Mass Media and Birth

I guess I wasn't the only one thinking about how media influences our expectations of birth! Vicki Elson actually probably got the wheels turning before I even started working on my communications degree because she's written about the topic for ALACE. However, I'm very excited to order her new DVD, Laboring Under an Illusion: Mass Media Childbirth vs. the Real Thing, which can be seen here:

I am especially excited because I just wrote a paper on this very thing a couple of months ago. (I can't say I was excited about my sucky grade, but I thought I'd post it here simply because it is relevant.)

The Impact of Mass Communication on Women’s Perceptions of Birth
Kim Wildner, April 15, 2009

Mass communication both reflects and shapes the cultures in which it exists. It seems logical that women’s experiences of the important events in their lives would likewise be reflected and shaped by mass communication. Birth is one such experience.

Perhaps since the invention of the printed word, mass communication has been integral in determining the core beliefs that will impact a woman’s perceptions of her birthing experience. Indeed, by accident or by design, for better or for worse, mass communication has been very influential in changing the way birth is viewed, and not just by women.

The Bible was probably the first book to mention birth, even before the advent of the printing press. Though it would be unlikely that women themselves were reading the text, it would have served as instruction none-the-less, as it would have been the guide by which clergy ministered to their flocks.

The printing press made the Bible more widely available in the 1400s and 1500s. The availability might have qualified it as ‘mass communication’ at this point, but it would still take time for literacy rates among women to catch up. Still, it is important to explore what the Bible actually says about birth because it is an instance where mass communication profoundly influences women and their birth experiences.

It is commonly thought that painful birth is the curse for Eve’s sin of eating the apple in the Garden of Eden. Genesis 3:16 tells us, “Unto the woman he said, I will greatly multiply thy sorrow and thy conception; in sorrow thou shalt bring forth children; and thy desire shall be to thy husband, and he shall rule over thee.” (King James Version)

John 16:21 also tells us that birth is painful. In fact it is mentioned several times in the Bible that birth is painful. Yet, as Helen Wessel discovered when she researched the original biblical language in writing The Joy of Natural Childbirth: Fifth Edition of Natural Childbirth and the Christian Family, the word translated as ‘pain’ (estev) for all the passages regarding birthing is used elsewhere in the Bible…but translated as ‘toil’. Wessel asserts that before interpretations beginning between in about 200-400 A.D., there was no mention of Eve’s curse. (Wessel, 1994)

Before the Bible, women got their information regarding birth from the village ‘wise woman’ or midwife. Knowledge was passed from woman to woman, mother to daughter. However, in Witches, Midwives and Nurses, A History of Women Healers, a sinister plan is revealed. (Ehrenreich, English, 1973) The Church set out not only to reinforce the idea of women as evil and birth as a curse, but the beloved midwives were demonized as well.

The Malleus Maleficarum, or “The Hammer of the Witches” was written in 1486 by priests James Sprenger and Henry Kramer. These men decried midwives as the greatest threat to Christianity and declared them witches, in part for the heresy of helping women find comfort in birth, because according to the Bible, suffering in birth was God’s will.

The Malleus Maleficarum, as translated by Montague Summers in 1928, is still available through major booksellers, and according to Merskin in Witch-Hunts, and Persecution of the Other, (Merskin, 2007) has sold 60.5 million copies in 44 languages. Granted, despite these eventual numbers, this would not have been a work read by the laity then or at any other point right up to the present. However, with the leaders of the Church well versed in the evils of women through the work, it very much would have influenced the culture in which they lived.

Efforts to influence women through mass communication became more refined in the early 1900s. Dr. William Sadler, a prominent physician who wrote for women’s magazines of the time, published a book in 1916 titled The Mother and her Child. (Sadler, 1923) This book was intended for a mass audience, and he emphatically cautioned against use of midwives, portraying birth as a very dangerous medical event with a physician the very minimum requirement, preferably in attending women in the hospital. (Sadler, 1916)

The problem is that at the time, infant mortality was higher for doctors (and highest yet for hospital births) than for midwives. Dr. Levy, in the American journal of Obstetrics and Diseases of Women and Children (Kosmak, 1918) stated:

Of the babies attended by midwives, 25.1 per 1000 died before the age of one month; of those attended by physicians, 38.2 per 1000 died before the age of one month; and of those delivered in hospitals, 57.3 per 1000 died before the age of one month. These figures certainly refute the charge of high mortality among the infants whose mothers are attended by midwives, and instead present the unexpected problem of explaining the fact that the maternal and infant mortality for the cases attended by midwives is lower than those attended by physicians and hospitals. ( pp. 44)

So, if midwives had better outcomes, why would Sadler and other doctors utilize the mass communication tools of the time to exert a considerable effort convincing women then were in grave danger at home with midwives? Doctors had decided they needed more ‘teaching’ material (i.e. women) and that the midwives were interfering with their access. Meeting notes from the American Association for Study and Prevention of Infant Mortality (1913) explain:

Another very pertinent objection to the midwife is that she has charge of 50 per cent of all the obstetrical material of the country, without contributing anything to our knowledge of the subject. As we shall point out, a large percentage of the cases are indispensable to the proper training of physicians and nurses in this important branch of medicine. (Study and Prevention of Infant Mortality, 1912. Paragraph 2 of ‘Elimination of the Midwife’)

The mass communications campaign to disparage the midwife and drive women into the hospital to birth so that doctors might use them for teaching purposes was so successful that most women to this day give birth in the hospital, thinking the reason they should choose the hospital is because it is safer and that the reason birth moved to hospital was for safety reasons.

In fact, even today, it is not safer to birth in the hospital than at home. In 2005, the British Medical Journal published a study by Johnson & Daviss, Outcomes of planned home births with certified professional midwives: large prospective study in North America that supported previous findings, which were that mortality (death) outcomes for women attended by midwives at home and doctors in the hospital were essentially the same, except that in the hospital women and babies were injured (morbidity) more often. (Johnson & Daviss, 2005)

This study came on the heels, and was possibly a response to, a study that was published in the U.S. and widely publicized through assorted mass media outlets. That 2002 study was titled Outcomes of Planned Home Birth in Washington State. (Pang, Heffelfinger, Huang, Benedetti & Weiss, 2002) However, just as in previous attempts to discredit safe birthing alternatives, devious tactics were used to sway public opinion.

Just as in the early 1990s, when infant deaths that occurred under a physician were attributed to a midwife if she’s been anywhere near the mother in labor, and in 1978, when the American College of Obstetricians and Gynecologists (ACOG) issued a press release declaring “Out-of-hospital births pose a 2-5 times greater risk to a baby’s life than hospital births,” using health department statistics that included stillbirths, late miscarriages, infant abandonments and infanticide (Stewart, 1981, pp 222.), the Pang study, as the 2002 study become known, was intentionally misleading by basing conclusions on flawed methodology.

For one thing, the title doesn’t just insinuate, but flatly states outcomes of planned homebirths. The authors actually admit right in the paper however, that since Washington state birth certificates (the source of their statistics) do not identify planned home births, that the authors defined ‘planned’ for themselves. They also clearly state that they include babies from 34 weeks gestation. However, midwives do not attend births less than 37 weeks gestation at home. Births at 34 weeks gestation would likely be precipitous (fast), premature babies with no birth attendant at all. As in the 1970s, any out-of-hospital birth is included, because the birth certificates do not include a way to differentiate between midwife-attended and taxi cab births. (CfM, 2002)

Interestingly, results of another homebirth study were also released in 2002 by the Canadian Medical Association. (Janssen, Lee, Ryan, Etches, Farquharson, Peacock, & Klein, (2002). They concluded, as other researchers have, “There was no increased maternal or neonatal risk associated with planned home birth under the care of a regulated midwife.” Somehow, this study didn't make it to major news outlets.

But the propaganda persists. Again, more recently ACOG and the American Medical Association (AMA) used access to major news outlets and the internet to ‘inform’ the public that homebirth and midwifery are unsafe, despite all of the evidence from around the world to the contrary. (Hunter, 2008; Wagner, 2006)

Again, we could ask ‘why?’ when 100% of the countries with better outcomes than the U.S. have midwives attending birth? (Wagner, 2006) Economics provides one answer.

Rikki Lake is making women stand up and take notice of their viable birthing options with her DVDThe Business of Being Born. (Scelfo, 2008.) In this documentary, Lake explores how women ended up in hospitals, tethered to IVs and electronic fetal monitors, submitting to a plethora of interventions that not only do not make birth safer for mothers and babies, but in some cases inflict pain and introduce complications. (BBC News, 2009; Enkin, Keirse, Neilson, Crowther, Duley, Hodnett, & Hofmeyr, 2000)She followed this with a just released book, Your Best Birth
followed by a just launched web community called My Best Birth.

But Lake went further. She initiated a media blitz that has been so effective that originally, she was named in the position statement issued by ACOG, and later by the AMA, that once again deemed homebirth and midwives unsafe, forcing Lake to respond in a Huffington Post blog. (Lake, Block & Epstein, 2008)

At a time when cesarean rates are rising due to skillful manipulation of women through the media (Park, 2008; Reichman, J., (2007), and mass communication is informing women that breastfeeding confers insignificant benefit to babies (Celizic, 2009) when science refutes that on a regular basis (Madden, 2008) it is essential that parents begin to recognize how successful the media is at shaping the beliefs that will impact their children’s lives forever.

The average woman doesn’t tend to read the books like Obstetric Myths versus Research Realities by Henci Goer, or Born in the USA: How a broken maternity system must be fixed to put women and children first, by Marsden Wagner. She reads What to Expect When You’re Expecting, because it’s handed out at their doctor’s office as a continuation of the mass communications machine. My personal observation is that they don’t read the books that will actually help them make good decisions because the last 100 years of constant and effective use of mass communication has convinced them there is nothing wrong with the system, despite the fact that infant mortality rates are some of the worst in the developed world, with 45 countries losing fewer babies (CIA, 2009), and maternal mortality rates worsening as well (Medical News Today, 2007).

Birth is portrayed negatively in books like Midwives, (Bohjalian, 1998) where there is just enough fact mingled with fiction to make an impossible story plausible for the reader, and in movies and television, too.

Unarguably, birth is horrible for a large number of women, so some would say the media is only reflecting reality. Yet we’ve just seen that our expectations are subtly imprinted with what others want us to believe. What if there are other voices that have gone unheard; voices of women who have birthed safely, and in ecstasy, sometimes even painlessly?

There are, and their always have been, around the world and throughout time. Judith Goldsmith give us many examples in Childbirth Wisdom: From the World's Oldest Societies. (Goldsmith, 1994) of women briefly stopping work to birth their babies easily, then returning to their tasks; of labors so short and painless that women birthed even while asleep.

Dr. Lamaze, Dr. Bradley and Dr. Grantly Dick-Read, in the 1940s and 50s would all come to believe that birth didn’t have to be painful, after seeing painless birth in other cultures where the women didn’t expect to feel pain. The incident involving Dick-Read that led him to come to this conclusion is that as a new doctor, he attended a poor women in labor and offered her chloroform. She refused, asking “It didn’t hurt. It wasn’t meant to, was it?” (Grantly-Read, 2005). These voices were present, but not heard, largely because there was no concerted mass communication effort.

Today, movies and the internet are making women question what they thought they knew. Born in the U.S. A., a documentary that critically examined routine intervention in birth, was actually shown on the PBS program Independent Lens. What Babies Want: An Exploration of the Consciousness of Infants brought in the ‘star power’ of Noah Wiley (of E.R. fame) to help us understand that what babies experience in their earliest developmental phases actually impacts their entire life. Pregnant in America: A Nation’s Miscarriage used a Michael Moore type approach to investigative reporting on the Nation’s maternity care, and Orgasmic Birth: The Best Kept Secret not only showed women that birth can be blissful without drugs, but got airtime on ABC’s 20/20. (ABC, 2009)

Women have been assailed with magazine articles, books, movies, and propaganda issued as 'press releases', all telling them that one of the safest options they have is unsafe. The indoctrination is so complete that the lie has become accepted as a self-evident truth, and to question it paramount to heresy.

So we come to the 21st century with firmly entrenched beliefs that birth must be painful and very dangerous. Is this the truth, or is it the result of carefully crafted mass communication; disseminated information meant to keep women fearful, manifesting the painful, frightening experience it in the process? For the one thing that most assuredly will create pain and complications is fear, by the mechanism of introducing adrenaline into the mammalian birth.

Circumstances are different now than they were 100 years ago. Women are smart, savvy consumers with far more available resources. Exposed to an idea with merit, they have the ability to research their options. They can vote, they have buying power and they have decision-making power over most of their reproductive options. It remains to be seen if they will choose to make decisions based on a very successful mass communications strategy, or will they become part of a new wave of critical thinkers who can rise above the noise and make decisions based on solid evidence. At least now, for every contrived ‘news’ story like, Are Home Births Dangerous? AMA Says Women Should Use a Hospital-Some Doctors Disagree, which aired on ABC News to bolster ACOGS position (Hunter, 2008), there is usually a credible source to refute it, like Lamaze, Intl. who posted, Is Home birth safe? Talking points related to: ACOG Statement on Home Birth on their website. The question is, will families bother looking if they don’t recognize the effect mass communication has on them in the first place?

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