Knowledge of childbirth is more than just biological knowledge, it is also about social knowledge and particularly influenced by the predominant knowledge of where birth occurs (Lazarus, 1997). Birth is socially marked and shaped (Jordan, 1992), and can be illustrated by how movement during labour is represented in the literature. This thesis provides data from three different viewpoints and illustrates how each group, as a social group, shapes how knowledge around movement is formed, valued and disseminated.
Women’s ways of knowing can be seen as intrinsic; from the intuitive knowledge women are said to instinctively have about birth, the knowledge shared with other women, to the knowledge shared in the wider public domain. Kitzinger (2006) states immobility was imposed
on women by doctors in the 19th century who wanted women supine to make examination
easier. This can be seen as the beginning of the loss of socially gained experiential women’s knowledge around movement in labour. From Kitzinger’s work, the birthing woman appears central to the birth process. When the woman’s traditional spirituality, home environment, familiar props, and birth-supporters are present and considered, movement during birth appears expected. The woman as the expert in her birthing body moves into positions that she feels will assist her. The experiential knowledge and skills of the birth-attendants are used if necessary, to support movement in assisting the birth process. This is in stark contrast to the hospital environment, with often little room to move and the supine position providing the best position for the woman to be monitored. The dominance of the obstetric bed in the labour-room combined with the expectation of birth on a bed renders movement during birth as ‘alternative’. Jowitt (2014) suggests obstetric birth does not recognise the influence movement has on the fetus’s journey through the bony pelvis.
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Whilst Balask appeared to introduce active-birth antenatal education and was deemed ‘revolutionary’ at the time, this was actually ‘return to women’s birth knowledge’ (Kitzinger, 2005). However, how women today access knowledge around movement in childbirth and how this informs their beliefs is unknown.
Birth is a biological event, but it cannot be defined purely by an explanation of biological knowledge as birth takes place in a social world that is shaped by cultural beliefs and practises (Oakley, 1980). Oakley discusses the historical development of how medicine and specifically obstetrics, as a male-dominated profession, sought to remove women and women’s knowledge around women’s reproductive functions. In doing so, they established themselves as experts, in possession of all the resources necessary to care for and control women during childbirth.
If, as a society or institution, we are only validating objective scientific knowledge on women’s seemingly natural behaviour during labour, this remains the case in current childbirth practice. Movement in labour is sometimes viewed as a soft intervention offering women comfort and should be ‘recommended’ or ‘allowed’ if conducive, but does not take precedence over such things as Electronic Fetal Monitoring (EFM). Women can be viewed as manipulable reproductive machines who inform obstetric technology that then needs interpretation. This can create a discord between medical and maternal frames of beliefs around childbirth as no recognition is given to women and their psychological, social and emotional needs.
Davis-Floyd (2001) identified three models of maternity care that influence care given; the technocratic model influences the majority of obstetric care. This system of care mechanises the body, objectifies the woman, and gives power to the practitioner over the woman as the holder of authoritative knowledge required to manage birth. This technocratic approach is evident within most of the obstetric literature by the way in which movement in labour is researched; attempting to establish a valid reason for mobility and upright positions in labour through designing research projects which aim to measure the effect on the length of labour. The obstetric literature separates movement from the woman and does not recognise it as an intrinsic part of labour but as something that aids labour or not, disregarding movement as natural and intuitive and as much a part of labour as the woman, her uterus and her child. Oakley describes how women are physiologically and psychologically defined in context to
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childbirth through cultural ideals of the medical profession. Little of the obstetric literature refers to women other than in a physiological sense, the idea of labour as something separate from the woman and to be observed, measured and controlled. This demonstrates the underlying beliefs of the obstetric view of birth and is congruent with Davis-Floyd’s work and the technocratic model of care.
Whilst Dick-Read, Leboyer and Odent appear to recognise the effects of environment, hormones, psychological concepts and emotion on women during labour, the practice they advocate can be seen as paternalistic. Their methods of birth involve environments or practices that are instructed, facilitated or manipulated, mostly in clinical environments constructed by carers giving them authoritative knowledge.
Odent particularly aligns women’s actions during labour with natural and instinctive behaviours that emphasise the animalistic nature of birth and an irrational way of behaving; positioning himself as expert and facilitating an environment where he is the holder of authoritative knowledge. It could be argued that the concepts of relaxation techniques, gentle birth and ‘primitive’ birthing form part of traditional midwifery practice gained from experiential knowledge based on attending births and being a woman living within other women. However, for these practices to become valid it required doctors to systematically identify and record them, thus making propositional knowledge.
Propositional knowledge, theoretical knowledge that is written down and codified (Kent, 2000), takes precedent in the obstetric or medical hierarchy of knowledge and other types of knowledge are not deemed as valuable (do Mar Pereira, 2017; Dalmiya and Alcoff, 1993). This is evident in how movement in labour is represented in the obstetric literature and in the NICE guidelines. Movement and positions during labour are observed, compared and measured, statistical significance is specified and a decision is made as to whether this ‘intervention’ can be justifiably used, thus forming authoritative knowledge.
Most obstetric literature also views knowledge around movement during birth as extrinsic to the woman, attempting to define it, measure its effect and then apply it to reach a desired outcome in a way that is standardised and applicable to all, regardless of the individual and wider psychological, emotional and sociological circumstances.
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Whilst a view of the obstetric literature has been provided on how women, labour and movement are represented, the way obstetricians use this knowledge and what informs their beliefs around movement in labour is unknown.