This friend of mine and I had spent a lot of time talking...about IVs for example. So when the nurse said, "I'm going to put an IV in your arm," and she left the room to go get it, I said, "Laura, why are you letting her do this? You said you weren't going to have one." She looked at me with this real confused expression on her face and she said "I don't know." The nurse stuck her with an IV. She was given an enema. She was shaved and everything, and she just sat there and let it be done to her.
-Kim Lozenski

The "prep" is a multistep procedure that usually includes: (1) separation of the woman from her partner, as he is asked to go fill out papers while she is ushered into the "prep" room; (2) replacement of the woman's clothes with a hospital gown; (3) shaving the pubic hair of the woman in labor; and (4) the administration of an enema. These procedures all take place in the "prep room" or the labor room, one right after the other, but for the sake of clarity I will discuss each one separately.



    Description and Official Rationale

The partners (husbands, friends, significant others) of laboring women are nowadays widely admitted to the labor and delivery rooms from which they were excluded until the 1970s. Their admission did not occur easily in the U.S; it was the result of a long and hard-fought campaign by parents, childbirth educators, and obstetricians such as Robert Bradley, originator of the Bradley Method® of "husband-coached" childbirth. Hospital tolerance of the fathers' presence increased as it was discovered that when fathers are educated and prepared for birth, the support they provide the laboring woman enables her to cope with her labor in more socially acceptable ways (breathing instead of screaming, for example), thus both helping her and making it easier for hospital personnel to cope with her. (Some of the obstetricians I interviewed expressed the belief that the couple is less likely to sue in case of problematic birth outcome if the father is present during labor and birth and "can see how hard the doctor is working to take care of his wife and child.")

Although 91% of the women in my study who gave birth in the hospital expected to be with their partners throughout labor, all of these women were separated from their partners during the "prep," even those who had been promised by their obstetricians that they would be able to remain together at all times--an experience they share with the vast majority of American women who try to birth in the hospital with their partners present. I have been unable to find any scientific justification for this separation period in the obstetrical literature --indeed, the wheelchair and the separation of the laboring couple are not even mentioned in the obstetrical texts I examined (Benson 1980; Cunningham, Macdonald and Gant 1989; Oxorn and Foote 1975; Pritchard and MacDonald 1980; Pritchard, MacDonald and Gant 1985; Wynn 1975). The reasons given by medical personnel for this separation were that the husband would not want to see his wife given an enema nor to watch her pubic hair being shaved. Some nurses also felt that they could get their routine diagnostic and examination work done more efficiently while they had the patient all to themselves.


Positive effects of the presence of the partner generally include decreased anxiety and fear, increased concentration on breathing techniques with his help, enhanced self-confidence, and decreased emotional stress. Negative effects of separation from the partner during the prep are generally minimal if the woman is not in much pain, although some of the women in my study, for example, reported that their labors slowed down until they were reunited with their partners. Those women who were "prepped" during heavy labor reported that the pain of their contractions increased during the separation period, while their ability to maintain "control" decreased.


Many of the women, in response to the official rationale presented to them for the separation period, noted that their partners were with them through vomiting, using the bathroom, and giving birth, all of which made their exclusion at the beginning rather absurd. Yet all those who asked not to be separated found tremendous resistance on the part of the hospital staff to the idea, and none were successful at remaining together. July Sanders and her husband experienced this resistance as follows:

They get you and whisk you away from your husband, and he has got to fill out these papers. We went every time [she has four children] and registered and paid. We even paid a $500 deposit the first two times so he wouldn't have to spend one second away from me. And you know, he barely got there for the second one, and we had done all that stuff! I kept saying "Where's my husband? This baby's crowned!" And he was down there filling out unnecessary-- we're not going to skip town!...You know? We were going to be there for several days, and they just treat you--I really feel like they need a lot of education for um, for making it a lot easier.

    Susan Smith also found this procedure discouraging:

By the time my husband was allowed in the labor room so many things had happened and so many people had tried to help as his substitute that I was confused and losing control.


In the separation of husband and wife during the "prep," we see the continuance of the conceptual demarcation of ritual boundaries begun with the wheelchair, as the woman's body is claimed for the institution by its representative, the nurse. In "Is There a Family? New Anthropological Views," Collier, Rosaldo, and Yanagisako state:

The family is seen as representing not only the antithesis of the market relations of capitalism; it is also sacralized in our minds as the last stronghold against the State, as the symbolic refuge from the intrusions of a public domain that constantly threatens our sense of privacy and self- determination.

-1982:25

In the hospital, the father stands as witness to and participant in not only the birth of his child, but also his wife's birth into her new identity as mother, his own birth as father, and the birth of his family as a new social unit. Thus his presence represents a strong conceptual victory for the family in relation to the core values of American society, insofar as it constitutes: (1) acknowledgment on the part of society of the ritual significance of the father's own individual passage into parenthood; and (2) a powerful symbolic recognition of the family's integrity and importance in relation to society.


However, in other, equally significant ways, the father's inclusion at birth constitutes a victory for society. By including the father at birth, society stands to: (1) strengthen and reinforce the stability of the nuclear family as its basic organizational unit in an era when the integrity of that unit seems threatened by the high divorce rate and by growing rates of "unpartnered" pregnancy and birth; and (2) ensure that the father too will receive the messages sent by the rituals of hospital birth. As Coleman Romalis points out in "Taking Care of the Little Woman" (1981), including the father at birth often enables the hospital to co-opt him in favor of the technocratic model and then to utilize his influence to further the alignment of his wife's perceptions with that model. Moreover, including the father enables society to "have its cake and eat it too": by ritually separating husband and wife during the "prep," the hospital can make the very clear symbolic statement that, although the family is indeed important in American society, the institution is more so.

This "standard hospital policy" sends two powerful messages: "the hospital has the right to separate husband and wife, and thus holds an authority higher and greater than the family," and "the laboring woman, soon to deliver to society its new member, now conceptually belongs to the institution, and must be marked as such." This marking is accomplished by the prep itself.

Wheelchair |Clothes|Shaving|Enema
Bed|Fasting |IV|Pit Drip |Analgesia|Amniotomy
EFM|IEFM |Cervical Checks|Epidural|Push/Don't Push
Transfer |Lithotomy|Sheets|Episiotomy
Mirror|Apgar |Washing|Eye |Vitamin K|Bonding|Separation
Bassinet|Wheelchair|Nature to Culture|Summary
Introduction