Lauren Rochholz

Professor Dubois

HRS 220

14 September 2004

Women and Birth

Authors Penny Armstrong and Sheryl Feldman argue passionately for the value of natural childbirth in their selections "On the Power" and "The Nature of Birth." Using data gathered both firsthand and from others' studies, Armstrong and Feldman assess the physical and mental condition of mother and child in various childbirth situations. The women contend that natural childbirth is often inappropriately discarded as a viable option.

Armstrong and Feldman use a host of statistics and personally collected data -- Armstrong is a midwife -- to substantiate their claims that natural childbirth is often less risky for mother and child. National statistics cited in the article demonstrate a far greater rate of intervention and hazard than those on which Armstrong prides herself:

At home, [Armstrong] uses no analgesics or regional anesthetics because they can repress infant respiration; national, the rate of use of epidurals (a regional anesthetic) is 60 percent. Her episiotomy rate is less than 1 percent; the national rate is 61 percent. Her transfers to physician and/or hospital care are less than 10 percent. Cesareans. . . represent 6 percent; the national figure is 24 percent. Her perinatal morality rate -- which includes stillbirths and infant deaths in the first seven days of life -- is 5 per thousand; nationally the figure is 10.4 per thousand. (Nature 30)

Additionally, the authors associate energy loss (Nature 40), the repression of the endorphins needed to combat the pain of contractions, fear, stress (Nature 46), hindrance of the hypothalamus that "directs the interplay of hormones (Nature 45), intrusion of "strange people and strange events" (Nature 44), and an environment encumbered by "intellectual demands and control requirements" (Nature 45) with hospital births. They write extensively of the "crime" of performing episiotomies, juxtaposing both an athlete's muscles and a cellist strings to those muscles that, if cut, interrupt "the music of the body, the resonance and the potential for rapture" (Nature 39). The authors conclude that all of these circumstances decrease the power and effectiveness of the woman's ability to give birth naturally.

More important than the physicality of giving birth, Armstrong and Feldman insist that natural childbirth is an exceedingly empowering mental process. The hospital or other sterile setting that does not allow for enough "security, warmth, quiet, and darkness" (Nature 46) often is damaging to women (Nature 41). Home births, on the other hand, have "not only power, but grace and simplicity" (Nature 34). Specifically, the authors focus on two separate, but related, psychological elements, each of which has a lasting impression on a mother, for better or for worse: respect and power.

The "distrustful atmosphere of the hospital staff" (Nature 41) is a cornerstone to the authors' case for home births. The authors argue that doctors and nurses often do not show laboring mothers the respect they and the childbirth process deserve. By using the "Friedman labor curve" inappropriately -- though "designed to describe the average length of labor, many practitioners and review committee [use] it the other way around -- to prescribe how long a labor might be. One either began pushing after twelve hours of active labor or one was a candidate for intervention" (Nature 41) -- doctors can cause mothers to lose confidence in an instant. In fact, Armstrong and Feldman assert that "it is in the nature of birth to benefit from respect" (Nature 53), that natural birth practitioners "do not manage birth so much as they nourish it" (Nature 54). Assimilating the experiences of the women of the Cesarean Prevention Movement with their own hospital delivery encounters, the authors articulate another issue of respect:

The doctor does have responsibility for the medical conduct of a labor and birth, and the patient does not have knowledge equal to that of the physician. But, as we will see later, women who feel that their caregivers have responded to their concerns are generally grateful to rely on their judgment. The conflict seems to arise when the woman feels she is being silenced (Nature 61).

Feeling neglected by doctors, many women of the CPM felt they "had had cesareans because they couldn't or didn't make themselves heard" (Nature 62). The authors represent the lasting effects of such experiences as tragedies. Included among these infringements is the disregard of the mother once the child is born; with all staff "focused on successful outcome, ...the human in whom life [has] re-created itself, [is often] ignored" (Power 24).

The power associated with birth is inextricably intertwined with this issue of respect. The authors argue that both are key to insuring a positive childbirth experience, and a lack of either is disastrous: "We find that the power that comes to woman at birth is not, after all, as inconstant as it might seem. It can be derailed, diminished, even paralyzed, but that's often our doing. It is like the women who carry it, becoming silent only when it is not respected" (Power 25). Armstrong and Feldman personify this power to further emphasize its vitality and all-consuming nature: "The power is vulnerable. It can be undercut. It can and will stall, wallow, and punish. It can and will retreat, grow taciturn, withold" (Power 20). The contrast of career-oriented, educated Leslie's hospital birth with young farmhand Rachel's home birth further emphasizes the extent to which empowerment dictates a woman's birthing experience; indeed, while having nearly identical circumstances (child stuck on the spine, umbilical cord wrapped around the neck) the two seem to switch roles -- Leslie becomes a slave to her feelings of failure while Rachel is empowered by her success (Power). The authors conclude that in hospital births, "what is routine is the diminution of power. What is common is the absence of respect. What lasts is the sense of failure" (Power 24).

The assertions that Armstrong and Feldman make in these selections are tempered by the rather limited scope of subjects for study. That is, the home births Armstrong has performed (an unspecified number of the twelve hundred with which she had assisted at the time of the book) seem to be almost entirely in Amish communities. Even if this were not the case, they cite in detail the ideal home births of only Rachel, Silla, and Becca, all Amish women. Of the other birthing experiences noted, one woman is Amish (Mary) and one is not (Leslie). The authors do note that they use "the Amish as a naturally occurring control group, a laboratory, a tool for understanding how culture infiltrates the physiologic process of birth" (Nature 31). However, studying one culture produces concrete findings applicable to that culture only. Since it is logical to assume that non-Amish women sometimes opt for natural births, their study seems incomplete. The authors never make any further hypotheses as to whether or not a mother's cultural upbringing may affect her birthing choices.

The authors are clearly interested in spreading the message of home birth as a practical option for expectant mothers. It is likely that they do believe wholeheartedly in this cause. The use of a group six midwives for additional defense of their beliefs (Nature 63), though, does little to further their claims. It is highly unlikely that other midwives would rally against their own profession and even more unlikely that Armstrong and Feldman would, since this is not an exercise in scientific method, share any such criticisms. To their credit, Armstrong and Feldman are keenly aware of the resistance to natural birth:

Although she knows the benefits of the vaginal birth and the disadvantages of the cesarean, a midwife still cannot impose natural birth upon a woman. It is impossible. So the midwife follows the only course left to her: She gives a woman complete information, offers abundant reassurance, and then supports a woman's decisions. The realities of birth, not moral considerations, put the responsibility for the decisions on the woman. (Nature 66)

The authors could strengthen their argument with a more extensive acknowledgment that hospital births are not always disastrous for mother and child. They fleetingly mention that "American women are getting their babies" (Nature 29) and that for some women "natural birth was not serving them well" (Nature 30), but never concede that perhaps sometimes hospital births are an acceptable choice.

Conjecturally, religious beliefs can play an important role in the decision for or against natural birth. The Amish community stipulates the humility of its people, and Armstrong and Feldman's examples were no exception; the "makeshift device for weighing the new baby," the "homestitched pads" for the bed, Rachel's young, unformed, uncertain persona, and the "ever-lengthening afghan" are representative of such a society (Power 17-18). Such dedication to simplicity suggests natural childbirth as the best choice for delivering a child. Perhaps more significantly, though, the decision to have a natural birth may result from a "subtle religious faith, one that embraced, as God's will, the unpredictable turnings of nature" (Nature 35), as Armstrong describes Joseph and Silla's beliefs. Though statistics attest to the relative safety of home births, if something should go terribly awry, the medical staff and assistance available at a hospital may be some distance away and "God's will" may be the seen as the only bearable explanation for an unpleasant outcome. The authors also write briefly of the need for a good support system with natural childbirth (Nature 51-52); often a husband can be this support to his wife, this intimate relationship having been cultivated in part by a religious belief in mutual respect and unconditional love.

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Megan Kordela

Gender & Religion in

Cross-Cultural Perspective

September 10, 2004

Expanding the Borders of Knowledge

In the article Are "Old Wives' Tales" Justified?, Vrinda Dalmiya and Linda Alcoff call for a change in the way we define knowledge, explain why a change is necessary, and lay out how a change might be epistemologically possible. More specifically, they suggest that the way society defines knowledge currently excludes women's and lower-class people's knowledge from the general body of knowledge. Dalmiya and Alcoff go out of their way to ensure the integrity of their writing. My goal in writing this paper is to summarize Dalmiya and Alcoff and to suggest that their work is imperative to the feminist movement in that without changing what we accept as knowledge or who we accept knowledge from, our knowledge of humanity will be incomplete.

Dalmiya and Alcoff start their article by suggesting that something is currently wrong in how we define knowledge epistemologically. They do this by beginning with a story from the Indian epic The Mahabharata, where the tables are turned. A wife, confined to the realm of her household, tells a Brahmin, a sage, how to find truth. (218/219) Her knowledge and morality are such that they guide the Brahmin in this story. Her women's knowledge gives her access to wisdom that must be acknowledged. This is to contrast with the current state of affairs in Anglo-America, where:

Traditional women's beliefs – about childbearing and rearing, herbal medicines, the secrets of good cooking, and such – are generally characterized as "old wives' tales." These "tales" may be interwoven into the very fabric of our daily lives and may even enjoy a certain amount of respect and deference as a useful secret-sharing among women. But nevertheless, it remains the case that they are considered to be mere tales or unscientific hearsay and fail to get accorded the honorific status of knowledge. (217)

Although a women's knowledge in The Mahabharata becomes a guide for a wise man in ancient literature, in present-day United States, women's knowledge is not taken seriously. Women's knowledge is not acceptable as knowledge in our time and place.

First they put forth the idea of midwifery in order to (a) show the salience of women's knowledge, (b) to illustrate a history of how this field got left out of the general body of knowledge, and (c) to illustrate how it can be brought into the general body of knowledge. Until recently in developed countries, and even now in underdeveloped countries, women gave birth with the assistance of a midwife –one who had had her own children, had delivered other women's children, and in general, was learned about the bearing and raising of children.

Midwives could turn the baby in the womb to avoid a breech presentation, they could perform abortions, and they provided a wealth of practical guidance on everything from inducing conception to curing breast infections. Midwives also had knowledge of herbal remedies that could hasten a protracted labor, reduce the pain of childbirth, and inhibit the chances of miscarriage; many of these herbal concoctions are still used today in modern pharmacology. (222)

he above statement implies that midwives "knew" what they were doing. It is proven through their skills and success rate. (222/223) However, when doctors came to take over in the field of OB/GYN, midwives became marginalized. Why?

Dalmiya and Alcoff explain that acceptable knowledge comes in the form of "S knows that p" where S is someone who knows a proposition to be true. From this is derived that all knowledge must be propositional (220). Although propositional knowledge is not defined in the article or my dictionary, I gather that it is knowledge that is first put forth. (i.e. I know this information because it was told to me in an academic setting.) Therefore, according to the "S knows that p" model of knowledge, all knowledge must be written, gained in an academic setting, and it must be knowable by all (i.e. it cannot be knowledge specific to one person or one group of people). This form of knowing excludes participation from anyone who doesn't know how to read and anyone who hasn't obtained a formal education. In fact, this form of knowledge excludes specifically women's knowledge on each of the three criteria alone. Many women in earlier times in America, and many women today around the world, cannot read. As a result, much of what is called women's knowledge is passed down orally, or learned through "on the job" experience, and so not written down. As many women in the world tend to be stay at home mothers and wives, they have not obtained a formal education. Finally, as things such as the knowledge of birthing children, etc… is primarily learned experientially (I've done it and know what it feels like), they cannot be totally universal information. Though a man helps many women through childbirth, he will never really "know" what it is like. Dalmiya and Alcoff site Nagel to support their case. (228) He states that one cannot truly experience what another experiences. We can only be told and try to understand.

Having shown that women, and in fact the rest of the illiterate population have indeed been excluded from contributing to the body of knowledge, Dalmiya and Alcoff finish the article by presenting ways that knowledge could become more inclusive. More specifically, "knowing how" to do something such as raising a child, and "Gender –experiential knowing" such as birthing a child, need to be proved to be worthy of making up part of the body of knowledge, even though they may not be part of the academic society.

Our claim that epistemology is unjustified in ignoring knowing how and G-experiential knowing assumes that these two processes have a right to be considered epistemically significant. (231)

The authors show that a number of scientists and philosophers have already headed in the direction of expanding the definition of knowledge to make it more inclusive, such as Jaggar, Nussbaum, Ryle, Nietzsche, and Sartre. Indeed, at the beginning of the article we find out that Aristotle defined knowledge as more expansive than propositional.

The epistemic invalidation of old wives' tales has been caused, in part by the fact that modern epistemology has forgotten the lesson from Aristotle that knowledge can come in two forms: propositional and practical. Since Descartes, epistemology has restricted its principal definiendum to propositional knowledge. (220)

According to Aristotle's definition, knowledge may be practical; implying that knowing how to do something is at least as good as knowing something. Dalmiya and Alcoff do not stop here though. Going on the premise that being able to do something is not necessarily knowledge, they state that:

The agent of the skill must have access to the rules or conditional propositions while performing the action, but this propositional awareness cannot be a separate act of knowing that. Such a middle ground can be carved out by the notion of (iii) the agent being able to recognize conditional propositions and rules underlying her skill if and when they are formulated for her. The feeling of familiarity when confronted with the propositions in question (implied by recognition) is supposed to explain that the subject did have some access to the propositions even though she did not and could not explicitly formulate or express this in propositional form. Thus a genuine instance of knowing how is a skill in which the subject has such a nascent grasp of the rules and principles underlying her activity that enable her to "recognize" a clear formulation of them, and it is the latter that makes her simples skill cognitively relevant. (237)

Thus they explain that "knowing how" can in fact be propositional and include "knowing that" if the one knowing how really knows how, even if one is illiterate. However, this is still not good enough. What we really have to do is define truth.

We can make judgments that a person does not know how to care for infants, for example, implying thereby that there is a "correct" and an "incorrect" way of handling newborns that is not only dependent on instrumental success or achieving some goals. So there clearly is some content to the notion of a correct way of using propositions or rules to achieve success, which could parallel the idea of a true proposition correctly "picturing" the world...... What we want to emphasize is that the fact that we make such judgments underscores the normative or valuative dimensions of our "knowing how to" ascriptions. Consequently, it is not merely the belief/assent to propositions that can be evaluated but also the way these propositions are used. Because evaluation or normativity is essential for epistemologically relevant processes, "S knows how to do x" passes muster. (238/239)

All that is left is to see if we can include Gender specific experiences. The authors show a number of ways that G-experiences are indeed knowledge. (239)

Since gender-specified facts consist in the way a certain experience feels like to a subject, the G-experiential awareness from that particular subjective point of view cannot be mistaken and, consequently, is justified. (240)

Therefore, though someone may not have learned a thing from a school, nor read a thing, it does not preclude him or her from using that thing as knowledge, even if it is gender experiential or how to do something.

In the article Are "Old Wives' Tales" Justified?, Dalmiya and Alcoff make sure that their writing is taken seriously by way of their many epistemological proofs and deductions. Though they may have a heart for their subject, they do not let it get in the way of logically and thoroughly defending their case. Their call for empathy, and respecting empathy goes well with what Gross says in Feminism and Religion. I suggest that this work is imperative to the feminist movement in that without changing what we accept as knowledge or who we accept knowledge from, our knowledge of humanity will not only be incomplete, but will be limited to knowledge of educated men.