I have given birth three times and was born once myself. The first birth I do not remember, but legend has it I was in a hurry and shot out of my motherâs body to be caught just in time by the obstetrician in her mustard yellow sari, still pulling on her rubber apron and gloves. That was on a stainless steel hospital bed in Suva, Fiji. When I first gave birth myself I had chosen a homebirth . This was in New Zealand, where midwives are usually the âlead maternity carerâ through pregnancy, often working across hospital and home settings. That was a long, slow birth, and I found myself at the end, wheeled into hospital and led onto a hospital bed where my feet were strapped into stirrups. The just-in-time crowning of my daughter was all that stopped me from an unwanted (and unnecessary) episiotomy from the doctor who leaned in with a scalpel and asked permission by saying âIâll just give you a little cutâ. Thank goodness for Luciaâs awesome sense of dramatic timing. The second time I gave birth was in Australia, where, in trying to find a midwife who would be my lead carer, I had few options. Lucky to have a secure academic income, I was able to pay for an independent midwife and gave birth at home in a lovely warm pool. For a moment I thought âI canât do this,â but my midwife whispered âYou can, you are,â and the next moment I was lifting my second daughter out through the water where Raffaella nestled back down to sleep, without uttering a sound. But it was during my last birth that I finally understood we were a team, baby and I, as I felt her turn into the birth canal and push herself out with her feet. That was Frederica, and she arrived in three pushes as the 11.45 am Maldon steam engine blew its whistle at the station.
My experiences are by no means unusual, but what is distinctive is that giving birth under two different maternity care systems gave me insight into the sometimes stark contrasts between the two. When I sought care during my second pregnancy in Australia, I encountered for the first time the so-called âbirth warsâ (MacColl, 2009) in which advocates of natural birth are pitted against those aligned with a technocratic (Davis-Floyd, 2001) or medicalised approach. The one side believe firmly that a womanâs body is designed to give birth and should be interfered with as little as possible, enabling what is termed ânormalâ physiological birth. The other side focus less on the conditions that would allow normal birth to occur, and more on the potential risks involved. Thus, the medicalised approach involves much more routine use of medical technologies and is quicker to intervene. In New Zealand, while these debates are present, there is not such a stark division between the two sides, and it is possible to remain within the state-funded maternity care system while planning for a midwife-attended homebirth. In Australia the public health care system is very different. In Australia I was forced to make a much more radical decision. If I wanted the care of a midwife, and I wanted the midwife I saw during pregnancy to be the one attending my birth, then I had little choice but to pay for the services of an independent midwife, and run the gauntlet of disapproving GPs and hospital staff when I went for the standard series of tests and scans. I lived in Sydney at the time, and for a city of 4.5 million, there were only 8 independent midwives. My experiences of these contrasts sparked a curiosity about why things were so different and, more importantly, how women were being affected as the birth wars shaped their experiences of childbirth. As a social scientist, and a human geographer, my scholarship is committed to the Marxist tradition in which the point of research is to understand the way things are so that they might change. And so, I began an ethnographic study intended to cut across the polarised debates.
In an effort to sidestep the birth wars, I thought to ask women to share their birth stories, while creating an inventory of the many different people and things that inhabited the birth space and had a role to play in shaping that space and womenâs experiences of birth. The idea was to flesh out the complexities and multiplicities of birth experiences, against a context in which women and carers are expected to take sides. My bedside reading during that second pregnancy, in which I first encountered the Australian maternity care system, was Jane Bennettâs Vibrant Matter (2010). Bennett opened up the idea that a thingâa spool of thread, a plastic cupâhas power and agency . The sense that things have power spoke to my experience at the time: inhabiting a pregnant body that felt no longer quite my own; interacting regularly with scales and measuring tapes and urine testing sticks that seemed to mediate the relationship between me and the growing baby; having to (re)learn very different ways of inhabiting the world, whether it was the narrow hallways at work, my ability to ride a bicycle, or the piles of cushions I needed to enable me to sleep at night. The idea that material objects, inanimate things, and my own sensing-feeling body had an active role to play in the world resonated. My exploration of Birthing Work was sparked in conversation with these ideas, and is an attempt to take Bennettâs challenge into the experience of childbirth, to explore âwhat things doâ in the spaces in which women give birth.
Bennettâs work sits alongside a larger literature that questions the human-centric focus of much social science and seeks instead to engage with how human societies sit alongside, within, and in intimate relations with, a range of non-human others. The work of Bruno Latour, Annemarie Mol and John Law, for example, emphasises the ways in which human actors do things in tandem with non-human actors.1 This approach, often presented under the banner âActor Network Theoryâ (ANT), prioritises a form of sociological analysis that begins by being attentive to the relationships formed between people and things in ways that make certain kinds of actions possible.2 In the context of pregnancy and childbirth, there is a lot of pressure to make the ârightâ decision about care (or testing , or where you give birth, or what you eat, or how you exercise, or whether you find out the sex of the babyâthe anxiety-provoking list goes on). Paying attention to the role that things play offered a way to explore the experience of childbirth in a different way, and I was curious to discover what such an approach would uncover.
In this book I start to figure out what happens if we take seriously what these âthingsâ do and the ways that they are put to work in making a birth. I explore how the experience of childbirth is made up of the shared work that things and people do, the way childbirth is âassembledâ from the conjoint, and often collaborative, efforts of all of these actors. Focusing on the diversity of actors engaged in the birth space is one way to get past the often paralysing debates around birth (and health care more broadly) that hinge on questions of making the ârightâ choices over maternity careâbut it does not preclude the need to think about how we, collectively, could do more to enable childbirth amidst loving kindness.
Getting Past the Birth Wars
The need to think about kindness and love in childbirth is something that deserves to be taken seriously. More than 90% of women worldwide will give birth at some point in their lifetime. While it only takes a short interval of time in a womanâs life, it is a deeply affecting and profound experience. A womanâs experience of birth can shape her mental, emotional and physical wellbeing, her capacity to care for her child. Not only this, but how a child is born has implications for their future health and development. New clinical research indicates that the care women receive before, during, and after birth has a profound and lasting impact on the health and wellbeing of both parents and babies.3 It also shapes the experiences of subsequent pregnancies and labour, with some women rejecting the health system altogether after experiences of bullying or trauma during care.4
In Australia and the United States (as well as many other places), the majority of birthing mothers will encounter a maternity care system immersed in highly charged, moralistic, and competitive debates about...