Childbirth, Midwifery and Concepts of Time

Christine McCourt, Christine McCourt

• Publisher: Berghahn Books
• Year: 2009
• ISBN:
  9780857455420
• Edition: 1
• Topic: Social Sciences
• Subtopic: Anthropology
• Index: Social Sciences

All cultures are concerned with the business of childbirth, so much so that it can never be described as a purely physiological or even psychological event. This volume draws together work from a range of anthropologists and midwives who have found anthropological approaches useful in their work. Using case studies from a variety of cultural settings, the writers explore the centrality of the way time is conceptualized, marked and measured to the ways of perceiving and managing childbirth: how women, midwives and other birth attendants are affected by issues of power and control, but also actively attempt to change established forms of thinking and practice. The stories are engaging as well as critical and invite the reader to think afresh about time, and about reproduction.

Part I

HISTORICAL AND CULTURAL CONTEXT

CHAPTER 1

FROM TRADITION TO MODERNITY: TIME AND CHILDBIRTH IN HISTORICAL PERSPECTIVE

Christine McCourt and Fiona Dykes

I was begot in the night, betwixt the first Sunday and the first Monday in the month of March, in the year of our Lord one thousand seven hundred and eighteen. I'm positive I was.– But how I came to be so very particular in my account of a thing which happened before I was born, is owing to another small anecdote…As a small specimen of this extreme exactness of his, to which in truth he was a slave,– he had made it a rule for many years of his life,– on the first Sunday night of every month throughout the whole year,– as certain as ever the Sunday night came,– to wind up a large house clock which we had standing upon the back-stairs head…he had likewise brought some other little family concernments to the same period, in order, as he would often say to my uncle Toby, to get them out of the way at one time.

— Laurence Sterne, Tristram Shandy¹

Delivered five kids and still looking great. Long, uncomfortable deliveries are a thing of the past.

— Advert for the Chrysler Voyager²

This chapter traces key aspects of the historical shift from traditional to modern and then postmodern concepts of time. The two quotes with which it begins were chosen to illustrate how this shift emerged and is reflected in aspects of popular culture. Sterne's Tristram Shandy has been regarded by many literary analysts as one of the first modern novels. The quote highlights the degree to which the plot and preoccupations of the story are centred on changes in notions of time of the author's day, as well as changing notions of how childbirth should be managed. The deliberate word play of the second quote, from a recent U.K. newspaper advert, associating childbirth with speed and technology, illustrates the degree to which modern, or postmodern, citizens are encouraged, indeed exhorted, to expect and demand instant results, what writers have referred to as a sense of acceleration (McGuire 1998) or the ‘vertigo’ of late modernity (Young 2007).

The historical shifts which we outline in this chapter took place mainly in European societies, from the early modern period onwards, but with colonialism and globalization their impact has been worldwide.³ We then focus upon historical shifts in ways of dealing with childbirth that occurred primarily in Europe in the same time period as part of a wider social and economic history, but were then spread globally via colonialism, capitalism and postcolonial development policies. In many ways, we suggest that the changes surrounding childbirth were a microcosm of the immense social and cultural changes of this period. The changing concepts of time resonate with both.

By drawing out the parallels between the changes in the conceptualization of time and childbirth we explore the links between macro- and micro-levels of analysis that will continue to be made throughout the book. The history of maternity care parallels that of time in interesting ways. Although the focus here is primarily on European history, the implications are global, since European institutions, including biomedicine have had a far broader impact and the concepts of time discussed here have been spread via the international development agenda, in the case of health, as well as through the wider economic forces of globalization. Childbirth is a particularly good case through which to illustrate such major changes in the social world.

Our story begins with the shift from pre- to early modern Europe, highlighting very briefly the agricultural, social and economic changes which prefigured the development of industrialization and capitalism in Europe. We then focus upon the development of different modes of production, leading to the factory and the production line, which have dominated so much of modern history. Following a number of writers (most notably Thompson 1967), we suggest that the development of clock time was a crucial mechanism as well as a symbol of change. It enabled major developments within industrial societies to take place but was also, arguably, called into being and required by them. We also note the important cultural and social changes, including major changes in ways of viewing the world, which formed part of this historical movement.

From Pre-modern to Early Modern Europe

While European economic and settlement patterns remained largely agricultural and peasant based, before the modern period, time was oriented mainly around the cyclical patterns of seasons and days (Le Goff 1986). The social historian E.P. Thompson (1967) described the work patterns of agricultural communities as primarily task-orientated, in the sense that work rhythms and use of time attended on what needed to be done, and this was closely tied to seasonal (what we shall call bio-geographical) time. For example, sheep must be attended at lambing time; crops must be gathered before the dry weather ends. The hours of the day are traced by the movements of the sun, the rhythms of plants and animals, the ebb and flow of tides.

Thompson was in effect pointing to a radical contrast between the patterns of pre-industrial work and the fragmented character of labour under capitalist development, where the tasks to be attended to are broken up and made to fit a factory production-line system. The tasks performed may not respond to the worker's perception of what needs to be done, or when, and they are often disconnected from the wider process of which they form a part. This very different form of task orientation is referred to in many of the critiques of modern healthcare provision which we touch on in the chapters to follow, where professionals' roles have changed from a focus on the whole case to performing fragmented, often repetitive tasks for a number of patients. Additionally, professionals, particularly those lower in the hierarchical chain of provision (often called the semi-professions), become infinitely substitutable for each other in regimes of time and action that are tightly monitored and governed by protocols, The historian Kahn (1989) used the term ‘need-orientated' to refer to cyclical time in contrast to linear or clock time. Cyclical time, as Kahn argued, is a bodily, rhythmic time that relates to the ‘organic cycle of life' in which one is ‘living within the cycle of one's own body'; it is a time that is ‘cyclical like the seasons, or the gyre-like motion of the generations' (Kahn 1989: 21).

In medieval Europe (circa AD 1100–1500), the pattern of landholding and use was primarily feudal and many people worked the land without a commodified form of ownership (in which land can be bought and sold like a product), a characteristic of many cultures until the more recent impact of economic globalization. Throughout this period, but particularly from around the fourteenth century, an interplay of developments led to fundamental social changes (Le Goff 1986). Among these were the movement to land enclosure, effectively creating private ownership of land and spurring the development of new agricultural technologies (Mathias 1983; Thompson 1973), and the demographic impact of the plague, and subsequent population recovery, which led to greater labour mobility (Hale 1994; Pawson 1979). Continuing developments in the specialization of craft skills and trade encouraged further urban development and the rise of a non-agricultural class in the population. The development of agricultural technologies and international trade links were also crucial triggers for the later development of secondary production technologies, particularly textiles, which required a shift from the more domestic bases of craft production to the factory (Hale 1994; Mathias 1983; Thompson 1968).

Historians of differing perspectives continue to debate the relative importance of economic, social and other factors in the changes which prefigured the rise of urbanization and industrialization in Europe, but it is clear that some interplay of the material and the social were involved in these profound changes. And as society and ways of living changed, so too did ways of viewing the world. Weber (1930) argued that cultural factors such as Protestantism were central to the rise of capitalism and the industrialization which accompanied it, while a Marxist perspective would argue for the fundamental importance of the means of production to such ideologies (Marx 1970). From this Marxist perspective time is seen in terms of exchange for money, shift work and exploitative forms of commodity production (see also Chapter 2).

Early modern Europe saw both profound changes in ways of interacting with the environment and in ways of viewing and understanding the world. The Enlightenment period in Europe can be seen as closely intertwined with the socio-economic developments we have sketched out. New concentrations of wealth no doubt facilitated the rise of an educated class with time and leisure to specialize in and pursue interests which went beyond the development of technology (Hale 1994; Hampson 1968). The work of scientists such as Galileo contributed directly to technological development, including that of the pendulum clock (Stengers 1997), while they also challenged fundamental world-views and cosmologies. It has, of course, also been argued that such changing world-views were themselves called into possibility by changing socio-economic conditions, and conditions of production (Thompson 1967). It was in this multifaceted context that the conditions of reproduction also fundamentally changed.

The Development of the Clock and Clock Time

The development of the clock forms a point of connection between politico-economic and sociocultural changes in early modern Europe. In his seminal essay on the development of capitalism and concepts of time, Thompson (1967) described the role of clock time as central to the social as well as economic changes taking place. The requirement to standardize time and mark it in particular ways was closely related to the shift from primarily agricultural to industrial labour (Le Goff 1986).

Once labour became primarily commodified, detached from the land and domestic spaces, and as industrial patterns of work developed, time needed to be regulated in different ways and was increasingly seen as a commodity itself – something to be spent, rather than passed. Similarly, the extension of trade and transport required the scheduling of time over long distances and between different systems – timetabling.

Thompson (1967) referred to Laurence Sterne's eighteenth century satirical novel Tristram Shandy (quoted above) to illustrate the degree of change in habits that had taken place. Tristram is able to date his conception precisely because of Mr Shandy's habit of winding the clock at a particular time every month (Sterne 1978[1759]). Interestingly, this novel, with its focus on the tug of war over Tristram's birth and whether it should be attended by the ‘old midwife' or Dr. Slop (the new style man-midwife with his instruments), juxtaposed the story of the clock's association with his conception and the conflict between tradition and modernity in childbirth which was underway at the time.

The technology of clock making developed particularly in the seventeenth century with the use of the pendulum and was regarded as an important craft. Early clocks were linked to astronomical time since they relied on ways of representing and marking the course of the sun, effectively to define the course of a day. Given seasonal and geographical variations, the speed of an astronomical clock is also variable, as the lengths of daylight hours change. The philosopher of science Stengers (1997) noted that hours of an equal length throughout the year were adopted in fifteenth century Europe, but clocks were not autonomous since the sun would be periodically in advance of, or behind, the clock. A system was adopted in Geneva in 1780 where the marking of midday was averaged throughout the year, and uncoupled from the sun's zenith, effectively meaning that social time cut through solar time. Following this, local differences in astronomical time were also cut through by social time, in order that timetables could be developed and synchronized, to facilitate railway and other forms of wider movement of goods and people. In 1845, Belgian time was organized into local zones, and in 1882 the ‘unique legal time' of the Greenwich meridian was adopted (Stengers 1997). This was clearly a response to colonial expansion and the growing internationalization of capital – goods and labour – and the spread of transport and communication networks (Hobsbawm 1968). Stengers pointed out, however, that ‘if the railroad still corresponds to a process of negotiation with nature and with the social, Greenwich time, from the moment it is proclaimed, is autonomised from nature and the social' (1997: 182).

Prior to the development of the pendulum clock, in 1658, the foliot clock (which relied on a complex system of falling weights) was still tied to astronomical time in that it needed to be adjusted, and could be adjusted, to daily variation in the length of hours. The pendulum clock enabled a fixed standard of time to be constructed, appearing to produce an autonomous law of time. The unit of measurement of time now became the ‘second’, which is calibrated according to the relationship between the length of the pendulum and the duration of its swing.⁴ This technical development therefore depended on the work of Galileo in physics, which formed a major aspect of Enlightenment changes in ways of viewing the world in early modern Europe. Stengers (1997) noted the degree to which the metaphor of the clock took hold in seventeenth and eighteenth century Europe, giving the image of God as the perfect clockmaker and eventually reflected in Newton's physics, with the notion of the clockwork universe.

Thompson (1967) noted that the use of clocks was initially on a communal level – the church clock or bell, for example, marked the beginning and end of the day, as well as the key rituals and points of transition of lives and of the religious calendar (cf. Le Goff 1986). This fitted their developing role in regulating the daily and work patterns of the population and clocks were subsequently centrally placed in workshops for similar purposes. Ownership of a clock stood as a sign of social status and, as Cipolla argued (1967), the seventeenth century marked the era when growing numbers of relatively wealthy urban dwellers, for example merchants, lawyers and doctors, could afford watches and clocks, which were being made at increasingly low costs. People increasingly timed activities they would never have thought of timing and saw punctuality and time keeping as virtuous. Clocks thus not only reflected but, in turn, influenced ways of thinking as they gradually replaced the cyclical and variable times associated with the seasons with a measured time that overrode these.

The development of the more individual ‘pocket watch' followed in the eighteenth century. The nature of work was changing gradually from one where a range of activities would be managed, according to need, weather and season, and the divisions between everyday life and work were less rigidly marked. Thompson (1967) argued that the typical pattern of the craftsman or pre-industrial worker was one of alternate bouts of intense labour and of idleness, a pattern that still persists in modernity only in certain self-employed occupations such as writer, artist or small farmer. We shall see in Chapter 5 how recent changes in the work of midwives, such as the model of caseload midwifery, have reintroduced such characteristically pre-industrial (or perhaps post-industrial) forms of work, where midwives' work patterns follow the needs of women on their caseload, including the unpredictable timing of labour, rather than midwives working in a shift system, caring for a range of women for short bursts of time, attending to fragmented parts of their pregnancy, birth or postnatal care. This chapter highlights the conflicts and tensions this produced for the midwives themselves, who were previously accustomed to working within a rigid shift system, and for the professionals with whom they worked within the context of the hospital system that was fundamentally unaltered.

Thompson (1967) traced the development of time first as a form of discipline, as illustrated by the use of the clock to discipline labour in the mills, potteries and textile workshops, and later employed in the development of the factory system. The system of ‘clocking in' for example, commenced, despite workers' resistance, in Wedgwood's pottery in England in the eighteenth century. Second, once disciplined, time could now be calculated and valued as a resource or commodity. Here, Thompson highlighted the importance of changing world-views, as workers themselves internalized the system of time-work discipline and learnt to value and bargain with their time in a similar way: workers' resistance began to shift from fighting against time, to fighting about time (1967: 85). Such changing norms would also have helped to limit the degree and impact of the popular resistance to the wider socio-economic changes underway. He also referred to the part the development of state education played in attempting to inculcate such a sense of time-work discipline in the population from an early age. Children were taught to follow rigid time regimes at school, enforced by discipline until they became habituated to it, as well as taught to value time in certain ways (1967: 84). In a similar vein, Weber's arguments about the role of Protestantism in the development of time-work disciplines were neatly illustrated by reference to eighteenth and nineteenth century tracts which emphasized the immorality of idleness: time as a wasted resource (Weber 1930).

Similarly, excerpts from diaries at the time illustrate the degree to which concepts of time had shifted to those where it is the spending of time, as marked by the clock, which matters over and above the job done (Thompson 1967). This form of thinking and acting, which became an important characteristic of U.S. culture, further influenced by the ‘pioneering’ disposition of protestant migrants from Europe, became the precursor to the production line system as epitomized by the Ford motor factory in the twentieth century. Thompson also noted how commodified concepts of time emerged in the discourse of economic rationalism, and in the international development agenda in the twentieth century, a discourse which seems not to recognize or acknowledge its own cultural basis.

Thompson saw the socially shaped forces of economic development as inculcating new habits an...