Book: Birth & Sex, by Sheila Kitzinger

birthAndSexSmTitle: Birth & Sex: The power and the passion
Sheila Kitzinger
Source: Veddma library
Available online

Notes: Sheila Kitzinger, a social anthropologist of birth, an author of 36 books published internationally, brings attention to the continuity of sexuality through procreational stages, including conception, pregnancy, and birth. One of the central themes in the book is de-sexing of birth that has stemmed from the obstetric practices and the perpetuated culture of fear surrounding birth. This trend leaves women full of fear of birth and inability to perceive it as an empowering act.

The author draws parallels between the need for privacy during both sex and birth, the similar hormonal cocktails for both, and brings up a possibility of orgasmic birth when a birthing woman is given the freedom to birth as she wishes and when she embraces the power carrying her through labour.

She quotes Barbara Katz Rothman on separatory approach in obstetrics:
“The history of Western obstetrics is the history of technologies of separation. We’ve separated milk from breasts, mothers from babies, fetuses from pregnancies, sexuality from procreation, pregnancy from motherhood. And finally we’re left with the image of the fetus as a free-floating being alone, analogous to man in space, with the umbilical cord tethering the placental ship, and the mother reduced to the empty space that surrounds it.”

This separation is perpetuated by the medical education, obstetric practice, and images in the media. Everything in a hospital setting is designed to create an impersonal atmosphere separating the figures of authority acting upon a woman’s body from the body itself that is treated as a reproductive machine. The author describes a typical hospital delivery during 1960s: “The obstetric delivery is a caricature of normal childbirth. Not only were the woman’s legs suspended in stirrups but her wrists too were often bound. Her body became the passive object on which the doctor acted to effect delivery. She lay flat on her back while he got on with the job at the lower end of her body. Her perineum was shaved as bald as an egg and the medical view of her was a heavily draped, lumpy object, like a sofa shrouded in dust covers, and a central window in the cloth with an opening in which the ball-shaped mass of the fetal head could be seen descending through the smooth, shiny, bulging balloon of the perineum. It appeared that the doctor was no longer doing things to a woman’s body, but was servicing a reproductive machine.” Even without the woman being bound and shaved, the current obstetric view of the birthing woman and the birthing process are not far from those described.

The author gives an overview of female physiology, hormones that play a role in childbirth, psychological and physiological changes in pregnancy, and the varying feelings women have about sex after birth. She discusses how birth process is disrupted in hospitals, including episiotomy, the origins of the clock-dominated birth based on the Friedmann curve to describe the “appropriate” labour progress, as well as the emergence of active management of labour instead of letting the labour progress on its own.

She describes the influence of the language used to describe the birth process on our perceptions of what is normal and expected during labour and birth: “When doctors and midwives describe pregnancy as ‘high risk’, a pelvis as ‘untried’ or ‘inadequate’, a cervix ‘incompetent’ or labour ‘prolonged’, talk about ‘failure to progress’ – and make casual comments about a ‘lazy uterus’, a ‘sloppy cervix’, or a ‘boggy fundus’, they impose a view of the female body as a machine always at risk of breaking down.” Language is extremely powerful at cementing our perception of a phenomenon as well as our attitude towards it. In birth, such language leads the medical system and the society to treat pregnant women as sick, their bodies inherently flawed, needing help delivering them from the intruder that the fetus is presumed to be, as well as from the pain of childbirth.

The power differential between the medical professionals and the birthing women in a hospital setting, combined with the cavalier approach to medical interventions in labour, results in some women viewing what happened to them in labour as birth rape. “They spoke about shame and disgust with themselves and their bodies, about guilt that they had in some way caused the violence, and how they felt different from other women, and isolated. They were haunted by similar images of being trapped, overpowered, physically assaulted and mutilated, and had flashbacks, nightmares and panic attacks.” Birth trauma stays with women for years, often surfacing as psychological issues that affect their family life, parenting, relationships, and work.

The author describes the introduction of the birth pools by Dr. Michel Odent in 1970s in France, creating the possibility of labour and birth in water. Dr. Odent has also introduced singing into his clinic: pregnant women, families, and some members of staff joined in singing together during antenatal clinic visits. Pregnancy and birth songs have been an important part of the ritual through the ages, but unlike the birth pools, singing had not taken off as a part of a modern hospital routine, perhaps due to logistical issues, one of which would be breaking down the rigid separation between the staff members and the birthing families, and requiring more flexible protocols that clash with the conveyor-like operation of a hospital. The book touches on the importance of birth dance, ritual songs, and unrestricted movement during birth in different cultures.

The significant changes in childbirth in the last half a century include the change of the place of birth from home to hospital bringing with it the medicalization of birth; shifting the control over what happens in labour from a midwife to an obstetrician; and technological revolution bringing with it the investigations and interventions starting early on in pregnancy. The author also discusses the re-emergence of home birth as a way to get away from all the interventions promoted in a hospital setting, and the roles of midwifes and doulas, including the struggles within birth professionals in different countries. She touches on midwife witch hunts taking place in some countries, and how risk management in obstetrics dictates more interventions, including early induction, Caesarean for breech, and planned Caesarean sections in general.

I have thoroughly enjoyed this book. The author touches on many issues affecting birth today, some widely discussed within the birthing community, and some not so well-known. Her insight on history of birth interventions and on removing sexual aspect from birth, as well as on societal impacts of the changes in birth process makes the book an enlightening read.

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