Each procedure will be discussed in four sections:
Each procedure will be discussed in four sections:
The first section will briefly describe the procedure and will present a summary of the official rationale for its use as explained in medical textbooks or taught in medical schools and training hospitals. These rationales are often complex; I have tried here to select their most salient features for presentation.
The second section will summarize evidence about the physiological and psychological effects these procedures have on laboring women. Often this evidence directly contradicts or refutes the medical rationale. Sometimes this refutation is compelling. Cases where available evidence indicates that obstetrical procedures either fail to accomplish their stated purpose, or actually cause harm, lead to the obvious conclusion that the only possible reasons for the continued performance of such procedures are ritual and symbolic. Indeed, one of the values of this research for me personally has been to be able to answer a question I have frequently heard from childbirth educators and birth activists: "Since so many of these procedures are so bad for women and babies, why do they keep on doing them?"
Here I must add a brief caveat: these first two sections, on "Official Rationale" and "Physiological Effects," do not pretend to be exhaustive and may seem oversimplified. Space considerations do not allow me to present all of the medical rationale for each procedure, nor all of the evidence for or against their physiological efficacy. The relevant literature includes hundreds of medical studies and a number of easily accessible books that sum up the scientific evidence for the lay reader (see, for example, Brackbill, McManus, and Woodward 1988; Brackbill, Rice, and Young 1984; Inch 1984; Stewart and Stewart 1976, 1977, 1979, 1981, Wertz and Wertz 1989).
The third section presents verbal reactions of the women in the study to these procedures, in order to enliven and humanize my analysis, to remind the reader that these procedures are experienced by thousands of women across the country every day, and to indicate the range of women's responses to these hospital birth routines.
The last section will present each routine as a transformative ritual which, through the careful and precise manipulation of powerful symbols, transmits a specific set of messages to the birthing woman, her partner, her new baby, and the hospital staff.
...symbolic acts operate through their capacity
to map changed or adjusted perceptions
of the possibilities inherent in a situation
onto the actor's orientation to it.
Nancy Munn, "Symbolism in a Ritual Context"