The Most Useful Thing Ever

THE MOST USEFUL THING EVER

This is useful when you're pregnant, every single time you think about labor and birth.

It's also useful, pregnant or not, at the dentist, on stage, during an argument, when you crave tobacco/sugar/heroin, when you can't sleep, in a traffic jam, in a courtroom, when your doctor says you're an "interesting case," and when your toddler spreads ketchup on the walls AGAIN.

You don't have to do it right. You don't have to do it well. You've probably done it lots of times already. You just have to remember to do it. You can do it right now, and it only takes 15 seconds. Ready?

Take a big breath as low in your belly as you can, and melt your face.

Take another breath, maybe even a little lower in your belly, and let your jaw go soft.

Take another one, and melt your shoulders too.

(If you need help with the melting part, think about the butter you left out on the kitchen table last August. Or the 3/4 of your body that really is just made of warm water, 98.6 degrees, held together by some bones and cells. Or what happens to ice cream in the microwave.)

How do you feel now?

Did you have any idea how much tension you were holding in your jaw and shoulders?

You might feel less nervous now. You might feel less pain. You might get a little glimpse of who you are, underneath all the stuff going on in your head.

You might also feel more nervous or more pain. That's because this can put you in touch with what you were trying so hard not to feel. That's okay. Keep breathing, and read this:

THINGS WE DON’T WANT TO FEEL...

...tend to boss us around. They tell us to tighten up, to hide behind addictive or compulsive behavior, to try to escape.

There are two kinds of Things We Don't Want To Feel.

One kind -- like memories of trauma -- should indeed be left alone, or, maybe better, explored only in the company of a good friend or skillful therapist. Sometimes it really is a good idea to "change the channel" on troubling thoughts or feelings. While distractions like sugar, alcohol, or television might be appealing, it's probably more effective to try a quick walk, or a hot bath, or roll your shoulders around, or do something else that gets your blood flowing and your body engaged.

The other kind is the more ordinary worries, embarrassments, and aches and pains of life. A lot of those things can lose their punch if we breathe them IN (don't worry -- an in-breath only takes about two and a half seconds), during which time we name them, explore them, notice where we feel them in our bodies, and peek at what's lurking underneath them. Then -- this is the important part -- on the OUT breath, we say the word "Calm" to ourselves. Just a few of these in-and-out breaths can be surprisingly relaxing -- it's amazing how much energy it takes NOT to feel our feelings. This technique has a fancy Tibetan name, "Tonglen," but it's so simple that I just call it "Yucky In, Calm Out."

Are your worries trying to tell you something? Is there something you need more information about, or more support with, or do you need to write it down and list some possible solutions? Do you need to plan some sort of action? My friend Dan says, "Don't get all mental about [insert problem here]. DESIGN YOUR LIFE."

LABOR AND BIRTH – WHAT REALLY WORKS?

If you do the little breathing and melting thing throughout your pregnancy, I promise that your pregnancy will be more fun. And maybe when you actually go into labor your body will say, "Oh, I know about this, I think I'll melt," in which case your shoulders won't steal energy from your uterus, you won't be so scared, and the pain and hard work of labor will be more tolerable or even welcome.

But in labor, just breathing and melting might not be adequate at all. While focusing on your breath does have a physiological relaxation effect, you'll probably need several of these:

LOVE from the people around you

WATER like a shower or bath or even just thinking about that 3/4 of your body that is water and can therefore flow however it needs to

RHYTHM like walking, rocking, chanting, counting, bouncing on a physioball

DANCING which is actually great in labor, with a friend, with happy music

MASSAGE on your lower back, your feet, your head and face, your shoulders -- tell them what you want!

WORDS you repeat in your head or out loud: "I'm doing it, I'm doing great," "My body rocks," "Yeah!" or "Run for the light, baby!"

LAUGHING at anything that strikes you silly

MEDICINES can help, but please make informed decisions about risks and benefits

I asked the world's expert on labor, my daughter Jasmine, how she gave birth to an 11-pound baby without drugs. "I don't know, Mom," she said. "Oh, come on, you must know something," I persisted. "I don't know, I just got into my animal place and did my work." There you have it, from the mammal's mouth: go feral, go wild, be as calm as your cat and as strong as a mama ox.

It would be cool if we just laid little eggs. It would be cool if we were like kangaroos, with babies less than an inch long that pop out and crawl up all by themselves into the pocket to nurse and finish growing outside their mommies' bellies. It would even be cool if we were like nonhuman primates, whose pelvic bones don't have to support walking upright, so their babies slip out more easily. But we're still animals, and birth is not something we do with our brilliant minds, it's something we do with our animal muscles and hormones and funny grunting noises. Roar!

"Childbirth as Action Adventure" article

This is from back in 1997. It's the article I wrote for Special Delivery, the newsletter of ALACE (Association of Labor Assistants and Childbirth Educators) just as I was finishing my thesis on this topic. Now the birth/media project is available as a DVD called LABORING UNDER AN ILLUSION: MASS MEDIA CHILDBIRTH VS. THE REAL THING (2009, 50 minutes, $19.95 at www.birth-media.com).

Childbirth as Action Adventure:

Frantic Antics on TV and in the Movies

by Vicki Elson, MA, CCE

From the birth scene in Gone With the Wind (“I don't know nuffin bout birfin babies, Miss Scarlett”) to the abdominal birth of Arnold Schwartzenegger’s baby in Junior (“Does my body disgust you?”), American television shows and movies have told the story of childbirth. Like any other form of cultural communication, these depictions both reflect cultural beliefs and norms, and help to shape cultural beliefs and norms.

Television and movie studios are in the business of delivering entertainment to audiences, thereby delivering audiences to advertisers and theaters. To accomplish this goal, they tend to emphasize the dramatic, the outrageous, and the tragic, out of proportion to their appearance in real life.

As a byproduct of this business, people watch TV and movie birth scenes, and are exposed to a mixture of childbirth facts, myths, and exaggerations. This might be useful, giving future parents an opportunity to explore their own hopes, fears, and beliefs. But when those viewers go into labor, has this exposure been helpful or hurtful? How can we, as childbirth educators, balance the industry’s influence with a dose of reality?

Now Playing

In an effort to get a handle on what’s being shown out there, I viewed 62 television and movie birth scenes, and studied dozens of variables in each. There were 39 (63%) television birth scenes and 23 (37%) movie birth scenes. There were 24 (39%) comedies, 30 (48%) dramas, and 4 (6%) actual births (i.e. documentaries).

If one could create a composite “average” birth scene from these 62 clips, the mother would be a married, white, upper-middle-class, heterosexual woman in her 30’s, happy to be having her first baby. (The overrepresentation of privileged people is common to the mass media in general, due to targeting of audiences with disposable income, and the belief that privileged people like to see “themselves” portrayed. Ethnic diversity is increasing, but portrayals are not yet proportionate to the population. Only 8 [13%] mothers appeared to be of African-American descent, two [3%] appeared to be Hispanic, and one [“Keiko” on Star Trek] was of Asian descent.)

In this composite, the father would be present but distracted. The birth would take place in a hospital. It would be fast and hard. The mother would be semi-sitting, wearing a hospital-issue “johnny” (see below: Does It Matter What She Wears?), and screaming. The person in control would be a white male doctor. The nurses would be white women. The baby would be a healthy boy (who looks about three months old). The music would certainly be cloying in the immediate postpartum bonding scene.

But this composite scenario doesn’t tell the whole story. In these 62 scenes, there were also significant numbers of:

w emergencies,

w disasters,

w unresolved crises,

w frantic rushes to the hospital (I call this the “Mad Rush Motif”),

w car births (when the “mad rush” didn’t make it),

w aggressive, judgmental, or threatening doctors and nurses,

w questionably competent doctors and nurses,

w attacks by laboring women on men,

w vehement maternal requests for drugs (“Give me drugs!”),

w whimpering maternal requests for death (“I want to die”),

w actual maternal deaths, and

w sick babies.

The screenwriters aren’t making these things up. Some real women do punch their partners, some do have very fast labors, some do require emergency care. But normal birth usually entails a lot of slow, hard work, and few problems. And normal birth is nearly absent in these depictions. Meanwhile, portrayals of rare and frightening complications are plentiful. Confident, dignified mothers are greatly outnumbered by silly, strident, and frightened mothers.

The producers are just doing their job. The purpose of drama is to keep us tuned in till the next commercial. Thus we have interesting variations on normal childbirth: women pregnant by aliens, dying at 300 times the normal rate, being held hostage during labor, or donating eggs to pregnant men. We have refreshing attempts to portray diversity, like showing lesbian or bisexual mothers in loving relationships (5% of the 62; controversy can increase viewership). Perhaps the most remarkable example of diversity is the incomparable six-breasted mutant goat woman giving birth (on her back!) in The Island of Dr. Moreau.

Who’s in Charge?

In most of the 62 scenes, a doctor was clearly in charge of the labor and birth. There were a few cases in which friends, relatives, or bystanders took charge. In a handful of cases, the mother shared power with her care providers. There was only one case in which a qualified midwife was in charge (Truly Madly Deeply, set in England). There were four scenes (6%) in which the mother herself was clearly in charge: frontier women on Through the River and Dr. Quinn: Medicine Woman (see below: Michaela Quinn, Wonderwoman of the Old Frontier), the woman who gave birth in a small car on Blossom, and the male alien “mother” on Alien Nation.

On television and in the movies, doctors are usually in charge of vulnerable women having hard and fast labors in hospitals. Theses doctors are mostly male, by a two to one ratio, with female doctors often behaving even more officiously than the male doctors.

In real life, labor usually isn’t easy and doctors are often helpful. But these TV and movie doctor stereotypes reinforce and normalize technocratic obstetrics, medicalization of a healthy human function, patriarchal control over women’s bodies, and institutional control over a profound family transition. They normalize the transfer of authoritative knowledge about birth away from the mothers themselves.

No Place Like Home

Most of the birth scenes I studied took place in hospitals. But 22% took place in non-hospital settings. Usually this was a dramatic device to heighten the suspense or the hilarity of the scene. Babies were born in cars, on airplanes, in the woods. Some were born at home by accident, by default, or because that was the norm in the last century.

Only one birth took place at home by conscious choice, and that was on Northern Exposure. Two weeks overdue, “Shelley” was planning to fly to the hospital in Anchorage for an induction. But, guided by whimsical visions, she decided only an hour before the birth that she should gather her close friends, husband, and doctor, and stay home. Bonding scenes included both quiet family intimacy and raucous community celebration downstairs in the bar.

There were no planned home births in modern times.

Dueling Paradigms

In real life, many women have a limited selection of birth settings and care providers. Their decisions are dictated by geography, economics, or medical politics. But while some women have limited options, we do, as a culture, have a choice of paradigms.

There is a healthy, empowering, alternative standard of care that is almost never portrayed on television or in the movies. In a “woman-centered birth,” the mother exercises freedom of choice regarding her setting, attendants, position, rhythm, etc.

Woman-centered (or “midwifery-model”) birth “has been proven to reduce the incidence of birth injury, trauma, and cesarean section” (See the MANA, NARM, MEAC, and CFM joint statement, 1997, Special Delivery, Winter 1997). The mother uses her attendants to support her in giving birth (as opposed to “being delivered”). Perhaps most importantly, the normal pain of childbirth is framed as healthy and bearable. Interventions are not routine, but are helpful in case of complications. There is a calm atmosphere of love and respect for the mother and her natural process. Her partner is more like a lover than a “coach.”

Where’s Poppa?

Proponents of paternal participation in childbirth will find plenty to celebrate in these birth scenes, as 55% of the scenes portayed the presence of fathers at birth. This reflects the fact that this element of family-centered birth is becoming a cultural norm in America in this generation.

However, many fathers were portrayed as terrified buffoons or ineffective helpers, and many were conspicuously late or absent. These depictions may provide opportunities for audience exploration of fathers’ anxieties about being present and useful at the births of their children, but there were few role models that men would be happy to emulate.

Of the fathers who were present, many provided encouragement, “coached” breathing, held the mothers’ hands or bodies, or videotaped the birth. Many were terrified, a few suffered injuries or illnesses during their wives’ labors, a few got into fights, and a few fainted. Several had serious doubts about fatherhood, and several more were profoundly and fundamentally changed by the experience of participating in the birth of their children. 8 fathers (13%) actually delivered or caught the baby (5 reluctantly, 3 confidently).

There were a number of expressions of love between the mothers and their partners. There were 10 birth scenes that included hugs or caresses, 16 included kisses, and 5 included “I love you’s.”

There were also 5 mothers who made physical attacks on their husbands, and 4 who made physical attacks on other people, usually men. 5 mothers blamed their husbands for the suffering of labor. Of 9 birth scenes that contained verbal attacks, 2 included the word “vasectomy.”

There was a lovely, insightful scene about the fruits of labor support at the end of thirtysomething. Having been through a long and difficult labor, and having weathered it and bonded deeply with the mother, the man glanced down the hospital corridor at a couple in early labor. The knowing look on his face conveyed how far he had come right through his doubts and fears and out the other side into a more enlightened state.

Time Warp

In most (79%) of the scenes I studied, labor appeared to be extremely fast, even precipitous. Time was severely distorted, and labor was condensed into mere minutes.

A 1996 University of New Mexico study measured the average length of labor as 19.4 hours after the first four centimeters of cervical dilation for a first-time mother, and 13.7 hours after the first four centimeters for a second-timer. Those first four centimeters can take hours or days, so the total length of labor may be considerably longer. Thus expectant parents should have a plan for handling precipitous labor, but should put more energy into planning to cope with the many hours of a normal labor.

The few labors that were portrayed as longish also happened to look like prolonged agony.

Danger Danger

In addition to distorting time, television and movie birth scenes often exaggerate danger. The mad rushes and the high incidence of near-instant labors feed a feeling that high anxiety is a normal part of labor.

Even documentaries sometimes follow the convention of adding gratuitous danger to normal birth. In The Mystery of Birth, there is footage of a healthy woman laboring very nicely, while an “educational” voiceover adds unnecessary anxiety and drama. The narrator emphasizes the baby’s danger and suffering, and belittles the mother’s participation. She reminds us that this is “the most dangerous journey in life...Zoe has no control over the speed of her delivery...Zoe can help by pushing with her stomach muscles but it’s not essential...women have given birth even when in a coma...the baby’s head is forced through the narrow neck of the womb...but until the lungs start functioning properly, the baby can suffer a lack of oxygen...he looks blue...four long inches later, it’s a rude awakening into the world.”
Maternal death was a theme in five of the 62 scenes. Two mothers died in childbirth, one “died” and was revived, one was going to die of cancer soon, and one was already brain-dead at delivery. In addition, one father died (of cancer) at the moment of birth. I suppose that fear of death is right up there with fear of the unknown in the subconscious minds of expectant parents, so it is not surprising that these themes are explored in the media. But some birth depictions go beyond mere exploration, and engender so much fear in viewers (especially pregnant viewers) that the viewers themselves report adverse effects.

The most extreme example of this was that infamous episode of E.R. (see below: For This They Give You an Emmy?), in which the mother died after a series of medical errors. I interviewed care providers who said their phones were “ringing off the hook” after it aired. That episode is also notable in that it wasn’t just women’s bodies that were untrustworthy in labor -- doctors weren’t even reliable as rescuers. I don’t know which is worse: portraying women as victims of their own bodies, or portraying their would-be rescuers as incompetent. That episode delivered a double whammy.

A Little Something

While that program was frightening, perhaps the birth scene on the sitcom Step by Step was just as damaging to the pregnant psyche. “Carol” was portrayed as out of control. She demanded drugs during contractions, while between contractions she was a bit more like her sweet self. The laughter on the laugh track was directed at her antics, which included vicious remarks to her husband. Her doctor and her husband seemed unable to cope with her pain or support her emotionally. Her desire to have natural childbirth was interpreted as unnecessary martyrdom (this was one of several examples of backlash against the natural childbirth movement).

Carol was finally pressured into taking “a little something for the pain.” The “little something” turned out to be epidural anesthesia. The doctor said, “It’s perfectly safe for you, and it won’t hurt the baby one bit.” (Note: While epidural anesthesia is usually safe and effective, and may be helpful for some women, the peer-reviewed medical literature documents at least 20 risks for mother and baby, ranging from nausea to increased incidence of surgical delivery to cardiac arrest.) Carol and her team were portrayed as intensely grateful for this intervention.

In labor, “Murphy Brown” was equally ridiculous, miserable, pathetic, and dangerous to men (she strangled two men by their neckties, and also did unspecified damage to the reproductive organs of one man). The producers of those programs missed opportunities to show loving support and maternal confidence. But of course, that’s our job as childbirth educators, not theirs.

I Don’t Think So

Inaccuracies are too numerous to list. For example, as a male carrying a baby, for some reason Mr. Schwartzenegger is exhorted to “push” during a cesarean section. Meanwhile, there is no attempt to explain how the fetus grew in his abdomen without any of the requisite maternal organs. Also...

w A 3-month-old doesn’t look like a newborn, no matter how much strawberry jam and cream cheese you smear on it.

w There were many babies without umbilical cords or placentas.

w Epidurals do have potential side effects (“Step by Step” denied this completely), and most make it impossible to move your legs around (like “Jackie” on “Roseanne”).

w Medical procedures and medications should require informed consent.

Drugs and Surgery

Despite all the danger, questionable medical support, and buffoonery, the cesarean section rate in these clips was only 16% (the national rate is around 22-24%). The indications for these surgeries were a mixture of reasonable but rare (i.e. placenta previa), controversial (i.e. routine cesarean for breech

presentation), and preventable (i.e. poor handling of a shoulder dystocia).

And despite all the requests for drugs (“Give me drugs!”), only 10% of the vaginal birth mothers had drugs administered. But they loved them. “Roseanne” was tripping on Demerol (unlikely!), having colorful visions of Jerry Garcia. Her sister “Jackie,” in another episode, stuck a fork in her leg and said, “I’m not having any pain, I had an epidural! See?” And on Step by Step, “Carol” breathed a woozy “God bless you” to her anesthesiologist.

In real life, epidurals are administered in up to 80% of American births. I suggest that television and movie portrayal of birth as unbearably painful -- and support as unreliable -- may contribute to the popular acceptance and normalization of this intervention.

Up the Down Staircase

While many of the TV and movie mothers were portrayed as giving birth in upright or semi-upright positions that are physiologically sensible, 33% of the vaginal-birth mothers were shown giving birth in supine or lithotomy positions, which force the mother to push the baby up and out, against gravity. The lithotomy position was popularized early in this century to facilitate forceps deliveries, episiotomies, and other interventions. It still sometimes includes immobilizing leg straps. Most natural childbirth advocates would agree that it should not be perpetuated as a cultural norm.

Breastfeeding

One bright spot in this study was the occasional portrayal of breastfeeding, indicating that this practice is coming back into acceptance in popular culture. Breastfeeding portrayals were rare (8% of the clips), and most were sources of jokes or melodrama. Murphy Brown was mystified by her own breastmilk: “It’s like one day you find you can get bacon from your elbow.” And “Chloe” (on E.R.) described her baby’s latch-on as being “like a staple gun.”

But there were no portrayals of bottlefeeding newborns. This was encouraging evidence that perhaps, despite the aggressive advertising tactics of formula companies, our culture is beginning to agree with worldwide nutritional experts that breastfeeding is best.

But Does It Really Affect Anyone?

Birth is a stage upon which competing mythologies are played out. So is television, and so are movies. If our birth customs provide a window into our culture, television and movie portrayals provide a window into our hopes, fears, and beliefs about birth.

Which mythologies do we relate to? Do they have medical, emotional, or spiritual consequences?

I made an informal study, distributing written questionnaires to groups of teens, expectant parents, and childbirth professionals about their experiences with portrayals of childbirth in movies and television. The survey results bolster my argument that moving-picture mass media consumption does make a difference in some people’s beliefs and feelings about childbirth. However, it is also clear from this survey that many people have considerable “conceptual distance” from movie and television birth scenes because they have other sources of information buffering them. I call these buffers “neutralizing forces.”

The following quotations reveal the richness and variety of people’s experiences watching birth scenes. Taken as a whole, these quotations provide some insight into patterns of effects.

Fear of Giving Birth

Some respondents clearly felt that consumption of movie and television birth imagery had negatively affected their feelings about childbirth.

The primary emotion I recall from media [birth scenes]...is FEAR. I am sure that viewing these births has affected my beliefs, hopes, and fears about giving birth even though it is not obvious to me how...I just don't see how all the hysteria presented to me my whole life about the dire medical emergency of birth could not have penetrated my beliefs. I’d sure like to break away from all this “bad” emotion...(Student, Boston)

I remember being younger and being afraid. There is a part of me that has absorbed these ideas and images and I have to fight to get rid of them. (Nanny, Boston)

I am going to adopt after seeing “The Miracle of Life.” (High School Freshman, Hadley MA)

PAINFUL...I would think, from what I’ve seen, that it would be much too painful for a wimp like me to bear. (High School Freshman, Hadley MA)

I can’t think of a specific scene in a film, but I believe that every “birth” I’ve seen in movies and on television was simply incredibly painful. I’ve watched women yelling and screaming in agony...until quite recently I thought of birth as a dangerous, medical procedure. I have a friend who has considered asking another woman to carry her child because she’s so terrified of the birthing process. (Student, Boston)

From Fear to Courage

Some respondents were aware that television and movie birth imagery has the power to influence them both positively and negatively. Some described an evolution from fear to courage, all within a context of consumption of imagery.

I am so glad I didn’t see “ER” [the episode in which the mother died] while I was pregnant (I was at the time). I would have gone into premature labor (by about 10 weeks!!) with sheer panic! I loved “Dr. Quinn [Medicine Woman].” She makes me (and hopefully other women) feel very capable!...We can do this...expect the unexpected...STRENGTH and POWER. (Manager/Mother, Northampton MA)

“ER” -- baby lives, mother dies -- I felt empty and so did the father. Yet happy the baby made it. Struggle ahead. Always on TV -- birth happen[s] so fast. You can’t squeeze a 12-72 hour labor into a 1-2 hour show. Videos of actual births and laboring were much more informative and fulfilling. Since I’ve started watching more birth experiences away from the mass media (real videos not doctored for TV), it has become less scary and even seems somehow possible. I used to feel scared and could not imagine being stretched in two. But, like I said, this is changing. (Research Assistant, Boston)

Looking Forward to Birth

Some respondents (though these were a minority in this survey) described their experiences with movie and television portrayal of birth as positive.

Documentaries of real births -- revealing -- descriptive -- detailed explanations accompanying the viewings -- They showed the beauty and natural process even through the sterile environment. Made me eager to have this experience myself -- also made me realize that I’d have to ask loud and clear for my preferences to be heard and heeded. (Waldorf School Teacher, Boston)

There was an excellent birth on “30something” when “Gary’s” partner gave birth, naturally, with no complications, and fairly realistically. It was inspirational. (Childbirth Educator, Long Island)

Neutralizing Forces

Several respondents described “neutralizing forces” in their lives as canceling out any effects from consumption of movie and television birth imagery. Such forces may include direct experience of giving birth, experience witnessing birth, stories about birth from friends or relatives, academic study of birth, or skepticism about the mass media in general.

Horror -- PAIN ... terror!! It [affected me] before I had my first [child]. I thought all births were like TV. I feared my birth more than anything else I’d ever feared in my life. (Childbirth Educator, Northampton MA)

Pain, happiness, joy, anxiousness...mostly the mother yelling to get the baby out of her and that it hurts. Sometimes...a mother dies. Seeing births on TV...didn’t change anything [for me]. What changes my ideas is my mother’s words. (High School Freshman, Hadley MA)

The births were really panicky. The families (husbands) always get really panicked and run around a lot. The mothers (once in the hospital bed) go through a lot of pain and screaming. They ask for drugs. I have seen and heard a lot about real birth. But before I didn’t want to have children because I was afraid of the pain. (High School Freshman, Hadley MA)

“ER” birth -- fear, excitement, triumphant Doctor, ingratiating mother, lots of pressure on mom (Push!)...”Roseanne” -- Jackie’s birth, I only remember her yelling for her epidural...These births were more recent than my history of positive homebirths so they have not affected me all that much except to make me feel isolated and misunderstood from the community at large. (Homemaker, Boston)

I’ve seen a lot of childbirths on TV...the primary emotion[s were] pain and excitement...the best was a c-section on the Learning Channel. I’ve seen 4 childbirths in real life. For one of those I was a coach. I’ve seen two girls be born vaginally and twin boys c-section and I coached my best friend through a breech baby girl. I think childbirth will be painful but I would still have kids, and naturally. (High School Freshman, Hadley MA)

It’s just entertainment. (High School Freshman, Hadley MA)

It is just TV. (High School Freshman, Hadley MA)

Through education the mysteries have been allayed -- yet thru no help of mainstream TV. (Midwifery Student, Boston)

It’s Unreal

Some respondents, with strong neutralizing forces in their lives, are annoyed or amused by unrealistic portrayals of childbirth.

[Media birth scenes] were fast, rushed, painful, out of control. They either took place in cars or strange places, or in the hospital. They all seem to happen quickly and are never “messy.” And despite the short labor and delivery, all the conversations about birth are “I labored for 52 hours with you...” Emphasis on pain and suffering. Before I studied midwifery or actual[ly] had my daughter, and before I talked to real women who had given birth, the births in the media seemed “normal.” Now I have read so much, been to births, and given birth, that they seem comical to me. (Mother, Boston)

It bothers me that birth isn’t being given an honest look -- TV doesn’t have enough time for an honest picture of birth. Birth is such an important and common event, why don’t more people know how it really happens, or protest against it when it’s portrayed inaccurately? (Apprentice Midwife, Boston

I always laugh in disgust at how birth is portrayed -- it is so unrealistic! As if the father could possibly tell the mother how to “breathe” --ugh! No wonder so many women say they swore at their hubbies during labor -- I would too, if he tried to tell me how to act when I am perfectly capable of doing it myself! (Mother, Boston)

Backlash

Another respondent demonstrated awareness that there is sometimes a backlash against the natural childbirth movement in television and movie portrayals of birth.

Recently, an episode of “ER” showed a birth ending in the mother’s death. It started with the parents saying they wanted “natural childbirth.” So of course they were punished for their hopes. The primary emotion was crisis and danger. (Childbirth Educator, Long Island)

Turn Off the Camera

And one young father expressed his dismay that an event as intimate as childbirth was portrayed at all.

As much as I am a child of the TV age, I don't view these as reality. I think childbirth should not be dramatized at all...it’s too personal. There are some acts or events that shouldn’t be viewed on any screen. (Furniture Maker/Father-to-be, Northampton MA)

The Truth is Entertaining, Too

Those of us who have given birth in a supportive environment have a hard time imagining any greater drama, comedy, or intensity. Perhaps we are not the only ones who find that authentic birth scenes can be at least as fascinating as birth scenes with floods, hijackings, or other gratuitous complexities added on.

Recommendations

Depending on whether a person has watched a lot of Chicago Hope or a lot of Family Ties, that person could come to various conclusions about birth. Bearing in mind that some people have no other source of information about childbearing, and are thus vulnerable to misinformation from movies and television, I suggest that producers would do new parents a service if they made some of the following changes:

1. Make birth more central to the story. Refrain from adding crises and other distractions. Emphasize the mother’s strength, her partner’s love, and a healthy outcome in a greater number of birth scenes.

2. Model maternal behavior that is not victim-oriented. Model care provider behavior that is not rescue-oriented. In other words, show women who labor bravely and well, with sensitive professional support that respects their autonomy.

3. Don’t scare the daylights out of pregnant women by depicting birth as a dangerous medical event and care providers as incompetent. Show clear, assertive communication between health care consumers and their care providers.

4. Show a greater variety of upright postures for labor and birth, and don’t show the supine or lithotomy positions at all.

5. Continue to increase ethnic, class, and age diversity.

6. Show a wider range of healthy, low, open, unafraid vocalizations. Birth is hard work, and it is unfair to represent it as easy, but it is also unfair to portray so much stress and fear in so many birth scenes.

7. Let more women wear their own clothes, and let more women choose the setting for their birth with greater awareness of alternatives. For example, planned home birth with good midwifery care is a safe and rewarding option for many families, and it was not portrayed in any of the scenes I studied.

8. Stop distorting time so extremely! While a handful of births are indeed very fast, most are much slower. A mad rush is seldom needed, and may be dangerous. A mad rush may also adversely affect labor by generating excess tension. Furthermore, the mistaken belief that birth is taking “too long” can lead to unnecessary interventions.

How Childbirth Educators Can Help

So that’s my wish list. But I’m not holding my breath, waiting for TV and movie producers to take more responsibility for healthy, confidence-inspiring portrayals of birth. After all, the industry rewarded that ghastly maternal-death episode of E.R. with an Emmy! Meanwhile, there are steps we educators can take to help balance out television and movie stereotypes.

First, we can help our clients to cultivate media literacy skills, becoming more discerning viewers. If print literacy consists of reading with comprehension, reading critically, and writing coherently and persuasively, media literacy could be said to consist of reading media “texts” with comprehension, reading these texts critically, and producing media of one’s own. Literacy has long been valued as an essential prerequisite to participation in democracy. But today, we are so saturated with audiovisual imagery that we must be at least as literate about the moving-picture mass media as we are about the printed word.

Second, we can show images of normal birth. I like to use slides with music, or videos of lovely births, to infuse my classes with a feeling of confidence in the natural process. As you can see from some of the quotes above, this can help to replace fearful feelings with hopeful ones.

Third, we can keep on teaching all about normal birth. Education eases that debilitating dread, fear of the unknown. Also, education enables parents to make good choices that can empower them and maximize their chances of having the kind of birth they want.

Help your students become active participants in the language of imagery. Help them find a sense of humor about the absurd things they’ve seen portrayed. And show them that they have many choices, both as individuals and as members of a culture.

The following notes were included as sidebars when this article was published in ALACE’s newsletter, Special Delivery.

And Now For Something Completely Different

In The Meaning of Life, Monty Python spoofed machine worship, medicine for profit, and the transfer of authoritative knowledge from mothers and fathers to doctors and institutions. Like Truly Madly Deeply, the only birth scene in the study to feature a competent midwife, this movie came from England.

Nurse: Mrs. Moore’s contractions are more frequent, Doctor.

Doctor #1: Good, take her to the Fetus Frightening Room.

Doctor #2: Jolly good. It’s a bit bare in here, isn’t it?

Doctor #1: Yes...more apparatus, please, Nurse. The EEG and the BP monitor...and get the machine that goes “ping.” And get the most expensive machine, in case the administrator comes.

Doctor #2: Lovely, jolly good, that’s much much better...

Doctor #1: Yes, that’s more like it.

Doctor #2: Uh, still something missing, though...

Doctor #1: Hmm...?

Both Doctors: Patient!

Doctor #1: Where’s the patient?

Doctor #2: Anyone seen the patient?

Doctor #1 (calling) Patient!

Nurse: Ah, here she is.

Doctor #1: Bring it over here...mind the machines!

Nurse: Sorry, Doctor.

Doctor #1 (to Mother): Come along.

Doctor #2 (shouting): Hello. Now don’t you worry!

Doctor #1 (also shouting): We’ll soon have you -- cured!

Doctor #2 (waving at Mother): Goodbye!

Doctor #1: Goodbye! Trip’s up!

Doctor #2: Leave it all to us. You’ll never know what hit you.

Doctor #1: Can I put the tube in the baby’s head?

Doctor #2: Only if I can do the episiotomy.

Doctor #1: Okay!

Doctor #2 (putting Mother’s legs into stirrups, exposing her perineum to the door): Come in, come in. (A crowd of assorted onlookers pours in.) Jolly good. (A man comes in with them, smiles at the Mother). Who are you?

Father: I’m the husband.

Doctor #2: I’m sorry, only people involved are allowed in here. (The Father is ushered out.)

Mother: What do I do?

Doctor #1: Yes?

Mother: What do I do?

Doctor #1: Nothing dear, you’re not qualified.

Doctor #2: Leave it to us!

Mother: What’s that for?

Doctor #2: That’s the machine that goes “ping.” (Doctor #1 presses a button, and the machine goes “ping.”) You see? That means your baby is still alive!

Doctor #1 (pointing at another machine, still shouting): And that’s the most expensive machine in the whole hospital!

Doctor #2: Yes. It cost over three quarters of a million pounds!

Doctor #1: Aren’t you lucky? (Mother smiles and nods.)

For This They Give You an Emmy?

“E.R.: Love’s Labors Lost” was, by far, the most frightening birth scene I studied. A lovable young couple, deep in love and anticipating their first baby, is destroyed by a doctor’s questionable decision-making and the ineptitude of the institution. Here’s a synopsis of this unlikely scenario.

Misdiagnosed toxemia brings on eclamptic seizures. The unconscious mother is revived and there is a moment of calm during an ultrasound (“Is that a boy or what?”).

The OB’s are “getting slammed upstairs,” so an ER resident, Dr. Greene, induces labor. As contractions come and go, the mother says things to her husband like, “I love you so much...shut up!”

The baby’s heart rate drops to 90, and the music goes scary. The mother, 5 cm dilated, requests an epidural, and the anesthesiologist instantly appears. Obstetricians, meanwhile, are nowhere to be found. As the epidural wears off, the fetal heart rate is slow again. The mother is fully dilated, and there is a mad rush to get a baby warmer and resuscitation kit.

Chaos follows: big needle, pudendal block, no progress, forceps, episiotomy, oxygen, rising maternal blood pressure, shoulder dystocia. “Oh my God,” says Dr. Greene. McRoberts maneuver, fundal pressure, extended episiotomy, posterior shoulder still stuck. “Why can’t you deliver this baby?” says dad. “Mr. O’Brien, please!” says Dr. Greene, then...”Let her go, it’s not working.”

More chaos: “Zavanelli” maneuver pushes the baby back in, cesarean section, total panic, father left out, local anesthetic is the best they can do, mother has another seizure, a tray of sterile instruments crashes to the floor. Dr. Greene asks everyone to calm down. Dr. Greene asks someone to go drag a NICU doctor and an OB down here STAT. Dr. Greene isn’t sure of technique. An underling says, “You’re asking me?” Dr. Greene replies, “I’m asking God.” Placental abruption, mother bleeding out, transfusion, birth, suction, clamp, baby not breathing, infant CPR, baby pinks up, 5 minute Apgar is 8.

An OB attending finally shows up and says, “You should have let me know you were in over your head.” Someone says, “Dr. Greene, she’s crashing.” Chaos again: bleeding, dopamine, “Bag her,” mother’s blood stops clotting, lidocaine, “Shock her,” CPR. Dr. Greene is still desperately and mechanically doing CPR when another doctor says, “It’s 30 minutes past too late. I’m calling it...time of death...”

Later, Greene hears a list of his mistakes from his supervisor. Missed preeclampsia, underestimated fetal weight, missed abruption, used forceps on too big a baby, and a “hack job of a cesarean.” Greene then has to tell the father, who is busy bonding with his new baby, that the mother is dead.

Michaela Quinn: Wonderwoman of the Old Frontier

Dr. Quinn: Medicine Woman is an example of a frontier woman portrayed as a paragon of womanly strength and courage. Michaela (“Dr. Mike”) rescues her husband Sully in the woods, sets his broken leg, tends the nasty gash on his shoulder, and watches defiantly but helplessly as their Native American friend is taken away by evil Army personnel. Meanwhile, her water breaks.

She and Sully give birth under a tree. The cord is around the baby’s neck as the head presents. Sully has to summon up his courage to clamp and cut the cord, and Michaela instructs him as she is giving birth.

Dr. Mike is a role model for other women with lines like, “I guess we have to learn to expect the unexpected;” “Women have been doing this forever;” “Whatever pain I experienced, it disappeared the moment I saw this little one’s face.” Extended family bonding is very sweet, and Dr. Mike quickly recovers her strength.

Does It Matter What She Wears?

Robbie Davis-Floyd (Birth as an American Rite of Passage, 1992) compares “technocratic” and “wholistic” models of birth. She suggests that hospital protocols ritually reinforce technocratic values.

One such protocol is the mother’s traditional costume, a blue sheet open up the back. Davis-Floyd suggests that wearing a hospital johnny places the mother in a “sick” role, makes her look like all the other “initiates” sharing the same liminal state, symbolically inverts her most public and private body parts, and prevents her from leaving the building. One birth scene I studied showed a labor so fast the mother barely made it to the delivery room -- but she still had time to change into the johnny.

Rent / Don’t Rent

Looking for a good video to recommend to your class? Steve Martin’s Parenthood is worth seeing. The birth scene is short but sweet, and the whole movie deals with all sorts of parenting issues, not all of them sugar-coated.

For the ultimate in the Mad Rush Motif, take a look at Nine Months. The movie focuses on a man wrestling with his ambivalence about fatherhood, unable to get excited about feeling the baby moving inside his wife’s belly, but later bonding gloriously with the baby via ultrasound video. When the labor has barely begun, the Mad Rush involves a car literally flying around corners and injuring assorted bystanders, all of whom pile into the car to go to the hospital. The climax features two simultaneous births, complete with an inexperienced doctor (Robin Williams!), a huge fight scene, galloping music, inappropriate use of a video camera, foul language, and other cinematic flourishes. Good for a laugh, not so good as a role model.

Tell your clients not to bother with She’s Having A Baby. It’s got a whiny father and a scary birth scene -- and those are the good parts.

Ruminations on Radicalism

This is my very first blog. It's an adaptation of an article I just submitted to a new radical childbirth publication called SQUAT. I love the name!

What do you think? Am I a radical? Are you? Or are we just working toward something sensible and equitable?

Some mamas get way too much intervention in childbirth, and others die from lack of access to medical care when it's truly necessary. In such a world, we must ALL advocate for equitable, sensible, evidence-based care.

For some, radicalism means unassisted childbirth. I believe that this trend has a valuable sociological purpose -- to remind us that most humans give birth just fine -- but I'm concerned that some individuals may pay the ultimate price. In some cases, the presence of a qualified, well-trained midwife might make a life-or-death difference. And if, say, the umbilical cord precedes the baby, or the baby is stuck in a shoulder-first presentation, or the placenta is blocking the cervix, or the placenta detaches before the baby is born, cesarean section is essential for survival.

To me, "radicalism" means holding down the holistic end of the spectrum, questioning protocols that are not evidence-based, expanding knowledge about natural childbirth methods, and adding a huge dose of love, gentleness, and respect to the equation. I've met many people who share these values. Some were wearing vegan sandals and some were wearing white coats.

I've been a childbirth educator and doula for 26 years, during which time the US cesarean section rate has skyrocketed. Everybody should know that in 1965 it was 4.5%, and now it's 32% and climbing -- without a corresponding improvement in outcomes.

In my work, radicalism means plugging away, year after year, educating pregnant people, forming alliances with holistic midwives, nurses, and doctors. It means offering doula and childbirth education services to everybody -- whether they are richer, poorer, younger, older, straighter, queerer, single, partnered, or incarcerated. It means looking at the global picture, working to reduce maternal and infant mortality and morbidity.

I have to say that statistically, it's not going very well. Capitalism maintains health care inequities. Some things just don't make sense -- like insurance that pays for hospital birth but not home birth with qualified midwives, even though the latter is equally safe and vastly more cost-effective (and, in our family's case, much more fun). Economic and time factors and the fear of malpractice lawsuits contribute to the cesarean problem. The ubiquity of interventions like continuous electronic fetal monitoring and epidural anesthesia contribute to the famous "cascade of interventions" scenario.

And there's one other factor that must be addressed: culturally, we are afraid of childbirth. This is exacerbated by TV and movies. It turns out that more pregnant people watch "reality" childbirth shows than attend childbirth classes. In my work, I've seen a change over the years -- as more and more people get their information from TV, they come to believe that birth is dangerous, fast, and undignified. They think that "normal" birth involves medical rescue, while natural birth is for hippies, weirdos, aliens, and old-timey pioneers.

That's why I focused my master's thesis (Anthropology, University of Massachusetts) on TV and movie birth scenes. Now that my radical little kids have grown into radical awesome adults (yes, I'm proud), I've had the energy to update that thesis and turn it into a film that's being distributed all over the world: "Laboring Under An Illusion: Mass Media Childbirth vs. The Real Thing" (www.birth-media.com).

Making the film, I didn't just want to whine about how unrealistic and terrifying TV birth scenes are. I wanted to juxtapose them with scenes from empowering natural childbirth documentaries, partly to highlight how ridiculous TV is, partly to keep from reproducing the very thing I was complaining about, and mostly to offer viewers an inspiring antidote. The natural childbirth films I excerpted are all worth watching in their entirety, and I hope that viewers will seek them out.

There was a silver lining to looking at birth through the lens of mass media. Since it's our shared popular culture, the film came out very accessible, and it's hilarious. I'm having a lot of fun with it.

I've been amazed to find that people are showing the film in Uganda, Greece, India, Malaysia, Australia -- apparently the US exports so much of its culture that its movies and TV shows are familiar all over the world.

I designed the film as a tool for pregnant people/partners, care providers, teachers of health, sex ed, and media literacy, and screenwriters who want to do a better job (coming soon: a new resource for Hollywood called REEL CHILDBIRTH -- Script Consultants Deliver The Facts).

Now that I've broken even on the project, I'll be dropping the price and trying to get the word out there in cyberspace so that anyone who might find it useful will stumble across it. If anybody wants to review it, tell me where to send a review copy.

As antidotes to the culture of fear, I also recommend short films called "It's My Body, My Baby, My Birth" and "Birth Day," both available at the delightful websites www.whatbabieswant.com and www.sagefemme.com. I recommend books by Ina May Gaskin, Penny Simkin, and The Boston Women's Health Book Collective.

Keep an eye out for these: There's a new film coming out called "No Woman No Cry," about global maternal and infant health issues. Also the film "Babies" looks like it will be fascinating. It's about the lives of four babies in Mongolia, Japan, Namibia, and California.

I live in western Massachusetts, and I welcome students of the childbirth arts to sit in on my classes in Northampton for free. These are some worthwhile local projects I'm involved in if you'd like to explore them:

www.theprisonbirthproject.org
www.motherwoman.org
www.greenriverdoulas.org
www.carecenterholyoke.org
www.cradlefamily.com

I wish you all the very best!