Childbirth in a Technocratic Age: The Documentation of Women’s Ex ...

outcome not too far from what they had imagined. But for many more, Maggie included, those same forces collide in unanticipated ways, producing an unwelcome mismatch between childbirth expectations and subsequent experiences that stand to create unsettling, powerful, and lasting impressions of this otherwise life-affirming event.

The cause of mismatches between maternal expectations and experiences is not, I would argue, a simple matter of how any one woman’s body behaves in childbirth, though one most certainly cannot dismiss that factor. Instead, today’s women are living in a culture characterized by conflicting forces that play out in labor and delivery. On the one hand, contemporary mothers have available to them grand opportunities that were unavailable to previous generations, such as ready and unrestricted access to information on childbirth and obstetric care (e.g., Murkoff & Mazel, 2008; Simkin, Bolding, Keppler, & Durham, 2010), hard-won rights to participate in maternal treatment decisions (e.g., American College of Obstetricians and Gynecologists [ACOG], 2008; Anonymous, 1977), and dozens of childbirth options designed to improve childbirth’s safety and quality. Constraining those opportunities, however, are gross inequities in health-care resources, with obstetric practice dictated as much by resource availability, institutional policy, physician convenience, and legal concerns as by maternal interests and needs (e.g., Armstrong, 2000; Block, 2008).

Take, for example, baths during labor: nearly half of women who labor in tubs find that baths provide effective pain relief (Declercq, Sakala, & Corry, 2002), but because of costs, professional resistance to changing traditional practitioner-centered treatment, and institutional concerns about risks that do not exist, access to this option is hardly widespread. One of the mothers in my study living in a large southeastern city reported that “only one hospital, one practitioner” offered ready access to a tub for laboring, and securing that practitioner’s care required the mother to change insurance plans. Another of my study mothers labored several hours in water but was instructed to leave the tub to facilitate placement of an internal fetal monitor—involving an electrode inserted through the mother’s vagina and placed in a tiny surgical cut in the baby’s