massage, food, entertainment, time. A woman’s body knows how to give birth, these midwives suggest, and they are present to support this process, not control it. CPM’s are illegal in 23 states, including North Carolina. CPM’s caught performing a homebirth in any of these 23 states are prosecuted for practicing medicine without a license.
The second issue investigated in this class is the event of death. 100 years ago the vast majority of Americans died at home surrounded by family and loved ones. Today, the vast majority of Americans die alone in a hospital, surrounded by machines. Moreover, a gap between when a person dies and when the family thinks they are dead can become very wide; i.e., the definition of death is not always clear. Meanwhile, “hospice” (which was founded in England a century ago by midwife Cicely Saunders), is a practice that tries to close this gap; once a person is within six months of dying, hospice advocates discontinue all treatments, giving palliative care (pain relief), along with a midwifery model of support. Each dying person has a team that works with them to make sure they are comfortable and have everything they need. Hospice has many problems, though. Its rules vary from state to state and, because it is composed mostly of volunteers, it varies even within a state. It is often difficult to determine when a person is six months from death, so in many cases, hospice enters too late. The midwifery model even extends beyond death to the care of the body. How is a corpse dealt with and who gets to decide that? Family? Religious leaders? Lawmakers? Land developers?
No one is discrediting the great advantages medicine has brought to our world, even or especially at birth and death. What this class is arguing for is a conversation that tries to recover some of the best practices of earlier or more female centered models of care. “Interpreting Bodies” revisits the discourse of midwifery, which argues that the processes of birth and death are not illnesses that need to be cured, but rather are normal and natural events in the course of a life. Instead of using drugs and technology to manage these events, midwifery seeks the path of “being with” the patient through these changes, and only using drugs or technology to assist a natural transition. What is this process of “being with” and how does it differ from the ways we are treated in medical settings today?
Evaluation
Paper 1: Explain why hospital births are standard care in America. Is the material around midwifery persuasive to you and if it is, why is it still thought of as outmoded and old-fashioned. If you support hospital births, explain why they are thought of as best practice, and for whom. 5–10 pages 30%
Paper 2: What assumptions are circulating in medical and religious language that block the idea of a good death? Or using two sources from outside class, explain why green deaths may or (may not) become the wave of the future 5–10 pages 40%
The remaining 30% will be based on your attendance, participation, and general presence toward course material.
Please, no electronic devices in this class.
Book List
Section One: Midwives of Birth
Ladies Hands, Lion’s Heart, Carol Leonard
Cut it Out, Theresa Morris
Section Two: Midwives of Death
Being Mortal, Atul Gawande
Greening Death, Suzanne Kelly