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Chapter Seven Giving Birth in a Culture of Risk Consequences for Mothers M­ others’ anticipation and experience of birth have often conflicted with obstetricians ’ approach to and medical understanding of birth. This clash became especially obvious in the 1970s and 1980s, when feminist activists condemned as unnecessary, demeaning, and even harmful, many treatments that obstetricians had long touted as beneficial. Although ­ mothers and doctors attempted to respond to each other’s positions, they often talked past one another. The largely white, female, college-­ educated activists who challenged the nation’s largely white, male obstetricians never fully appreciated the array of pressures that obstetricians contended with. Nor did most obstetricians fully grasp the legitimacy of ­ mothers’ complaints about inhumane treatment. This rift between ­ women and the physicians specializing in ­ women’s medicine has had broad, per­ sis­ tent consequences.1 Generation Gaps While neither all physicians nor all ­ mothers have ever approached childbirth in a monolithic way, specific views have predominated in each generation. The­women who gave birth to the baby boomers in the 1940s, 1950s, and 1960s sought and received medical care in an era of physician paternalism—­ a form of control that was particularly pronounced in obstetrics and gynecol­ogy. Doctors ­were the experts. They made the medical decisions. Who was the patient to question them? One ­ mother who gave birth to her first child in 1949 and her second in 1952 184  Cesarean Section exemplified that tradition. She recalled of her pregnancies and births: “The doctor was in command. . . . ​ The doctor was God. And when the doctor told you this is how it’s ­ going to be, you ­ didn’t worry. You let the doctor worry.”2 The baby boomers, the ­ daughters of ­ these ­ women, matured in a dif­fer­ ent world. Most ­were still in school in the 1960s and 1970s, as the ­women’s rights movement came to the fore. That movement helped shape their views and aspirations. Rather than accede to doctors’ instructions and hospital routines during birth, as their­mothers had, they questioned every­thing. One ­woman wrote of her impending birth, “I am enraged about having my baby in a hospital! The doctor said I must be on my back in stirrups, I must have a pubic shave, and I must have an enema. . . . ​ I ask, who is having this baby?” Criticism of ­ women’s medicine became the overriding narrative among health reformers in the 1970s, challenging the authority of male physicians and driving change.3 The next generation of American ­ women took the successes of the ­ women’s movement for granted. They had grown up in a world where federal law mandated gender equity, where ­women working outside the home was the norm, and where schools, from the primary grades through higher education, nurtured ­ women’s academic and athletic talents. Yet the ­legal mandate that ­women must receive the same treatment as men in public life did not necessarily result in equal treatment for ­ women. ­ Women carry and grow fetuses. They give birth. They lactate. In the absence of social supports formulated to respond to ­those realities, such as the paid maternity leave and government-­ subsidized daycare enjoyed by working ­ women in almost ­ every other industrialized country, American working ­ women found themselves at a disadvantage to working men. Same treatment did not translate to equal treatment. Without accommodations for ­ women’s special abilities, the change wrought by the ­ women’s movement made life more, rather than less, difficult for the growing number of ­ women who ­ were new ­ mothers and also working outside the home.4 Given their milieu, this latest generation has approached childbirth not as the empowering activity so many of their ­ mothers celebrated but as one more draining task in an already too-­ busy life. As one young ­ woman chided, “In a world where ­women are constantly proving their worth—in the office, on the playing field, at home—­unmedicated childbirth need not be singled out as ‘proof’ of one’s strength.” ­These ­ women tended to ridicule the natu­ ral births that so many of their­ mothers found inspiring. If medicine could tame the intensity of ­ labor, then why not embrace the treatments? If an intravenous Pitocin drip provided the means to schedule a birth that would other­ wise interfere with work commitments and the Giving Birth in a Culture of Risk   185 care of other ­ children, why not use it to mitigate the disruption? If epidurals allowed ­ mothers to sleep, read, converse normally, and watch tele­ vi­ sion...


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