This article appears in the International Journal of Gynecology and Obstetrics,

Vol 75,Supplement No. 1, pp. S5-S23, November 2001.

Abstract: This article describes three paradigms of health care that heavily influence contemporary childbirth, most particularly in the West, but increasingly around the world: the technocratic, humanistic, and holistic models of medicine. These models differ fundamentally in their definitions of the body and its relationship to the mind, and thus in the health care approaches they charter. The technocratic model stresses mind-body separation and sees the body as a machine; the humanistic model emphasizes mind-body connection and defines the body as an organism; the holistic model insists on the oneness of body, mind, and spirit and defines the body as an energy field in constant interaction with other energy fields. Based on many years of research into contemporary childbirth, most especially through interviews with physicians, midwives, nurses, and mothers, this article seeks to describe the twelve tenets of each paradigm as they apply to contemporary obstetrical and health care, and to point out their futuristic implications. I suggest that practitioners who combine elements of all three paradigms have a unique opportunity to create the most effective obstetrical system ever known.

This article describes three paradigms of health care that heavily influence contemporary childbirth, most particularly in Western, industrialized nations, but now increasingly all over the globe.¹ I call these three paradigms the technocratic, humanistic, and holistic models of medicine (Davis-Floyd 1992; Davis-Floyd and St. John 1998). Of these three paradigms, humanism as a model for change stands the best chance of success in this era of the deepening penetration of technology into birth; thus “Humanizing Childbirth” was a most appropriate theme for the International Congress on Humanizing Childbirth held in Fortaleza Brazil in 2000, which the articles in this volume reflect. But in order to understand humanism in health care and obstetrics, it is essential to understand the other two approaches as well.

THE TECHNOCRATIC MODEL OF MEDICINE

The way a society conceives of and uses technology reflects and perpetuates the value and belief system that underlies it. Despite its pretenses to scientific rigor, the Western medical system is less grounded in science than in its wider cultural context; like all health care systems, it embodies the biases and beliefs of the society that created it. Western society’s core value system is strongly oriented toward science, high technology, economic profit, and patriarchally governed institutions (Davis-Floyd 1992). Our medical system reflects that core value system: its successes are founded in science, effected by technology, and carried out through large institutions governed by patriarchal ideologies in a profit-driven economic context. Among these core values, in both medicine and the wider society, technology reigns supreme. As has been clear for over twenty years, most routine obstetrical procedures have little or no scientific evidence to justify them. They are routinely performed not because they make scientific sense but because they make cultural sense. As we shall see below, they exemplify certain fundamental aspects of technocratic life.

The Twelve Tenets of the Technocratic Model

(1) Mind-body Separation and (2) The Body as Machine.

The main value underlying the technocratic paradigm of medicine is separation. The principle of separation states that things are better understood outside of their context, that is, divorced from related objects or persons. Technomedicine continually separates the individual into component parts, the process of reproduction into constituent elements, and experience of childbirth from the flow of life. But first and foremost, it separates the human body from the human mind.

The body presents a profound conceptual paradox to our society, for it is simultaneously a creation of nature and the focal point of culture. How can we be separate from nature when we are part of it? Descartes, Bacon, and others, neatly resolved this problem in the 1600s, when they established the philosophical separation of mind and body upon which the metaphor of the body-as-machine depends. This idea meant that the superior cultural essence of man, his mind–as well as the superior spiritual essence, his soul–could remain unaffected while the body, as a mere part of mechanical nature, could be taken apart, studied, and repaired.

This metaphor of the body-as-machine could have been inherently egalitarian, but the industrializing nations of the West were male-centered, patriarchal societies. Thus the male body came to be medically viewed as the prototype of the properly functioning body-machine. The female body, as it devi­ated from the male standard, was regarded as inherently defective and dangerously under the influence of nature, which due to its unpredictability, was itself regarded as in need of constant manipulation by man (Merchant 1983; Davis-Floyd 1992). As a result, despite the growing acceptance of birth as mechanical like all other bod­ily processes, it came to be viewed as an inherently imperfect and untrustworthy mechanical process, and the metaphor of the female body as a defective machine eventually formed the philosophical foundation of modern obstetrics. Furthermore, as the factory production of goods became a central organizing metaphor for social life, it also became the dominant metaphor for birth: the hospital became the factory, the mother’s body became the machine, and the baby became the product of an industrial manufacturing process. Obstetrics was thereby enjoined to develop tools and technologies for the manipulation and improvement of the inherently defective process of birth, and to make birth conform to the assembly-line model of factory production.

(3) The patient as object, and (4) Alienation of practitioner from patient. 

Mechanizing the human body and defining the body-machine as the proper object of medical treatment frees technomedical practitioners from any sense of responsibility for the patient’s mind or spirit. Thus, practitioners often see no need to engage with the individual who inhabits that body-machine, preferring instead to think of and talk about a patient as “the C-section in 112.”  Jordan (1993) demonstrates how this tendency to objectify patients can extend to refusal to discuss any details of a case with the person who embodies it. This kind of alienation from their patients is often trained into physicians during medical school and residency, as they are taught to protect themselves by avoiding emotional involvement. It logically follows that there is no reason to deal with the patient’s emotions at all. Thus they are free to protect their own feelings from the pain of caring too much. Technocratic physicians do not value lengthy conversations with their patients, preferring to keep their visits short. Although it is well-known that touch and caring are powerful factors that can positively influence both a woman’s experience of labor and the outcome of the birth (see below), it is rare to see obstetricians touching laboring women, holding their hands, or sheltering them in an embrace.

(5) Diagnosis and treatment from the outside in.

When most machines break down, they do not repair themselves from the inside; they must be repaired from the outside, by someone else. Thus in technomedicine, it follows that one must attempt to diagnose problems, cure disease, and repair dysfunction from the outside. The most valued information is that which comes from the many high-tech diagnostic machines now considered essential to good health care. Such diagnostic technologies are pervasive in pregnancy and childbirth, from ultrasounds in early pregnancy to electronic fetal monitoring during labor. And treatment too is from the outside in—when labor slows, the amniotic sack is pierced with a hook and pitocin is poured into a vein to speed it up; when a baby seems stuck, it is pulled out with forceps or cut out with a knife.

The routine administration of IVs to women in labor is a good example of the massive overuse of this outside-in approach. There is plenty of scientific evidence (Enkin et al. 2000; Goer 1995, 1999; Rooks 1997) to indicate that it’s much healthier for a woman to eat and drink during labor. But the IV makes a powerful symbolic statement: it is the umbilical cord to the hospital. The IV places the woman in the same relationship of dependence on the institution for her life as the baby in the womb is dependent on her for its life (Davis-Floyd 1992). By extension, one can see IVs as a perfect symbolic expression of life in the technocracy: we are all umbilically linked to institutions and through them, to society. As a vein is penetrated with a needle and then with the fluid flowing through the IV line, our homes are penetrated by water, sewer, telephone, and electricity lines. The fullest symbolic extension of the IV lies in its expression and display of our ongoing fusions of ourselves with the technologies we create. A “cyborg” is a cybernetic organism, a fusion of human with machine. In the cultural arena of reproduction, we are escalating the pace of our own cyborgification (see Davis-Floyd and Dumit 1998).

(6) Hierarchical organization and (7) Standardization of care.

Like its industrial predecessor, the technocracy is a hierarchically organized society. The term technocracy implies use of an ideology of technological progress as a source of political power (Reynolds 1991). It thus expresses not only the technological but also the hierarchical, bureaucratic and autocratic dimensions of this culturally dominant reality model. Even as many businesses seek to make a paradigm shift by transforming themselves into “organizational networks” and “flat corporations,” the medical system remains true to its role as society’s microcosm, rigidly hierarchical in terms of the power of physicians as a group, the emphasis on specialty over primary care, and in terms of the subordination of individual needs to standardized institutional practices and routines.

The standardization in hospital birth is dramatically evident in most modern hospitals. Upon entering the hospital, the laboring woman is taken in a wheelchair to a “prep” room. There her clothes are removed, she is asked to put on a hospital gown, and a vaginal exam is performed. Her access to food is limited or prohibited, and an in­travenous needle is inserted in her hand or arm. The external fetal monitor is at­tached to the woman to monitor the strength of her contractions and the baby’s heartbeat. Periodic vaginal exams are performed to check the degree of the baby’s descent. All of these procedures in most modern hospitals are routinely performed without scientific justification  (Enkin et al. 2000; Goer 1995, 1999; Rooks 1997).

As the moment of birth approaches, there is an intensifica­tion of actions performed on the woman, as she is transferred to a delivery room, placed in the lithotomy position, covered with sterile sheets and doused with antiseptic, and an episiotomy is performed. After the birth, she is handed the baby for a certain amount of time, her placenta is extracted if it does not come out quickly on its own, her episiotomy is sewn up, and finally, she is cleaned up and transferred to a hospital bed. Or she may have a cesarean section; in countries like Brazil and Mexico, that operation seems to be rapidly becoming routine (Castro 2001; Potter et al. 2001).

Of course, there are many variations on this theme. Some procedures that used to be standard in US hospitals in the 1940s, 1950s, and 1960s such as handstrapping, the exclusion of fathers, and shaves and enemas are no longer used, although some are still common in developing countries. Other major changes since then have included the father’s presence and women remaining conscious during birth. When possible, many women opt for delivery in a birthing suite or LDR (labor-de­livery-recovery room), where they can wear their own clothes, do with­out the IV, and walk around during labor. Yet in spite of these concessions to consumer demand for more humanistic birth, a basic pattern of high-technological intervention remains: most hospitals now require at least periodic electronic monitoring of all laboring women; analgesics, pitocin, and epidurals are widely administered; and cesarean section rates are increasing. Thus, although some medi­cal procedures drop away, the use of the most powerful signifiers of the woman’s dependence on science and technology intensifies.

(7) Authority and responsibility inherent in practitioner, not patient.

In line with its hierarchical structure, the technocratic model invests authority in physicians and in institutions and their personnel. Obvious cues such as titles and white coats signal the authority of the physician, who can add to his status by withholding information, and using technical jargon the patient cannot understand. When the doctor is the authority, the patient lacks responsibility. Many doctors are able to present an option as the answer quite easily, by simply refusing to discuss non-paradigm alternatives. In this scenario, a patient’s most comfortable role is abdication of personal preference in favor of the doctor’s choice.

In childbirth, one of the most graphic demonstrations of the power of “doctor’s choice” is the lithotomy position so popular with doctors not because it is physiologically sound, but because it enables them to attend births standing up, with a clear field for maneuvering. We know very well that this position complicates childbirth, but the many good physiological reasons to allow women to give birth in upright positions (which include increased blood and oxygen supply to the baby, more effective pushing, and wider pelvic outlets) are far less important to most physicians than their own comfort, convenience, and status. In the West, “up” is good and “down is bad”: the person who is “on top” has the status and the power, and rarely gives it up for the good of the laboring woman and child.

Technomedicine’s investment of both authority and responsibility in physicians and hospitals is a double-edged sword. Although medical personnel do have the power to give orders to patients and establish institutional policies and procedures, they can be and often are held to be accountable for deaths and outcomes that no mortal could prevent. The proliferation of lawsuits against obstetricians  over the past two decades is testimony to the way citizens have turned this tenet of the technocratic model against its proponents.

(8) Supervaluation of science and technology.

The general public tends to assume that doctors are scientists, but most medical students receive little or no training in research methodology and analysis. A 1978 study carried out by the Office of Technology Assessment of the United States Congress reported that “only ten to twenty percent of all procedures currently used in medical practice have been shown to be efficacious in controlled trials”;  in the 1990s, it is still true that over half of the techniques physicians routinely employ have not been proven in rigorous testing. Yet the power of the technomedical paradigm is such that physicians will rapidly accept procedures and technologies in keeping with it, while rejecting those that do not. So, while science is “supervalued” as an ideology in this paradigm, its actual findings are often discounted or ignored.

Likewise, the technologies that predominate in medical treatment are those that support the “evolution through technology” ethos of the technocratic model, in which progress means the development of ever more sophisticated machines. When a doctor uses a “low-tech” tool like a stethoscope, he touches the patient, speaks to her, listens with his own ears to hers or the baby’s heartbeats, interprets the sounds through his own bodily perceptions, and arrives at a diagnosis that depends in large part on his physical senses. When the same doctor uses a computerized axial tomography (CAT) scanner or an electronic fetal monitor (EFM), only the machine touches or interacts with the patient during the procedure. The physician’s role is to interpret the mechanically mediated results, which are regarded as more objective and reliable than his perceptions.

Such new technologies are usually introduced by their marketers, who tend to describe them solely in terms of their best-case use and minimize any detrimental effects. EFM  is a case in point (Kunisch 1989). Its manufacturers regularly paid physicians’s trips to medical conferences; upon arrival, they found themselves walking through elaborate EFM displays to get to the meeting rooms (Wagner 1997). Now pervasive in hospital birth, the EFM has resulted not in better outcomes but in higher costs and higher Cesarean rates. Nevertheless, many hospitals in the US routinely employ these machines in more than 80 percent of labors.

Rapid diffusion and acceptance of a new technology often has more to do with its symbolic value than its actual efficacy. Machines can mesmerize:

The amplified fetal heartbeat sounds like galloping horses . . . both the sound of the gal­loping and the vision of the needle traveling across the pa­per, making a blip with each heartbeat, are hypnotic, often giving one the illusion that the machines are keeping the baby’s heart beating” (Harrison 1982:90).

So powerful is this illusion that nurses Davis-Floyd has interviewed often become reluctant to detach the mother from the monitor because they fear that the baby’s heart will stop. While they know intellectually that this is nonsense, nevertheless they are emotionally swayed by the symbolic power of these machines.

Once machines like the EFM, along with CAT and positron emission tomography (PET)  scanners and hundreds of others, are there, they must be reckoned with, and any decision not to use them begins to look like substandard care–a reality that reflects both the financial and the symbolic supervaluation of technology in the American medical system. Such machines serve the powerful symbolic purpose of “upgrading” medical care in keeping with our notions of evolutionary progress; indeed, our newest cultural value is the flow of massive amounts of information through sophisticated electronic systems—just the kind of option that the EFM provides.

(9) Aggressive intervention with emphasis on short-term results, and (10) Death as defeat

Since the dawn of the Industrial Revolution, Western society has sought to dominate and control nature. And the more we controlled nature, including our natural bodies, the more we feared the aspects of nature we could not control. This led to the emergence of a phenomenon that anthropologist Peter C. Reynolds (1991) has labeled the “One-Two Punch” of technological intervention. Take a natural process that seems to need fixing—say, a river in which salmon annually swim upstream to spawn. Punch One:  “Improve it” with technology–build a dam and a power plant, generating the unfortunate byproduct that the salmon can no longer swim to their spawning grounds. Punch Two: Fix the problem created with technology with more technology–take the salmon out of the water with machines, let them spawn and grow the eggs in trays, feed the babies through an elaborate system of pipes and tubes, then truck them back to the river and release them downstream. Reynolds’ brilliant insight was that, while most people see Punch Two as an accidental byproduct of Punch One, the deeper truth is that Punch Two is the point. We in the West have become convinced that altering natural processes makes them better–more predictable, more controllable, and therefore safer.

It is not hard to see how this One-Two punch of mutilation and prosthesis applies to birth. The birth process seems to us to be chaotic, uncontrollable, and therefore dangerous. So we “improve” it with technology. First we take it apart–deconstruct it–into identifiable segments. Then we control each segment with the obstetrical equivalent of dams and floodgates (EFM, pitocin, drugs.). When the unfortunate byproduct of this technological reconstruction of birth is a baby in distress from a now-dysfunctional labor, we rescue that baby with more technology (episiotomy, forceps, Cesarean section). Then we congratulate ourselves on a job well done, just as the builders of the salmon hatchery congratulate themselves for “saving the salmon.”

Reynolds’ One-Two Punch is a powerful motivating force in American society–I call it the technocratic imperative. This impetus to improve on nature through technology has as its ultimate aim to free us altogether from the limitations of nature. The more able we become to control nature, including our natural bodies, the more fearful we become of the aspects of nature we cannot control. Death becomes the ultimate signifier of defeat, proof that in fact we have not succeeded in transcending nature’s limitations, and thus the ultimate enemy, to be defeated at all costs. Lifesaving procedures for low birth weight infants, often implemented without respect for their eventual quality of life, like high tech intervention for the terminally ill, represent attempts at sustaining the fragile thread of life against all odds. The underlying ethos behind the routine application of so many unnecessary procedures to birth is fear of death. These procedures keep fear at bay by giving both practitioners and birthing women the illusion of safety: they appear to minimize risk while in fact they often generate more problems than they solve.

Technomedical hegemony: (11) A profit-driven system; and (12) Intolerance of other modalities.

The word “hegemony” refers to an ideology espoused by the dominant group in a given society. In a multi-cultural society such as that of the United States in the late 20th century, no one set of ideas about medicine, religion, economics, or anything else is shared by everyone. Nevertheless, there are ideologies that are obviously dominant: in economics, the hegemonic ideology is capitalism, and in health care, it is the technomedical model. When an ideology is hegemonic, all other competing ideologies become “alternative” to it. Thus healing modalities such as midwifery, chiropractic, homeopathy, naturopathy, acupuncture, and so forth have been viewed as alternative to allopathy. While these modalities command increasing respect and usage, allopathic technomedicine still sets the standards for care. Its hegemonic status works to ensure its profitablity: pharmaceutical and medical technology companies constitute by far one of the most profitable industries in the United States. The median after-research profit rate in 1993 for the makers of the top-selling prescription drugs was more than five times higher than the median profit rate for all Fortune 500 companies in the same year (Pollack 1995). Any system–-medical, economic, religious, or otherwise-–that gains sociocultural ascendancy and then rigidifies, shutting out new information and refusing to incorporate contradictory evidence, is in mortal danger both to itself and to the public it serves. Such hegemonic systems can benefit from frontal attacks, which can serve to keep them flexible and responsive to the changing realities of changing times. It is in that spirit that I have presented this analysis.

THE HUMANISTIC MODEL OF MEDICINE

In the United States and elsewhere, the excesses of technomedicine have long been the subject of heated discussion and debate. Humanism arose in reaction to these excesses as an effort driven by nurses and physicians working within the medical system to reform it from the inside. Humanists wish simply to humanize technomedicine–that is, to make it relational, partnership-oriented, individually responsive, and compassionate. This caring, commonsensical approach is garnering wide international appreciation and support. Clearly less radical than holism, clearly more loving than technomedicine, this humanistic paradigm has the most potential to open the technocratic system, from the inside, to the possibility of widespread reform.

The Twelve Tenets of the Humanistic Model

(1)  Mind-Body Connection

The humanistic approach neither demarcates a total separation between mind and body, as does technomedicine, nor claims oneness for mind and body, as does the holistic model. Rather, it recognizes the influence of the mind on the body and advocates forms of healing that address both. Proponents of this paradigm see body and mind as being in constant communication, citing scientific research in the field of psychoneuroimmunology and elsewhere. Thus the humanistic paradigm insists that it is impossible to treat physical symptoms without addressing their psychological components. Psychoneuroimmunologist Candace Pert explains:

Viruses use [the same receptors as the neuropeptides that carry emotions] to enter into a cell, and depending on how much of the natural juice, or the natural peptide for that receptor is around, the virus will have an easier or a harder time getting into the cell. So our emotional state will affect whether we’ll get sick from the same loading dose of a virus.  . . Emotional fluctuations and emotional status directly influence the probability that the organism will get sick or be well. (1993:190)

The implications for childbirth of the notion that the mind affects what happens in the body are obvious and profound. Humanism in childbirth allows for the possibility that the laboring woman’s emotions can affect the progress of her labor, and that problems in labor may be more effectively dealt with through emotional support than through technological intervention.

(2) The Body as an Organism

Although in some ways the human body is like a machine, it is a fact of biological life that the body is not a machine but an organism. Such a conclusion has powerful repercussions for treatment, as the way the body is defined will shape the way it is treated by a culture’s health care system. “Even medical therapies that are the most machine-like would be ineffective without the innate healing powers of the organism,” which has “properties that no machine has: those of growth, regeneration, healing, learning, and self-transcendence” (Tresolini et al., 1994)

Defining the body as an organism charters the development of an array of treatments that may be irrelevant to a machine but matter a great deal to an organism. Unlike machines, mammalian organisms feel pain and respond emotionally to interactions with others and to changes in their environment. Most mammals respond positively to the comfort of a loving touch and shrink from contact that is harsh or punitive. Thus a paradigm of healing based on a definition of the human body as an organism would logically stress the importance of kindness, of touch, and of caring. These dimensions have special significance for the care of laboring women, from the ways they are treated during labor to the need of mother and baby to remain together after birth. The best analog for the term humanism in the medical literature is the term bio-psycho-social, which acknowledges that this model takes in to account biology, psychology and the social environment.

(3) The Patient as Relational Subject

Most humanists are not afraid to establish a real human connection with their patients, to come to know them not just as patients but as individuals, not as “the C-section in 112” but as “the mother with twins whose sister just died.” David Spiegel (et al.1989 ) showed  that women with advanced breast cancer who participated in weekly support groups not only felt better emotionally, but ultimately lived an average of eighteen months longer than did women with comparable breast cancer and medical care who did not attend such groups. This added survival time was, according to Spiegel (1993), “longer than any medication or other known medical treatment could be expected to provide for women with breast cancer so far advanced.” This study has been followed by a number of large-scale studies showing that more and better social support from family and friends is associated with lower odds of dying and better odds of healing at any given age.

Starting in the 1970s, natural childbirth activists in large numbers in the US and other countries began to demand that fathers and significant others should be allowed into delivery rooms, that mother and baby should not be separated after birth, that friends and relatives be allowed to remain with the laboring woman if such was her desire. The effect of the presence of caring others during childbirth does far more than simply work toward a more pleasant labor experience; it can be central to the positive outcome of that experience.

(4) Connection and Caring between Practitioner and Patient

Whereas the technomedical paradigm is based on the principle of separation, and the holistic model on integration, the principle underlying the humanistic approach is connection: the connection of the patient to the multiple aspects of herself, her family, her society, and her health care practitioners. Humanism requires treating the patient in a connected, relational way as any human being would want to be treated–with consideration, kindness, and respect. This paradigm insists on the deep humanity of the individuals involved and stresses the importance of the patient-practitioner relationship to the healing process. The phrase “relationship-centered care” has been suggested “to capture the importance of the interaction among people as the foundation of any therapeutic or healing activity “ (Tresolini et al.1994).

In childbirth the strongest evidence of the power of relationship-centered care comes from the doula research. A doula is a female companion especially trained to give labor support. Sosa, Kennell, Klaus, and their associates, (1980, 1982, 1988) compared the results of normal hospital labors with labors of women attended one-on-one by a doula. They found that doula support dramatically reduced problems of fetal asphyxia and labor dystocia, shortened length of labor, and enhanced mother-infant interaction after delivery (see also Klaus, Kennell, and Klaus 1993).

(5) Diagnosis and Healing from the Outside In and from the Inside Out

Where the technomedical model emphasizes diagnosis and healing from the outside in, and the holistic model from the inside out, the humanistic model calls for a moderate application of both approaches. The physician-patient communication it emphasizes allows physicians to elicit information from deep within the patient and combine it with objective findings. Accordingly, humanists find that how to listen is as important as knowing what to say. Listening skills are crucial for obtaining the correct mix of data required for diagnosis.

Noting that a clinician will perform from 120,000 to 160,000 interviews during a career, Smith (1996) points out that the biomedical model teaches students to elicit symptoms of disease using a “doctor-centered” interviewing process. The physician elicits many bits of nonpersonal data, starting with the patient’s chief complaint, then synthesizes them into a description of the patient’s disease. But humanistic doctors know that the presenting complaint often masks an underlying problem. A woman complaining of fatigue, depression, and body aches may have lupus or may be despondent over a failed marriage. Practitioners must adopt an open-ended learning approach in order to create the space and time necessary to bring forth the underlying dynamic.

This open-ended learning approach forms an important part of what Smith (1996) calls the “patient-centered interview.” Instead of asking a series of closed, rapid-fire questions, the physician simply encourages patients to express what is most important to them, which will usually come out as a combination of personal data and data about symptoms. Allowing patients to lead keeps their ideas and concerns paramount and  enhances their sense of autonomy. The patient-centered interview can form an invaluable part of the humanistic physician’s ability to be both technically competent and humanistically caring.

(6) Balance between the Needs of the Institution and the Individual

Humanism counterbalances technomedicine with a softer approach, which can be anything from a superficial overlay to profoundly alternative methods . It is superficially humanistic to decorate a technocratic labor room so the machines don’t stand out so much; it is deeply humanistic to provide women with flexible spaces in which they have room to move around as much as they like, to be in water if they wish, to labor as they choose.

Most medical institutions are designed to support and implement technocratic principles. These institutions are so highly regulated with respect to infection control, medical/surgical and nursing procedures, security, and liability that it is often not possible for one individual to effect significant change. So sometimes humanistically inclined physicians must content themselves with superficial improvements; but very often, committed individuals find they can do more. In the US, nurse-midwives have gained a reputation as the practitioners who try the hardest to provide deeply humanistic care within hospitals (see Rooks 1997; Davis-Floyd 1998). Thus two humanistic changes often sought by childbirth activists include convincing hospitals to give women the right to choose midwives as their birth attendants, and to have access to one-on-one doula care.

(7) Information, Decision-making, and Responsibility Shared between Patient and Practitioner

The poles between empowerment and dependence form the framework within which doctors and patients make decisions. Most health professionals are trained to bring linear information to bear in their decision-making; in addition, the humanistic paradigm allows non-linear, subjective processing to play a significant role. This is the balanced or empathic style of thinking. “Empathic” refers to the ability of one person to understand another’s reality even if that reality is beyond their direct experience. Even when straightforward evidence of disease is present, doctors still have considerable latitude regarding how mutual they are willing to allow decision making to be. In the technomedical model, each situation seems to dictate a matching action. The humanistic model opens situations to multiple options.

The doctrine of informed consent establishes that patients have a right to understand their diagnosis and prognosis, their proposed treatment and its risks and benefits, and their treatment options. In the technocratic model the discussion of options outside of conventional medicine is generally impossible due to the doctor’s allegiance to technocratic approaches and ignorance of alternatives. Discussing  no treatment as an option is equally unlikely. But in humanism, open discussion of treatment choices leads naturally to an exploration and sharing of values, and doctors are more likely to respond favorably or at least neutrally to a patient’s wish to try alternative methods or to employ no treatments at all.

Arthur Kleinman (1988) expands the notions of the patient’s right to information and the “patient-centered interview” to a more dialogic approach. He suggests that the goal of the practitioner should be to enter into the experience of illness as patients perceive it by listening carefully to their narratives. To more deeply understand a patient’s story, the physician can try to interpret the patient’s symptoms as symbols of deeper life issues and to grasp the influence of the patient’s cultural, personal, and family explanatory models. Like other humanistic and holistic physicians, Kleinman  (1988) stresses the value and importance of the placebo effect, which can be activated purely through the strength of the physician-patient relationship and thus should be tapped in every healing encounter.

Medical sociologist Eliot Freidson (1967) asserts that the need for information is apt to result in conflict simply because a lay culture is encountering a professional culture at a moment of crisis. To balance this, the doctor needs to communicate a trustworthiness to the patient so that the patient can accept or reject recommendations without feeling either bullied or negated. Although some physicians might fear liability with this level of information-sharing, the Consensus Conference on Doctor-Patient Communication held in Toronto in 1992 found that most lawsuits against doctors are the result of communication faults rather than errors in medical judgment.

(8) Science and Technology Counterbalanced with Humanism

Humanistic physicians take science as their standard and use virtually the same tools and techniques as technomedical doctors. The difference lies in timing and selection. Humanists may be more willing to wait, more apt to be conservative, more open to mind/body approaches. Humanists who are primary care doctors (family physicians, internists, pediatricians, gynecologists) may delay referring to a specialist and attempt to resolve a problem using more conservative methods, provided they have the consent of the patient to do so. Humanistic specialists will naturally be inclined to use the technology at their disposal, but will emphasize caring and relationship alongside it, a combination John Naisbitt (1980) captured in the phrase “high tech, high touch.”

A whole new class of birth technologies has been developed that can be considered humanistic, from portable tables that allow babies in distress to be resuscitated at their mother’s sides to sophisticated birthing chairs that allow women to be in upright positions. But for such interventions to be truly humanistic, they should be used at a patient’s request or desire and their use should be soundly evidence-based. For example, epidural anesthesia can be considered a humanistic intervention because it takes away pain while allowing women to be “awake and aware.” But there is nothing humanistic about forcing epidurals on women who don’t want them. On the other side, how humanistic is it to allow women who arrive at the hospital demanding an epidural to have one in very early labor? A great deal of evidence now shows that if given before 5 cm dilation, epidurals can significantly slow labor. But when epidurals are given after five cm dilation, such problems are rare. Humanistic obsetricians and midwives try to evaluate the evidence and to make decisions that reflect the balance between what science shows to work and the needs and desires of the women they attend.

A good example of counterbalancing science and technology with humanistic principles stems from a birth Davis-Floyd once observed, in which a mother laboring in a hospital supported by her husband and a doula rejected the delivery table and asked to be allowed to give birth on the floor. The physician and nurses attending her asked themselves what science truly demanded in that situation. The answer was that there was nothing scientific at all about giving birth flat on one’s back on a delivery table; it was in fact much more evidence-based to give birth upright on the floor. What science did demand was a clean area for the delivery. So the nurses took the sheets off of the table and put them on the floor, and the woman, propped with pillows, cheerfully sat on top of them to give birth. In other words, ideally, humanistic care should be evidence-based care that reflects real science and not medical tradition.

(9) Focus on Disease Prevention

Most proponents of humanism are also strong proponents of science-based public health initiatives that stress prevention and deal sensibly with the public environment. They point out that providing a village or a country with a clean water supply will do far more good for the health of far more people than building high-tech hospitals, as will ensuring clean air, adequate nutrition, and access to primary health care.

Prevention has been limited to the public health arena presumably because it does not turn a profit, unlike the sale of high tech medical equipment and pharmaceuticals. No one benefits in any immediate sense when people stop smoking, but a model in which compassion, not profit, is the driving force, has room for prevention and for social programs that reflect political agendas that protect the disenfranchised. Thus the public health paradigm, which stresses long-term, large-scale disease prevention and health promotion, corresponds closely to the humanistic paradigm, which stresses long-term individual and family (biopsychosocial) disease prevention and health promotion. In fact, humanists often leave private medical practice for work in the wider arena of public health.

The implications of this prevention-based approach in childbirth are enormous. True prevention of complications in childbirth would involve addressing the problems that lead to maternal and fetal deaths at their source. But often public health programs like the Safe Motherhood Initiative are heavily influenced by technomedical perspectives. Technomedicine identifies hemorrhage, toxemia, anemia, and the like as the sources of maternal death. But the underlying causes of these problems are the interrelated factors of poverty, poor nutrition, contaminated food and drinking water, the lower status of women, and overwork. Initiatives that try to solve the problem of maternal mortality by building more hospitals and stocking them with more machines fail to address these core problems; instead, they  perpetrate the agenda of technomedicine.

Both the public health paradigm and the humanistic model are compassion-driven; both focus on disease prevention, health promotion, and public education. The public health paradigm takes a broadscale, population-wide approach, while the humanistic model focuses more specifically on the individual relationships between family, patient, and provider and the effects of these relationships on illness prevention, diagnosis, and treatment.

(10) Death as an Acceptable Outcome

In childbirth, where death usually arrives suddenly, the technocratic approach to the death of a baby is to whisk away the body, leaving the parents with empty arms. The humanistic way is to allow the parents all the time they need with that baby, so that the pain of death is not augmented by the pain of sudden separation. In the wider cultural arena, the humanistic approach to death is one of individual choice about the manner of dying. Individuals can sign living wills in advance, requesting that life-prolonging measures be limited. The hospice movement has brought death back into the home by supporting the dying individual and the family, not with major medical intervention but with the comfort of pain relief. This highly humanistic approach stem from a philosophy that profoundly honors a patient’s individuality and freedom of choice. The process of conscious dying under both the humanistic and holistic paradigms becomes an opportunity to heal one’s relationships with spouses, lovers, children, friends, oneself, and God. Grievances can be forgiven, old wounds mended, unmet needs and wishes fulfilled. In such cases, the death of an individual can provide tremendous opportunities for healing for families and entire communities.

(11) Compassion-Driven Care

Byron and Mary Jo Good (1993, 1995) suggest that the juxtaposed “central symbols” of competence and caring  represent a cultural tension developed throughout medical education that is linked to a dualistic discourse characteristic of contemporary Western medicine.  Competence is closely associated with the natural sciences, caring with the humanities. Competence is a quality of knowledge and skills, caring a quality of persons. They also note that this juxtaposition of competence and caring, present throughout the history of Western medicine, reflects the larger struggle between science and culture, technology and humanism, which in the West are often seen as opposing forces.

It is precisely these contradictions that the humanistic approach to medicine seeks to resolve. Physicians faced with suffering are expected to process information quickly, arrive at, and often implement a course of treatment. In technomedical circles, emotions are thought to interfere with such abilities. In both humanistic and holistic serttings, feelings are accepted as part of the healing response. The driving ethos of the humanist is compassion-–the ability to sense and feel the needs of others even if they are outside of one’s own experience. When they sit down by a laboring woman’s bed and breathe with her through a contraction, humanistic physicians are working to re-create a place in medicine for the human values of partnership, relationship, compassion, and caring. Only after three decades of scientific research documenting the benefits of this humanistic approach are technocratically trained physicians allowing themselves to be human, letting go of the fear that others will think them weak and incompetent if they open themselves to their own feelings and learn skills for processing their patients’ feelings without becoming emotionally overwhelmed.

(12) Open-Mindedness toward Other Modalities

Most humanists have no intention of learning alternative healing techniques, although in general they are open-minded and support patients who chose to use alternatives–as long as the overall treatment program includes conventional care. While many humanists adopt a sort of bemused tolerance to alternative modalities, some do advocate dietary and lifestyle changes that border on the holistic, and take a more proactive stance toward other healing alternatives. Physicians in transition to humanism need not undergo any noticeable change in beliefs about what causes or cures disease. Simply being nicer, more caring, more willing to touch and communicate repositions them in the humanistic model. Most will not undergo the radical shift in values that permits them to go beyond compassion to employ the healing power of that mysterious thing called energy in overcoming disease. This is the realm of the holistic physician.

THE HOLISTIC MODEL OF MEDICINE

If the technocratic model of medicine is the ruling hegemony, the holistic model of medicine is the ultimate heresy. Of the three paradigms I discuss, the holistic model encompasses the richest variety of approaches, ranging from nutritional therapy to traditional healing modalities such as Chinese medicine to various methods of directly affecting personal energy. Some holistic practitioners study a particular modality while others employ an eclectic approach, often of their own design. Holism often calls on individuals to be active, asking them to make major modifications in their lifestyles. It may also ask them to be passive, to simply receive prayer or a transfer of healing energy.

The term holism was adopted by some of the pioneers of this movement to express their inclusion of the mind, body, emotions, spirit, and environment of the patient in the healing process. The principles of connection and integration that underlie the holistic paradigm arise from the fluid, multi-modal, right-brained thinking that, after centuries of devaluation in the West, is finally beginning to regain lost ground (Eisler 1995). While the whole brain is involved in all brain functions, it is possible to say that the right hemisphere is predominantly involved in perceiving the gestalt, the whole. In contrast to the classifying and segmenting unimodal approach of left-brained, linear systems of thought, fluid thinkers use multimodal means of perception to apprehend the whole and to intuit the ever-shifting relationships of its parts. It is thinking of, with, and through the body and the spirit–holistic thinking, fluid thinking that transcends logical reasoning and rigid classifications in favor of what Starhawk (1989), one of its principal spokespersons, calls the “spiral dance.” She means the spiral of the vortex, the tornado, the creative matrix in which all things are tossed around and mixed up beyond any making sense. From the deep integrative chaos of this energy vortex arises the surprise–the unpredictable relationship, the unexpected connection, the revealing intuition–that so often constitutes a prime element of holistic healing.

The Twelve Tenets of the Holistic Model

(1)  Oneness of body-mind-spirit

Mind and body, wrought asunder by Cartesian rationalism, and reconnected in medical humanism, are reunited in holistic medical care. The worst problem here is language: we are so used to speaking in terms of mind/body separation that even holistic healers find themselves still using the words “mind” and “body”; when they are careful, they will refer to the “bodymind” to indicate that it is all one thing. A large part of the initial impetus for the reuniting of mind and body in holistic healing was the dawning realization that the brain, the physical seat of the mind, is not located only in the head but in fact extends throughout the central nervous system. Understanding that the brain is distributed throughout the body makes it much harder to talk or think about body and mind as separate entities.

If the mind is the body, and the body is the mind, then how one responds to the treatment of even so mechanical a thing as a broken arm will have as much to do with how one thinks and feels about that broken arm as about what kind of cast is put on it. In the holistic approach, addressing the psychological states and emotions of the pregnant or laboring woman is not just helpful, it is the essential aspect of care. Like humanists, holistic physicians are finding that they need much more engagement with the patient to get at those intangibles of mind and emotion now seen to be as much a part of the illness as its physical manifestation.

The holistic paradigm also insists on the participation of the spirit in the human whole. In incorporating soul it into the healing process, holistic healers bring medicine back into the world of the spiritual and the metaphysical from which it was separated during the Industrial Revolution. The spirituality of holistic healers tends to be fluid, and to take the form of a loose identification with Eastern or New Age philosophies more often than with Judaism, Christianity, or Islam. Where the technomedical model is rigid and separatist, the holistic model recognizes no sharp divisions or distinct boundaries. This is another reason why holism is so threatening: in many people’s minds, to trifle with boundaries is to invoke chaos. And indeed, chaos theory and systems theory both inform and underpin the holistic paradigm and its insistence on the oneness of body, mind, and spirit.

(2) The Body as an Energy System Interlinked with Other Energy Systems

The holistic paradigm moves far beyond the narrow view of the body-as-machine, past the humanistic view of the body as an organism, all the way to a limitless view of the body as energy. Defining the body as an energy system provides a powerful charter for the development and use of forms of medicine and treatment that work energetically such as acupuncture, homeopathy, intuitive diagnosis, Reiki, hands-on healing, magnetic field therapy, and therapeutic touch. “Energy medicine” acknowledges the possibilities that an individual’s health can be influenced by such subtleties as the vibrations of anger or hostility or the electromagnetic fields created by power plants and microwaves, of these presuppose non-physical reality. Today’s physicists relish documenting the vanishing frontier between matter and energy. Medical research would require complete restructuring if it accepted such conclusions from other disciplines. For example, while medicine hotly refutes the impact of the investigator on research, physics recognizes the Heisenberg Principle, which acknowledges the influence of the observer on the observed. Even the intentionality of the experimenter can profoundly affect the outcome of an experiment (Wiseman and Schlitz 1996). How can an observer separate from the observed phenomenon affect its behavior? Acceptance of this second tenet answers this question: the observer and the observed are not separate, but are energy fields in constant interaction with each other.

Many midwives Davis-Floyd has studied in the US define themselves as holistic and consciously seek to work with what they call “birth energy.” Indeed, they believe that the primary intervention a midwife can make is at the energetic level.  Intervening to “redirect the energies” can ensure that no other type of intervention will be needed. If a labor stalls and a cesarean seems imminent, a midwife who has a feel for the power of energy may  throw open the window, put on some music, and get the mother up to dance. Or she might leave the room to allow the birthing couple some privacy, so that the loving energy of their relationship can infuse the birth experience. The important point is that for the practitioner who works at the level of energy, these sorts of interventions will not be afterthoughts or overlays, but will be basic and primary–the first line of care.

(3) Healing the Whole Person in Whole Life Context

This tenet of the holistic model of medicine, a logical corollary of the first two, acknowledges that no single explanation of a diagnosis, no single drug or therapeutic approach, will sufficiently address an individual’s health problems; rather, such problems must be addressed in terms of the whole persons and the whole environments in which they live. It is no accident that the most commonly asked question in holistic health is “What’s going on in your life?” This question expresses the holistic view that illness is a manifestation of imbalance in the bodymindspirit whole. Here holism accepts to the fullest findings from psychoneuroimmunology and other fields that the immune system, or the process of pregnancy and birth, can be impeded by exhaustion, depression, emotional stress, the loss of a loved one, toxins in the air and the water, the stresses of technocratic life. The corollary of this view, of course, is that a healthy immune system, as well as a healthy pregnancy and birth, can be facilitated by multiple means, from dialogue to dream analysis to dance, from massage to exercise to organic food.

(4) Essential Unity of Practitioner and Client

Many holistic practitioners try to drop the word “patient” in favor of “client,” as this term implies a mutually cooperative, egalitarian relationship.  Where the humanistic model emphasizes the value of a mutually respectful connection between practitioner and client, still essentially separate and distinct beings, the holistic model offers the possibility that they are not separate but are fundamentally one. If the body is an energy field, then as they interact the energy fields of client and practitioner can merge.

(5)  Diagnosis and Healing from the Inside Out

While they may, if appropriate, order “outside-in” diagnostic tests, holistic practitioners will primarily diagnose and treat from the inside out–in other words, they will rely to a significant extent on the knowledge that arises from their own intuition, just as they will trust the inner knowing of their clients. Intuition is defined by the third edition of the American Heritage Dictionary as “the act or faculty of knowing or sensing without the use of rational processes; immediate cognition.” The knowledge on the basis of which decisions are made is defined as “authoritative knowledge “ (Jordan, 1993).  Technomedical practitioners tend to regard textbooks, diagnostic tests, and the advice of experts as authoritative, and to dismiss the still, small voice of intuition. But holistic practitioners (like some humanists) tend to regard intuition as a primary source of authoritative knowledge, along with the books and the machines. Thus, in holistic practice, “diagnosis and healing from the inside out” can refer to the information that arises from deep inside both patient and physician–a phenomenon explained at its core by their essential unity.             Midwives often consider intuition to be a primary source of knowledge about pregnancy and birth, as do all the holistic obstetricians Davis-Floyd has interviewed (Davis-Floyd and Davis, 1997; Davis-Floyd and St. John 1998). Their willingness to rely on intuition comes from their deep understanding of the body as energy and their trust in right-brained, gestaltic kinds of thinking that do not rely on logic but on that sudden flash of insight from which unity and healing can arise.

(6) Individualization of care.

Holistic physicians are trained in technomedicine and have seen the damage standardized hospital policies and hierarchies can do to individuals. In general, they do their best to respond to the individuality and unique needs of each patient within the constraints imposed on them by hospital and legal regulations. For the laboring woman, individualization of care means that standardization does not apply. Her labor is uniquely her own. She eats and drinks and moves about at will. She gives birth in the place of her choice attended by the people and practitioners of her choice. And the practitioner does not respond to the variations in her labor in standardized ways. A midwife dealing with a stalled labor might invite one woman to dance, might ask another if she is afraid to give birth, and might suggest a long walk with a third. Her intuition will guide her to respond to individual circumstances in individual ways. But the focus stays on the birthing woman. It is her unique needs and rhythms that will be paramount in the unfolding of her birth.

The unexpected twists that can result from holism’s high value on both individualization and interconnectedness are suggested in the theory of self-organizing systems (Wheatley 1992), which states that even the smallest event, if it happens in just the right place at just the right time, can dramatically alter the whole system. Holistic healers try not to make assumptions about cause and effect. They tend to expect the unexpected and to be prepared for healing to arise in strange places and mysterious ways. A chance remark can instantly transform a woman’s perception of her condition and become the foundation of a cure. Holistic healers know better than to assume that they are the ones who heal the patient. They know that any one of a myriad of interactions over which they have no control can spark a healing process. Their genius lies in their ability to recognize that tiny flame when it is lit and help it to grow instead of extinguishing it.

(7) Authority and Responsibility Inherent in the Individual

A basic tenet of holistic healing is that ultimately, individuals must take responsibility for their own health and wellbeing.² No one can really heal anyone else; individuals must decide for themselves if they want to be healed, and if so, they must take action to achieve that goal–give up smoking, exercise, eat right, maybe even give up a lucrative job that makes them unhappy or a relationship that is harmful to their health. Holistic practitioners in general tend to see themselves as part of a healing team, of which the patient is a full-fledged, indeed the most significant member. Many of our interviewees repeatedly expressed their frustration with patients who refuse to take responsibility for their own health. They may greet the new client prepared to offer her empowerment, full participation in decision-making, informed choices, and so on, yet the patient may want only to be handed a prescription and told how many pills to take, or to schedule her cesarean between conference calls (Davis-Floyd 1994). Although some of our interviewees refuse to revert to the hierarchical mode and may refer such patients to another MD, most accept and work with the patient’s desire to place the physician in charge, or try  to re-educate patients to take back the authority and responsibility they have surrendered.

 (8) Science and Technology Placed at the Service of the Individual

If the technocratic model of medicine can be snappily characterized as “high tech/low touch,” and the humanistic model as “high tech/high touch,” then it would seem to follow logically that the holistic model of medicine would be “low tech/high touch.” Sometimes this is true, as in the case of hands-on energy, nutritional medicine, herbal therapies—healing modalities for which no technological artifacts are used. But holistic healing can and often does incorporate high technology, from biofeedback machines to lab tests and diagnostic computers. Holistic healers in general do not reject technology; rather, they place it at the service of their clients, instead of allowing the technologies of health care to dominate, intimidate, and lay the ground rules for treatment. Usually these technologies are not invasive, nor do they produce the toxic effects of many of the technologies of conventional medicine. In childbirth, they range from administering oxygen to a laboring woman in need of extra energy, to birth balls that facilitate changes in position, to jacuzzis with overhead ropes to pull on as the woman bears down. Such technologies do not dominate and control; rather, they work with physiology to empower the woman to give birth.

And what of science? As we have seen, physicians are reluctant to change many commonly used procedures even when evidence reveals them to be inappropriate. French physician Michel Odent, a world leader in holistic childbirth, often notes that “science will save us.” He is referring to the emerging trend in Western obstetrics toward evidence-based care. If obstetrical care in most hospitals were to become truly evidence-based, then most standard interventions, including routine IVs, routine use of pitocin, and the lithotomy (flat-on-the-back) position would have to be eliminated; women would eat, drink, and move about freely during labor; and they would give birth in upright sitting or squatting positions (Enkin et al. 2000; Goer 1995, 1999; Rooks 1997).

(9) A Long-Term Focus on Creating and Maintaining Health and Well-Being

Technocratic physicians often express extreme frustration over the patient’s failure to follow doctor’s orders. In contrast, holistic physicians most frequently voice frustration over patients who make no long-term commitment to improving their health but want the doctor to provide them with a quick fix and let them get on with their lives as before. Quick fixes are poor substitutes for long-term lifestyle changes that can maintain good health. Holistic practitioners want their clients to make long-term changes in their diets and lifestyles that will not simply prevent illness but will actively generate good health. Giving up sugar, caffeine, and highly processed foods, taking vitamin supplements, eating nutrient-rich organic vegetables, exercising regularly, and dealing with stress through meditation are examples of the kinds of long-term changes that are often necessary to the creation of wellness. Holistic obstetrical practitioners know that pregnancy is an important time to be making such changes, not only for the health of the baby but also to ensure the long term health of the mother. The problem is of course that many people are resistant to such long-term lifestyle alterations. Holistic practitioners must engage in a great deal of client education, and must maintain a great deal of patience, in order to support people in making this kind of change.

(10) Death as a Step in a Process

Beyond the humanistic view of death as “the final stage of growth” lies the holistic paradigm’s redefinition of death not as any kind of final end but as an essential step in the process of living. This view stems from holists’ definition of the body as an energy field, and from their deep-seated understanding of the transmutable nature of energy. Because of their integrated views on the essential oneness of body, mind, and spirit, it is only at the moment of death that holists grant these a conceptual separation. At death, in this view, the energy of the body decays and returns to earth, while the energy of the spirit or the individual consciousness continues on. Most holists seem to accept some version of Eastern philosophies of reincarnation, a processual view that allows the interpretation of death as an opportunity for continued growth into a new kind of life in spirit and then again in flesh. While this positive view of death does not lead holists to rush to embrace death, it does tend to give them a strong sense of trust in the essential safety of the universe and in the wisdom and worth of its ways.

(11) Healing as the Focus

To say that the holistic model focuses on healing instead of on profit is not to dismiss the role of money and the practitioner’s need to make a livelihood within the system. Holistic practitioners have strong views about money—both for themselves and as part of their professional identity. While they are conscious of the need to earn a living, it follows their personal commitment to work rather than drives it. Few of the holistic physicians I have interviewed practiced within the framework of managed care, for example, where medicine and money are strongly affiliated. Only a few were on staffs of hospitals, where major health expenses are incurred, and virtually none were members of organized medicine (as exemplified by the American Medical Association and its regional counterparts).

Recognizing that healing occurs not in response to their actions but in the support and stimulation of the vital force, in the exchange of energy between individuals, or in the long slow progress toward health that often rewards serious lifestyle changes, holistic doctors are keenly aware of their partnership with patients. Money is part of this exchange. Unlike doctors who practice technomedicine and are apt to live stressful and harried lives wherein they are unable to care for themselves adequately, holistic doctors are tend to find that their own healing often accompanies that of their patients, as it is practically impossible to espouse a holistic philosophy without applying it to oneself. In the mutual appreciation that often arises between holistic doctor and patient, a deep experience of value replaces the focus on money.

(12) Embrace of Multiple Healing Modalities

As we have seen, the holistic paradigm’s definition of the body as an energy field in constant interaction with other energy fields makes possible its embrace of multiple modalities that remain unacceptable to proponents of the technomedical paradigm. The ultimate holistic vision entails a profound revolution in health care. Were this paradigm to gain cultural ascendance, the dominance of the technomedical model would be replaced with the cultural valuation of a multiplicity of approaches. Midwifery, homeopathy, naturopathy, acupuncture, et al. would take their places as respected and legitimate disciplines. Practitioners of each modality would know enough about the others for appropriate referral. Above all, the public would be educated in the techniques of self-care, healthy lifestyle and the appropriate use of a variety of approaches to healing.

Holistic medicine’s embrace of multiple healing modalities is gaining increasing public attention and acceptance. The clearest evidence for this statement comes from a study which determined that one third of Americans sought the services of a non-MD practitioner in a one year time period–and paid out of pocket for three quarters of the cost of these services (Eisenberg at al 1993). Another finding of this survey was that 72 percent of the maverick patients did not tell their doctors about their use of alternative medicine. Perhaps the center stage given to this study reflects the financial impact on medicine it uncovers, as well as the finding that the users of non-conventional therapies were well-educated, middle-income whites, from 25-49 years of age–one of the very best markets for orthodox medicine.

THE TECHNOCRATIC, HUMANISTIC, AND HOLISTIC MODELS OF MEDICINE

The Technocratic Model of Medicine

1. Mind/body separation

2. The body as machine

3. The patient as object

4. Alienation of practitioner from patient

5. Diagnosis and treatment from the outside in (curing disease, repairing dysfunction)

6. Hierarchical organization and standardization of care

7. Authority and responsibility inherent in practitioner, not patient

8. Supervaluation of science and technology

9. Aggressive intervention with emphasis on short?term results

10. Death as defeat

11. A profit?driven system

12. Intolerance of other modalities

Basic underlying principle: separation

Type of thinking: unimodal, left?brained, linear

The Humanistic (Biopychosocial) Model of Medicine:

1. Mind?body connection

2. The body as an organism

3. The patient as relational subject

4. Connection and caring between practitioner and patient

5. Diagnosis and healing from the outside in and from the inside out

6. Balance between the needs of the institution and the individual

7. Information, decision?making, and responsibility shared between patient and

practitioner

8. Science and technology counterbalanced with humanism

9. Focus on disease prevention

10. Death as an acceptable outcome

11. Compassion?driven care

12. Open?mindedness toward other modalities

Basic underlying principles: balance and connection

Type of thinking: bimodal

The Holistic Model of Medicine

1. Oneness of body?mind?spirit

2. The body as an energy system interlinked with other energy systems

3. Healing the whole person in whole?life context

4. Essential unity of practitioner and client

5. Diagnosis and healing from the inside out

6. Networking organizational structure that facilitates individualization of care

7. Authority and responsibility inherent in each individual

8. Science and technology placed at the service of the individual

9. A long?term focus on creating and maintaining health and well?being

10. Death as a step in a process

11 Healing as the focus

12. Embrace of multiple healing modalities

Basic underlying principles: Connection and integration

Type of thinking: Fluid, multimodal, right?brained   

As a society’s medical system mirrors its core values in microcosm, so the evolution of medicine can influence the evolution of the wider culture. We must ask, Who do we want to make ourselves become through the kinds of health care we create? Contemporary obstetrical practitioners have a unique opportunity to weave together elements of each paradigm to create the most effective system of care ever designed on this planet. Information is available about indigenous childbirth practices from many cultures, some of which (such as massage and upright positions for birth) are highly beneficial and should be incorporated.  More information than ever is available from scientific studies that tell us much of what we need to know about the physiology of birth and the kinds of care that truly support women to give birth. And technologies exist to support every kind of labor choice. If we could apply appropriate technologies, in combination with the values of humanism and the spontaneous openness to individuality and energy chartered by holism, we could in fact create the best obstetrical system the world has ever known. This is the challenge we offer to those who attended the Fortaleza conference and to those who wish to continue their work.

Acknowledgements

I wish to express deep appreciation to Dr. Anibal Faundes for his careful, thorough, and sensitive editorial work on this article, and to Gloria St. John, co-author of From Doctor to Healer, for allowing me to adapt some of our mutual work for this article.

Notes

1. Certain portions of this article draw heavily on From Doctor to Healer: The Transformative Journey (Davis-Floyd and St. John 1998) and Birth as an American Rite of Passage (Davis-Floyd 1992). For more information, please see these works; see also Davis-Floyd 1990, 1994; Davis-Floyd and Davis 1997; and <www.davis-floyd.com>.

2. Please note: The notion that authority and responsibility for health inhere in the individual is useful for thinking about the health care of the middle and upper classes. But the poor usually do not have the luxury of choosing their diet, their job, or their lifestyle. Nor can they afford the many options presented by holistic healers, as these are usually not covered by private or government insurance systems. A huge limitation of holistic healing has been its confinement to the wealthier segments of society and its almost total unavailability to the poor. Perhaps the greatest challenge confronting proponents of holism is to make their services available to the poor: it will take a global paradigm shift of epic proportions in order for insurance systems in all countries to reimburse multiple forms of care. But this is the ultimate holistic vision: that allopathic hegemony would be replaced with systems in which all modalities would be equally accessible to all people.

REFERENCES

Castro, Arachu, Angela Heimburger, and Ana Langer, 2001. “Iatrogenic Epidemic: How Health Care Professionals Contribute To The High Proportion Of Cesarean Sections In Mexico.” Unpublished ms.

Davis-Floyd, Robbie E.

1987.   “Obstetric Training as a Rite of Passage.” Medical Anthropology Quarterly 1(3):288-318.

1990. “The Role of American Obstetrics in the Resolution of Cultural  Anomaly.” Social Science and Medicine 31(2):175-189.

1992.  Birth as an American Rite of Passage. Berkeley, Los Angeles, and London: University  of California Press.

1994. “The Technocratic Body: American Childbirth as Cultural Expression.” Social Science and Medicine 38(8):1125-1140. Also available at <www.davis-floyd.com>.

1998. “The Ups, Downs, and Interlinkages of Nurse- and Direct-Entry Midwifery.” In Getting an Education: Paths to Becoming a Midwife, eds. Jan Tritten and Joel Southern, pp. 67-118. Eugene OR: Midwifery Today. Also available at <www.davis-floyd.com>.

Davis-Floyd, Robbie E. and Elizabeth Davis.  1997. “Intuition as Authoritative Knowledge. ” In Childbirth and Authoritative Knowledge: Crosscultural Perspectives, eds. Robbie Davis-Floyd and Carolyn Sargent, pp. 315-349.  Berkeley: University of California Press. Also available at <www.davis-floyd.com>.

Davis-Floyd, Robbie E. and Gloria St. John. 1998. From Doctor to Healer: The Transformative Journey. New Brunswick NJ:Rutgers U. Press.

Davis-Floyd, Robbie E., and Joseph Dumit. 1998. Cyborg Babies: From Techno-Sex to Techno-Tots. New York: Routledge.

Davis-Floyd, Robbie and P. Sven Arvidson. 1997. Intuition–The Inside Story: Interdisciplinary Perspectives. New York: Routledge.

Eisenberg, David M., R.C. Kessler, C. Foster, F.E. Norlock, D.R. Calkins, T.L. Delbanco. 1993. “Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use.” New England Journal of Medicine 328:246-252.

Eisler, Rianne. 1995. Sacred Pleasure: Sex, Myth, and the Politics of the Body.  HarperSanFrancisco.

Enkin, Murray, Marc Keirse, James Neilson, Caroline Crowther, Lelia Duley, Ellen Hodnett, and Justus Hofmeyr. 2000.  A Guide to Effective Care in Pregnancy and Childbirth. 3^rd edition. New York: Oxford University Press.

Friedson, Elliot. 1967. Review Essay:“Health Factories: The New Industrial Sociology,” Social Problems 14(Spring):493-400.

Good, Mary-Jo Delvecchio. 1995. American Medicine: The Quest for Competence. Berkeley: University of California Press.

Good, Byron and Mary-Jo Delvecchio Good. 1993. “’Learning Medicine’: The Construction of Medical Education at Harvard Medical School.” In Knowledge, Power, and Practice: The Anthropology of Medicine and Everyday Life, eds. Shirley Lindenbaum and Margaret Lock, pp. 81-107. Berkeley: U. of California Press.

Goer, Henci.  1995.  Obstetric Myths versus Research Realities.  Westport CT: Bergin and Garvey.

—–1999. The Thinking Woman’s Guide to a Better Birth. New York: Perigree/Penguin.

Harrison, Michelle. 1982. A Woman in Residence. New York: Random House.

Jordan, Brigitte. 1993 [1978])  Birth in Four Cultures: A Cross-Cultural Investigation of Childbirth in Yucatan, Holland, Sweden and the United States, 4th edition, revised and updated by Robbie Davis-Floyd. Prospect Heights, Ill.: Waveland Press.

Kennell, John

1982  “The Physiologic Effects of a Supportive Companion (Doula) During Labor.” In Birth: Interaction and Attachment  ed. Marshall H. Klaus and Martha O. Robertson, pp 92-105. New Jersey: Johnson and Johnson.

Kennell, John, Marshall Klaus, Susan McGrath, Steven Robertson, and Clark Hinckley

1988 “Medical Intervention: The Effect of Social Support During Labor.” Pediatric Research April:211 (Abstract #61).

Klaus, Marshall H., John Kennell, Phyllis Klaus. 1993. Mothering the Mother : How a Doula Can Help You Have a Shorter, Easier, and Healthier Birth. Addison Wesley.

Kleinman, Arthur. 1988. The Illness Narratives: Suffering, Healing, and the Human Condition. New York: Basic Books.

Kunisch, Judith. 1989. “Electronic Fetal Monitors: Marketing Forces and the Resulting Controversy.” In Healing Technology: Feminist Perspectives, ed. Kathryn Strother Ratcliff, pp. 41-60. Ann Arbor: University of Michigan Press.

Merchant, Carolyn 1983  The Death of Nature: Women, Ecology, and the Scientific Revolution. San Francisco: Harper & Row.

Naisbitt, John. 1980. Megatrends: Ten New Directions Transforming Our lives. New York: Warner Books.

Pert, Candace. 1993. “The Chemical Communicators.” In Healing and the Mind, eds Bill Moyers and Betty Sue Flowers, pp. 177-194. New York: Doubleday.

Pollack, Ron. 1995. “Worthless Promises: Drug Companies Keep Boosting Prices.” Oakland Tribune. July 7.

Potter, Joe C., Elza Berquo, Ignez H. O. Perpetuo MD, Ondina Fachel Leal, Marta Rovery Souza, Maria Celia de Carvalho Formiga, and Kristine L. Hopkins. 2001. “Unwanted Cesarean Sections among Public and Private Patients in Brazil.” Unpublished ms.

Reynolds, Peter C. 1991  Stealing Fire: The Mythology of the Technocracy. Palo Alto, Calif.: Iconic Anthropology Press.

Rooks, Judith. 1997. Midwifery and Childbirth in America. Philadelphia: Temple University Press.

Smith, Robert C. 1996. The Patient’s Story: Integrated Patient-Doctor Interviewing. Boston: Little, Brown and Co.

Sosa, R., J. Kennell, S. Robertson, and J. Urrutia

1980  “The Effect of a Supportive Companion on Perinatal Problems, Length of Labor, and Mother-Infant Interaction.” New EnglandJournal of Medicine 303:597-600.

Spiegel, David.  1993. “Social Support: How Friends, Family, and Groups Can Help.” In Mind-Body Medicine: How To Use Your Mind for Better Health, eds. Daniel Goleman and Joel Gurin, pp. 331-349. Yonkers, New York: Consumer Reports Books.

Spiegel, David, J. R. Bloom, H.C. Kramer, and E. Gottheil, 1989. “Effect of Psychosocial Treatment on Survival of Patients with Metastatic Breast Cancer.” Lancet 2:888-891.

Starhawk. 1989. The Spiral Dance: A Rebirth of the Ancient Religion of the Great Goddess. HarperSanFrancisco.

Tresolini, Carol P. and the Pew-Fetzer Task Force on Advancing Psychosocial Health Education. 1994. Health Professions Education and Relationship-Centered Care. San Francisco CA: Pew Health Professions Commission.

Wagner, Marsden. 1997. “Confessions of a Dissident.” In Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives, eds. Robbie Davis-Floyd and Carolyn Sargent, pp.366-396.  Berkeley: University of California Press.

Wheatley, Margaret. 1992. Leadership and the New Science: Learning about Organization from an Orderly Universe. San Francisco: Berrett-Koehler Publishers.

Wiseman, R. and Marilyn Schlitz. 1996. “Experimenter Effects and the Remote Detection of Staring.” Annual Proceedings of the Parapsychological Convention, San Diego, California.

Zukav, Gary. 2000. Soul Stories. New York: Simon and Shuster.

Author Bio:

Robbie Davis-Floyd, Ph.D, a Research Fellow in the Department of Anthropology, University of Texas (Austin), is an internationally known cultural anthropologist specializing in medical, ritual, and gender studies, and the anthropology of reproduction. She is the author of numerous articles and of Birth as an American Rite of Passage (1992); co-author of From Doctor to Healer: The Transformative Journey and The Power of Ritual (forthcoming), and coeditor of eight collections, including Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives (1997); Cyborg Babies: From Techno-Sex to Techno-Tots (1998); Reconceiving Midwives: The New Canadian Model of Care (forthcoming); and Midwives in Mexico: Continuity, Controversy, and Change (forthcoming). Funded by the Wenner-Gren Foundation for Anthropological Research, she has recently completed a major research project on the development of direct-entry midwifery in the United States, the results of which will appear in Mainstreaming Midwives: The Politics of Change. Her studies of contemporary transformations in Mexican midwifery are ongoing.

Contact information:

Robbie E. Davis-Floyd, Ph.D.

Research Fellow, Dept. of Anthropology, University of Texas at Austin

804 Crystal Creek Drive, Austin, Texas 78746

<davis-floyd@mail.utexas.edu>  <www.davis-floyd.com>

Home and Office: 512-263-2212   Mobile/VoiceMail: 512-426-8969

Robbie Davis-Floyd and Melissa Cheyney

This chapter appears in Childbirth across Cultures: Ideas and Practices of Pregnancy, Childbirth, and the Postpartum , edited by Helaine Selin and Pamela K. Stone, Springer 2009, pp. 1-22.

Once upon a time, there were six little pigs who set out to seek their fortunes in the world (okay, we know that in the original story there were only three, but just bear with us here!). Far away from home they journeyed, until the first little pig spied a peaceful meadow with a stream running through it; there he stopped his hot and weary journey. In two hours he had built himself a house of straw, then he spent another hour building animal traps, after which he set about to laugh and dance and play all day. It was like that every day — he would spend three to five hours hunting wild game, after which he could do as he pleased. The female pigs gathered wild grains, tubers and fruits so that food was available even when the hunt failed. Although the first little pig didn’t always like to admit it, the female pigs brought in 70%-80% of the diet from foraging, and often helped with the hunting and trapping as well. He was feeling very content, for he had wished to find an environment that could sustain him and his small band of kin pigs, and he had. Sure, he and his like-minded friends experienced high infant mortality rates and a resulting life expectancy of around 35 years, as well as high death rates from endemic disease and accidental death. However, as they discussed frequently in their abundant leisure time (in between the long stories they loved to tell), these problems were offset by their varied and nutritious diets and high mobility, which made sanitation and infectious disease transmission non-issues. Life was good and gender relationships egalitarian for the most part

The first little pig and his kith and kin were so successful at their hunting and gathering that after a couple hundred thousand years, they had overpopulated the most fertile areas of the world. Under pressure to feed so many mouths, necessity (the mother of all invention) was combined with the knowledge of plant life cycles developed during the days of gathering to create a new subsistence strategy–horticulture. The second little pig and his matriline began to fell trees and to plant gardens, and for the first time in human history, planted foods to supplement those that were foraged. The work was harder and longer — it took five to six hours a day — but still they had plenty of leisure time for singing, dancing, and storytelling. The females did most of the work anyway, planting, cultivating, harvesting and processing the food they grew, and chopping wood and carrying water, while the males spent their time hunting and performing the rituals that assured them that all was, and would remain, as it should be. They built their houses of sticks because they were still semi-nomadic, moving their villages every five years as garden soil and large game populations were exhausted. This kept life interesting. The diet was highly varied and population densities low enough to keep infectious disease in check, and while the seeds of gender inequality were sown along with the first domesticated plants, for the most part, life was good for the horticultural pigs.

The third little pig was horrified at his brothers’ lack of industriousness. He knew the danger they were in from the big bad wolf, and that silly little houses of straw and sticks stood no chance should the wolf try to huff and puff and blow them down. So he went much farther down the road and through the millennia, away from the wolf’s territory, until he found a nice flat field good for planting, near a large river from which he could divert water for irrigation. He set to work building himself a sturdy house of wood and stone that the wolf could not blow down. It took him weeks of hard labor, working eight to ten hours a day to build the house, and then more weeks to dig the irrigation canals and plant his large field. He knew that his lazy hunter-gatherer and horticulturalist brothers would soon be coming to him for shelter and food, and he, the industrious agriculturalist, planned to be prepared. The third little pig and his friends enjoyed increased population densities as more of them settled down and committed to growing their food. Yes, there was less variability in what they had to eat, and food production was extraordinarily labor intensive, but with the availability of safe weaning foods, female pigs could nurse for shorter periods of time allowing for a return to fertility and shorter interbirth intervals so more little pigs could be born to work the fields and build the communities. Standing water from irrigation ended up being a pesky vector for mosquito-borne diseases like malaria, and sanitation and acute crowd infections became an issue, but agriculturalist pigs could also acquire possessions, own land and rise to the tops of social hierarchies, especially where female pig production and reproduction could be exploited. He was sure that he was much safer from the big bad wolf than his brother pigs who were still living in the forests, the jungles, and the wild fields where danger roamed.[ii] Life was good, although without much leisure, the third little pig didn’t have as much time to enjoy it.

The fourth little pig watched with resentment as intensive agriculture took over the most fertile land, and foraging and small-scale horticulture became marginalized. His desire to roam and explore new lands was the hunting-gathering legacy of wanderlust, and he had no desire to settle down. He gathered up his goat hair tent and began herding animals through agricultural territory, exploiting high hills, low valleys, the wild Northern steppes and the plains of Africa, developing humankind’s fourth subsistence strategy — pastoralism — and enjoying his freedom. Because male pigs tended to own, care for and manage the herds, and because they often had to fight for rights of passage through agricultural lands, pastoral warrior cultures developed that functioned to enhance male pig power. Their domination of herding tended to be reflected in other aspects of social organization – including the near universality of patrilineal decent, patrilocal residence patterns and segregation of the sexes. Life was good for the male chauvinist pigs, but symbolic and social stratification by gender spelled trouble for females, especially where strict honor codes and the exchange of women as chattel challenged girl-pig autonomy.

The fifth little pig, watching the dependence of his brothers and sisters on nature and knowing its dangers, was sure he could improve on matters. Farming could be industrialized, and by moving into cities and building large tenements made of bricks that could sustain huge populations densities, a work force would be available to modify the fruits of agricultural labor into value-added products for sale under a capitalistic economic system. Yes, some exploitation of pig children and recent pig immigrants would be necessary and infectious disease rates would rise, especially where sanitation and food quality was poor, but the fifth little pig could also amass huge stores of material wealth because he owned the means of production. With eventual improvements in sanitation, basic public health interventions and an intentional decrease in family size as children became more expensive to raise,  life expectancy would rise, providing a long lifetime over which to feel the intense need to buy the products produced in factories with innovative technologies and machinery. The fear of the big bad wolf would become a distant memory thanks to habitat destruction and the increasing distance of settlements from unmodified landscapes. Life was good for the fifth little pig and his industrializing friends, especially when they could exploit natural resources and a cheap labor force in the other pigs’ homelands.

The sixth little pig was so far removed from nature that he lost all sense of its value and devoted himself to inventing complex technologies, building gleaming cities of glass and concrete, paving over all things green and putting as many products as possible into elaborate plastic wrappers with widely identifiable logos and branding. He developed a technocratic society[iii] organized around an ideology of progress through the development of high technology and the global flow of information. Beginning just a few decades ago, the forces of globalization, consumerism and neocolonialism transformed even the most remote agriculturalists into dependents in an exploitative, global economy that produces vast inequities between high and low-income nations. The sixth little pig and a few of his elite investor friends benefited, while many others struggled to access even the most basic of resources. Soon environmentalist pigs began to notice that the nature that they had worked so hard to tame through technology was turning on them as industrialization heated the planet, melted the glaciers, and polluted the atmosphere. The sixth little pig started to wonder whether he and his industrialist brother had gone too far. 

And sure enough, as we all know, the big bad wolf (who escaped from a zoo rehabilitation program) did in fact show up, and he huffed, and he puffed, and he blew down the houses of the little pigs, who all came racing over to the house of their technocratic brother, who let them in and slammed the door just in time! In the end, they were safe in the sixth little pig’s McMansion where the big bad wolf could not harm them. But the first five little pigs were unhappy with the eighty-hour work week, lack of medical insurance and rampant consumerism, perceived needs and massive debt that the technocracy had to offer. They were frustrated by the lower status that was culturally assigned to them because of their “uncivilized” pasts. They felt uncomfortable in the air-conditioned home with the zero lot line, and missed the sounds of the wind in the trees. The first five little pigs became medical anthropologists and began to reflect on what had been lost when modernization became the primary goal during the Industrial Era. They realized with regret that the big bad wolf was nothing more than a metaphor for the wild, uncontrollable and chaotic natural world that pigs had been attempting to tame through culture. They didn’t want to give up their cars, computers, and cell phones, but they did wonder…perhaps there was a lesson to be learned from the story of the big bad wolf?

 Folktales often condense millennia of historical events into one short story, and this one is no exception. From the time of our emergence as Homo sapiens, perhaps as long as 195,000 years ago (McDougall, Brown and Fleagle 2005, White et al. 2003), we have lived as hunter-gatherers, picking fruit from trees, foraging wild grains, digging for vegetables, and hunting animals both large and small. The power of our own experiences, “living in the now”, and the effects of socialization that make “normal” simply what we are used to, can obscure the fact that the technocratic society we know and reproduce in today accounts for less than 1% of human history (Table 1). Only 1-2% of our biological make-up has evolved since the ape-human split between five and seven million years ago, meaning that the vast majority of our genes are ancient in origin (Trevathan, Smith and McKenna 2008). There have been a few simple genetic changes since the third little pig and his wife invented agriculture around 10-12,000 years ago,[iv] but the pace of cultural evolution is generally much faster than biological evolution. As a result, humans today occupy 35,000-year-old model bodies that are not particularly well adapted to the technocratic and industrializing cultures many of us live in (Armelagos, Brown, and Turner 2005; Eaton, Eaton III, and Cordain 2002).

Subsistence Strategy	Emergence (years before present)_
Hunting/Gathering	>100,000
(99% of human history)
Horticulture	12,000
Agriculture	10,000
Pastoralism	8,000
Industrialism	250
Technocracy	40

Table 1. Human Subsistence Pattern Timeline.

One of the primary contributions of evolutionary approaches in anthropology has been to remind us that Homo sapiens today still live in Paleolithic bodies adapted for the stressors faced by the first little pig. Current diet, lifestyle and reproductive patterns are drastically different from those that produced the selective pressure under which humans and human childbirth evolved. This mismatch in genes and culture promotes, accelerates and fosters certain diseases, especially those associated with changes in diet, reduced exercise levels and excessively interventive and mechanistic approaches to childbirth (Cheyney 2003, 2005; Trevathan, Smith, McKenna 1999, 2008). The notion that discontinuities between the conditions under which humans evolved and the conditions we live in today produce dis-ease is called the “discordance hypothesis”, and it forms the foundation for a relatively new subfield of Medical Anthropology called Evolutionary or Darwinian Medicine. This approach examines health conditions generated by the discordance between evolved biology and current culture and attempts to propose evolutionarily sound solutions or treatments (Stearns, Nesse and Haig 2008; Trevathan, Smith and McKenna 1999, 2008; Williams and Nesse 1991).

In this chapter, we discuss not the diversity in the ways childbirth is treated or culturally elaborated around the world as highlighted in the rest of this volume, but instead, we focus our attentions on the biocultural features that unite Homo sapiens as a species. We review what we see as remarkable similarities in human birth mechanisms and cultural practices over time and argue that, pre-Industrial Revolution, these similarities were an outgrowth of our common evolutionary heritage as bipedal primates. With industrialization, there emerged a fear-based need to control nature that, along with the hegemony of biomedicine, again produced relatively uniform cross-cultural birthing practices, though the latter differ significantly from premodern norms. We examine this shift in the cultural elaboration of birth at the onset of the Industrial Era and discuss three areas where current obstetric approaches can benefit from holistic, cross-cultural and evolutionary perspectives. Our approach is co-evolutionary, meaning that we focus on dual-inheritance, or the identification of relationships between evolutionary biology and culture (Hewlett, De Silvestri, and Guglielmino 2002). We use “biocultural” and “co-evolutionary” throughout to emphasize the interactions between genes, culture, behavior and unequal relationships of power (Goodman and Leatherman 1998) that combine to produce the cross-cultural birthing patterns we see today.

THE BIOCULTURAL EVOLUTION OF MODERN HUMAN CHILDBIRTH

The unique anatomical characteristics of the human pelvis and the complex delivery mechanisms they necessitate have occupied the research agendas of numerous evolutionary biologists (Lovejoy 1988; Rosenberg 1992; Rosenberg and Trevathan 1996; Trevathan 1987, 1988, 1997, 1999; Trevathan and Rosenberg 2000; Washburn 1960) since anthropologist Wilton Krogman (1951) first referred to childbirth as a “scar of human evolution”.  The difficulty of human childbirth relative to other primates (Stoller 1995) is thought to stem primarily from the so-called “obstetrical dilemma” or the conflicting evolutionary pressures on human pelvic shape that necessitate a relatively wide yet flattened pelvis to optimize energetically efficient muscular attachments required for bipedalism (Lovejoy 1988) on the one hand, and an open, rounded and spacious passageway for the birth of relatively large-brained infants on the other.  These competing selective pressures have resulted in an obstetrical compromise that requires the passage of a fetal head that is nearly the same size or larger than the maternal pelvis.  As a consequence, human babies, unlike their primate relatives, must maneuver through a series of complex orientations, called the cardinal movements or mechanisms of labor, as they travel through the changing diameters of the birth canal during delivery (Trevathan 1987, 1988, 1997, 1999; Trevathan and Rosenberg 2000) (Figure 1).  As a result, researchers, with few exceptions (Walrath 2003, 2006), have tended to see human birth as more painful and of longer duration relative to other mammals and to non-human primates, though for healthy mothers and babies, not necessarily more dangerous.

<<put figure 1 here>>

Figure 1. Mechanisms or cardinal movements of human delivery in occiput anterior presentations (from Trevathan, Smith and Mckenna 1999: 196).  PERMISSION requested from Oxford University Press

The comparatively difficult nature of parturition in our species has led researchers (Rosenberg 1992, 2003; Trevathan 1999) to hypothesize about the effects of our uniquely human obstetrical adaptations on changes in birthing behaviors and cultural norms over time. While non-human primates usually choose to give birth alone and under the cover of night, human mothers almost always seek out assistance from female relatives, friends and/or experienced birth attendants. Biological anthropologist Wenda Trevathan (1997, 1999) reasons that at some point in human history, the benefits of assisted birth would have outweighed the safety of solitary delivery. She finds support for this argument in the cross-cultural observation that very few societies idealize unassisted birth, and in those that do, solitary birth may only be expected of women who have already had one or more babies and/or in mothers with uncomplicated deliveries.[v]

This condition of “obligate midwifery”, or the uniquely human need for an attendant, Trevathan (1997) argues, evolved in response to three important differences between the mechanisms of birth in humans relative to other primates.  First, because human babies almost always emerge facing away from the mother (a position called occiput anterior), it is difficult for the mother to reach down, as non-human primates do, to catch the baby and to clear an airway or remove the umbilical cord from around the infant’s neck (Figure 2). Secondly, modern humans give birth to secondarily altricial[vi]  infants who require extensive care from the time of delivery. The relative helplessness of the human infant may be an additional reason why extra hands at a birth contribute to improved reproductive success, especially where mothers are exhausted by particularly long and difficult labors. Thirdly, Trevathan (1997) notes that powerful maternal emotions around labor and birth, including excitement, anxiety, fear, tension, joy and uncertainty, may have provided the evolutionary impetus for women to seek out support. The emotions of childbirth that encourage us to pursue assistance and companionship may be seen as biocultural adaptations to the physiological complications that result from bipedalism.  Taken together, these three components of human birth may have contributed to the transformation of the process from a solitary to a highly social enterprise, setting humans on a trajectory toward social and cultural interventions in birth (Trevathan 1997).

<<insert figure 2 here>>

Figure 2. Solitary, occiput posterior delivery in nonhuman primates (from Trevathan 1987: 91, Drawings by Bryan McCuller).  Permission requested from Aldine de Gruyter.

THE CULTURAL ELABORATION OF CHILDBIRTH: BIOMEDICAL HEGEMONY AND THE TECHNOCRATIC MODEL

Enter culture… At some point in human history, perhaps around a million years ago with the appearance of large-brained Homo erectus, as Karen Rosenberg (1992, 2003) has proposed, human ancestors began to seek assistance, and in so doing, initiated the transformation of birth from a solitary, biological process to a biocultural and social one. As the chapters in this volume demonstrate, the nuances of each culturally constructed birthing system — the dietary taboos, the ideal direction to face during delivery, the rituals considered necessary for a successful birth, the first words whispered into the ears of newborn babes — are limitless in their variety. However, a broad, historical view makes far more visible what the birthing systems of hunter-gatherers, horticulturalists, pastoralists, and agriculturalists have in common. Up until the Industrial Age just 250 years ago, the essential cultural practices associated with childbirth were relatively uniform. Women all around the world moved freely during labor, changing positions frequently as a method for managing the pain associated with labor contractions and cervical dilation. They ate and drank as they pleased within the cultural confines of what was considered acceptable, nourishing and safe for the mother and baby. They were attended by other women whom they knew well, in a place that was familiar to them — usually in their home or in the home of a female relative. They labored and birthed in upright positions using instinctive knowledge to expand the size of the pelvis, capitalize on gravity, and to maximize the efficiency of the abdominal muscles needed for pushing (Figure 3). They developed artifacts like birthing stools and chairs, threw ropes over beams to pull against, birthed in flexible hammocks, and used poles for support in order to facilitate upright birth. Midwives knelt down in front of the upright mothers to receive their babies. Newborns were kept with their mothers for warmth, and long-term exclusive breastfeeding, co-sleeping, slings and other technologies kept baby and mother close during a year or more of external gestation (McKenna 2003; Montague 1971; Trevathan and McKenna 2003).

<<put figure 3 here>>

Figure 3. Childbirth woodcut showing an upright birthing position in Europe during the Middle Ages (From When Midwifery Became the Male Physician’s Province: The Sixteenth Century Handbook: The Rose Garden for Pregnant Women and Midwives by Eucharius Rosslin, 1513 (Rosslin and Arons 1994: 31). Book is out of print.

These basic cultural adaptations were normative until the huge social changes associated with industrialization moved birth from home to hospital and fundamentally changed the cultural face of birth, while doing little to reduce mortality and morbidity (Cassidy 2006; Wertz and Wertz [1977] 1989; Wilson 1996). In fact, it was the industrialization of birth, not birth itself, that gave women the fear of birth they have today (Cassidy 2006; Ulrich 1990; Wertz and Wertz 1989; Wilson 1995). Before the widespread acceptance of germ theory, the large, unsanitary lying-in hospitals of industrialized nations produced massive epidemics of puerperal or childbirth fever in the 18^th, 19^th and early 20^th centuries (Crawford 1990; Leavitt 1986; Pollock 1990, 1997). Women died by the thousands in the lying-in hospitals of Europe and the United States until the germ theory of disease became accepted in the late 19^th and early 20^th centuries. As a result, massive precautions were taken in hospitals to prevent or decrease puerperal fever and other infections with a primary focus on attempts at sterilizing, standardizing and managing the birth process. Birthing mothers were painted from breasts to knees with orange iodine, forbidden to touch their own infants, and separated from them after birth, sometimes for days, even though more infections started (and still start) in nurseries than in babies kept with their mothers (Bertini et al. 2006; James et al. 2008; McDonald et al. 2007; Nguyen et al. 2007). Ritualized procedures like enemas and pubic shaving were instituted under the premise that they would prevent infections. It has taken decades of research to show definitively that such practices do not in fact decrease rates of infection; they were implemented because of cultural categories and unfounded beliefs and are still common in developing countries (Cuervo, Rodriguez, and Delgado 2000; Baservi and Lavender 2001; Reveiz, Gaitan, and Cuervo 2007).

Over the last 40 years, the interventions that were introduced into the birthplace during industrialization have multiplied as societies like the United States have embraced high-tech, invasive solutions. As a result, much of our knowledge of unmedicated birth has been lost (Davis-Floyd 2001b). Physicians have been de-skilled and often no longer know how to attend normal deliveries patiently. After all, why learn how to attend a vaginal breech birth when a cesarean is so much easier (for the physician), and often more lucrative, to perform? As birth became more medicalized around the world, in most places, midwives lost their prestige as the guardians and guides at normal deliveries, becoming subordinated to physicians and trained out of traditional practices toward more industrial and technocratic approaches to birth.

Yet a midwifery revival is taking place — as more and more midwives realize what is being lost, they are working to regain their positions as the keepers and researchers of knowledge about physiologic birth, speaking and practicing outside the dominant paradigm, holding open a conceptual space where technocratic birth may be challenged (Cheyney 2008; Davis-Floyd 1992, 1997, 2001a, 2003, 2004; Davis-Floyd and Johnson 2006; Downe 2004). Biomedical hegemony, or the power-laden rule by cultural consent that constructs some models as authoritative (Jordan 1997) and others (like the midwifery models of care) as fringe, retrogressive and uncivilized, means that today, birth looks quite similar all over the world, yet quite different from the kind of births the wives of the first four little pigs would have experienced.

Today, as a result of the transformation of birth during the industrial and technocratic eras, women are not allowed to eat, drink, or walk around during labor. Dressed in hospital gowns and hooked up to intravenous lines that often carry pitocin[vii], prophylactic antibiotics and narcotics for pain, they give birth flat on their backs or in semi-sitting positions. The most notable differences in the contemporary medical treatment of birth have little to do with the specific customs of particular cultures, but instead, are more closely tied to the vast disparities between resource-rich and resource-poor countries. In most high-income nations, women receive significantly more interventions with pharmaceuticals and technologies applied at a higher rate, in more attractive and humane hospital settings. In most low-income nations, women receive less expensive and often outdated interventions like shaving, enemas, and episiotomies without the benefits of expensive interior decorating. In both rich and poor countries, cesarean rates are rising exponentially without a concomitant improvement in maternal and fetal health outcomes (Althabe et al. 2006; Wagner 2006). Cultural differences and traditions have been largely obscured by the highly influential and heavily standardized biomedical hospital procedures now common in almost all industrialized and industrializing nations.[viii] Technology has tamed the big bad wolf, damming, controlling and homogenizing the raw, elemental power of birth. However, the rapidly rising rates of iatrogenic morbidity, and in some places, the rising rates of perinatal and maternal mortality due to excessive obstetrical intervention (Betran et al. 2007, Liu et al. 2007, Villar et al. 2006, 2007) suggest that perhaps we have lost something in the process. What does the big bad wolf still have to teach us?

preModern Birthing Patterns and Why they Matter

Returning to the discordance hypothesis as applied to childbirth and the lens of Evolutionary Medicine, we have identified several areas where the conditions under which human childbirth evolved differ so substantially from the cultural norms enforced under technocratic models of birth that they require closer examination. Cross-cultural midwifery approaches, with their often-explicit rejection of the key components of the technocratic model, combined with their subversive application of time-honored behaviors and premodern traditions, provide an important point of comparison for critically examining contemporary, technocratic practices. The cross-cultural midwifery norms, for example, of encouraging movement in labor, upright pushing positions, the provision of intensive emotional support during labor, along with active encouragement of long-term breastfeeding and co-sleeping adaptive complexes are associated with significantly improved psychosocial and clinical outcomes for both mother and baby (McKenna, Mosko and Richard 1999; McKenna and McDade 2005).

We propose that midwifery and other low-tech, high-touch models of care that attempt to preserve “natural” (read those with a long history in human and non-human primates) birthing practices, produce the positive outcomes documented in so many studies, because they reduce the discordance between evolutionary biology and recent culture. The do this via a mechanism that promotes working with, rather than against, the evolved biological and psychosocial needs of human mothers (Anderson and Murphy 1995; Durand 1992; Fullerton, Navarro, and Young 2007; Janssen, Holt, and Myers 1994; Janssen et al. 2002; Johnson and Daviss 2005; Murphy and Fullerton 1998; Rooks 1997; Schlenzka 1999). A closer examination of the premodern, reclaimed midwifery practices listed above, through the lens of Evolutionary Medicine, provides a clear, evidence-based template for the reform of contemporary, technocratic models of birth.

Unrestrained Movement in Labor Followed by Upright, “Physiologic” Pushing

Freedom of movement in labor used to be a cross-cultural norm, as it is in our closest living primate relatives, and the notion that women should lie in bed with their ability to self-comfort hindered by tubes and devices for fetal monitoring or intravenous fluid delivery is relatively recent and one that makes little sense from an evolutionary perspective (Trevathan 1999). There is a large body of clinical research that documents the value of upright postures and mobility during the first stage of labor (the stage where the cervix dilates) for speeding and easing the complicated descent through the pelvis that is unique to humans (Bodner-Adler et al. 2003; Gupta and Hofmeyr 2004; Gupta and Nikodem 2000). Upright postures maximize the dimensions of the pelvis, while improving blood flow to the baby by preventing compression of the large vessels that run along the mother’s spine, supplying the uterus with oxygenated blood. Women who deliver outside the technocratic model with midwives or holistic physicians tend to labor and push in upright positions in accordance with the physiologic urges that come with an unmedicated second stage (the stage where the baby moves down through the birth canal and is born) (Cheyney 2005; Davis-Floyd et al. 2009). Epidural rates of close to 80% in U.S. hospitals (Declercq et al. 2006), however, prevent most women from utilizing the well-documented benefits of upright labor and pushing positions like squatting that optimize the curve of the human birth canal called the Curve of Carus (Figures 4 and 5).

<<put figure 4 here>>

Figure 4. Changes in the Curve of Carus with Maternal Positioning (from Sutton and Scott 1996:55). This book is out of print.

<<put figure 5 here>>

Figure 5. Homebirth mother reclaiming a premodern birthing position, assisted by midwives, assisted by the comforting effects of water made possible by the high-tech, hot tub (Photo by Peter Gonzalez).

Technocratic models of pushing rely instead on a technique called “laboring down,” meaning that epidurally administered medications are stopped or slowed during pushing so that mothers can regain enough sensation to feel and follow the physiologic urge to push. However, because the numbing and temporarily paralyzing effects of spinal or epidural anesthesia take a variable time to recede, women often begin to feel the urge to push and yet cannot move freely to maximize their efforts.  This means that most women who deliver under the technocratic model do so in a semi-sitting position with restricted movement. Many will, of course, still go on to birth vaginally. However, for those women with a tighter fit, the inability to move into more upright pushing positions, as well as the reduced ability to feel the urge to push, may mean the difference between a vaginal and a surgical delivery. Non-physiologic pushing, we argue, partially explains the high rates of cesarean delivery and associated maternal and neonatal morbidity that characterizes modern, technocratic obstetrics (Althabe et al. 2006). [Editor’s note: See the chapter by Travis Harvey and Lila Buckley that suggests that fear of childbirth pain is the prime motivation for cesarean in Chinese women.]

Obligate Midwifery, Continuous Labor Support and the Avoidance of “Intimate Strangers”

The intimacy of time-intensive, continuous labor support provided by birth attendants who are a part of a woman’s community or have come to know her well over the course of her pregnancy may play an additionally decisive role in how human birth unfolds. The calming presence of a familiar midwife or other companion may, for example, help to mitigate levels of stress hormones like cortisol and epinephrine that are known to inhibit the effects of oxytocin — the hormone that stimulates labor contractions (Jolly 1999). The complex evolutionary relationships between hormones produced during fear and/or pain responses and those that stimulate labor combine to produce what have been called the “white coat” and “weekend” effects in humans and in non-human primates, respectively. These effects are characterized by the lessening or complete cessation of labor contractions when women and other primates feel afraid or anxious in response to being observed by doctors (“white coats”) and/or researchers. Where women experience a decrease in labor contractions in response to fear or uncertainty (compensated for in the hospital by the administration of pitocin), non-human primate mothers who live in captivity are often able to delay delivery until their attendants leave the holding facility (hence the “weekend” effect).

The release of adrenaline and cortisol in response to fear and stress, and the consequent slowing of labor, may have served an adaptive function in the past because such mechanisms prevent mammals — humans included — from delivering fragile infants under conditions of predatory danger. However, fears of pain, the hospital, specific procedures (like the placement of an IV catheter), or even just the feeling of self-consciousness that can come with laboring in front of “intimate strangers”, and the contraction-dampening effects of stress hormones are less beneficial in a technocratic environment where delivery must occur according to a relatively rigid time schedule to be considered “normal”. If human childbirth evolved under conditions of obligate midwifery as proposed by Trevathan, and with the underlying assumption that we still occupy Paleolithic bodies, then midwifery and other holistic models of care that focus on trust, building relationships, and reducing maternal stress hormones through intensive emotional and psychosocial support during labor partially explain the excellent outcomes associated with homebirth and other alternative models of care cited above. Current technocratic approaches vastly underestimate the evolved psychosocial and physiological needs of women in labor.

Low Intervention Birth – Long-term Breastfeeding – Co-sleeping Adaptive Complex

The intimacy and connectedness that facilitate human childbirth have also been extended and applied to early parenting behaviors and mother-baby coevolutionary patterns among primates. James McKenna (2003), an evolutionary biologist who focuses on early infant sleeping, breastfeeding and breathing patterns, has examined contemporary Western childrearing practices like solitary sleeping and scheduled nursing from the perspective of evolutionary medicine. His work challenges the basic assumption that solitary sleep should be considered “normal” for human babies, concluding instead that an understanding of evolutionary biology and cross-cultural and cross-species comparisons suggests that there are benefits to parent-infant co-sleeping and long-term, on-demand nursing (McKenna and McDade 2005; McKenna and Mosko 2001). These benefits include the promotion of early bonding, growth and neurological development in the newborn and, perhaps most importantly, the regulation of breathing patterns in altricial infants especially during stages of deeper sleep. Safe co-sleeping and nighttime breastfeeding may also be protective against Sudden Infant Death Syndrome (SIDS) in some contexts. McKenna argues that long-term breastfeeding and parent-infant co-sleeping are part of an adaptive complex for primates that evolved to allow for intensive parental investment, social learning and rapid postnatal brain growth in altricial infants (McKenna, Mosko and Richard 1999).

A growing number of birth and early parenting activists around the world are beginning to question the decline in continuous contact in childrearing that characterized parenting practices until four decades ago, when “plastic babysitter” technologies like monitors, swings, cribs and car seats began to replace continuous physical contact (DeLoache and Gottlieb 200; Hrdy 1999; Small 1999, 2001). Midwives and holistic pediatricians who value the external gestation period described by McKenna (2003) and others (Montague 1971; Trevathan and McKenna 2003) argue that more high-touch, alternative parenting practices often produce babies that are healthier (emotionally and physically) than bottle-fed, solitary-crib-sleeping and stroller-carried infants that are the norm under the technocratic paradigm.

Because we see birthing behaviors as inextricably linked to mother-baby co-evolution and early parenting adaptations like exclusive, on-demand breastfeeding and sensory proximity of mother and baby during sleep, we propose an extension of McKenna’s (2003) breastfeeding-co-sleeping adaptive complex to include low-intervention, physiologic birth as an approach that helps to decrease the discordance between human biology and our technocractic culture. The alertness of unmedicated infants, combined with the evolutionary and premodern cultural norm of keeping the mother-baby-unit intact in the hours immediately following birth, facilitates the cascade of hormonally regulated mother-baby bonding that promotes exclusive and long-term breastfeeding (Ludington-Hoe, Hadeed, and Anderson et al. 1991a, 1991b; McKenna 2003; Odent 2007; Trevathan and McKenna 2003).

***

We have reviewed what we see as remarkable similarities in human birth mechanisms and cultural practices over time and argued that, pre-Industrial Revolution, these similarities were an outgrowth of our common evolutionary heritage as bipedal primates. With industrialization, there emerged a fear-based need to control nature that, along with the hegemony of biomedicine, again produced relatively uniform cross-cultural birthing practices, though the later differ significantly from premodern norms. While we acknowledge the multiple culturally-mediated differences in the ritual treatment of birth, we are also struck by the remarkable similarities in premodern birthing practices in hunting-gathering, horticultural, agricultural, and pastoral societies. These births were characterized by freedom of movement, upright positions, midwives (or female relatives) in attendance, and breastfeeding and co-sleeping during the external gestation period.  Our common evolutionary heritage as bipedal primates and the normal, instinctive physiology of birth were relatively honored in premodern societies.

In striking contrast, birth in the industrial and technocratic eras, while very similar cross-culturally, looks very different from what our the first four little pig mothers would have experienced — women flat on their backs, hooked up to intravenous lines and monitors and cared for by “intimate strangers”. This transformation away from what evolutionary biology might predict increases the discordance between the evolved physiology of human childbirth and contemporary cultural interventions. Using the lens of Evolutionary Medicine, we have identified several areas where premodern birthing and childrearing patterns can provide a corrective to current technocratic approaches that, we argue, do little to honor the Upper Paleolithic bodies we occupy. These areas include:

• structural-and institution-level changes needed to facilitate unrestricted movement in labor
• upright physiologic positions for pushing
• continuous labor support
• increased provider-mother connection through continuity of care
• removal of cultural and protocol constraints that inhibit the honoring of human external gestations through exclusive, long-term, on-demand nursing and technologies like co-sleepers and slings that increases vital, tactile stimulation of our infants.

Evolutionary approaches, while certainly not without limitations in that they carry their own set of contestable presuppositions, are valuable in as far as they provide yet another way of critically examining birth in cultures that supervalue science. We encourage biomedical researchers and clinical practitioners to consider not only the proximate or immediate contexts of an individual woman’s pregnancy, but also the larger, evolutionary history of our species that has shaped our biology and, to some extent, our culture and behaviors. In addition, we advocate a deeper and more explicit acknowledgment of the fact that recent human evolution has not unfolded within a power vacuum. Rather, the influences of industrialism, technocracy, and gendered power inequities have generated a biomedical hegemony that has been perpetrated around the world through both colonialism and the maladaptive imitation of what appears to be “best” because it is modern. Adjusting our critical lens to see birth within the larger and more holistic contexts of cross-cultural and evolutionary perspectives, we can combine the best of what technological innovations have to offer, while also embracing the wild beauty and instinctive power of the big bad wolf in the birthplace (Figure 6).

<<put figure 6 here>>

Figure 6. An untamed, physiologic, midwife-attended birth in Porto Alegre, Brazil, 2007 (Photograph by Ricardo Jones, MD).

Robbie Davis-Floyd

Melissa Cheyney

References

Anderson, R. E., and R. Murphy. “Outcomes of 11,788 Planned Home Births Attended by Certified Nurse Midwives: A Retrospective Descriptive Study.” Journal of Nurse Midwifery 40(1995): 483-492.

Allison, Anthony C. “Protection Afforded by Sickle-Cell Trait Against Malarial Infection.” British Medical Journal 1(1954): 290-294.

Althabe, F., et al. “Cesarean Section Rates and Maternal and Neonatal Mortality.” Birth 33(2006): 270.

Armelagos, G., P. Brown, and B. Turner. “Evolutionary, Historical and Political Economic Perspectives on Health and Disease.” Social Science and Medicine 61.4(2005): 755-765.

Basevi, V., and T. Lavender. “Routine Perineal Shaving on Admission in Labour.” Cochrane Database of Systematic Reviews 1(2001): CD001236.

Beall, Cynthia M., and A. Theodore Steegmann, Jr. “Human Adaptation to Climate: Temperature, Ultraviolet Radiation, and Altitude.” Human Biology: An Evolutionary and Biocultural Perspective. Ed. Sara Stinson, Barry Bogin, Rebecca Huss-Ashmore, and Dennis O’Rourke. New York: Wiley-Liss, Inc. 2000. 163-224.

Bertini, G., P. Nicoletti, F. Scopetti, P. Manoocher, C. Dani and G. Orefici. “Staphylococcus Aureus Epidemic in a Neonatal Nursery: A Strategy of Infection Control.” European Journal of Pediatrics 165.8(2006): 530-5.

Betrán, Ana, Mario Merialdi, Jeremy A. Lauer, Wang Bing-shun, Jane Thomas, Paul Van Look, and Marsden Wagner.“Rates of Caesarean Section: Analysis of Global, Regional and National Estimates.” Pediatric and Perinatal Epidemiology 21(2007): 98-113.

Biesele, B. 1997. “An Ideal of Unassisted Birth: Hunting, Healing, and Transformation among the Kalahari Ju/’hoansi,” Childbirth and Authoritative Knowledge: Cross Cultural Perspectives. Ed. R. Davis-Floyd and C. Sargent. Berkeley: University of California Press. 474-499.

Block, J. Pushed: The Painful Truth about Childbirth and Modern Maternity Care. Cambridge, Massachusetts: DaCapo Lifelong Books, 2007.

Bodner-Alder, B., K. Bodner, O. Kimberger, P. Lozanov, P. Husslein, and K. Mayerhofer. “Women’s Position During Labour: Influence on Maternal and Neonatal Outcome.” Wiener Klinische Wochenschrift 115.19-20(2003): 720-3.

Byford, Julia. Dealing with Death Beginning with Birth: Women’s Health and Childbirth on Misima Island, Papua New Guinea. Ph.D. Dissertation. Canberra: Australian National University, 1999.

Cassidy, Tina. Birth: The Surprising History of How We Are Born. New York: Atlantic Monthly Press, 2006.

Cheyney, Melissa. Darwin and the American Homebirth Movement: Toward an Evolutionary Obstetrics. Paper Presented at the American Anthropological Association Meetings. Chicago, Illinois, 2003.

—. In Transition: A Biocultural Analysis of Homebirth Midwifery in the United States. Unpublished Ph.D. Dissertation. Eugene: University of Oregon, 2005.

—. “Homebirth as Systems-Challenging Praxis: Knowledge, Power and Intimacy in the Birthplace.” Qualitative Health Research 18.2(2008): 254-267.

Crawford, P. “The Construction and Experience of Maternity in Seventeenth-Century England.” Women as Mothers in Pre-industrial England. Ed. V. Fildes. London: Routledge, 1990. 3-38.

Cuervo, L. G., M.N. Rodriguez, and M. B. Delgado. “Enemas during Labor.” Cochrane Database of Systematic Reviews 2(2000): CD000330.

Davis-Floyd, Robbie. Birth as an American Rite of Passage. Berkeley: University of California Press, 1992.

—. “Intuition as Authoritative Knowledge in Midwifery and Homebirth,” Childbirth as Authoritative Knowledge: Cross-Cultural Perspectives. Ed. R. Davis-Floyd and C. Sargent, Berkeley: University of California Press, 1997. 315-349.

—. “The Technocratic, Humanistic, and Holistic Models of Birth.” International Journal of Gynecology and Obstetrics 75.1(2001a): S5-S23.

—. “La Partera Profesional: Articulating Identity and Cultural Space for a New Kind of Midwife in Mexico.” Daughters of Time: The Shifting Identities of Contemporary Midwives, Medical Anthropology. Ed. Robbie Davis-Floyd, Sheila Cosminsky, and Stacy L Pigg. Medical Anthropology special 2 part issue. 20.2-3(2001b): 185-243.

—. “Home Birth Emergencies in the U.S. and Mexico: The Trouble with Transport.” Reproduction Gone Awry, Social Science and Medicine. Ed. Gwynne Jenkins and Marcia Inhorn. 56.9(2003): 1913-1931.

—. Birth as an American Rite of Passage, 2^nd edition. Berkeley and London: University of California Press, 2004.

Davis-Floyd, R., and G. St. John. From Doctor to Healer: The Transformative Journey. New Brunswick, New Jersey: Rutgers University Press, 1998.

Davis-Floyd, R. and C.B. Johnson. Mainstreaming Midwives: The Politics of Change. New York: Routledge, 2006.

Davis-Floyd, Robbie, Lesley Barclay, Betty-Anne Daviss, and Jan Tritten, eds. 2009. Birth Models That Work. Berkeley: University of California Press.

Declerq, Eugene, Carol Sakala, Maureen Corry, and Sandra Appelbaum. Listening to Mothers II: Report of the Second National US Survey of Women’s Childbearing Experiences, Executive Summary. New York: Childbirth Connection, 2006.

DeLoache, Judy, and Alma Gottlieb.. A World of Babies: Imagined Childcare Guides for Seven Societies. Cambridge: Cambridge University Press, 2000.

DeVries, Raymond.. A Pleasing Birth: Midwives and Maternity Care in the Netherlands. Philadelphia: Temple University Press, 2004.

DeVries, R., C. Benoit, E. van Teijlingen, and S. Wrede, eds.. Birth by Design: Pregnancy, Maternity Care and Midwifery in North America and Europe. New York: Routledge, 2001.

Downe, Soo, ed.. Normal Childbirth: Evidence and Debate. Edinburgh: Churchill Livingstone, 2004.

Durand, M.. “The Safety of Home Birth: The Farm Study.” American Journal of Public Health 82.3(1992): 450-453.

Durham, WH.. Coevolution: Genes, Culture, and Human Diversity. Stanford, California: Stanford University Press, 1991.

Eaton, S.B., S.B. Eaton III, and L. Cordain.. “Evolution, diet, and health.” Human Diet: Its Origin and Evolution. Ed. P.S. Ungar and M.F. Teaford. Westport, Connecticut: Bergin and Garvey, 2002. 7-17.

Engelmann, G.. Labor Among Primitive Peoples. New York: AMS Press, [1882] 1977.

Fullerton, J., A. Navarro, and S. Young.. “Outcomes of Planned Home Births: An Integrative Review.” Journal of Midwifery and Women’s Health 52.4(2007): 323-333.

Goer, H., and R. Wheeler.. The Thinking Woman’s Guide to a Better Birth. New York: Pedigree Books, 1999.

Goodman, A., and T. Leatherman.. “Traversing the Chasm between Biology and Culture: An Introduction.” Building a New Biocultural Synthesis: Political-Economic Perspectives on Human Biology. Ed. A. Goodman and T. Leatherman,. Ann Arbor: University of Michigan Press, 1998. 3-42.

Gupta, J., and G. Hofmeyr.. “Position for Women During Second Stage of Labour” Cochrane Database of Systematic Reviews 1(2004): CD002006.

Gupta, J., and C. Nikodem. “Maternal Posture in Labour.” European Journal of Obstetrics, Gynecology, and Reproductive Biology 92.2(2000): 273-7.

Hewlett, Barry S., Annalisa De Silvestri, and C. Rosalba Guglielmino.. “Semes and Genes in Africa.” Current Anthropology 42.2(2002): 313-321.

Hodnett, E., S. Gates, G.J. Hofmeyr, and C. Sakala.. “Continuous Support for Women during Childbirth.” Cochrane Database of Systematic Reviews 3(2005): CD003766.

Hrdy, S. B.. Mother Nature: Maternal Instincts and How They Shape the Human Species. New York: Ballantine Books, 1999.

James, L., et al. “Methicillin-Resistant Staphylococcus Aureus Infections among Healthy Full-Term Newborns.” Archives of Disease in Childhood, Fetal and Neonatal Edition 93.1(2008): F40-4.

Janssen, P., V. Holt, and S. Myers.. “Licensed Midwife-Attended, Out-of-Hospital Births in Washington State: Are They Safe?” Birth 21.3(1994): 141-148.

Janssen, P., S. Lee, E. Ryan, D. Etches, D. Farquharson, D. Peacock, and M. Klein.. “Outcomes of Planned Home Births Versus Planned Hospital Births After Regulation of Midwifery in British Columbia.” Canadian Medical Association Journal 166.3(2002): 315-323.

Johnson, K.C. and B.A. Daviss.. “Outcomes of Planned Home Births with Certified Professional Midwives: Large Prospective Study in North America.” British Medical Journal 330.7505(2005): 1416-1422.

Jolly, A.. Lucy’s Legacy: Sex and Intelligence in Human Evolution. Cambridge, Massachusetts: Harvard University Press, 1999.

Jordan, Brigitte.. “Authoritative Knowledge and Its Construction.” Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives. Ed. Robbie-Davis-Floyd and Carolyn F. Sargent. Berkeley: University of California Press, 1997. 55-79.

Katz, SH.. “Food and Biocultural Evolution: A Model for the Investigation of Modern Nutritional Problems.” Nutritional Anthropology. Ed. FE Johnson, New York: Alan R. Liss, 1987. 41-63.

Klein, M., S. et al.. “Epidural Analgesia Use as a Marker for Physician Approach to Birth: Implication for Maternal and Newborn Outcomes.” Birth 28.4(2001): 243-248.

Konner, M., and M. Shostack.. “Timing and Management of Birth among the !Kung: Biocultural Interaction in Reproductive Adaptation.” Cultural Anthropology 2.1(1987): 11-28.

Krogman, W.. “The Scars of Human Evolution.” Scientific American 185(1951): 54-57.

Kroeger, Mary, and Linda Smith.. The Impact of Birth Practices on Breastfeeding: Protecting the Mother and Baby Continuum. Sudbury, Massachusetts: Jones and Bartlett Publishers, 2004.

Leavitt, J.W.. “Under the Shadow of Maternity: American Women’s Responses to Death and Debility Fears in Nineteenth-Century Childbirth.” Feminist Studies 12.1(1986): 129-154.

Lewin, R., and R. Foley.. Principles of Human Evolution, 2^nd edition. Oxford: Blackwell Publishers, 2004.

Liu, S., R.M. Liston, K.S. Joseph, et al.. Maternal Mortality and Severe Morbidity Associated with Low-Risk Planned Cesarean Delivery Versus Planned Vaginal Delivery at Term. Candaian Medical Association Journal 176(2007): 455-460.

Lovejoy, O. C.. “The Evolution of Human Walking.” Scientific American 259.5 (November 1988): 118, 122–123, 125.

Ludington-Hoe, S., A. Hadeed, and G. Anderson. “Physiologic Responses to Skin-to-Skin Contact in Hospitalized Premature Infants.” Journal of Perinatology 11.1(1991a.): 19-24.

—. “Randomized Trials of Cardiorespiratory, Thermal and State Effects of Kangaroo Care for Preterm Infants.” Paper presented at the biennial meetings of the Society for Research in Child Development. Seattle, Washington, 1991b..

McDonald, J.R., et al.. “Methicillin-Resistant Staphylococcus Aureus Outbreak in an Intensive Care Nursery: Potential for Interinstitutional Spread.” The Pediatric Infectious Disease Journal 26.8(2007): 678-683.

McDougall, Ian, Francis Brown, and John Fleagle.. “Stratigraphic Placement and Age of Modern Humans from Kibish, Ethiopia.” Nature 433(2005): 733-736.

McKenna, J.. “Sudden Infant Death Syndrome in Cross-cultural Perspective: Is Infant-Parent Sleeping Protective?.” The Manner Born: Birth Rites in Cross-cultural Perspective. Ed. L. Dundes. Walnut Creek, California: Altamira Press, 2003. 163-178.

McKenna, J. and T. McDade. 2005. Why Babies Should Never Sleep Alone: A Review of the Cosleeping Controversy in Relationship to SIDS, Bedsharing and Breast Feeding. Paediatric Respiratory Review 6(2): 134-152.

McKenna, J. and S. Mosko. 2001. “Mother-infant co-sleeping: Toward a new scientific beginning.” Sudden Infant Death Syndrome: Problems, Progress and Possibilities. Ed. R.Byerd and H. Krous, 258-272. New York: Arnold.

McKenna, J., S. Mosko and C. Richard.. “Breastfeeding and Mother-Infant Cosleeping in Relation to SIDS Prevention.” Evolutionary Medicine. Ed. W. Trevathan, E.O. Wilson and J. McKenna. New York: Oxford University Press, 1999. 53-74.

Montague, A.. Touching: The Human Significance of Skin. New York: Harper and Row Publishers, 1971.

Murphy, P. and J. Fullerton.. “Outcomes of Intended Home Births in Nurse-Midwifery Practice: A Prospective Descriptive Study.” Obstetrics and Gynecology 92.3(1998): 461-470.

Nguyen, D.M., E. Bancroft, L. Mascola, R. Guerara and L. Yasuda.. “Risk Factors for Neonatal Methicillin-Resistant Staphylococcus Aureus Infection in a Well-Infant Nursery.” Infection Control and Hospital Epidemiology 28.4(2007): 406-11.

Odent, Michel.. Birth and Breastfeeding. Forest Row, East Sussex: Clairview Books, 2007.

Pollock, Linda A.. “Embarking on a Rough Passage: The Experience of Pregnancy in Early-Modern Society.” Women as Mothers in Pre-Industrial England. Ed. V. Fildes. London: Routledge, 1990. 39-67.

—. “Childbearing and Female Bonding in Early Modern England.” Social History 22(1997): 287-306.

Reveiz, L., H. G. Gaitan and L. G. Cuervo.. “Enemas During Labour.” Cochrane Database of Systematic Reviews 4(2007): CD000330.

Rooks, J.. Midwifery and Childbirth in America. Philadelphia: Temple University Press, 1997.

Rosenberg, K.. “The Evolution of Modern Human Childbirth.” American Journal of Physical Anthropology 35(1992): 89-124.

—. “Comments. Response to D. Walrath. 2003. Rethinking Pelvic Typologies and the Human Birth Mechanism.” Current Anthropology  44.1(2003): 5-31.

Rosenberg, K. and W. Trevathan.. “Bipedalism and Human Birth: The Obstetrical Dilemma Revisited.” Evolutionary Anthropology 4(1996): 161-168.

—. “The Evolution of Human Birth.” New Look at Human Evolution.  Special Edition of Scientific American November 2001: 72-77.

Rosslin, E. and W. Arons.. When Midwifery Became the Male Physician’s Province: The Sixteenth Century Handbook: The Rose Garden for Pregnant Women and Midwives. North Carolina: McFarland and Company, 1994.

Schlenzka, P.. Safety of Alternative Approaches to Childbirth. Unpublished Ph.D. Dissertation. Palo Alto, California: Stanford University, 1999.

Shostack, M.. Nisa: The Life and Words of a !Kung Woman. Cambridge, Massachusetts: Harvard University Press, 1981.

Small, Meredith F.. Our Babies, Ourselves: How Biology and Culture Shape the Way We Parent. New York: Anchor Books, 1999.

—. Kids: How Biology and Culture Shape the Way We Can Raise Young Children. New York: Anchor Books, 2001.

Stearns, S., R. Nesse and D. Haig.. “Introducing Evolutionary Thinking for Health and Medicine.” Evolution in Health and Disease. Ed. S. Stearns and J. Koella. Oxford: Oxford University Press, 2008. 1-16.

Stoller, M.. “The Obstetric Pelvis and Mechanism of Labor in Nonhuman Primates.” American Journal of Physical Anthropology 20(1995): 204.

Sutton, J. and P. Scott. Understanding and Teaching Optimal Foetal Positioning. New Zealand: Birth Concepts, 1996.

Trevathan, W.. Human Birth: An Evolutionary Perspective.  New York: Aldine de Gruyter, 1987.

—. “Fetal Emergence Patterns in Evolutionary Perspective.” American Anthropologist 90(1988): 674-681.

—. “An Evolutionary Perspective on Authoritative Knowledge About Birth.” Childbirth and Authoritative Knowledge. Ed. R. Davis-Floyd, and C. Sargent. Berkeley: University of California Press, 1997. 80-90.

—. “Evolutionary Obstetrics.” Evolutionary Medicine. Ed. Trevathan, W., E. O. Smith, and J. McKenna. New York: Oxford University Press, 1999. 183-208.

Trevathan, W. and J. McKenna. “Evolutionary Environments of Human Birth and Infancy: Insights to Apply to Contemporary Life.” Children’s Environments 11(2003 [1994]): 88-104.

Trevathan, W., and K. Rosenberg.. “The Shoulders Follow the Head: Postcranial Constraints on Human Childbirth.” Journal of Human Evolution 39(2000): 583-586.

Trevathan, W., E. O. Smith, and J. McKenna, eds.. Evolutionary Medicine. New York: Oxford University Press, 1999.

—. Evolutionary Medicine and Health: New Perspectives. New York: Oxford University Press, 2008.

Ulrich, Laurel Thatcher.. A Midwife’s Tale. New York: Vintage Books, 1990.

Villar, J., E., et al.. “Caesarean Delivery Rates and Pregnancy Outcomes: The 2005 WHO Global Survey on Maternal and Perinatal Health in Latin America.” The Lancet 367.9525(2006): 1819-1829.

Villar, J., et al.. “Maternal and Neonatal Individual Risks and Benefits Associated with Caesarean Delivery: Multicentre Prospective Study.” British Medical Journal 335.1025(2007): 1-11.

Wagner, M.. Born in the USA: How a Broken Maternity System Must Be Fixed To Put Mothers and Babies First. Berkeley: University of California Press, 2006.

Walrath, D.. “Rethinking Pelvic Typologies and the Human Birth Mechanism.” Current Anthropology 44.1(2003): 5-31.

—. “Gender, Genes, and the Evolution of Human Birth.” Feminist Anthropology: Past Present and Future. Ed. P. Geller and M. Stockett. Philadelphia: University of Pennsylvania Press, 2006.pages?

Washburn, S.. Tools and Human Evolution. Scientific American 203(1960): 3-15.

Wertz, R.W., and D.C. Wertz. Lying-In: A History of Childbirth in America. New York: Free Press, [1977] 1989..

White, T.D., B. Asfaw, D. DeGusta, H. Gilbert, G.D. Richards, G. Suwa, and F.C. Howell.. “Pleistocene Homo sapiens from Middle Awash, Ethiopia.” Nature 423(2003): 742-747.

Williams, G., and R. Nesse. The Dawn of Darwinian Medicine. Quarterly Review of Biology 66(1991): 1-22.

Wilson, Adrian. The Making of Man-Midwifery: Childbirth in England 1660-1770. Cambridge, Massachusetts: Harvard University Press, 1995.

>? ?K  ??=MsoNormal style=’margin-top:4.0pt;margin-right:0in;margin-bottom:4.0pt; margin-left:.3in;text-indent:-.3in’>  1992.  Birth as an American Rite of Passage. Berkeley, Los Angeles, and London: University  of California Press.

1994. “The Technocratic Body: American Childbirth as Cultural Expression.” Social Science and Medicine 38(8):1125-1140. Also available at <www.davis-floyd.com>.

1998. “The Ups, Downs, and Interlinkages of Nurse- and Direct-Entry Midwifery.” In Getting an Education: Paths to Becoming a Midwife, eds. Jan Tritten and Joel Southern, pp. 67-118. Eugene OR: Midwifery Today. Also available at <www.davis-floyd.com>.

Davis-Floyd, Robbie E. and Elizabeth Davis.  1997. “Intuition as Authoritative Knowledge. ” In Childbirth and Authoritative Knowledge: Crosscultural Perspectives, eds. Robbie Davis-Floyd and Carolyn Sargent, pp. 315-349.  Berkeley: University of California Press. Also available at <www.davis-floyd.com>.

Davis-Floyd, Robbie E. and Gloria St. John. 1998. From Doctor to Healer: The Transformative Journey. New Brunswick NJ:Rutgers U. Press.

Davis-Floyd, Robbie E., and Joseph Dumit. 1998. Cyborg Babies: From Techno-Sex to Techno-Tots. New York: Routledge.

Davis-Floyd, Robbie and P. Sven Arvidson. 1997. Intuition–The Inside Story: Interdisciplinary Perspectives. New York: Routledge.

Eisenberg, David M., R.C. Kessler, C. Foster, F.E. Norlock, D.R. Calkins, T.L. Delbanco. 1993. “Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use.” New England Journal of Medicine 328:246-252.

Eisler, Rianne. 1995. Sacred Pleasure: Sex, Myth, and the Politics of the Body.  HarperSanFrancisco.

Enkin, Murray, Marc Keirse, James Neilson, Caroline Crowther, Lelia Duley, Ellen Hodnett, and Justus Hofmeyr. 2000.  A Guide to Effective Care in Pregnancy and Childbirth. 3^rd edition. New York: Oxford University Press.

Friedson, Elliot. 1967. Review Essay:“Health Factories: The New Industrial Sociology,” Social Problems 14(Spring):493-400.

Good, Mary-Jo Delvecchio. 1995. American Medicine: The Quest for Competence. Berkeley: University of California Press.

Good, Byron and Mary-Jo Delvecchio Good. 1993. “’Learning Medicine’: The Construction of Medical Education at Harvard Medical School.” In Knowledge, Power, and Practice: The Anthropology of Medicine and Everyday Life, eds. Shirley Lindenbaum and Margaret Lock, pp. 81-107. Berkeley: U. of California Press.

Goer, Henci.  1995.  Obstetric Myths versus Research Realities.  Westport CT: Bergin and Garvey.

—–1999. The Thinking Woman’s Guide to a Better Birth. New York: Perigree/Penguin.

Harrison, Michelle. 1982. A Woman in Residence. New York: Random House.

Jordan, Brigitte. 1993 [1978])  Birth in Four Cultures: A Cross-Cultural Investigation of Childbirth in Yucatan, Holland, Sweden and the United States, 4th edition, revised and updated by Robbie Davis-Floyd. Prospect Heights, Ill.: Waveland Press.

Kennell, John

1982  “The Physiologic Effects of a Supportive Companion (Doula) During Labor.” In Birth: Interaction and Attachment  ed. Marshall H. Klaus and Martha O. Robertson, pp 92-105. New Jersey: Johnson and Johnson.

Kennell, John, Marshall Klaus, Susan McGrath, Steven Robertson, and Clark Hinckley

1988 “Medical Intervention: The Effect of Social Support During Labor.” Pediatric Research April:211 (Abstract #61).

Klaus, Marshall H., John Kennell, Phyllis Klaus. 1993. Mothering the Mother : How a Doula Can Help You Have a Shorter, Easier, and Healthier Birth. Addison Wesley.

Kleinman, Arthur. 1988. The Illness Narratives: Suffering, Healing, and the Human Condition. New York: Basic Books.

Kunisch, Judith. 1989. “Electronic Fetal Monitors: Marketing Forces and the Resulting Controversy.” In Healing Technology: Feminist Perspectives, ed. Kathryn Strother Ratcliff, pp. 41-60. Ann Arbor: University of Michigan Press.

Merchant, Carolyn 1983  The Death of Nature: Women, Ecology, and the Scientific Revolution. San Francisco: Harper & Row.

Naisbitt, John. 1980. Megatrends: Ten New Directions Transforming Our lives. New York: Warner Books.

Pert, Candace. 1993. “The Chemical Communicators.” In Healing and the Mind, eds Bill Moyers and Betty Sue Flowers, pp. 177-194. New York: Doubleday.

Pollack, Ron. 1995. “Worthless Promises: Drug Companies Keep Boosting Prices.” Oakland Tribune. July 7.

Potter, Joe C., Elza Berquo, Ignez H. O. Perpetuo MD, Ondina Fachel Leal, Marta Rovery Souza, Maria Celia de Carvalho Formiga, and Kristine L. Hopkins. 2001. “Unwanted Cesarean Sections among Public and Private Patients in Brazil.” Unpublished ms.

Reynolds, Peter C. 1991  Stealing Fire: The Mythology of the Technocracy. Palo Alto, Calif.: Iconic Anthropology Press.

Rooks, Judith. 1997. Midwifery and Childbirth in America. Philadelphia: Temple University Press.

Smith, Robert C. 1996. The Patient’s Story: Integrated Patient-Doctor Interviewing. Boston: Little, Brown and Co.

Sosa, R., J. Kennell, S. Robertson, and J. Urrutia

1980  “The Effect of a Supportive Companion on Perinatal Problems, Length of Labor, and Mother-Infant Interaction.” New EnglandJournal of Medicine 303:597-600.

Spiegel, David.  1993. “Social Support: How Friends, Family, and Groups Can Help.” In Mind-Body Medicine: How To Use Your Mind for Better Health, eds. Daniel Goleman and Joel Gurin, pp. 331-349. Yonkers, New York: Consumer Reports Books.

Spiegel, David, J. R. Bloom, H.C. Kramer, and E. Gottheil, 1989. “Effect of Psychosocial Treatment on Survival of Patients with Metastatic Breast Cancer.” Lancet 2:888-891.

Starhawk. 1989. The Spiral Dance: A Rebirth of the Ancient Religion of the Great Goddess. HarperSanFrancisco.

Tresolini, Carol P. and the Pew-Fetzer Task Force on Advancing Psychosocial Health Education. 1994. Health Professions Education and Relationship-Centered Care. San Francisco CA: Pew Health Professions Commission.

Wagner, Marsden. 1997. “Confessions of a Dissident.” In Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives, eds. Robbie Davis-Floyd and Carolyn Sargent, pp.366-396.  Berkeley: University of California Press.

Wheatley, Margaret. 1992. Leadership and the New Science: Learning about Organization from an Orderly Universe. San Francisco: Berrett-Koehler Publishers.

Wiseman, R. and Marilyn Schlitz. 1996. “Experimenter Effects and the Remote Detection of Staring.” Annual Proceedings of the Parapsychological Convention, San Diego, California.

Zukav, Gary. 2000. Soul Stories. New York: Simon and Shuster.

Author Bio:

Robbie Davis-Floyd, Ph.D, a Research Fellow in the Department of Anthropology, University of Texas (Austin), is an internationally known cultural anthropologist specializing in medical, ritual, and gender studies, and the anthropology of reproduction. She is the author of numerous articles and of Birth as an American Rite of Passage (1992); co-author of From Doctor to Healer: The Transformative Journey and The Power of Ritual (forthcoming), and coeditor of eight collections, including Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives (1997); Cyborg Babies: From Techno-Sex to Techno-Tots (1998); Reconceiving Midwives: The New Canadian Model of Care (forthcoming); and Midwives in Mexico: Continuity, Controversy, and Change (forthcoming). Funded by the Wenner-Gren Foundation for Anthropological Research, she has recently completed a major research project on the development of direct-entry midwifery in the United States, the results of which will appear in Mainstreaming Midwives: The Politics of Change. Her studies of contemporary transformations in Mexican midwifery are ongoing.

Contact information:

Robbie E. Davis-Floyd, Ph.D.

Research Fellow, Dept. of Anthropology, University of Texas at Austin

804 Crystal Creek Drive, Austin, Texas 78746

<davis-floyd@mail.utexas.edu>  <www.davis-floyd.com>

Home and Office: 512-263-2212   Mobile/VoiceMail: 512-426-8969

]]> http://davis-floyd.com/birth-and-the-big-bad-wolf-an-evolutionary-perspective/feed/ 0 http://davis-floyd.com/ways-of-knowing-open-and-closed-systems-2/ http://davis-floyd.com/ways-of-knowing-open-and-closed-systems-2/#comments Mon, 10 Oct 2011 13:50:42 +0000 Robbie Davis-Floyd http://davis-floyd.com/?p=346 WAYS OF KNOWING: OPEN AND CLOSED SYSTEMS

Robbie Davis-Floyd

This article was published in Midwifery Today 69 (Spring): 9-13, 2004.

Copyright is held both by Midwifery Today and by Robbie Davis-Floyd.

Both give permission for the replication of this article for educational purposes.

            This special issue of Midwifery Today focuses on midwifery knowledge. The following articles in it will address the specifics of this body of knowledge. But first, it is important to take a broader look at the differences between open and closed knowledge systems. Why? Because any knowledge system whose adherents wish it to remain responsive to changing events in a rapidly changing world must remain open to absorbing new information and adapting itself to that new information. To achieve an open knowledge system, one must first understand what it means for a knowledge system to be “closed.”

How Knowledge Begins

When a baby is gestating in the mother’s womb, neural circuits are being formed in its brain.  This process begins in early pregnancy and continues as the baby grows, until by the time of birth the baby’s developing brain already contains millions of pathways and connections.            Much of the information that flows along these circuits is cultural. As it develops, the baby receives enormous amounts of cultural information from the mother’s activities—when she goes to sleep, when she wakes, how she moves during the day, her speech patterns, her emotions, etc. So we begin to learn before we are born the most basic patterns of the culture we are born into. From then on, the cultural information most easily processed by the baby after birth is information that conforms to the cultural rhythms to which it is already accustomed. Yet the potential always exists in babies and in children for the easy accommodation of entirely new information. In other words, the brains of babies and children are open systems, readily able to create synaptic connections that generate entirely new neural networks that can process entirely new information. That is why it is so easy for the young to learn new languages, for example: their brain structures are so open to absorbing new information that they have no resistance to it.

A neural pathway at high magnification   The development of neural networks in a baby’s brain from birth to age 2

Stage One Thinking/Naïve Realism

If a child grows up in one culture and is exposed for the first twenty or so years of his or her life only to the rhythms, patterns, language, and belief system of that culture, her neural networks will become permanently set in those terms. After that, learning a new language or internalizing the norms and values of a different culture or belief system becomes increasingly difficult over time. Why? Because integrating new information always requires the formation of entirely new neural pathways in the brain. For a child, that process is effortless; for adults whose neural structures are already set, that process requires enormous amounts of time, energy, and concentrated effort to create new bridges across the synaptic gaps between what they already know and what they desire to learn.

Individuals who are never required to “think beyond” the belief systems of the cultures in which they are raised can over time lose the ability to process new information and can become neuro-cognitively rigid in their thinking. More precisely, humans never really lose that ability, but they can become resistant to it, unwilling to put in the time and energy it would take to develop those new neural pathways. Such individuals are subject to what some brain theorists have called Stage One Thinking.¹ For Stage One thinkers, the world is as their culture defines it. There is only one possible set of interpretations of reality, and that set of interpretations IS reality. In other words, theirs is a closed system. Anthropologists call this way of thinking “naïve realism”—the notion that “my way is the only way there is.” Most members of small-scale societies, before their massive exposure to Western culture, were naïve realists. In modern societies, all religious fundamentalists are naïve realists—they are completely convinced and certain that their way of knowing is right and is (or should be) “the only way.”

Stage One Thinking: The Rigid Mind–“Everything in its place”

Across cultures and throughout history, ritual has played a critical role in the creation of Stage One thinkers. Rituals enact a society or group’s core values and beliefs. Through rhythmic repetition and the use of powerful core symbols, ritual constantly works to imprint these core beliefs and the behaviors that accompany them in the minds and bodies of its participants.

Stage Two Thinking/Ethnocentrism

Stage Two thinkers are what anthropologist call “ethnocentric.” Ethnocentrists know that other ways of knowing and believing exist, and may be willing to acknowledge that it’s OK for others to think differently. But they are entirely certain that their way is better. At best, ethnocentric Stage Two thinkers feel pity for everyone else who simply doesn’t understand how much better their way is. At worst, ethnocentrists try to wipe out those who don’t believe as they do, considering the existence of other ways of knowing a threat to their own or an heretical abomination (consider the Crusades, for example). Ethnocentrism, like naïve realism, is a closed system, constantly reinforced by the rituals that enact and sustain that system.

Stage Three Thinking/Cultural Relativism  

In dramatic contrast, Stage Three thinkers are entirely open. They come to a realization at some point in their lives that every culture and religion has created their own story about the nature and structure of reality, and who is to say whose story is right? In anthropological terms, Stage Three thinkers are cultural relativists who come to see every story about reality as relative to every other story. Nobody is “right,” nobody has a lock on truth, so every knowledge system must be understood in terms of its ecological, historical, and political context, and must be respected as legitimate in its own right. This kind of cultural relativism can sound ideal—it entails respect for, appreciation of, and understanding of every story that every culture or religion tells. Such tolerance! No bigotism, no racism, no ethnocentrism, no judgment.

And yet it is not ideal in a global sense. In some cultures, such as those of rural Pakistan, men are entitled to beat their wives every night. In some cultures, torture of political prisoners is normal. In some cultures, like that of the contemporary US, putting millions of people in prison for relatively harmless crimes is the norm. In Western biomedicine, which has spread all over the world, women are routinely abused and harmed in the name of a science which is not science but biomedical belief and tradition. By what standard can cultural relativists say that such culturally accepted behaviors are not OK?

Stage Four Thinking/Global Humanism 

This dilemma posed by cultural relativism has led to an increased global focus on the development of Stage Four thinking, which anthropologists call global humanism. Stage Four/global humanist thinkers recognize the intrinsic integrity and value of every cultural and religious story, yet seek a higher standard that can be applied in every context to ensure the rights of individuals, most particularly the poorer and weaker members of society. No one should be beaten, or raped, or abused. Everyone should have access to clean water and good nutrition and effective health care and good pay for their work. Such things seem desirable goals to global humanists, yet they do not exist in many places. So global humanists seek to think beyond even cultural relativism, seeking universal standards that work for everyone. They want to validate and legitimate every culture while devaluing and discouraging practices that hurt people who do not deserve to be hurt in this higher sense. They are acutely aware that they are on an almost impossible mission, yet one that must be attempted anyway for the good of all. Knowing that totalitarian systems are always harmful, and that no one system can ever really be perfect, they understand that they must keep their knowledge systems open to new information, engaging in bioethical discussion and debate, trying to figure things out without assuming superiority for any one system.

These first two are MC Escher prints representing the fluidity and unknowability of reality. Stage Four thinkers can relate: they recognize reality’s ambiguity and fuzziness, and they know that categories are not solid, things can fade into and out of each other. The world is not black and white but many-colored. Things are not in their places because there is no “place.”

Stage Four thinkers do develop and perform rituals, but such rituals are usually very fluid attempts to express and enact larger, more global values. Since the beliefs of Stage Four thinkers are open to flux and change, the rituals they create tend to constantly change as well, or to be spontaneous enactments of something going on in the moment. Think here of the closing rituals at Midwifery Today conferences, which tend to consist of hand-holding and songs that occur to people to sing in celebration of midwives and women. These are very unlike the rigid, pre-set rituals performed in churches, temples, synagogues, etc. that enact very specific and relatively unchanging sets of beliefs.

The Four Stages of Cognition

The following diagram is my attempt to illustrate the differences between these four stages of cognition. The black circle indicates how for Stage One thinkers (naïve realists), there is only one way of perceiving the world. Stage Two thinkers (ethnocentrists) still come out of one way of thinking, are aware of other ways, may find them threatening, amusing, or interesting, yet consider them essentially irrelevant to real knowledge or truth: “our way is best.” Both Stage One and Stage Two systems are closed. Stage Three thinkers (cultural relativists) are usually raised in one system, yet give credence and legitimacy to all systems and are open to learning more, as indicated by the little lines extending out from the circles. Stage Four thinkers (global humanists) try to weave a hologram out of all systems that has its own internal cohesion in terms of standards of behavior that work for everyone, yet are always open to new ideas and always willing to rethink the holograms they weave to accommodate new information and to broaden the systems of meaning they weave.

The Four Stages of Cognition

Midwives, Midwifery Knowledge, and the Four Stages of Cognition

Stage One/Naïve Realist Midwifery Systems

Many traditional midwives, and some professional midwives, are Stage One thinkers. They are socialized during their midwifery training to one way of thinking and knowing about birth, have no exposure to other ways, and thus have no incentive to “think beyond” what they are sure they know about birth. Such “naïve realist” midwives can practice within their communities, whether traditional or hospital-based, for their lifetimes, without ever questioning their practices and the beliefs that underlie them. Such midwives still exist, yet are rare in the contemporary world, in which it is becoming increasingly difficult to avoid exposure to other ways of thinking and knowing.

Stage Two/Ethnocentric Midwifery Systems

It is far more possible for thousands of contemporary midwives to be ethnocentric rather than naively realistic. Ethnocentric midwifery knowledge and practice systems can be (1) indigenous or (2) biomedical.

(1) Indigenous midwives, if left alone, are most likely to be Stage One thinkers. But most traditional midwives are in some way exposed to biomedicine, which has been massively adopted in developing countries as the most “modern” and progressive system. Unfortunately, this exposure has most often taken the form of TBA training courses, which “train” traditional midwives in biomedical ways of thinking and practicing. These trainings are highly ethnocentric: the biomedical practitioners who do the teaching are usually not interested in what the midwives know or how they practice, but rather in teaching them “the best way,” which in their minds is the biomedical way.

Biomedicine is itself an extremely ethnocentric and relatively closed Stage Two system. Biomedical practitioners are constantly exposed to new information, yet they tend to incorporate only the kinds of new information that fit within their pre-existing knowledge system. Physicians, for example, are socialized into biomedical ways of thinking, knowing, and believing for at least four years of medical school, three years of residency, and often more if they go on into subspecialties. Their neural pathways are established in terms of what I call the technocratic model of medicine. Confronted with information that does not match what they learned during their training—in other words, information that does not flow easily along their pre-established neural pathways—they are most likely to ignore or discount such information. An obstetrician who reads a study comparing epidurals with other types of pain medication can easily process that kind of information, for example, but the same obstetrician presented with multiple studies that demonstrate the benefits of doulas, being in water, massage, and constant changes in position for pain relief will be likely to discount this kind of information. To process it, he would have to be willing to take the time and energy it would require to develop thousands of brand new synaptic connections and neural pathways along which this new information could flow and become integrated into his cognitive system. Most obstetricians can barely keep up with the information that comes across their desks every day that updates them on the latest drugs and technologies (simply amplifying things they already know). Entrenched in a belief system that relies on drugs and technological interventions to manage birth, they see no reason to exert the much greater amounts of energy it would take to assimilate information from outside their technocratic paradigm. This is also true of thousands of professional midwives around the world, who work hard to learn accepted biomedical ways and then are thrust into busy practices. Overworked, overstressed, and often underpaid, they too are unwilling to open their cognitive systems to processing information that contradicts the biomedical approaches they are taught.

The drawing below metaphorically illustrates the multiple possibilities such ethnocentric/Stage Two practitioners have for dealing with new information: it can flow along their established neural pathways and be assimilated (filed in accessible filing cabinets, for example), or it can be thrown down one of those tubes into oblivion, or it could be filed way in the back, where the synaptic connections stop, in a filing cabinet labeled “information I don’t want to process but might be useful sometime.”

Bodily habituation to closed systems. The diagrams I have offered to illustrate my points are of the mind. Yet the most effective and enduring kinds of learning have to do with our bodies. When you sit in a classroom and listen to lectures, or read books, you are learning didactically—through your mind. When you take a blood pressure or insert an IV or do a pelvic exam the same way a thousand times, you are learning with your body. Body knowing is the hardest kind of learning to change because it involves habituation. Becoming physically habituated to doing things the same way all the time means that your learning process becomes ingrained not only in your brain but also in the cells and muscles of your hands and arms, legs and feet, posture and movement. This kind of knowing is out of mental consciousness and thus cannot be overcome by mental exposure to studies that contradict it.

How do you gain confidence that a woman’s labor is under control? You hook her up to the monitor and assume that the information that flows through it is telling you all you need to know. How do you resuscitate a baby in distress? You cut the cord and rush to the table attached to the wall where the equipment you think you need is attached. How do you deal with what you have been taught is prolonged pushing? You cut an episiotomy and perhaps grab the forceps or the vacuum extractor. You don’t have to think about it—your body just moves to do it. Birth is not a good catalyst for change in such cases, as most babies come out alive and relatively healthy most of the time anyway. So the more you do it that way, the more it becomes the only way you can imagine doing it.

It is ironic that science, which was supposed to be the foundation of obstetrics, does not support most standard obstetrical practices. Yet science has been used by obstetricians for 150 years to justify the interventions they invented and then increasingly performed. Science used ethnocentrically for Stage Two biomedical thinkers is a blinder for what is really medical tradition, passed down from teacher to student through apprenticeship/experiential learning.

Stage Three/Cultural Relativist Midwifery Systems

I have no data at all to support this assertion, but it seems to me that very few midwives in the contemporary world are true cultural relativists. Midwives deal with life and death, and know that their decisions can result in either one. Stage One midwives make decisions based on the only knowledge they have; Stage Two midwives make decisions based on the knowledge they are sure is best. But of thousands of midwives I have talked with, I can’t think of who bases her decisions on no standards at all. Postpartum hemorrhages must be stopped if at all possible. Babies in transverse lie cannot be born unless the midwife does something. Stage One and Stage Two midwives will deal with such complications as their belief systems dictate. But midwives with open minds and systems fluid enough to encompass multiple cultural realities will not be content to approach such complications in whatever way the culture of the woman they are attending would dictate. If they know a way that is scientifically proven to have better efficacy than a traditional way (whether traditional in a biomedical or an indigenous sense), they will apply it. The decisions they make in life-crisis situations are not based on a “whatever the culture says” attitude, but rather on a “whatever works” attitude. And what midwives with open cognitive systems know about what works will constantly change as they are exposed to new information, whether it comes from science, from traditional midwifery, or from a workshop they just attended the day before.

Stage Four/Gobal Humanist Midwifery Systems

In today’s rapidly changing and highly fluid world, to be truly effective, midwives must remain constantly open to the new information that is constantly emerging from science and from the increasingly availability of midwifery knowledge from multiple systems—allopathic, indigenous, traditional, biomedical, alternative or complementary, etc. Sometimes the best option for a birth complication might be a homeopathic remedy, sometimes it might be a position used by traditional midwives, sometimes it might be a cesarean section. The Stage Four midwife will keep her system open to new learning from many sources. And she will seek the highest moral and ethical standards, which involve giving compassionate, woman-centered care responsive to the needs of the individual regardless of what the system dictates.

Why Many Midwives Do Not Give Stage Four/Globally Humanistic Care

Cognitive openness and humanistic standards are not easy to maintain, especially in a busy and stressful practice. Even those Stage Four midwives who want to remain open to new learning and new ways of thinking find that the more stress they are under, the less able and willing they are to process new information. Often they simply don’t have the energy or the time. Persistent stress can reduce even highly fluid, Stage Four thinkers to Stage Two or Stage One levels by causing cognitive overload and the development of “tunnel vision”–the need to shut out most stimuli and focus on one thing only. In other words, stress can make fluid thinkers become rigid, if only for a while. How often have you thought, on an especially stressful day, “just don’t tell me one more thing”? Usually rest will restore Stage Four thinkers to their normal fluid state. But if the stress continues for too long or becomes too intense, anyone can disintegrate into Substage–a condition of hysteria, panic, or even full-fledged nervous breakdown (also known as “losing it”).

Performing rituals can stabilize individuals under stress at Stage One, thereby preventing them from degenerating into Substage. (When the airplane falters, you start to pray. When the crops fail, you make offerings to the gods. When labor slows, you administer pitocin and hook up the monitor.) Stage One rituals can generate a sense that everything is under control (even if it isn’t). Practitioners facing what they see as constant potential crises in childbirth use such Stage One rituals preventatively, so that things always feel or seem to be under control.

Let’s take a quick look at what women studied by anthropologists all over the world have said about professional midwives working under high levels of stress in Third World countries:

• “They shave you.”
• “They cut you.”
• “They leave you alone.”
• “They don’t let your family members in to be with you.”
• “They yell at you and sometimes, they slap you.”

Perhaps most midwives who practice in these ways at first approached midwifery with high ideals of serving women, just as most obstetricians do. But if you are practicing in a rural clinic in Papua New Guinea or a huge hospital in India, where supplies are limited or non-existent, there are more women than you can possibly care for, there is often no running water and little or no food available for the women, you are treated as inferior by physicians and nastily by nurses who resent your authority, and you are paid so little you can barely support your family, it is most likely that your ideals will fade away in face of unbearable realities. You will shut down cognitively and focus on finding any bits of pleasure or relaxation you can—in other words, you will take every opportunity to drink coffee with your colleagues and ignore the women screaming for your help in the next room. Such are the effects of stress, overwork, underpay, and professional devaluation. Many anthropologists have noted that midwives new to work in such places are often initially horrified by the behavior of their elders and work harder to support and care for the women, yet a few months or years later, will be behaving exactly like the colleagues they initially abhorred.²

What about midwives in the developed world, where technology, supplies, clean water, and food, are readily available, the pay is reasonable, and schedules offer time off to be with one’s family? Indeed, it is this kind of midwife who is most likely to care about moving beyond rigid knowledge systems to create a more open, fluid, and individually responsive style of midwifery care. And yet even First World professional midwives are likely to succumb to the pressures of biomedical socialization and habituation to certain routines, to practice defensively to avoid accusations of malpractice, to conform to institutional systems rather than take the time and energy to fight them.

For one example, in the UK 70,000 professional midwives attend 70% of births. To American professional midwives, this situation seems ideal. Yet the Stage Four midwifery thinkers in the UK note sadly that most of those 70,000 midwives have become the source of, not the solution to, the problem. Habituated to hospital birth and biomedical routines, most British midwives have fought rather than welcomed the British government’s mandate for more home births. Mavis Kirkham and others have documented how such midwives move among their patients giving vague information, refusing to answer specific questions, offering little or no one-on-one support, and dealing with patient requests by answering “Sister wouldn’t like it”—“Sister” meaning the starched and unbending head midwife who runs her clinic more like a business than a support service.

How Midwives Can Foster Stage Four Thinking for Themselves and Other Midwives

(1) Attendance at midwifery conferences. When a midwife goes away to a conference, she is free from the daily pressures of her practice to take in new information. She is exposed to ways of thinking, knowing, and practicing that may not match her own. The midwives in the developed world who tend to become rigid in their practices rarely attend such conferences; they are the ones who most need to attend.

Over the past twelve years, I have attended hundreds of midwifery conferences, and have watched how midwives “get their juice” through being there. Midwifery Today conferences are particularly salient in developing and maintaining Stage Four thinking, as their organizer, Jan Tritten, makes every effort to include all types of midwives—professional, traditional, nurse-, direct-entry—on her programs so that every Midwifery Today conference provides opportunities for midwives to be exposed to the ways other midwives think and know. MANA and ACNM also provide many such opportunities—their conferences include workshops that range from the highly technical to the highly holistic. Particularly exciting are conferences held in countries where midwives are beginning to move outside their normative practices, such as the home birth conferences recently held in Spain. ICM conventions bring together professional midwives from all over the world, and every time slot on the program offers at least a dozen sessions appealing to every possible midwifery knowledge, skill, special interest, or cultural approach. Small-scale regional midwifery conferences allow midwives living in relatively close proximity to share common interests and expand their knowledge bases about their own history and political situations.

Every midwifery conference I have ever attended has offered its participants many ways to “think beyond” established paradigms and practices; thus I encourage every practicing and student midwife to attend as many such conferences as she practically can.

(2) Learning from women. Midwives who practice the same way for many years are usually midwives who have stopped listening to mothers. Every woman a midwife attends can bring something new to her knowledge and practice. I have interviewed hundreds of midwives about their education and practice, and have often been struck by the changes in practice that can result from listening carefully to and learning from just one woman, who perhaps is unusual but who can teach the midwife herself something new about how best to provide woman-centered care.

(3) Learning from midwives. Midwives have lots of stories to tell, and they tend to be excellent story-tellers. When midwives get together and tell stories, they are not just engaging in chit-chat, but are sharing important aspects of what they learn and how they learn it, of what they know and how they use that knowledge, whether it is didactically obtained or intuited in the moment. When obstetricians get together and discuss birth, the stories they tell are usually stories of pathologies that they find intrinsically interesting because of the puzzles they present, or crises in which they saved or failed to save a life. In dramatic contrast, midwives tend to prefer to tell stories of normal birth, or of how they helped a birth that could have become pathological stay normal (a process I call “normalizing uniqueness”). So much  midwifery lore and knowledge is encoded in these stories: listen to them, record them, write books and articles full of them so that others can learn what your stories have to teach!

[Note to editor: This paragraph could be cut if necessary] It is fascinating to me that the earliest midwives to write down midwifery knowledge, like Sarah Stone in Britain in 1737, were not able or did not think to abstract what they knew into categories like “how to handle a post-partum hemorrhage.” Rather, they told the stories of the births they attended. The first British midwife to write abstractly about midwifery knowledge, Elizabeth Nihell in 1760, had been taught and heavily influenced by William Smellie, one of the early male midwives.³ That is one reason why Ina May Gaskin’s Spiritual Midwifery has been so important and influential for so many midwives around the world: she told stories, and in the telling one can see how her knowledge developed through her individual experiences with the women she attended.⁴ Her second book, Ina May’s Guide to Childbirth, offers many stories written by the couples she attended.⁵ Into these stories, Ina May interjects in her own words the points at which she had a flash of intuition or a “hunch” that such-and-such might be a good thing to do, and tried it out. The stories allow us to witness her learning process in action and observe how her Stage Four thinking abilities kept her open to learning directly from women and from her own intuition, experientially, in the moment.

(4) Attention to the scientific evidence. The body of scientific evidence supporting many traditional and professional midwifery practices is ever-growing. Every midwife should keep up with it, as so much of it reinforces what has become internationally known as “the midwifery model of care.” Real science is differs fundamentally from biomedical tradition. Every Stage Four midwife should have science at her command, all references ready to counteract every biomedical objection to the kind of care she wishes to give.

(5) Attention to other healing philosophies and modalities. Naturopathy, chiropractic, homeopathy, Reiki, breath therapy, massage therapy, pre- and perinatal psychology, Ayurveda, Chinese medicine, and many other types of “complementary” health care, as well as many indigenous knowledge systems, have much to offer the contemporary professional midwife. It is not possible for every midwife to know all of these systems, but it is possible to be open to what they can offer by learning about them, incorporating one or some of them, and finding practitioners to whom clients can be referred.

Conclusion

Around the world, midwives are under siege as the power and influence of biomedicine grows. Traditional midwives are in danger of extinction and professional midwives are too often ethnocentric servants to biomedical ways of knowing and practicing. Yet in every country, there are dozens and sometimes thousands of midwives, both traditional and professional, who are Stage Four global humanists striving to think beyond established paradigms and practices. Such midwives are constantly working to combine the best of indigenous, allopathic, and alternative knowledge systems to create fluid and open midwifery knowledge systems responsive to women’s needs and desires, to ideas and information from other midwives and health care workers, to scientific evidence, and to “whatever works” from wherever it can be learned. If you are a midwife practicing in the 21^st century, you have two brand new advantages that your historical counterparts did not have: (1) access to information from a rich variety of sources; and (2) strength in local, national, and international organization. I ask you to utilize these strengths, acknowledge your limitations (remember that stress can take you “down” both physically and cognitively), and strive to keep your knowledge systems open to the learning that this new world can multiply provide.

Endnotes

1. The “four stages of cognition” schema I present here can be found in Schroder, H. M., M. Driver, and S. Streufert, Human Information Processing (New York: Holt, Rinehart, and Winston), 1967. The combination of this theory with the anthropological concepts of naïve realism, ethnocentrism, cultural relativism, and global humanism is entirely my own. Further discussion of this combination can be found in Davis-Floyd, Robbie and Gloria St. John, From Doctor to Healer: The Transformative Journey, New Brunswick NJ: Rutgers University Press, 1998 and Davis-Floyd, Robbie and Charles Laughlin, The Anatomy of Ritual (New York: Random House/Schocken), n.d. (forthcoming).

2. The anthropological studies I draw on are too many to be listed here. Partial references can be found in Davis-Floyd, Robbie, “Mutual Accommodation or Biomedical Hegemony,” Midwifery Today, March 2000, pp 12-17, 68-9. Full references to and descriptions of many of these works can be found in Davis-Floyd, Robbie, Sheila Cosminsky, and Stacy Leigh Pigg, “Introduction” to Daughters of Time: The Shifting Identities of Contemporary Midwives” (a special triple issue of Medical Anthropology 20:2-3/4, 2001). This Introduction is also available at www.davis-floyd.com

­ 3. Stone, Sarah, A Complete Practice of Midwifery, Consisting of Upwards of Forty Cases or Observations in That Valuable Art, London: printed for T. Cooper, 1737; Nihell, Elizabeth, A Treatise on the Art of Midwifery. Setting Forth Various Abuses therein, especially as to the Practice with Instruments: The Whole Serving to put all Rational Inquiries in a fair Way of very safely forming their own Judgement upon the Question; Which it is best to employ, In Cases of Pregnancy and Lying-In, a Man-Midwive, or, a Midwife, London: A. Morley, 1760. Stone and Nihell’s works are described and compared by Herrle-Fanning in Body Talk: Rhetoric, Technology, Reproduction, edited by Mary M. Lay, Laura J. Gurak, Clare Gravon, and Cynthia Myntti. Madison: University of Wisconsin Press, 2000.

4. Gaskin, Ina May, Spiritual Midwifery. Summertown, Tennessee: The Book Publishing Company, 1977.

5. Gaskin, Ina May, Ina May’s Guide to Childbirth. New York: Bantam, 2003.

Author Bio

Robbie Davis-Floyd, PhD, a cultural/medical anthropologist specializing in the anthropology of reproduction, is Senior Research Fellow in the Dept. of Anthropology, University of Texas Austin. An international speaker, she is author of over 80 articles and of Birth as an American Rite of Passage (1992); coauthor of From Doctor to Healer: The Transformative Journey (1998), and The Anatomy of Ritual (forthcoming); and coeditor of eight collections, including Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives (1997); Cyborg Babies: From Techno-Sex to Techno-Tots (1998); and Mainstreaming Midwives: The Politics of Change (2005). Her research on global trends and transformations in health care, childbirth, obstetrics, and midwifery is ongoing. She can be reached via email at davis-floyd@mail.utexas.edu. Her website, which contains most of her published articles and descriptions of her books, is www.davis-floyd.com.

The Trouble with Transport

Robbie Davis-Floyd Ph.D.

This article appears in a special issue of Social Science and Medicine, called Reproduction Gone Awry,

edited by Marcia Inhorn and Gwynne Jenkins, Vol. 56, No. 9, 2003, pp. 1913-1931.

Abstract: Proponents of the global Safe Motherhood Initiative stress that primary keys to safe home birth include transport to the hospital in cases of need and effective care on arrival. In this article, which is based on interviews with American direct-entry midwives and Mexican traditional midwives, I examine what happens when transport occurs, how the outcomes of prior transports affect future decision-making, and how the lessons derived from the transport experiences of birthing women and midwives in the U.S.and Mexicocould be translated into improvements in maternity care. My focus is on home birth in urban areas in Mexicoand the US. In both countries, biomedicine and home-birth midwifery exist in separate cultural domains and are based on distinctively different knowledge systems. When a midwife transports a client to the hospital, she brings specific prior knowledge that can be vital to the mother’s successful treatment by the hospital system. But the culture of biomedicine in general tends not to understand or recognize as valid the knowledge of midwifery. The tensions and dysfunctions that often result are displayed in midwives’ transport stories, which I identify as a narrative genre and analyze to show how reproduction can go unnecessarily awry when domains of knowledge conflict and existing power structures ensure that only one kind of knowledge counts. This article describes: (1) dis-articulations that occur when there is no correspondence of information or action between the midwife and the hospital staff; and (2) fractured articulations of biomedical and midwifery knowledge systems that result from partial and incomplete correspondences; contrasts these two kinds of disjuncture with the smooth articulation of systems that results when mutual accommodation characterizes the interactions between midwife and medical personnel; and links these American and Mexican transport stories to their international context, describing how they index crosscultural markers, and suggest solutions, for “the trouble with transport.”

Key Words: Childbirth, home birth, midwives, hospital, transport, US,Mexico

Introduction

In Mexico, home birth, while diminishing in frequency, still exists as a vital tradition and viable cultural option for many women; in the US, it was almost obliterated by the 1950s but in recent decades has formed the focus of a social movement of midwives, mothers, and childbirth activists dedicated to maintaining home birth as a viable option. As proponents of the global Safe Motherhood Initiative have long stressed, in both the developing world where home birth is often a necessity, and the developed world where it is a choice, primary keys to safe home birth include transport to the hospital in cases of need and effective care on arrival (Fullerton, 2000). In this article, I examine what happens when transport occurs, how the outcomes of prior transports affect future decision-making, and how the lessons derived from the transport experiences of birthing women and midwives in theU.S. andMexico could be translated into improvements in maternity care. Two aspects are critical to the viability of transport: (1) Can the mother get there? In other words, is there a hospital within reach and can a vehicle be found? (2) What happens when she arrives? The first, availability of transport, is a major issue in ruralMexico and elsewhere in the developing world and deserves separate and thorough attention. Here my focus is on home birth in urban areas in Mexico and the US, where the trouble with transport is not its lack but rather what happens when transport places the mother who had planned to give birth at home, and the midwife attending her, in interaction with biomedical personnel.

In both countries, biomedicine and home-birth midwifery exist in separate cultural domains and are based on overlapping but distinctively different knowledge systems. When a home-birth midwife arrives in the hospital with her client, she brings with her the general ways of knowing and style of practice that characterize her cultural domain, and her specific prior knowledge about the woman’s overall health, personality, desires, and labor process. This knowledge can be vital to the mother’s successful treatment by the hospital system. But the culture of biomedicine in general tends not to understand or recognize as valid the knowledge of midwifery. Thus in the hospital, the midwife may have no authoritative status. Yet she must interface with medical personnel if she is to communicate information the hospital staff may need to provide appropriate and effective care for her client. Smooth articulation of the medical and midwifery knowledge systems facilitates the safest transition for the woman and her baby, but all too often, disjuncture and dis-articulation occur. The tensions and dysfunctions that result are displayed in midwives’ transport stories, which I here identify as a narrative genre. In this article, I will seek to unpack these stories for the collision of worlds they encapsulate and the points of fracture and permeability in the crusts of those worlds that they reveal.

I will focus specifically on the transport stories told by two groups of midwives with whom I have conducted extensive interviews: American direct-entry (non-nurse) midwives who attend home births, and a small group of traditional Mexican midwives who practice in and around the large urban city of Cuernavacain the state of Morelos, just south of Mexico City. After describing these two groups of midwives and the national contexts within which they learn and practice, I will narrate some of their stories, analyzing them as cultural terrains that reveal how reproduction can go unnecessarily awry when domains of knowledge conflict and existing power structures ensure that only one kind of knowledge counts. I will describe such encounters as (1) dis-articulations that occur when there is no correspondence of information or action between the midwife and the hospital staff; and (2) fractured articulations of biomedical and midwifery knowledge systems that result from partial and incomplete correspondences. I will contrast these two kinds of disjuncture with the smooth articulation of systems that results when “mutual accommodation” (Jordan, 1993) characterizes the interactions between midwife and medical personnel. In the Conclusion, I will link these American and Mexican transport stories to their international context, describing how they index some of the crosscultural markers for “the trouble with transport.”

Articulation and Authoritative Knowledge: Biopower Meets the Home-Birth Midwife

ar.ti.cu.late vt. (1) to put together by joints; (2) to arrange in connected sequence, fit together, correlate. vi. to be jointed or connected. n. a joint in a stem or between two separable parts, as a branch and leaf [or] a node or space between two nodes

–Webster’s New World Dictionary, 2000

My use of the term articulation at various points in this article comes from Gramsci through Lawrence Grossberg. In We Gotta Get Outa This Place: Popular Conservatism and Postmodern Culture (1992, p. 54), Grossberg notes that the concept of articulation “provides a useful starting place for describing the process of forging connections between practices and effects.” His starting place will be my ending place, as most of the stories I recount below illustrate connections that could potentially have been forged but instead were either never made or only partially constituted. These disjunctures in what could have been functional, smoothly bending joints stem from the dominance of biomedicine—a hierarchical system that has sought, in general, not to articulate with home-birth midwifery but rather to eliminate it through discounting its practices and knowledge base. In Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives, Brigitte Jordan (1997, p. 56) noted that

for any particular domain several knowledge systems exist, some of which, by consensus, come to carry more weight than others, either because they explain the state of the world better for the purposes at hand (efficacy) or because they are associated with a stronger power base (structural superiority), and usually both. In many situations, equally legitimate parallel knowledge systems exist and people move easily between them, using them sequentially or in parallel fashion for particular purposes. But frequently, one kind of knowledge gains ascendance and legitimacy. A consequence of the legitimation of one kind of knowing as authoritative is the devaluation, often the dismissal of all other kinds of knowing.

Jordanmaps out what happens when one kind of knowing does gain ascendancy, thus opening up the possibility of asking what happens when an ascendant knowledge system and a devalued one must interface. Why do adherents of a dominant knowledge system sometimes dismiss what adherents of a devalued system have to say, sometimes give them partial credence, and other times honor them, act promptly on their recommendations, and include them in the process? The stories I analyze below illustrate all of these possible scenarios.

In the process of describing how Western biomedicine gained its cultural ascendancy, Michel Foucault identified the cultural authority it carries as a form of “biopower,” which he defined as “disciplines of the body,” used as “numerous and diverse techniques for achieving the subjugation of bodies and the control of populations” (1978, p. 140). This subjugation and control include the biomedicalization of bodily processes like childbirth and the development of institutions within which such processes are supposed to take place, along with formalized structures for managing them.Jordanaugments Foucault’s notion of biopower with her focus on the status of particular knowledge systems:

It is important to realize that to identify a body of knowledge as authoritative speaks, for us as analysts, in no way to the correctness of that knowledge. Rather, the label “authoritative” is intended to draw attention to its status within a particular social group and to the work it does in maintaining the group’s definition of morality and rationality. The power of authoritative knowledge is not that it is correct but that it counts. (Jordan, 1997, p. 57)

Although the midwives in the US and Mexico whom I have studied treat their own knowledge system as authoritative in the home context, they are acutely conscious of the larger and higher authority carried by biomedicine not only inside the hospital but also in the culture at large. As we will see, much of the time these midwives do not accept biomedical knowledge as truth or fact; many of their practices and much of their midwifery knowledge system constitute a radical critique of obstetrics, challenging its claims to the authority of fact and truth. But these midwives also understand that in the hospital as in the wider culture, including in courts of law, their radical critique goes largely unheard and their ways of knowing do not count. Faced with this formalized system of biopower that discounts their individualized approach to maternity care, during transport midwives nevertheless often seek to communicate what they know, in the interests of securing the care for which they brought the woman to the hospital, which they deem to be necessary for their client’s safety and well-being. So as they enter the hospital, they extend into that system what I will identify as fingers of articulation in an effort to generate a productive interface. The following detailed examination of midwives’ transport stories intends to illuminate what happens along a spectrum of possibilities from dis- to smooth articulation, from the dismissal of these outreaching fingers to their clasping by a biomedical hand. Through examining this spectrum of articulations between knowledge systems, I hope to augmentJordan’s explanations of what happens when one system of knowledge discounts another with a more nuanced consideration of how, in specific situations, the dominant system can come to take the subaltern system into partial or fully accommodative account.

Methodology

 Articulation is a continuous struggle to reposition practices wihtin a shifting field of forces.

–Lawrence Grossberg (1992, p. 54)

This article is based on my continuing research on American midwives (begun in 1995) and in Mexico (begun in 1997). The focus of this research is midwifery politics in relation to the process of professionalization that American direct-entry midwives (Davis-Floyd, 1998b, 2002a, 2003), Mexican professional midwives (Davis-Floyd, 2001a), and a small and unique group of Mexican traditional midwives (Davis-Floyd, 2001b) are undergoing.¹ This research did not specifically focus on transport stories as a genre or on transport as a salient issue. But during its course (which involved hours of formal interviewing and even more hours of “hanging out” with midwives), I heard many transport stories told, only some of which ended up on tape by luck or circumstance. Thus this article in no way pretends to constitute a comprehensive exploration of transport stories, a task I suggest to future ethnographers.² For even though they had not constituted a specific research focus, over time these transport stories began to emerge for me as a narrative genre that richly encapsulates clashes of power and ideology between the biomedical and midwifery systems and their potentially devastating consequences for mother and baby, constituting salient cathexes for the trope of “reproduction gone awry.” The particular stories I present here, told by American direct-entry midwives and Mexican traditional midwives, were chosen both for their representative nature and for the transnational similarities they index. These similarities include exclusively out-of-hospital practice and concomitant marginalization vis-à-vis the biomedical system, and thus embody the collision of worlds I seek to analyze.³ In both countries, there are a few nurse-midwives who attend both home and hospital births; their transport experiences are somewhat different, especially when they practice and carry authoritative status in both domains. I suggest them as potential subjects of a future study.⁴ The following section will describe the two groups of midwives on whom I focus here, and the larger national and transnational contexts within which they work.

Backgound and Context: Obstetrics and Midwifery in the US and Mexico

The effects of any practice are always the product of its position within a context.

–LawrenceGrossberg (1992, p. 54)

In theUSin 1999, obstetricians, together with some family practice physicians, attended approximately 92% of all births. Their discourse around childbirth centers on “managing risk”—from an obstetrical point of view, every birth is a potential disaster and must be managed authoritatively and preventively to ensure the best possible outcome. Thus most women laboring in American hospitals today are routinely hooked up to IV lines and electronic fetal monitors throughout labor. Their labors are often induced or augmented with a variety of pharmacologic agents, including pitocin and cytotec. Epidural anesthesia is commonly used to eliminate pain. Just under half of birthing women receive an episiotomy to enlarge the vaginal opening and speed delivery. Just under 30 percent of all babies in theUSare pulled out with forceps, vacuum extractors, or via Cesarean section (Ventura, Martin, Curtin, Menacker & Hamilton, 2001). As I and others have previously described (Davis-Floyd, 1992, 1994, 1998a; Martin, 1987; Rothman, 1982, 1989), the performance of birth in American hospitals tells a cultural story about the female body as a defective machine in need of assistance by technical experts and other more perfect machines. It also enacts and displays the technocracy’s supervaluation of speed, efficiency, control, high technology, and the flow of information through cybernetic systems. Technobirths are typical and normative in American hospitals through a consensual, biopowerful process jointly driven by physicians, who tend to be trained exclusively in that approach, and women, who tend also to supervalue technology, control, and most especially the elimination of labor pain (Davis-Floyd, 1994). For instance, use of epidural anesthesia necessitates the use of many other technologies to monitor for and intervene in complications associated with the epidural. In other words, while some women might make other choices if they had more information, generally speaking the interventive American approach exists by mutual agreement between women and physicians steeped in the core values and overall approach to life characteristic of their technocratic culture. Both groups believe that this approach offers both comfort and safety in the face of an unpredictable natural process that proceeds more safely when carefully controlled, in the same way that a river subject to flooding seems improved when a series of dams and floodgates are installed.

To hospital practitioners steeped in this approach, the choice for home birth appears to be a choice for pain and random chaos in contrast to order and control. Most hospital-based practitioners have never seen a home birth and know little about the knowledge base of home birth midwives, in part because of a near-total lack of contact. The many safe and woman-centered births that take place at home are invisible to the medical gaze; biomedical discourse tends to center around “botched home births.” This phrase is one I have often heard bandied about by medical practitioners who tend to assume that any home birth that ends up in the hospital must be “botched,” even if it is the result of an appropriate transport.⁵ Of course, the midwifery response is usually a sarcastic comment about enormous numbers of “botched hospital births”; women who have had “botched” hospital experiences and later choose home birth are an important source of such accounts. This trading of insults is an in-group phenomenon: hospital practitioners complain to other hospital practioners about home birth and midwives; midwives complain to other midwives about hospital practitioners. Dialogue between these groups is rare; mostly, their members inhabit separate worlds that only intersect when a home birth goes awry and a transport is the necessary result.

Throughout most of the twentieth century, the movement of birth was from home to hospital, as technomedicine became increasingly dominant and cultural notions of safety became increasingly tied to the technomedical management of birth (see DeClerq, DeVries, Viisainen, Salvesen & Wrede, 2001). Reacting to what they experienced as “over-medicalization,” in the 1970s thousands of American women began to move their births away from the hospital and back to the home; a new class of practitioners emerged to serve them in what came to be known as the lay midwifery renaissance. By the 1990s, many of these lay midwives had been practicing for over twenty years and had ample opportunity to create a distinctive knowledge base for out-of-hospital midwifery (e.g. Frye, 1995; Davis, 1997; Gaskin, 1990; Rooks, 1997, pp. 225-294). As part of their process of professionalization, they dropped the appellation “lay” in favor of the European term “direct-entry,” which indicates that they entered directly into midwifery education without passing through nursing first (see Davis-Floyd, 1998b). The exact number of direct-entry midwives practicing currently in the USis not known; educated guesses place it at around 3000. Almost all of them work exclusively out-of-hospital, attending around one percent of births.⁶ Approximately 5500 nurse-midwives practice mostly in hospitals, attending around seven percent of all births (Declerq, 2001).⁷ In 1982 a coalition of lay and nurse-midwives created a national organization, the Midwives’ Alliance of North America (MANA), whose primary purpose is to support out-of-hospital midwifery. In 1995, tired of being accused of being “ignorant” and “untrained,” and wanting to offer consumers assurance of competence, MANA members created a new national certification that could test and validate their knowledge, skills, and experience–the Certified Professional Midwife (CPM) credential (Davis-Floyd, 1998b; Rooks, 1997).⁸ At this time of writing, there are over 700 CPMs in the US, and three in Mexico. CPM certification honors multiple kinds of midwifery education, including apprenticeship, which seems to many home birth midwives to most effectively teach the experiential, intuitive, non-interventive, and trust-based approach they value as deeply as their technomedical knowledge and skills. CPMs and other independent direct-entry midwives practice legally or a-legally in 35 states and illegally in 16 states.⁹ In most alegal and illegal states, they are fighting uphill battles for legalization (Davis-Floyd & Johnson-Levitin, nd). In some states where they are licensed, their services are covered by private insurance companies and by Medicaid (and sometimes managed care). But in most states, home birth attended by direct-entry midwives is still an out-of-pocket expense—a factor that exercises a significant limitation on its growth. (In states likeWashington andFlorida where home birth is reimbursed, the percentage of home births is on the rise.) While their practices are not uniform, most direct-entry midwives practice according to specific protocols (sometimes individually arrived at, sometimes mandated by state regulation, and sometimes consensually established by local or regional midwifery associations) that include lists of specific conditions and circumstances that warrant hospital transport. These midwives are presently forming a new professional organization, tentatively named the “CPMAlliance,” to generate more uniform national standards for the increasing numbers of midwives achieving CPM certification, a process that will take some time to develop.

In Mexico, biomedicine has not only taken over childbirth but is redefining its very nature. While high technologies like electronic fetal monitors are not as readily available as in U.S. hospitals, in vaginal deliveries extreme interventions like fundal pressure (Kristeller) and manual extraction of the placenta are common, and Mexico’s Cesarean section rate (just under 40%) is one of the highest in the world (Belizán, Althabe, Barros & Alexander, 1999; Fernandez de Castillo, 1997).¹⁰ A common argument against midwifery made by government officials and MDs is that there are plenty of doctors and nurses in Mexico, that the poor are entitled to the same care as the middle class, and that therefore progress in maternal health care should entail giving everyone access to hospitals and doctors. This argument is representative of what has been called the “megarhetoric of developmental modernization” (Appadurai, 1996, p. 10), which identifies a single point in a given area toward which development should be progressing (Appiah, 1997, p. 425): in health care, that single point is Western biomedicine.

As Marcia Good Maust (2000) has shown, Mexico’s high Cesarean rates stem in large part from physicians’ deeply held belief that birth is a dangerous process that can cause harm to mothers and babies and that technological interventions like Cesarean sections are the best way to ensure the safety and wellbeing of mother and child. Such physicians see midwives as a hangover from the undeveloped past, a temporary evil that must be replaced as quickly as possible with the vanguard of the future–modern health care. In the US and other developed countries, a postmodern discourse (one that stems from multiple points of reference, that does not assume the superiority of any one method) around the benefits of professional midwifery care and certain indigenous approaches–such as walking during labor, upright positions, and herbal remedies—occasionally punctuates the national dialogue about birth. This discourse is barely heard in today’sMexico, outside of some branches of the public health sector. In theUS, nurse- and direct-entry midwives, backed by supportive consumers and often by public health officials, due to their record of good outcomes and cost-effectiveness (Rooks, 1997), are engaged in active campaigns to increase government and public awareness of the multiple benefits of midwifery care. But inMexico, there are no midwifery lobbyists to disturb legislative halls.

Nevertheless, many working-class women resist government initiatives to bring birth into clinics and hospitals, choosing instead to birth at home attended by a midwife.¹¹ Officially labeled “traditional birth attendants” (TBAs) by WHO and UNICEF, these midwives refer to themselves as parterastradicionales (“traditional midwives”: see Davis-Floyd, 2001a, b for more detail). They are usually mothers who have given birth several times and who have become midwives by being asked to attend the births of friends and relatives, slowly gaining first-hand experience of birth. Some of them undertake long apprenticeships, while others learn simply by attending births. Between 1995 and 1996, traditional midwives attended less than 17% of births in Mexico (INEGI, 1999). The majority are over 65 years of age (SSA, 1994); many are dying without training replacements (Good Maust, Güémez Pineda & Davis-Floyd, nd).¹²

Efforts to reduce maternal and perinatal mortality in the Third World by UNICEF and WHO and those engaged in implementing the Safe Motherhood Initiative have for two decades centered around “TBA training”—short, usually two-week-long courses taught by biomedical personnel, usually doctors, nurses, or professional midwives to community midwives (Jordan, 1993; Pigg, 1997). Almost always, these courses are extensions of biopower, fingers of articulation reaching from biomedicine into indigenous communities designed not to clasp hands in mutual accommodation but to alter what they encounter. Very seldom do the “trainers” enter a community and spend time there learning about indigenous birthways before they try to intervene. Rather, they attempt to educate traditional midwives in biomedical ways of thinking, most especially about conditions of risk that are deemed to necessitate transport. InMexicoand other countries, UNICEF has just discontinued funding for TBA training courses; since maternal mortality rates have not dropped after 20 years of TBA training, the conclusion is that such training is ineffective. This conclusion is based on the assumption that mothers die because midwives give them inadequate care or fail to transport them in cases of need. As I have described elsewhere (Davis-Floyd, 2000), in rural areas the unavailability of transport is often the greater problem. But refusal or deliberate delay of transport does occur; as we will see, often the reasons for this delay stem from negative prior transport experiences.

TBA training courses and other forms of exposure to biomedicine have resulted in fundamental alterations in practice for many traditional midwives in Mexico. Across the country, it is now common for them to give pitocin injections to hurry labor, to insert IVs for hydration, and to wear blue biomedical garb when attending births. Combining such practices with the traditional sobada (massage), herbal treatments, and religious beliefs,Mexico’s contemporary midwives practice at the intersection of various cultural domains.

These forces and trends have particularly influenced midwives who practice in urban areas, as my extensive interviews with seven traditional midwives who live and practice in various colónias in or around the city of Cuernavaca reveal. These urban parteras tradicionales (unlike many of their rural counterparts) have long been incorporated into the state health care system in Morelos through bi-monthly seminars on family planning and other topics; the government uses them as agents of family planning and birth control, a service desired by women which they are happy to provide. All seven went through a period of using allopathic interventions like oxytocin injections to induce stronger contractions; experiencing complications as a result, all have returned to the use of their traditional herbs. Today they routinely send women out for ultrasounds when they diagnose a breech or transverse presentation to confirm their diagnosis, and offer their clients an eclectic potpourri of traditional techniques like external version (turning the baby manually) and biomedical options like sending a woman to a doctor they know and trust for a Cesarean section. Dancing fluidly at the interface of biomedicine and their traditional systems, these midwives are strategically negotiating the boundaries between knowledge systems and creatively producing a hybrid and increasingly well-articulated knowledge system of their own. In this endeavor they are assisted by a new group of parteras profesionales (professional midwives) whom I have described elsewhere (Davis-Floyd, 2001a). These professional midwives, three of whom are CPMs, are all members of MANA and have worked to extend MANA’s support of midwives and home birth into Mexico by putting on five annual MANA Mexico conferences around the country and by recruiting as dues-paying members interested traditional and professional midwives.¹³ My Cuernavaca interviewees are members of MANA and regularly attend these conferences, often doing volunteer work on conference organization; in recent years they have also attended, via scholarships from MANA, various MANA conferences in the U.S.

Significant differences in lifeworld, knowledge base, and practice styles distinguish American direct-entry midwives from the urbanized traditional midwives ofCuernavaca, along with equally salient differences in social class and access to wealth, education, and other resources of the technocracy. But their similarities are also relevant here. The transport stories they relate below can most effectively be interpreted in light of the understanding that the members of both groups do not practice in conceptual or geographic isolation, as some midwives do, but rather exhibit all the characteristics of what I have called the “postmodern midwife”—one who balances and evaluates knowledge systems in a relativistic way, and who participates in transnational networks of community-building and information exchange (Davis-Floyd & Davis, 1997; Davis-Floyd, Cosminsky & Pigg, 2001). Like American homebirth midwives, the midwives of Morelos are busy balancing knowledge systems and constructing hybrid identities in urban areas in which they must constantly engage in strategic negotiations with physicians. Their membership in MANA gives them access to international midwifery networks; participation in these networks is helping them to form a new state association to support traditional midwifery in Morelos, and to participate in a national certification project for Mexican midwives that is currently underway (see Davis-Floyd, 2001a).

From an anthropological point of view, both the Cuernavaca midwives and American direct-entry midwives elide and confound the usual distinctions between professional and traditional midwives: some of the American home-birth midwives who are professionally licensed and certified were trained through apprenticeship or self-study; the Cuernavaca midwives, trained the same way but considered lay practioners by their government, are engaged in an unnamed but nevertheless visible process of professionalization (see Davis-Floyd, 2001b). Their ethnic, economic, and class differences are salient; yet despite these differences, and because of their mutual dedication to the welfare of women and belief in the safety and efficacy of home birth, it is fair to say that the members of both groups are inspired by the transnational ideology of home birth and “sisterhood” in midwifery that MANA seeks to foster. Both groups critique the failures and limitations of biomedicine and have a strong sense of mission about preserving home birth in the face of biomedical hegemony. They believe in women’s ability to give birth with little intervention most of the time, in the superiority of homes and birth centers as the sites of birth, and in the efficacy of their own knowledge systems and skills.¹⁴ They do not undertake transport unless they are convinced that the situation is truly in need of technomedical intervention, and when they do transport, their intent is to do all in their power to make the medical system respond in ways they consider appropriate. Thus their transports usually involve at least two people from outside the biomedical realm: the mother who needs help, and the midwife who will not abandon her even when she is no longer in charge of her care.¹⁵

All midwives who practice out-of-hospital must occasionally transport. No national statistical data on transport for Mexico is available, but in the US, home birth midwives have a transport rate of about 8% (Johnson & Daviss, 2001). In other words, 92% of their clients give birth safely at home, while 8% are transported to the hospital during or after labor for various reasons: 6% of their clients are transported for precautionary reasons like failure to progress in labor, meconium staining in the amniotic fluid (possibly but not necessarily a sign of fetal distress), or a retained placenta after the birth. Approximately 2% of their clients are transported for potentially life-threatening emergencies (Johnson and Daviss 2001). (My Cuernavaca interviewees anecdotally report similar rates.) The transport stories I have culled from my interview data and selected to recount below cluster inside that 2%; I urge my readers to keep in mind that the circumstances they recount are quite rare and not representative of the vast majority of births. These experiences are most likely to be encoded in narrative because they are so unusual and also because of their heavy emotional charge. Stories give meaning and coherence to experience; midwives who transport under frightening circumstances often need to find that coherence and to evaluate through narrative, with the benefit of hindsight, their own actions and those of the mother and the biomedical personnel.

In transport situations, there are various ways in which “awryness” can occur: (1) The fact that transport is indicated means that the natural process of birth has in some way gone awry, or seems likely to; (2) the midwife may wait too long to summon transport, either because of prior bad experiences with transport, as we will see below, or because of the midwife’s lack of knowledge of indications for transport;¹⁶ (3) the hospital staff taking the call may not understand the urgency of the mother’s problems; (4) EMTs may fail to respond appropriately, or there may be disjunctive communication between the midwives and the EMTs; (5) arrival at the hospital can go awry for the mother and the midwife if either is ignored or mistreated; (6) even well-intended biomedical interventions can at times do more damage than they fix; (7) not all natural disasters are fixable by biomedical means, so even with the very best of care, the death of mother or baby can occur. Only some of these possible levels of awryness are articulated in the stories I tell below. I selected these particular six stories because they are typical: they represent the range of possible outcomes of transport and are emblematic of many other situations and possibilities I do not have room to treat here. Since I have no way of ascertaining the truth or untruth of these stories, for the purposes of this article I take them at face value and unpack them for what they reveal about midwives’ perceptions of and the meanings midwives attribute to events as they unfold.

The Stories

 Analyzing an event involves (re)constructing it or, in Foucault’s terms, fabricating the network of relationships into with and within which it is articulated, as well as the possibilities for different articulations.

–Lawrence Grossberg (1992, p. 54)

In this section, the stories as the midwives recounted them to me are italicized; these stories are not direct quotes but my retellings (unless otherwise indicated). Contextualizing information, my analyses and interpretations, and the midwives’ additional comments, appear in regular font.

Dis-Articulation

Carrie’s First Story: Unnecessary Delay

Carrie Smiley is a Certified Professional Midwife (CPM) who has practiced in Atlanta, Georgiafor over 18 years, attending during that time over 850 births.¹⁷ Her practice is “unlawful” (meaning that it is punishable in the misdemeanor category). Most of the home births she attends are for white middle-class couples. She does prenatal care out of her own home, a two-story house at the edge of a small lake in an attractiveAtlanta suburb. She began her birth career in the late 1960s working as a volunteer in labor and delivery, and then took training as a biomedical assistant, working in labor and delivery and for a pediatrician for several years. Starting in 1977 she began attending the home births of friends; in the early 1980s she undertook a year-and-a-half apprenticeship with another home-birth midwife who later became her partner. The following episode took place in 1984, during the early years of Carrie’s home-birth midwifery practice. But it should not be regarded as dated, as it typifies many transports that presently occur, especially in “illegal” states.

Carrie and her partner are attending a mother pregnant with her first child, laboring at home and planning a home birth. After about eight hours of labor, the mother has reached ten centimeters dilation and is starting to feel the urge to push. Monitoring the baby’s heart tones, the midwives detect strong decelerations, a sign of fetal distress. Hoping to get the baby out quickly, the midwives ask the mother to push a few times to see if the baby will come down. When they realize that the mother is not going to be able to get the baby out with sufficient expediency, they get her to kneel in a knee-chest position, put her on oxygen, and call the EMTs. When ten minutes pass and the EMTs have not yet arrived, the midwives help the mother into their car, planning on driving her to the hospital themselves. Just as they are ready to go, the ambulance pulls up and blocks the driveway. Announcing, “We’re here now, we’ll take it from here,” the paramedics pull the mother out of the midwife’s car and help her into the ambulance. But they refuse to heed the midwives, who are urging that they must rush the mother to the hospital, insisting that first they have to get a history. Asking questions like “have you had any nausea during this pregnancy?” the EMTs are wasting precious time. Frantic at the delay, and knowing the baby might be suffering from oxygen deprivation, the midwives ask the paramedics to put the mother on oxygen. They refuse, wanting to continue with the history, so the midwives get their own oxygen tank out of the car, at which point the medics finally accede and hook the mother up to the ambulance oxygen tank. As the ambulance starts toward the hospital, the midwife riding with the mother asks her to get on her hands and knees to relieve any possible cord compression, but the paramedics get upset and turn the mother flat on her back. Knowing that this position will exacerbate cord compression and reduce blood and oxygen flow to the baby, the midwife compromises by turning the mother on her side, and continues to listen to the fetal heart tones.

            Arriving at the hospital, the midwives are told that there are several obstetricians present in the hospital, but only the one on-call is allowed to treat a “walk-in” and he is not in-house and will have to be called. Increasingly frantic, the midwives insist to the nurse in the ER that the baby is in distress. The nurse auscultates the heart tones, records them at 130, announcing this to the midwives and the mother, and tells the midwives that “Everything is fine; we will take over from here.” She will not look at the records the midwives brought, which show the heart fluctuations, nor pay heed to their insistence that this is an emergency. The midwives are not allowed to remain with the mother in the ER or to accompany her to labor and delivery. Instead they are sent to the waiting room. Carrie says, “Every time we went outside the room, we noticed that everyone seemed to be looking at us and talking about us.”

Terrified that they will be arrested and sent to jail, the midwives finally head home. Later they learn that it took the doctor on-call one hour and 45 minutes to show up. In the meantime, the nurses caught the baby, who was stillborn. The cause of death was listed on the hospital record as “prolonged fetal distress.” The EMT records said that the mother had been antagonistic and refused oxygen, which the midwives insist is untrue. The nurses said the mother refused the electronic fetal monitor. The hospital pushes the mother to file criminal charges against the midwives, but the mother tells the hospital personnel that this death is clearly the hospital’s fault, that the midwives acted appropriately and bear no blame, and that if the hospital should try to harass the midwives in any way, she will sue the hospital, not the midwives.

In Carrie’s view, she and her partner did their best. Trained to detect fetal heart rate decelerations and to recognize which ones are dangerous, they responded appropriately to the signs of fetal distress. But in retrospect, Carrie wishes that they had taken the woman to the hospital themselves. When I asked her why they called 911 in the first place, Carrie responded, “We were really dumb—we thought that was the appropriate thing to do.”

From Carrie’s point of view, blocking the driveway and announcing “We’ll take it from here” demonstrated the EMTs’ arrogant and authoritative attitude, which at first glance seemed to leave no further role for the midwives to play. She feels that she and her partner demonstrated strength in their refusal to accept this dismissal. Rather, they flexibly and creatively tried to work with the EMTs to help the mother get what they felt she needed. Frustrated by their inability to convince the EMTs of the need for haste, they experienced their success in getting the mother back on oxygen as a small victory. They had good reason to believe that the baby was oxygen-deprived, so when the EMTs refused to act, the midwives resorted to the non-verbal but nonetheless eloquent strategy of getting their own oxygen tank out of the car, figuring that the EMTs would rather use their own oxygen than accept it from the midwives.

One possible reason for the baby’s lack of oxygen might have been that the cord was compressed. Cord compression is usually exacerbated when a woman lies flat on her back, so the midwives wanted to put the mother on her hands and knees in the ambulance, as this is the position most likely to take the most pressure off the cord. (In addition, the flat on the back position can cause supine hypotension (low blood pressure) in women because it occludes the vena cava, resulting in inadequate circulation of blood (which carries oxygen) to the placenta and baby). But a woman on her hands and knees in an ambulance is a strange and unsettling sight and most likely did not match the medic’s internal maps of proper patient position or behavior, or of safety while driving. So the midwives had to give up on the most physiologic position; here again they creatively compromised, finding a position that minimizes both cord and vena cava compression while not challenging the medics’ views of how a patient should be positioned. For Carrie and her partner, these stand as examples of midwives’ ability to think around situations to get the system to meet the woman’s needs. Such creativity has been demonstrated to be typical of subaltern groups, who must be as aware of the features of the dominant group as of their own in order to successfully navigate inside the dominant system (Schaef, 1992).

Several obstetricians present in a hospital, but only the one on-call is allowed to treat “walk-ins,” and that one is not in the hospital: here Carrie’s voice dripped with sarcasm. For her this situation evidences hospitals’ tendencies to be highly structured, category-oriented, and rule-bound. Her outside gaze notes that people who have a place inside the biomedical system, having contracted with a private obstetrician, are more likely to get an immediate response than the anomalous, un-placed “walk-in.” The fact that the nurses would not look at the midwives’ records seems analogous to the medics’ refusal to heed the midwives’ insistence on haste. Instead, the EMTs wanted to take a history, which of course the midwives already had. But the information the midwives had obtained did not count for these biomedical personnel, who valued only the knowledge they themselves obtained. It seems to Carrie that reality as defined by biomedical categories (taking a history, allowing only one OB to attend a walk-in, counting only information obtained by biomedical personnel) was more salient here than reality as the midwives, the mother, and the stillborn baby experienced it.

Tragically, the mother’s refusal to be put on the electronic monitor denied the biomedical system an indicator on which it might have acted. This refusal probably stemmed from the distrust of the biomedical system and its technology that led the mother to plan a home birth in the first place. When the ER nurse announced that the heart tones were at 130, the mother took this news to mean that the problem had resolved itself and “everything was fine.” Carrie later learned that in the labor and delivery unit the fetal heart rate decelerations were noted and recorded by the nurses who were auscultating the mother, but for some reason they never told the mother that they could hear the decelerations, so she continued in the belief that the heart tones were still OK. Emphatically, Carrie stated that if the midwives had been allowed to remain with the mother, they would have convinced her to allow the monitor; she said “We would have done everything from cutting a huge episiotomy to jumping on her tummy to get that baby out. But we were sent away.”

Carrie’s sarcasm extends to the “lie” the EMTs told on their official records, a lie she is sure they told to cover themselves in case of lawsuit. It is likely that the paramedics assumed that as biomedically trained practitioners, their word carried more authority and cultural weight than the words of the midwives and the mother, so their notes were more likely to be seen as valid. Practicing inside a hegemonic cultural space can facilitate one’s claim to truth. Practicing outside that space not only calls one’s veracity automatically into question, but also puts one at risk of legal action: Carrie and her partner feared being sent to jail since their practice is unlawful in Georgia. They have dealt with this threat through their excellent outcomes, on which they keep careful statistics; through obtaining CPM certification, which is not recognized in Georgia but at least shows that they have been tested and have demonstrated the requisite competence; and through publicity: every few years, a local paper publishes a several-page spread on Carrie and her practice, showing pictures of her and of the happy couples she has attended. She feels that this high level of visibility affords her far more protection in the form of community support than would remaining underground.

Reality is as one perceives it and the effects of any given event depend not on the actual circumstances of that event but on how they are narrated. On both sides of this particular biomedical/midwifery//biopower/counterpower fence, opinions were formed or reinforced by this experience. We can imagine that the story that circulated among hospital personnel about this birth was very different from the one the midwives tell: chances are it was a story about another botched home birth attended by irresponsible midwives. On the midwifery side, it was one more story about the absurdity of biomedical bureaucracies and the arrogance and narrowmindedness of biomedical personnel–nurses, physicians, and EMTs alike. And it was a story about the dedication and loyalty of the midwives’ clients: when I asked Carrie why the mother did not sue the hospital, she responded, “Because she knew that if she did, the hospital would come after us.”

Later Carrie added, “Before this experience, I always thought that if you have a problem, you call the paramedics. Now I know that if you want a problem, you call the paramedics.” She notes that this experience made her much savvier about the limitations of the biomedical system. Specifically, it taught her and her partner to always make sure they transported only to hospitals with on-call physicians in-house, and not to involve the paramedics if there was any way the midwives could transport the client on their own. And, as we will see below, it led Carrie over time to work to develop a network of relationships with individuals in the hospitals to which she now transports in order to enhance her ability to prevent this kind of disarticulation of systems, and to facilitate the kind of smooth articulation that can save lives.

Luz’s Story: A Transnational Parallel with a Different Ending

Laura de la Luz Gomez (“Luz” for short) is a traditional midwife of over 30 years’ experience who attends home births in the impoverished barrio of Santa Laura, just north of the city of Cuernavaca in the state of Morelos, Mexico. Luz and her family live in a crowded one-room house made of wood and corrugated tin, with a dirt floor. They are building a much bigger house of brick and cement next door; they have been working on it for 25 years and it is finally near completion. Years ago, Luz and her family chose to pour the resources they could have put into the house into the construction of a birth center behind their one-room shack. The shack is hot, small, and unadorned; the cement-floored, freshly painted birth center is spacious, cool, and breezy. Two double beds allow family members to keep women company during labor; Luz’s autoclave and midwifery equipment rest on the table in between the beds. The women of her barrio like this birth center and prefer it to their own houses. There Luz attends four to five births per month. In the summer of 1999, Luz told me the following story.

A woman who had not come to Luz for prenatal care showed up on her doorstep one day in labor. Luz does not like to attend women she has not seen before, but nevertheless took her in. Listening to the baby’s heart tones through her fetoscope, Luz heard the heartbeat drop from 135 to 100, then rise back to 135, then drop again. She called a taxi¹⁸ and transported the mother to the hospital, where she carefully explained to the nurse on duty that this was an emergency. In spite of her entreaties, she and the laboring woman were ignored. Luz insisted to the nurse that the baby was suffering, and the nurse said “How do you know that?” “Because I am a midwife with thirty years’ experience,” Luz replied, “and I checked this patient and I know she needs to be in the hospital because the baby’s heart tones show distress. And she has just come to me for the first time with no prenatal care, and you tell us to refer in such cases, and so for these two reasons I am referring.” “Sit down for half an hour,” responded the nurse. “The doctors will be with you when they can.” “No, call the doctor now!” insisted Luz. “The baby is in danger, it is very big and is not coming down, she needs a Cesarean.” Luz continued:

We were there one hour and a half waiting. I could hear the doctors laughing and laughing down the hall—they were drinking their coffees. When I knocked on the door, they were putting away the cups. And still they made us wait. And I got really angry and I said to her husband, “Do you have money?” And he said, “Well, I’ve been working so I have some.” And I said “OK, well go and get it, because you’re going to need it—I am taking her away from here.” And so I called the doctor who is a friend of mine at a sanatorio (private clinic), and he said “OK, you can bring her in and I will do the Cesarean.” And we took that woman to his clinic and he did the Cesarean. It cost a lot, but we got out of that problem, didn’t we? They tell us to “refer at the first points of alarm,” so that the baby or the mother won’t die because of my ineptitude. Ha! El plan de trabajo mio es lograr a que viva la gente, no a que se muera.” (My plan of work is to succeed at people living, not dying.)

Like Carrie’s story, Luz’s story is about a midwife responding appropriately to dropping heart tones yet being ignored by biomedical personnel. In both stories, the midwives express their efforts to get attention and their enormous frustration at being ignored. Luz went so far as to appropriate the lexicon of TBA trainings when she listed to the nurse not one but two reasons for referral. “You tell us to refer in such cases”: the plural “you” indexes the biomedical trainers who told her that she should send patients to whom she has not provided prenatal care to the hospital if they show up in labor, and that consistent fetal heart decelerations are an indication for transport. Taking the biomedical system at its collective word, Luz used those same words to try to get the system to respond. Yet like Carrie and her partner, in spite of the “thirty years of experience” Luz invoked in an attempt to garner authority, she was ignored—an act that constituted a de facto dismissal of Luz from having any kind of authority, and which she resented deeply.

Not willing to sit passively and wait, Luz went so far as to knock on the door of the doctors’ lounge, and was again dismissed. As in Carrie’s case, this hospital was not going to respond smoothly or quickly to a “walk-in.” But there was some benefit in trying, as this second dismissal convinced Luz that she was never going to get anywhere in that hospital, a realization that inspired her to search for an alternative. Exhibiting a creativity in hostile circumstances parallel to that of Carrie and her partner, but with better results, Luz conceived the idea to take the woman to a doctor she trusted and often worked with. His practice was private and would require financial payment, while the hospital, as part of the Mexican public health system, would have been free. So a prerequisite was to ask the woman’s husband if he had money and could pay for the Cesarean. His affirmative answer freed Luz to implement her plan that mother and child should “live and not die.”

Like Carrie’s story, Luz’s experience highlights the frustration midwives often feel at the lack of obstetrical recognition or valuation of their knowledge. Midwives see themselves as guardians of the normal. They are skilled at recognizing when a situation deviates from the normal and lands in the realm of obstetricians, who are experts in the abnormal. From a midwife’s point of view, this professional demarcation system might work well if midwives’ knowledge about normal and their ability to diagnose abnormal were regarded as authoritative by nurses and obstetricians. But as we have seen, in the face of biopower and biomedical knowledge, the midwife’s knowledge and attempt to generate a response from the medical system often simply do not count; in this case, dis-articulation—no response from the hospital to the midwife–was the result.

The fascinating difference between Luz’s story and Carrie’s lies in their endings. In Carrie’s story, the disarticulation of systems ended in the baby’s death, and might have done so in Luz’s story as well. But Luz found the opportunity to seek a smoother articulation. Over years of practice and referral, she had built a mutually respectful relationship with one obstetrician who did not question her diagnosis, but rather was immediately ready to respond. So she was able to create a radically different ending to this otherwise very similar story. Luz said, “What happens is that the politics are against us, so we have to be as creative as we can.”

Fractured Articulations

Lana’s Story: An Inaudible Voice

Lana Lane, an American direct-entry midwife, learned midwifery through a two-year apprenticeship inFairbanks, during which, with her mentor, she attended over 100 births. Shortly after finishing her training in 1985, she moved toWasilla,Alaska, where she went into partnership with Susan Eakin. By then the direct-entry midwives ofAlaskahad achieved their legislation and were practicing legally. This story, told to me by Lana’s partner Susan, took place the following year.

Arriving at the home of a woman in early labor who lived less than five minutes away from a tertiary care center in Anchorage, Lana performed a vaginal exam to check the degree of cervical effacement, dilation, and station (the position of the baby’s head), and suddenly found the umbilical cord in her hand. Susan said, “The cord was just below the baby’s head. Lana tried to slip it up away from the vaginal opening, hoping the head would block it, which can sometimes be done if too much cord doesn’t wash down. But the cord just kept slipping, so all Lana could do was keep the cord from being pinched (which would cut off the baby’s blood and oxygen supply) by splinting it between her fingers and pushing the head off it.” While the mother crouched on her knees and prayed, Lana maintained the head in place, telling her partners to administer oxygen to the mother and the father to call 911. He held the phone for Lana as she described the situation and begged them to have an operating room ready. At that point, the baby’s heart tones were fine. The ambulance arrived in two minutes. The EMTs were cooperative and did not question the midwife’s judgment. Lana straddled the stretcher below the mother, applying counter-pressure to the baby’s head with one hand and with the other using the Doppler to monitor heart tones that were steadily dropping. They were inside the hospital within minutes. But upon arrival, they found that nothing had been done to prepare for the Cesarean. For thirty minutes, Lana knelt on the stretcher holding the head in place and listening to the heart tones drop—50, 40, 30. She lost her voice from screaming for the hospital staff to hurry. But by the time the Cesarean was finally performed, the baby had died.

A prolapsed cord is life threatening to the baby—when the cord is in front of the baby’s head, it is compressed, thereby cutting off blood and oxygen circulation to the baby. Unless the baby can be birthed immediately or a Cesarean quickly performed, the baby is likely to die. In this situation, wherever it occurs, the mother must get into the knee-chest position, which takes the pressure off the cord, while the practitioner kneels behind her and applies counter-pressure to the baby’s head so that the cord is not compressed between the head and the woman’s pelvis. Keeping her hand inside the mother’s vagina, the practitioner must hold up the baby’s head until the baby is removed by Cesarean—a dramatic scenario to say the least, the success of which depends on how quickly the Cesarean is performed.

This story resonates with pain; indeed Lana’s partner Susan, who first recounted it to me, was crying as she spoke. She did not know exactly why Lana’s pleas for speed were ignored, but she felt sure that it had something to do with the hospital staff’s disapproval of home birth. The worst case scenario would interpret hospital personnel as deliberately ignoring this “walk-in” from outside to prioritize the women inside and/or to punish her for trying to give birth at home. Prior and subsequent experiences have ensured that Susan holds this worst-case view. She said:

In my opinion, the reason no one came to the rescue is because it was a planned home birth gone bad. I don’t think they “believed” Lana knew a thing. More than once we’ve been forced to wait on circumstances they would normally be scampering to fix. I could tell you several stories in which the medical staff tried to hang us, instead of acknowledging that we transported appropriately.

In contrast, the scenario that attributes the best intentions to the hospital practitioners has to do with the logistics of hospital procedures. When a cord prolapse occurs in hospital, the practitioner who identifies it issues a crash call, the obstetrical team flies into action, and when all goes well the baby is delivered by Cesarean within ten minutes. But getting everything in place for a Cesarean is very expensive in terms of the personnel and equipment needed, and most hospitals have experiences of doctors, paramedics, nurses, and/or midwives telling them to prepare for a Cesarean when one really isn’t needed. Setting up unnecessarily ties up rooms, obstetricians, and anesthesiologists and may keep them from being available if needed elsewhere. Thus it is logical that a hospital would want to assess the situation before taking action, especially on the word of a person unknown to them (which might include a private physician) (Judith Rooks, personal communication¹⁹).

This transport took place in 1986 but cannot be dismissed as anachronistic—similar scenarios still play out around the country, especially in states where midwives practice illegally but also in states where they are legal but not well accepted by or well known to biomedical practitioners. It illustrates the dysfunctions generated by partial, fractured articulations between the biomedical and home-birth midwifery systems. The biomedical system’s first response was appropriate—the EMTs supported the midwife to continue her work and did not challenge the validity of her knowledge or approach. And on the phone the hospital promised a response. But somewhere between the promise and the mother and midwife kneeling on the stretcher in the hall, a fracture occurred in what had promised to be a system of smooth articulation, and it was the baby who fell through the crack. Both the worst-case scenario (that the hospital deliberately delayed action to punish the midwives and the mother for attempting a home birth) and the best-case scenario (that, given the expense and difficulty of preparing the OR, hospital practitioners didn’t feel they could risk taking these unknown midwives at their word) point up the importance of prior dialogue and relationship between the hospital and the midwives in order to establish mutual trust and systems of smooth articulation well in advance of this kind of emergency.

Marisa’s Story: A Public Humiliation

Marisa Salinas defines her primary identity as that of a traditional midwife; she also is a registered nurse. Her friend and colleague Laura de la Luz lives to the far north of Cuernavaca, while Marisa’s residence is in a barrio called Tejalpa to the east of the city on the road to Tepoztlán and Cuautla. Marisa became a traditional midwife because she resented the subordination of the nursing role, and found allopathic biomedicine entirely too interventionist for her taste. She attends four to five births a month, mostly in women’s homes but also in the bedroom she uses as a birth center; she has a separate room for prenatal exams. Every time I have visited, wild herbs lie drying on the prenatal exam table, a visual elision of boundaries and juxtaposition of worlds that is characteristic of the hybrid nature of these midwives’ practices.

            One night Marisa received a phone call from the family of a distant cousin of her husband, from a small rural town. The cousin was six months pregnant and the family was worried about her and wanted to know if they could bring her to Marisa for a check-up. Thinking they mean at some future date, Marisa agreed. At about six the next morning the woman arrived on her doorstep. Marisa was already in her nursing uniform, about to head out on a campaign to offer Pap screens to rural women. She didn’t like the way the woman looked, and immediately took her blood pressure; the diastolic pressure was 170, suggestive of pre-eclampsia. Marisa immediately called a taxi and accompanied the woman to the hospital. By the time they arrived, the woman was convulsing. The hospital staff put her into intensive care, while Marisa waited outside in the waiting room:

And every so often the doctor came out and told me that I am this thing and that thing, saying “Useless midwives, why do you take these cases when they are serious and high-risk?” yelling at me in front of all the people in the waiting room. And the second time he came out he said more things to me and threatened me and in truth made me feel very bad. “Don’t leave,” he said. “Because if she dies right now we’re going to see about you.” And I got scared. I didn’t do anything besides take her blood pressure and bring her straight to the hospital. And after a while her family arrived and I told them that she started convulsing all of a sudden. I told them that I hadn’t done anything, that I had been headed somewhere else and took a detour to accompany her.

And finally the family spoke with the doctor and explained everything to him, and I spoke with another doctor there who knows me and has always helped us midwives. That first doctor was a real despot. And yes he finally apologized to me, because the doctor who is kind to me and respects me is the head of obstetrics at that hospital, and made him apologize. But he apologized to me in private in a little back room, and he insulted me in public in front of everyone. The whole thing made me feel sick. But in the end they did save her life and the baby’s life. In the ultimate case I wasn’t the one who was important, right? She was, and the baby was. But yes, my morale did go way down. What did I do wrong? Why would I keep her here and have her die on me? That despot wouldn’t even let me tell him what I had found.

As a nurse, Marisa has often served as first assistant at Cesareans; she has good relationships with several physicians who respect her, and so the doctor’s belittling remarks took her by surprise. Even worse than the insults, from her point of view, was the doctor’s complete unwillingness to listen to the facts of the case; he blamed and judged her without even knowing what had happened. As with Carrie, Luz, and Lana, the midwife’s knowledge and prior experience did not count–in Marisa’s case, indeed, did not exist inside the system. The other midwives at least verbalized what they knew, even if they were not heeded, while Marisa’s voice had no chance to be heard. So even in this case, where the hospital recognized the gravity of the situation and immediately took over the care of the woman in appropriate ways with a good outcome for mother and child, the midwife was punished. As she told me the story, which took place six months before our interview in summer 2000, Marisa’s face turned red and tears came to her eyes. She was grateful that the doctor and hospital staff saved the life of mother and child, but kept returning to the personal damage done to her. The doctor’s apology seemed to her too little and too late—the humiliation was public, the apology forced and done in private.

From the biomedical point of view, it is important to understand that the doctor’s specific question, “Useless midwives, why do you take cases that are serious and high-risk?” reflects his understanding that traditional midwives are taught a series of risk factors in training courses and told that they should always refer such cases. Earlier we saw Luz mention two of these risk factors as reasons for transport: fetal heart rate decelerations and unknown prior history. Pre-eclampsia is another such risk factor. Although in this particular case, the doctor’s insult was unfounded, he had other reasons to make it. The traditional midwives I have interviewed in Cuernavaca often do take high risk cases, choosing to ignore the protocols they have been taught, because of the circumstances under which they practice. Dona Alina Garcia, one of the most respected traditional midwives in Morelos and Marisa’s close friend and mentor, explains:

In a given moment the woman comes knocking on my door with eight or nine centimeters of dilation, and I can’t turn her away even if it is a case of high-risk—I have to attend her. And we have moved forward with plants, with massage, we give all that is within our reach to give health to the parturient woman so that everything turns out well. . . . When the case is high risk because the baby comes breech, in the moment of the birth we have to be doing maniobras [hand maneuvers] to turn it, and if it can’t be done, we have to receive it as it comes, even if the person never went to a prenatal consult. . . . A low-lying placenta is a high-risk case, right? What we do is push the placenta to one side and the baby can come through and be born. Only when really the placenta comes first, and then the baby—placenta previa–then we have to take her to the hospital, because that truly is a case of high-risk.

Marisa too acknowledges that she has often attended women that would be labeled high-risk by the biomedical system. For example, it is not uncommon for poor Mexican women to avoid prenatal care—they don’t like the long waits at the hospital and the impersonal treatment they receive, so many of them just don’t go. Perhaps such a mother would prefer receiving prenatal care from a midwife, but she may not feel she can afford it or that it is really necessary, especially if she has had other children already. So then she comes to the midwife in labor, having avoided paying for prenatal care but preferring to pay for a midwife-attended birth over having a hospital birth for free. Or perhaps the midwife lives close by, and labor comes on precipitously, and there is no time to reach the hospital. So then, as Dona Alina says, what is the midwife to do? These midwives share an ethic of care that involves service to women; most traditional Mexican midwives (and some American direct-entry midwives) will not violate that ethic by turning away a laboring woman they have not attended prenatally before they even check her. And if they check her and encounter a problem that they feel they can handle, especially later in labor, they are very likely not to transport in order to save the woman from the otherwise inevitable Cesarean.

Although many Mexican traditional midwives accept the notion of biomedical superiority and devalue their own skills in relation to biomedicine, Marisa and her postmodern colleagues in Morelos do not. Like American direct-entry midwives, they see their own knowledge system as more appropriate than technomedicine for all normal and some high-risk births, and they engage in a radical critique of technomedical limitations, pointing out that most doctors have no idea how to deliver breeches, much less turn them, or to deal with low-lying placentas. They simply perform a Cesarean in anomalous cases. Women who come to traditional midwives in urban areas are usually there because they do not want to have a Cesarean birth, which has become almost normative in urban Mexican hospitals. Urban women who go to a traditional midwife could have gotten biomedical care for free; they want her care badly enough to pay for it. The postmodern midwives of Morelos charge around fifteen American dollars for a birth—a far cry from the two or three thousand dollars American direct-entry midwives often charge. But for the urban and rural poor who seek the traditional midwives out, their fees, even though usually offered on a sliding scale, can still be a challenge to pay. Home- or birth-center birth with a traditional midwife in an urban area like Cuernavaca, where hospital birth has long been the norm, is thus a deeply desired alternative choice in the same way that it is in the United States. It was the existence of this alternative, which many doctors would like to elimate in the cities at least, combined with the even more provocative willingness of midwives to ignore the protocols they are taught in their training courses, that had the doctor already so angry at traditional midwives in general that he blew up at Marisa without even bothering to learn the facts of this particular case. His knowledge system insists that Cesareans are the solution in almost all high-risk situations, and that the midwives’ maniobras are both ineffective and dangerous. This physician’s successful management of the mother’s eclamptic seizure, which the midwife could not manage, is of course one of the lifesaving skills that allows him to maintain his belief that only his knowledge counts.

It is worth noting that in each of the earlier stories, the biomedical staff would have had to trust the midwife’s knowledge to take quicker action, as the complications resulted from fetal heart rate anomalies detected by the midwives but not by biomedical staff, and a cord prolapse that only the midwife had confirmed by touch. We can speculate that the reason why Marisa’s cousin got such quick attention when the other women we have heard about did not was the visible, unmistakable, and dramatic nature of her condition, which required no reliance at all on the midwife’s knowledge to diagnose.

As in Carrie’s story, the threat of legal action against the midwife hovers in the air in Marisa’s story. Unlike Carrie, Marisa practices legally with her identification card from the health department, issued to her upon completion of her two-week TBA training course. She also relies on her nursing registration for various aspects of her practice. There is no national certification as yet available for Mexican midwives; Marisa is highly supportive of midwives’ current efforts to create one (see Davis-Floyd, 2001a), as she has longed for years to be able to prove her worth to the physicians in town. In the meantime, like the other traditional midwives in Cuernavaca I have interviewed, she continually augments her education through workshops and seminars given by various organizations and continuing education courses at local universities. The walls of her prenatal exam room are covered with framed certificates from these courses; she showed me a large drawer full of others she intends to frame. Such certificates are proudly displayed by all of my interviewees in Mexico as visible evidence of their commitment to education and their ongoing quest to improve themselves as practitioners. Sadly, Marisa noted that while these certificates do carry weight with her clients, she didn’t suppose they would make a difference to the “despot doctor.” She was truly terrified by his threat to “see about you” should the woman die; as I noted above, although Marisa and her colleagues practice legally, when there is a death they are often arrested and put in jail before an investigation is complete. In Marisa’s story, as she is the first to point out, the mother’s transition from midwife to hospital was smooth; the fracture ocurred in the interaction, or lack of it, between the midwife and the doctor. This fracture made Marisa realize that the certificates on her wall cannot protect her from biopowerful devaluation, and gave her a great deal of impetus to address this fracture by working to increase midwife power through supporting the formation of a midwives’ association and the legal fund its members hope to generate.

Marisa’s story finds a transnational echo in one told to me by Dina Farraw, an American CPM from Arkansas, who transported a client after a home birth for a retained placenta. The doctor did remove the placenta, but only after sternly telling the woman and her husband that it was “child abuse” to give birth at home with midwives. This insulting remark was most likely made out of sincere beliefs that midwives are ignorant and that home birth is a highly risky enterprise. The statistics on the safety of home birth in theUSare not taught in medical school, and most obstetricians are simply unaware of the good outcomes home birth midwives generally achieve (Rooks, 1997, pp. 345-384). Of course, it is ironic that the doctor’s belief in the midwives’ ignorance stems from his own. The hegemony of obstetrics has forced midwives to educate themselves in its ideology and assumptions, protocols and lexicon to enhance their chances of successfully interfacing with it and of being able to defend their actions in its terms. In contrast, the marginality of midwifery has allowed obstetricians to remain ignorant about it. Obstetricians tend to be unilingual in the language and technologies of biopraxis, while my midwife interviewees on both sides of the border tend to be multilingual. They manipulate the lexicons of both obstetrics and midwifery, as well as of various folk systems of practice and belief that inform the lifeworlds of the clients they attend. Midwives thus transgress and elide professional boundaries on a daily basis, while obstetricians tend to reinforce them. Fractures in attempts at articulation (like these doctors’ insulting remarks) often result from this kind of obstetrical boundary reinforcement.

In both theU.S.andMexico, a few physicians are willing to elide and transgress professional boundaries in order to support home birth midwives. Such support can be costly: In the U.S., some physicians have lost their hospital privileges, their insurance, and their ability to practice in their communities as punishment for working with home birth midwives, including a very recent case in the state of Massachusetts. Of course, the more physicians supportive of home-birth midwifery are marginalized within biomedicine, the less ability they have to create needed structures for smooth articulation.

Smooth Articulation

It is important to remember that for all the transports that go awry, many others go smoothly and most do not result in anyone’s death even when they are characterized by fractured articulations. Very few urban midwives in Mexico and the U.S. ever lose a mother, but out of every 1000 births, two or three babies will die no matter where they are born or who attends them. In the US, home birth data indicate that babies whose births start out at home do not die at any higher rates than babies whose births start out in the hospital–there is no added risk to home birth (Rooks, 1997; Macdorman & Singh, 1998; Johnson & Daviss, 2001). As I noted above, only 2% of transports are true emergencies; the same emergencies happen in hospitals. But clearly, transports that involve fracture or dis-articulation between biomedicine and midwifery can amplify the problems already generated by the complication that motivated the transport; sometimes those disjunctures alone are enough to cause a death that would not otherwise have occurred. On the other hand, when a home-birth transport is treated as effectively as a problem that takes place within a hospital, the chances for survival of mother and baby are greatly enhanced. This more positive scenario requires smooth articulation between the biomedical and home-birth midwifery systems, which the following two stories will illustrate. They both come from Carrie Smiley, the afore-mentioned CPM from Atlanta, Georgia.*

A mother pregnant with her second child, whose first birth had been very fast, started bleeding during mild early labor with contractions six to eight minutes apart. Carrie had sent her for an ultrasound at 34 weeks, which had been normal, so she knew she was not dealing with a placenta previa (the placenta does not move after 34 weeks). Carrie noted that “If the mother had not had ultrasound, there is no way I could have checked her with that much bleeding at home.” (In a case of true placenta previa, doing a cervical check can cause harm.) Carrie checked the baby’s heart tones, which sounded good. Carrie was concerned by the dark red color of the blood, which indicated that it was not from a superficial cause. She called the hospital and talked to the nurse-midwife who works for Carrie’s back-up doctor, telling her it looked like some kind of placental abruption might be occurring. They drove the mother to the hospital, where the nurse welcomed them into the labor and delivery unit and put the mother on an electronic fetal monitor, hooked up an IV, and drew blood to type and screen in case she had to have a Cesarean. The baby’s heart tones remained steady and strong. The doctor came in about ten minutes after they arrived and said to Carrie and the nurse, “It looks like you have everything under control.” Carrie expressed her concern about the color of the blood, but the doctor was not worried. He stayed for only about five minutes. After he left, the mother labored for another three hours. She spent time in the jacuzzi, sat on the toilet and then the birth ball for a while; eventually, she got in bed to try to rest. Carrie and the nurse-midwife turned off all the lights in the room. When pushing contractions kicked in, the mother pushed for about ten minutes, as Carrie recalls, and delivered on her hands and knees while the nurse-midwife caught the baby. The baby stayed with the mother. The placenta came fairly quickly after the birth; when Carrie and the CNM examined it, they could see a five centimeter clot on it—an indication that the placenta had partially detached in that area and had been bleeding from that place for a while. (If a placenta detaches uniformly after the birth, there will not be many clots on it unless it has been sitting in the uterus for quite a while, but if there is a partial separation, there will be clotting or additional clotting at the site of the partial separation.) The mother and baby went home the next morning. After the birth, the doctor told Carrie that she probably could have stayed at home for this one. And Carrie told him, “You have to realize that it’s important for me to transport sooner rather than later when I have the option.” And he said “You are right—I don’t always see it from your side.”

In the hospital, a partial placental separation is not cause for major alarm, since facilities for a Cesarean are there at hand. But home birth midwives like Carrie prefer to err on the side of caution—if you see too much bleeding to feel OK about it, you transport. A primary ingredient in Carrie’s willingness to transport early rather than late is the excellent relationship she has established over time with this doctor and this particular hospital. She said,

Since the early years of my practice, over time we have built up a lot of really good rapport, so that we have a lot of unoffficial back-up [it can’t be official as Carrie’s practice is not legal or licensed in Georgia.] We now have a doctor who is providing backup for us in that during the pregnancy he will see the mothers if we need him too–if we need an ultrasound he’ll do one in the office. He says he doesn’t like home birth but also he doesn’t like the fact that many doctors are refusing to see home birth mothers. He says everybody deserves good medical care when necessary. And if something comes up in labor, we can call the nurse-midwives who are always in-house. They listen to what we have to say on the phone and have everything set up when we arrive–the operating room ready, the doctor already in-house. So it is a really good situation—there are no animosities or repercussions or “attitudes” toward home birth mothers. The doctors aren’t exactly thrilled–they have said to the CNMs, “I wish you’d quit being so nice to these midwives so they’ll quit bringing women in.” And the CNMS have answered, “Would you rather leave them at home?” And the hospital is wonderful! It has no newborn nursery—I would consider them mother-baby friendly. The babies are never taken away from the moms unless they are really in trouble and need to be in the NICU.

Carrie’s experiences point out that different kinds of articulations can happen in the same location as the actors come to know and develop trust in each other over time.

In 1978 with the first publication of Birth in Four Cultures, Brigitte Jordan issued a call for the replacement of top-down, culturally inappropriate obstetrical systems with models of mutual accommodation between biomedical and indigenous systems–a plea that is equally significant for non-indigenous home-birth midwifery systems. Both Luz’s earlier story about transferring a patient from an unsupportive hospital to a private clinic with a physician who knew and trusted her, and Carrie’s story above illustrate the positive results of this sort of mutual accommodation. Nurse-midwives are especially well-placed to achieve it, as they inherently straddle and bridge (and occasionally fall into the fissures beween) biomedicine and home-birth midwifery. Establishing close relationships with home birth midwives who are not legal is simultaneously a transgressive and a boundary-spanning act. This prior communication between Carrie, the nurse-midwives, and the supportive physician certainly facilitated the smooth articulation of systems that both of these stories illustrate. Carrie feels that the key to this sort of smooth articulation is mutual respect and a cooperative attitude on the part of all concerned. Carrie’s long and safe practice in her community has earned her this kind of respect from the hospital practitioners who know her best. She notes that it can take years to build up this kind of relationship, especially with physicians who start out mistrusting midwives. Once established, though, such relationships tend to last. Many home birth midwives, including Carrie, Susan, Dina, Marisa, and Luz, do presently enjoy mutually accommodating relationships with one or two supportive physicians that they have worked hard to build over the years. But they note that such smooth articulations are jeopardized when the supportive MD moves away or retires and is replaced by a younger doctor “with an attitude,” as Carrie puts it, and then the midwife has to start all over again on the process of building trust. And most of my interviewees cannot always count on the availability of the physicians who support them; thus, even those who have spent years building good reputations and good relations with certain physicians sometimes still have to deal with fractured articulations during transport.

But in Carrie’s case, because of her long-term relationship with the nurse-midwives in her local hospital, the articulation between her knowledge system and that of the hospital and its practitioners is so smooth that she is more than willing to transport even for situations that have nothing to do with risk but rather with the mother’s comfort alone, as the following short story shows:

A primapara [mother giving birth for the first time] had pulled a muscle in her back at end of pregnancy and was in a lot of pain as a result; she called Carrie to her home in the middle of the night. Carrie arrived to find the mother was in very early labor, at two centimeters dilation, but with close to unbearable pain from the back spasms. Carrie spent hours trying to relieve the pain in her back with showers and warm compresses and massage. She said,

After a while we were running into brick walls as far as pain relief for the spasms, so we decided to go into the hospital where they have jacuzzis in the labor rooms. By the time we got there, she was 6 centimeters. The nurse-midwives who received us told her she was doing great. The jets did good counter-pressure on the back pain. They never started an IV and she had no pain medication. The baby’s heart tones always sounded great. I was able to catch the baby as “the grandmother” on the chart—the nurse working with us had had her babies at home, and the nurse-midwife was very supportive and felt this mom really deserved the continuity. The baby was fine and the family went home twelve hours after the birth.

As these two stories illustrate, smooth articulation between knowledge systems proceeds through points of overlap, transition, and communication that facilitate the seamless flow of information and linked, imbricated decision-making in which the actions taken by one person or group build on the information supplied by another. The relationships between Carrie and the hospital-based CNMs encompass such points, as do the relationships between theCuernavacamidwives and their supportive MDs. When this kind of decision-making takes place within the top-down biomedical system, such imbrication requires a rejection of its tendency to discount or dismiss as irrelevant other ways of knowing. Such rejections can and do take place at the level of the individual even when the system as a whole remains dismissive.

What motivates or inspires a physician to reject the top-down system and give credence to home-birth midwifery knowledge? In my experience, the ingredients key to an individual’s rejection of biomedical hegemony in favor of mutual accommodation include: (1) exposure to midwifery care; (2) exposure to midwives; (3) attention to the scientific evidence.

Exposure to midwifery care. Some doctors train in hospitals where nurse-midwives practice and thus are able to observe first-hand the benefits of midwifery care. Physicians I have interviewed are often awed by the midwife-attended births they witness, which are often visually and audibly nothing like previous births they have seen. Women attended by midwives in hospitals are more likely than women attended by physicians to give birth in upright positions, without an episiotomy, and with a great deal of hands-on support. Nurturance and consideration tend to characterize the midwife’s approach to the mother; shared decision-making takes place in a context of mutual respect. Physicians who do not ordinarily witness this kind of birth can find the experience transformative, can become imbued with a desire to incorporate this kind of respectful, humanistic approach into their own practice, and will be more likely to work with nurse-midwives in the future from a partnership, rather than a hierarchical, perspective. Occasionally a brave physician will venture outside hospital bounds and observe a midwife-attended home birth—an experience that tends to be emotionally evocative and ideologically transformative (see, for example, Wagner, 1997).

More profoundly, it is important to note that clinicians judge other clinicians as individuals, not just as members of a class or category; individual judgments can overcome prejudices based on subcultural differences. Does a practitioner give good care, make good decisions, communicate accurately? Individual practitioners decide the answers on the basis of experience. All clinical practitioners constantly gather experience and information, and react differently to a comment, order, or action from someone they trust as opposed to someone whose judgment has been faulty in the past or whom they do not know. Midwives work best with the doctors they have come to trust as a result of experience, and vice versa. But most doctors have little or no experience of working with home birth midwives; the experience they do have may be skewed if it comes only during emergency transports (see footnote 6). Lack of experience with working together creates problems that exacerbate and perpetuate lack of experience with working together (Judith Rooks, personal communication).

Exposure to midwives. Postmodern midwives in theU.S. andMexico, I can say without overstatement, tend to have huge hearts, impressive personalities, a strong sense of commitment and dedication to serving women, a secure sense of their own self- and professional worth, and a large fund of knowledge about parturition that seamlessly permeates their conversation. Simply spending time with them can turn a hospital practitioner from an opponent to a supporter. InU.S. communities where smooth articulation characterizes transport, home and hospital midwives, and sometimes physicians, often participate in periodic potluck dinners where models of mutual accommodation begin to emerge over casseroles and drinks. Hospital midwives who develop respect for and good relationships with home birth midwives often transmit this trust to the physicians with whom they work, in a kind of spillover effect that paves the way for future smooth articulations during transport. This kind of socializing, facilitated in theU.S. by the middle-class status shared by participants, is far less likely to occur inCuernavaca, where differences in social status between physicians and traditional midwives are more extreme.

Attention to the scientific evidence. There is increasing emphasis these days on “evidence-based medicine” (Rooks, 1999). As we have seen, midwifery tends to be more evidence-based than obstetrics because midwives are generally less interventive than physicians (Frye, 1995; Davis, 1997; Gaskin, 1990; Rooks, 1997) and the scientific evidence (Rooks, 1997, pp. 345-384; Macdorman & Singh, 1998; Goer, 1999; Enkin, Kierse, Neilson, Crowther, Duley, Hodnett & Hofmeyr, 2001) shows that many common interventions do more damage than good. Any doctor who actually looks at the evidence instead of relying solely on what he is taught by biomedical tradition will take note of the benefits of midwifery care, and will thus be less likely to assume a blanket superiority for obstetrics.

Crosscultural Perspectives on Transport

            Articulation is the production of identity on top of difference, of unities out of fragments, of structures across practices. Articulation links this practice to that effect, this text to that meaning, this meaning to that reality, this experience to those politics. . . And these links are themselves articulated into larger structures.

–LawrenceGrossberg, (1992, p. 54)

The experience of transport looms large in the minds of midwives because it is so emotionally loaded for them: they transport in hopes of resolving a situation they feel they cannot or should not handle at home, with hopes and prayers for a good reception most especially for the mother, but also for themselves. A positive reception in the hospital reinforces midwives’ sense of themselves as competent practitioners and elicits in them feelings both of pride in their good judgment and of gratitude toward the biomedical system for its efforts; a negative reception can leave the midwife and the mother emotionally scarred. Once burned, twice shy, they may in the future try too hard to avoid another transport, with potentially unfortunate results. Crosscultural research provides multiple examples (e.g., Allen, 2002; Barnes-Josiah, Myntti & Augustin, 1998; Iskandar, Atom, Hull, Dharmaputra & Aswar, 1996; Graham, 1999; Kroeger, 1996). For one brief example, Deborah Barnes-Josiah and her colleagues (1998) have shown that in Haiti, community midwives who have been badly treated in hospitals, or whose clients have received inadequate care after transport, try in the future to avoid transport by coping with emergencies at home as best they can, often until it is too late to seek help. If disaster befalls, the midwife is handed the blame, with no account taken of the prior experiences that generated her avoidance behavior.

The solution to the trouble with transport that the governments of developing countries have generally sought to implement usually involves the goal of eliminating home birth and traditional midwifery in favor of hospital or clinic birth attended by physicians and/or or professional midwives trained in two-year government-approved courses (Hsu, 2002; Jenkins, 2001; Sargent, 1989). Yet for a variety of reasons (see Davis-Floyd, 2000), women in many countries continue to choose their traditional attendants. Certainly, as Roger and Patricia Jeffrey pointed out in 1993, it is important not to romanticize indigenous midwifery and indigenous midwives; some indigenous customs are beneficial and some are not; some traditional midwives are competent practitioners within their own systems and some are not. Similar notes can be sounded about Western obstetricians: some intervene inappropriately, ignoring the evidence, while others exercise a more balanced and judicious approach. The transport stories I have recounted here should not be simplistically interpreted to indicate that all midwives are good and all biopowerful practitioners are bad or vice versa, but rather as ways of illuminating points of disjuncture and fracture, as well as models of smoothness, in the cross-boundary articulation of disparate knowledge systems.

Today in most developed countries, the home birth rate hovers around one percent. That home birth might be more widely chosen in the developed world if it were more readily available is indicated by the Netherlands, where the home birth rate has never dropped below 30% (Weigers, 1997), and New Zealand, where in recent years it has risen to 12% as the result of a strong alliance between midwives and consumers that has generated active government support. These two countries stand as models of what I would name seamless articulation—their midwives practice and their health care systems fully support birth in all settings, creating ease of choice and continuity of care across what in most other countries can only be seen as the home/hospital divide (DeVries, van Teijlingen, Wrede, & Benoit, 2001). In Europe as in the US, active movements seek to restore home birth as a viable option, with variable success. Meanwhile, in the developing world, home birth rates continue to decline in response to the pressures of modernization, yet millions of women still give birth at home, some because there is no other option, some out of active rejection of their region’s biomedical system, and others out of philosphical choice.

Home birth was both normal and normative for most of human history. But with the advent of biomedicine in the industrialized West, hospital birth became normative and home birth for most women ceased to exist as a viable or even thinkable option. In the developing world, this process is still unfolding; in countries like Mexico, it has already taken root to the extent that while home birth remains normative in rural areas, in the cities it has become an alternative and marginalized choice as it is in most of the developed world. Nevertheless, some women still make that choice, and traditional midwives continue to serve them, only now, like American midwives, these urbanized traditional midwives are developing hybrid techniques that reflect the mutiple systems of knowledge that intersect in their practices. They value the knowledge systems they are creating and the sometimes lifesaving knowledge system of biomedicine; yet the biomedical system, generally speaking, values only itself. Thus for both Mexican and American home birth midwives, biomedicine stands at once as the ultimate recourse and the ultimate enemy, often with no guarantees in any given transport as to which aspect will manifest.

The six transport stories I have recounted and analyzed here are fractals for thousands of others that shed light on the trouble- and stress-full interface between the worlds of biomedicine and home-birth midwifery. Spiraling beyond the bounds of the specific situations they recount, they index both the myriad possiblities for tragedy inherent in one knowledge system’s closed dismissal of its marginalized competitor, and the enhanced possibilties for more positive outcomes when members of that system open its boundaries to admit the fingers of articulation extended by practitioners from the outside. When parallel fingers reach out from the inside, taking account of midwives’ information, acting on their recommendations, and encouraging them to remain with the mother to provide ongoing support, the result can be what Grossberg (1992, p. 57) terms “active structures . . . that cut across domains and planes.” Further elaboration of such structures of smooth articulation could extend individualized links and nodes across the hospital/home divide, ending the dis-articulations, and mending the fractures, that generate much of the trouble with transport.

Acknowledgments

For their invaluable assistance in analyzing the transport stories, I wish to thank Sara Wickham RM, a home-birth midwife and midwifery instructor in the UK; Richard Jennings CNM, a hospital-based midwife in New York; Debbie Pulley CPM, a home-birth midwife in Georgia; William Camann MD, an obstetric anesthesiologist in Boston; and Judith Rooks CNM, an epidemiologist and expert on midwifery who also provided extremely helpful general editorial assistance. Many thanks also to Brigitte Jordan, Gwynne Jenkins, Marcia Inhorn, and three anonymous reviewers for their excellent editorial assistance. I wish to express my appreciation to the Wenner-Gren Foundation for Anthropological Research for its support of this research through grants #6015 and #6427.

Endnotes

1. During the course of this research, I have interviewed approximately 50 nurse-midwives, 45 nurse-midwifery students; 50 direct-entry midwives, 30 direct-entry midwifery students, 20 Mexican professional midwives, and 7 traditional midwives in Morelos who are professionalizing. I found both groups of Mexican midwives through my participation in conferences in theUSandMexicoput on by the Midwives’ Alliance of North America (MANA) (see Davis-Floyd, 2001a for more detail). I have also spoken informally or conducted short interviews with over 100 traditional Mexican midwives from all over the country.

2. Further research should include thorough quantitative and qualitative research on the treatment of transported women and its specific outcomes.

3. Other factors involved in the marginalized status these midwives hold in relation to physicians include differences in formal education, credentialling, and social class with wealth as proxy; inMexicoespecially, gender is also an important factor (Judith Rooks, personal communication, 2001).

4. Ideally, nurse-midwives’ transport experiences should be seamless but often are not. While there is excellent data on the statistical outcomes of nurse-midwife-attended births in the U.S., including home-hospital transports (Macdorman & Singh, 1998), I know of no research on American nurse-midwives’ transport experiences. In Mexico, nurse-midwives do not really exist as a class of practitioners. Rather, nurses who choose to specialize in obstetrics undergo an additional year of university training. Officially titled Licenciadas en Enfermeria y Obstetricia (colloquially known as las LEOs), these women mostly work as high-tech labor and delivery nurses, in addition to performing administrative work and teaching. But they do attend births and function like American nurse-midwives in a few private hospitals and clinics in centralMexico.

5. Medical practitioners who only see problematic home births that are transported to the hospital tend to think that all home births are “botched.” The rate of problems derives as a function of a numerator (number of cases with problems) and a denominator (total number of cases–the majority–that have good outcomes). If one only sees the numerator, it is impossible to realize that the rate of transports is actually very low compared to the number of successful home births.

6. In theU.S.there were 23,232 home births in 1998 and 23,518 in 1999–an increase of 1.2%. Midwives are not the only practitioners who attend home births. Of 23,518 home births reported onU.S.birth certificates in 1999, 2,476 (10.5 %) were attended by a physician, 12,123 (51.5%) by a midwife, and 8,524 (36.2 %) by someone else. Some, but not all of the “other” attendants were probably midwives practicing without legal authority (Ventura et al., 2001).

7. Nurse-midwives began their long struggle for legitimation in the 1920s. In 1955 they created a national association, the American College of Nurse-Midwives (ACNM), whose members have worked hard for decades to achieve legal and medical acceptance of their profession. Certified nurse-midwives (CNMs) are legal, licensed, and regulated in all states. Most of the 5500 or so practicing nurse-midwives attend births in hospitals; appromimately 200 of them attend births at home. The ACNM officially supports home births, and many of its members would like to be able to attend them. But ACNM-certified midwives must have physician backup and insurance and many are unable to attain these for out-of-hospital birth. For hospital births their services are covered by private insurance companies in all states, as well as by Medicaid and managed care. They attend 7% of American births; 96% of the births they attend take place in hospitals (Rooks, 1997; Paine, Dower & O’Neil, 1999, p. 343; Curtin, 1999, pp. 349-352).

8. MANA members created the North American Registry of Midwives (NARM) which in turn created CPM certification, issuing its first certificates in 1994.

9. CPMs and other direct-entry midwives are legal, regulated, and licensed, registered, or certified in 17 states; legal through judicial interpretation or statutory inference or a-legal in 18 states; effectively prohibited in 7 states where licensure is required but unavailable; and illegal in 9 states. For updates on these numbers, see <www.mana.org/narm>.

10. In public hospitals inMexico, the Cesarean rate increased from 13% in 1990 to 25% in 1997 – and from 25% to 37% inMexico City(Secretaría de Salud, 1998); in private hospitals the national average in 1997 was 52% (Comité Promotor por una Maternidad sin Riesgos, 1997). Recent research indicates the doctor-driven nature of this excess of Cesareans, which social scientists are now calling an “iatrogenic epidemic” (Castro, Heimberger, and Langer, n. d.).

11. Home birth is almost completely non-existent as an option for middle-class women, most of whom would not think of using the services of a traditional midwife; see Davis-Floyd, 2001a for exceptions.

12. Young people in Mexico today in general prefer to seek formal education into a profession, and see the hospital as the progressive place to go for birth (see also Fraser, 1995).

13. As of June 2001, MANA has 67 dues-paying members in Mexico, most of whom are either professional direct-entry midwives (see Davis-Floyd, 2001a) or urban traditional midwives in the state of Morelos. The annual conferences these MANA members in Mexicohave been putting on since 1995 are attended by hundreds of traditional midwives from all over the country.

14. MyCuernavaca interviewees keep notebooks recording their outcomes, and turn statistical forms into the Department of Health. It would be an excellent research project to compile their statistical data, including the outcomes of their transports.

15. A caveat: To my knowledge, most home birth midwives who transport enter the hospital and stay with their clients for as long as they are allowed to stay. But I have heard critiques from some hospital practitioners of home birth midwives who “dump their clients at the hospital door and take off.” Such midwives usually live in states where their practice is illegal or in places where local hospital personnel are known to be particularly negative and unreceptive. Leaving their clients at the door can be viewed as an extreme form of disarticulation stemming from midwives’ fear that any interaction with the hospital system at best will result in serious harassment and at worst will send them to jail—a powerful argument for the legalization of midwifery, which certainly facilitates the development of systems of smooth articulation.

16. Some midwives fail to transport because of lack of familiarity with medical indications for transport. I cannot speak to such situations here, because all of my interviewees for this article—American direct-entry midwives and the professionalizing traditional midwives ofCuernavaca–were thoroughly schooled in indications for transport.

17. All names are pseudonyms.

18. MyCuernavacainterviewees almost never call 911 for an ambulance because of long delays in arrival. Taxi drivers fees are low and they arrive quickly because they are familiar with local neighborhoods and rarely get lost, in contrast to paramedics.

19. Judith Rooks CNM, MPH is an epidemiologist and expert on midwifery care. She is the author of Midwives and Childbirth in America (1997), the definitive book on the subject.

References

Allen, D. R. (2002). Managing motherhood, managing risk: Fertility and danger in rural Tanzania.Ann Arbor:University ofMichigan Press.

anthropology of medicine in everyday life (pp. 7-31).Berkeley andLondon:

Appadurai, A. (1996). Modernity at large: Cultural dimensions of globalization.Minneapolis:University ofMinnesota Press.

Appiah, K. A. (1997).  Is the “post-” in “postcolonial” the “post-” in postmodern? In A. McClintock, A. Mufti, & E. Shohat(Eds.), Dangerous liaisons: Gender, nation, and postcolonial perspectives (pp. 420-444).Minneapolis:

Barnes-Josiah, D., Myntti, C., & Augustin, A. (1998). The three delays as a framework for examining maternal mortality in Haiti. Social Science & Medicine 46:981-993.

Belizán, J. M., Althabe, F., Barros, F. C., & Alexander, S. (1999). Rates and implications of Caesarean sections in Latin America: Ecological study. British Biomedical Journal 319:1397-1400. Available: www.bmj.com/cgi/content/full/319/7222/1397#art.

Castro, A., Heimberge, A., & Langer A. (n.d.). Iatrogenic epidemic: How health care professionals contribute to the high proportion of Cesarean sections inMexico. Unpublished manuscript.

Comité Promotor por una Maternidad sin Riesgos. (1997). Cesáreas: Tendencias actuales y perspectivas.Secretaría de Salud,Mexico.

Curtin, S. C. (1999). Recent changes in birth attendant, place of birth, and the use of obstetric interventions. Journal of Nurse-Midwifery 44(4): 349-354.

Davis, E. (1997). Heart and hands: A midwife’s guide to pregnancy and birth (3^rd ed.).Berkeley,CA: Celestial Arts.

Davis-Floyd, R. (1992). Birth as an American rite of passage.Berkeley:University ofCalifornia Press.

Davis-Floyd, R. (1994).  The technocratic body: American childbirth as cultural expression. Social Science & Medicine 38(8):1125-1140.

Davis-Floyd, R. (1998a). From technobirth to cyborg babies: Reflections on the emergent discourse of a holistic anthropologist. In R. Davis-Floyd & J. Dumit (Eds.), Cyborg babies: From techno-sex to techno-tots (pp. 255-283).New York: Routledge.

Davis-Floyd, R. (1998b). The ups, downs, and interlinkages of nurse- and direct-entry midwifery: Status, practice, and education. In J. Tritten & J. Southern (Eds.), Getting an education: Paths to becoming a midwife (4^th ed) (pp. 67-118).Eugene,OR: Midwifery Today. Available: www.midwiferytoday.com

Davis-Floyd, R. (2000, March). Global issues in midwifery: Mutual accommodation or biomedical hegemony? Midwifery Today, 12-17, 68-69.

Davis-Floyd, R. (2001a). La partera profesional: Articulating identity and cultural space for a new kind of midwife in Mexico. In R. Davis-Floyd, S. Cosminsky & S. L. Pigg (Eds.) Daughters of time: The shifting identities of contemporary midwives [Special issue] Medical Anthropology 20(2-3):185-243.

Davis-Floyd, R. (2001b, November). Las parteras de Morelos: The strategic negotiation of knowledge systems by postmodern midwives inMexico. Paper presented at the meeting of the American Anthropological Association,Washington,D.C.

Davis-Floyd, R. (2002). Southern discomfort: American midwifery as a cautionary tale. In I. Bourgeault, C. Benoit & R. Davis-Floyd (Eds.) Reconceiving midwifery: The new Canadian model of care.Ann Arbor:University ofMichigan Press.

Davis-Floyd, R. (2003). Qualified commodification: Consuming midwifery care. In J. Taylor, D. Wozniack & L. Layne (Eds.) Consuming Motherhood.

Davis-Floyd, R., Cosminsky, S. & Pigg, S. L. (Eds.). (2001). Daughters of time: The shifting identities of contemporary midwives [Special issue] Medical Anthropology 20(2-3/4).

Davis-Floyd, R. & Davis, E. (1997). Intuition as authoritative knowledge in midwifery and home birth. In R. Davis-Floyd & C. Sargent (Eds.) Childbirth and authoritative knowledge: Cross-cultural perspectives (pp. 315-349).Berkeley:University ofCalifornia Press.

Davis-Floyd, R. & Johnson-Levitin, C. (Eds.). (n.d.) Mainstreaming midwives: The politics of change.New York: Routledge.

Declerq, E. (2001). CNM birth attendance in the United States, 1998. Journal of Midwifery and Women’s Health 46(1):31.

DeClerq, E., DeVries, R., Viisainen, K., Salvesen, H. B., & Wrede, S. (2001). Where to give birth? Politics and the place of birth. In R. DeVries, E. van Teijlingen, S. Wrede & C. Benoit (Eds.). Birth by design: Pregnancy, maternity care and midwifery in North America and Europe (pp. 7-27).New York: Routledge.

DeVries, R., van Teijlingen, E., Wrede, S. & Benoit, C. (Eds.). (2001). Birth by design: Pregnancy, maternity care and midwifery in North America and Europe.New York: Routledge.

Enkin, M., Kierse, M. J. N. C., Neilson, J., Crowther, C., Duley, L., Hodnett, E. & Hofmeyr, J. (2000). A Guide to effective care in pregnancy and childbirth (3^rd ed.).New York:OxfordUniversity Press.

Fernandez de Castillo, C. (1997). Las cesareas en el sector privado. In Cesareas: Tendencias actuales y perspectivas.Mexico D.F.: IMES: Comité Promotor por una Maternidad sin Riesgos enMexico.

Foucault, M. (1978). The history of sexuality: An introduction (Vol. 1) (R. Hurley, Trans.).New York: Random House.

Fraser, G. (1995). Modern bodies, modern minds: Midwifery and reproductive change in an African American community. In F. Ginsburg & R. Rapp (Eds.), Conceiving the new world order: The global

Frye, A. (1995). Holistic midwifery: A comprehensive textbook for midwives in home birth practice (Vol. I), Care during pregnancy.Portland,OR: Labyrs Press.

Fullerton, J. (Ed.). (2000). Skilled attendance at delivery: A review of the evidence.New York: Family Care International.

Gaskin, I.M. (1990). Spiritual midwifery (3^rd ed.).Summertown,TN: The Book Publishing Company.

Goer, H. (1999). The thinking woman’s guide to a better birth.New York: Penguin Putnam/Perigree.

Good Maust, M. (2000). Making bodies: Cesarean narratives in Merida, Yucatan. Unpublished doctoral dissertation,University ofFlorida,Gainesville.

Good Maust, M., Güémez Pineda, M. & Davis-Floyd, R. (n.d.). Midwives in Mexico: Continuity, controversy, and change.Austin:University ofTexas Press, forthcoming.

Graham ,S. (1999). Traditional birth attendants in Karamoja, Uganda. Unpublished doctoral dissertation,SouthBankUniversity,London.

Grossberg, L. (1992). We gotta get outa this place: Popular conservatism and postmodern culture.New York: Routledge.

Hsu C. (2001). Making midwives: The logics of midwifery training in St. Lucia. In R. Davis-Floyd, S. Cosminsky& S. L. Pigg. (Eds.). (2001). Daughters of time: The shifting identities of contemporary midwives [Special issue] Medical Anthropology 20(4).

Instituto Nacional de Estadistica, Geografia e Informatica (INEGI). (1999). Encuesta Nacional de la Dinamica Demografica 1997. INEGI,Aguascalientes. Available: www.inegi.gob.mx

Iskandar, M., Atom, B., Hull, T., Dharmaputra, N. & Azwar, Y. (1996). Unraveling the mysteries of maternal death in West Java: Reexamining the witnesses. Depok: Center for Health Research, Research InstituteUniversity ofIndonesia.

Jeffery, R. & Jeffery, P. M. (1993). Traditional birth attendants in rural North India: The social organization of childbearing. In S. Lindenbaum & M. Lock (Eds.), Knowledge, power, and practice: The

Jenkins, G. (2001). Modernization and postmodernization in the changing roles and identities of midwives in rural Costa Rica. In R. Davis-Floyd, S. Cosminsky& S. L. Pigg. (Eds.). (2001). Daughters of time: The shifting identities of contemporary midwives [Special issue] Medical Anthropology 20(2-3).

Johnson, K. C. & Daviss, B. A. (2001, October). Results of the CPM Statistics Project 2000: A prospective study of births by Certified Professional Midwives In North America. Abstract presented at the annual meeting of the American Public Health Association, Atlanta,GA.

Jordan, B. (1993). Birth in four cultures (Rev. ed.).Prospect Heights,IL: Waveland Press.

Jordan, B. (1997). Authoritative knowledge and its construction. In R. Davis-Floyd & C. Sargent (Eds.), Childbirth and authoritative knowledge: Cross-cultural perspectives (pp. 55-79).Berkeley:University ofCalifornia Press.

Kroeger, M. (1996). Final consultant report. CHN III Project, Provincial Department of Health CentralJava,Indonesia.

MacDorman, M. & Singh, G. (1998). Midwifery care, social and biomedical risk factors, and birth outcomes in the USA. Journal of Epidemiology and Community Health 52:310-317.

Martin, E. (1987). The woman in the body.Boston: Beacon Press.

Paine, L.  L., Dower, C. M. & O’Neil, E. (1999). Midwifery in the 21^st century: Recommendations from the Pew Health Professions Commission/UCSF Center for the Health Professions 1998 Taskforce on Midwifery. Journal of Nurse Midwifery 44(4):341-348.

Pigg, S. L. (1997). Authority in translation: Finding, knowing, naming, and training “Traditional birth attendants” in Nepal. In R. Davis-Floyd & C. Sargent (Eds.), Childbirth and authoritative knowledge: Cross-cultural perspectives (pp. 233-262).Berkeley:University ofCalifornia Press.

politics of change (pp 42-58).Berkeley:University ofCalifornia Press.

Rooks, J. P. (1997). Midwifery and childbirth in America.Philadelphia:TempleUniversity Press.

Rooks, J. P. (1999). Evidence-based practice and its applications to childbirth care for low-risk women. Journal of Nurse- Midwifery 44(4):355-369.

Rothman, B. K. (1982). In labor: Women and power in the birthplace.New York: W.W. Norton.

Rothman, B. K. (1989). Recreating motherhood: Ideology and technology in patriarchal society.New York: W. W. Norton.

Sargent, C. (1989). Maternity, medicine, and power: Reproductive decisions in urban Benin.Berkeley:University ofCalifornia Press.

Schaef, A. (1992). Women’s reality (Rev. ed.).San Francisco: Harper.

Secretária de Programación y Presupuesto. (1979). Encuesta Mexicana de fecundidad, primer informe nacional.Mexico: Secretaria de Programacion y Presupuesto.

Secretaria de Salud (SSA—this agency was formerly known as the Secretaria de Salud y Asistencia, and is still abbreviated as SSA). (1994). La partera tradicional en la atencion materno infantil en Mexico. Available: www.ssa.gob.mx.

UniversityofCaliforniaPress.

UniversityofMinnesotaPress.

Ventura, S. J., Martin, J. A., Curtin, S. C., Menacker, R. & Hamilton, B. E. (2001). Births: Final data for 1999. National Vital Statistics Reports 49:1.Hyattsville,Maryland:NationalCenter for Health Statistics.

Wagner, M. (1997). Confessions of a dissident. In R. Davis-Floyd & C. Sargent (Eds.) Childbirth and authoritative knowledge: Cross-cultural perspectives (pp. 366-396).Berkeley:University ofCalifornia Press.

Weigers, T. (1997). Home or hospital birth: A prospective study of midwifery care in the Netherlands. Unpublished doctoral disseration:LeidenUniversity, NIVEL,Utrecht.

Robbie E. Davis-Floyd

This article appears as Chapter 22 in Unhealthy Health Policy: A Critical Anthropological Examination,

eds. Arachu Castro and Merrill Singer.AltamiraPress, pp. 329-350, 2004.

            As proponents of the global Safe Motherhood Initiative have long stressed, in both the developing world where home birth is often a necessity, and the developed world where it is a choice, primary keys to safe home birth include transport to the hospital in cases of need and effective care on arrival (Fullerton 2000). In this chapter, I examine what happens in the United States when transport occurs, how the outcomes of prior transports affect future decision making, and how the lessons derived from the transport experiences of U.S. birthing women and midwives could be translated into improvements in maternity care. In the developing world, two aspects are critical to the viability of transport: (1) Can the mother get there? In other words, is there a hospital within reach, and can a vehicle be found? And (2) What happens when she arrives? In the United States, where some form of transport is almost always available, the latter issue is by far the most salient.America’s trouble with transport is not its lack but rather what happens when it places the mother who had planned to give birth at home, and the midwife attending her, in interaction with biomedical personnel.

In the United States, as elsewhere, biomedicine and home birth midwifery exist in separate cultural domains and are based on overlapping but distinctively different knowledge systems. When a home birth midwife arrives in the hospital with her client, she brings with her the general ways of knowing and style of practice that characterize her cultural domain, and her specific prior knowledge about the woman’s overall health, personality, desires, and labor process. This knowledge can be vital to the mother’s successful treatment by the hospital system. But the culture of biomedicine in general tends not to understand or recognize as valid the knowledge of midwifery. Thus in the hospital, the midwife may have no authoritative status. Yet she must interface with medical personnel if she is to communicate information that the hospital staff may need to provide appropriate and effective care for her client. Smooth articulation of the medical and midwifery knowledge systems facilitates the safest transition for the woman and her baby, but, all too often, disjuncture and disarticulation occur. The tensions and dysfunctions that result are displayed in midwives’ transport stories, which I here identify as a narrative genre. In this chapter, I unpack these stories for the collision of worlds they encapsulate and the points of fracture and permeability in the crusts of those worlds that they reveal.

I focus specifically on the transport stories told by American midwives with whom I have conducted extensive interviews. I narrate six of these stories, analyzing them as cultural terrains that reveal how childbirth can go unnecessarily awry when domains of knowledge conflict and existing power structures ensure that only one kind of knowledge counts. I describe such encounters as (1) disarticulations that occur when there is no correspondence of information or action between the midwife and the hospital staff;, and (2) fractured articulations of biomedical and midwifery knowledge systems that result from partial and incomplete correspondences. I contrast these two kinds of disjuncture with the smooth articulation of systems that results when “mutual accommodation” (Jordan 1993) characterizes the interactions between midwife and medical personnel. In the conclusion, I link these U.S. transport stories to their international context, describing how they index some of the cross-cultural markers for “the trouble with transport.”

Articulation and Authoritative Knowledge: Biopower Meets the Home Birth Midwife

ar.ti.cu.late vt. (1) to put together by joints; (2) to arrange in connected sequence, fit together, correlate. vi. to be jointed or connected. n. a joint in a stem or between two separable parts, as a branch and leaf [or] a node or space between two nodes.  —Webster’s New World Dictionary, 2000

My use of the term “articulation” in this chapter comes from Gramsci through Lawrence Grossberg (1992:54), who notes that the concept of articulation “provides a useful starting place for describing the process of forging connections between practices and effects.” His starting place will be my ending place, as most of the stories I recount below illustrate connections that could potentially have been forged but instead were either never made or only partially constituted. These disjunctures in what could have been functional, smoothly bending joints stem from the dominance of biomedicine—a hierarchical system that has sought, in general, not to articulate with home birth midwifery but rather to eliminate it through discounting its practices and knowledge base. In Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives, Brigitte Jordan (1997:56) noted that

for any particular domain several knowledge systems exist, some of which, by consensus, come to carry more weight than others, either because they explain the state of the world better for the purposes at hand (efficacy) or because they are associated with a stronger power base (structural superiority), and usually both. In many situations, equally legitimate parallel knowledge systems exist and people move easily between them, using them sequentially or in parallel fashion for particular purposes. But frequently, one kind of knowledge gains ascendance and legitimacy. A consequence of the legitimation of one kind of knowing as authoritative is the devaluation, often the dismissal of all other kinds of knowing.

Jordan(1997) maps out what happens when one kind of knowing does gain ascendancy, thus opening up the possibility of asking what happens when an ascendant knowledge system and a devalued one must interface. Why do adherents of a dominant knowledge system sometimes dismiss what adherents of a devalued system have to say, sometimes give them partial credence, and other times honor them, act promptly on their recommendations, and include them in the process? The stories I analyze below illustrate all of these possible scenarios.

In the process of describing how Western biomedicine gained its cultural ascendancy, Michel Foucault identified the cultural authority it carries as a form of “biopower,” which he defined as “disciplines of the body,” used as “numerous and diverse techniques for achieving the subjugation of bodies and the control of populations” (1978:140). This subjugation and control include the biomedicalization of bodily processes like childbirth and the development of institutions within which such processes are supposed to take place, along with formalized structures for managing them.Jordan augments Foucault’s notion of biopower with her focus on the status of particular knowledge systems:

It is important to realize that to identify a body of knowledge as authoritative speaks, for us as analysts, in no way to the correctness of that knowledge. Rather, the label “authoritative” is intended to draw attention to its status within a particular social group and to the work it does in maintaining the group’s definition of morality and rationality. The power of authoritative knowledge is not that it is correct but that it counts. (Jordan 1997: 57)

Although the American home birth midwives whom I have studied treat their own knowledge system as authoritative in the home context, they are acutely conscious of the larger and more valued authority carried by biomedicine not only inside the hospital but also in the culture at large. Much of the time, these midwives do not accept biomedical knowledge as truth or fact; many of their practices and much of their midwifery knowledge system constitute a radical critique of obstetrics, challenging its claims to the authority of fact and truth. But these midwives also understand that in the hospital as in the wider culture, including in courts of law, their radical critique goes largely unheard and their ways of knowing do not count. Faced with a formalized system of biopower that discounts their individualized approach to maternity care, during transport midwives nevertheless often seek to communicate what they know, in the interests of securing the care for which they brought the woman to the hospital—care that they deem to be necessary for their client’s safety and well-being. So as they enter the hospital, they extend into that system what I identify as fingers of articulation in an effort to generate a productive interface. The following detailed examination of midwives’ transport stories intends to illuminate what happens along a spectrum of possibilities from disarticulation to smooth articulation, from the dismissal of these outreaching fingers to their clasping by a biomedical hand. Through examining this spectrum of articulations between knowledge systems, I hope to augmentJordan’s explanations of what happens when one system of knowledge discounts another with a more nuanced consideration of how, in specific situations, the dominant system can come to take the subaltern system into partial or fully accommodative account.

Methodology

This chapter is based on my continuing research on American midwives (begun in 1995). The focus of much of this research has been midwifery education, praxis, politics, and status within the American technocracy (Benoit et al. 2001; Davis-Floyd, 1998, 2003, 2004, in press; Davis-Floyd and Johnson2005). This research did not specifically focus on transport stories as a genre or on transport as a salient issue. But during its course, I heard many transport stories told. Over time, these transport stories began to emerge for me as a narrative genre that richly encapsulates clashes of power and ideology between the biomedical and midwifery systems and their potentially devastating consequences for mother and baby. The particular stories I present here embody the collision of worlds I seek to analyze. It is important to note that in the United States, there are approximately 200 nurse-midwives (out of over 6000 CNMs in practice) who attend both home and hospital births; their transport experiences are somewhat different, especially when they practice and carry authoritative status in both domains. I suggest them as potential subjects of a future study.¹ Because of the political problematics of midwifery practice and especially of transport, all names I utilize are pseudonyms.

Background and Context: Obstetrics and Midwifery in the United States

From an obstetrical point of view, every birth is a potential disaster and must be managed authoritatively and preventively to ensure the best possible outcome. Thus, most women laboring in American hospitals today are routinely hooked up to intravenous lines and electronic fetal monitors throughout labor. Their labors are often induced or augmented with a variety of pharmacologic agents, including pitocin and cytotec. Epidural anesthesia is commonly used to eliminate pain. Just under half of birthing women receive an episiotomy to enlarge the vaginal opening and speed delivery. Just under 30 percent of all babies in the United States are pulled out with forceps, vacuum extractors, or via cesarean section (Ventura, Martin, Curtin, Menacker, and Hamilton 2001). As various social scientists have previously described (Davis-Floyd 1992; Martin 1987; Rothman 1982, 1989), the performance of birth in American hospitals tells a cultural story about the female body as a defective machine in need of assistance by technical experts and other, more perfect machines; this has also been documented in Mexico (Castro 1999). It also enacts and displays the technocracy’s supervaluation of speed, efficiency, control, high technology, and the flow of information through cybernetic systems. Technobirths are typical and normative in American hospitals through a consensual, biopowerful process jointly driven by physicians, who tend to be trained exclusively in that approach, and women, who tend to also to supervalue technology, control, and most especially the elimination of labor pain (Davis-Floyd 1994). For instance, the use of epidural anesthesia necessitates the use of many other technologies to monitor for and intervene in complications associated with the epidural. In other words, while some women might make other choices if they had more information, generally speaking the interventive American approach exists by mutual agreement between women and physicians steeped in the core values and overall approach to life characteristic of their technocratic culture. Both groups believe that this approach offers both comfort and safety in the face of an unpredictable natural process that proceeds more safely when carefully controlled, in the same way that a river subject to flooding seems improved when a series of dams and floodgates are installed.

To hospital-based practitioners, the choice for home birth appears to be a choice for danger, pain, and random chaos in contrast to order and control. Most hospital-based practitioners have never seen a home birth and know little about the knowledge base of home birth midwives, in part because of a near-total lack of contact. The many safe and woman-centered births that take place at home are invisible to the medical gaze; biomedical discourse tends to center around “botched home births.” This phrase is often bandied about by medical practitioners who tend to assume that any home birth that ends up in the hospital must be “botched,” even if it is the result of an appropriate transport.² The midwifery response is usually a sarcastic comment about enormous numbers of “botched hospital births”; women who have had “botched” hospital experiences and later choose home birth are an important source of such accounts. This trading of insults is an in-group phenomenon: hospital practitioners complain to other hospital practitioners about home birth and midwives; midwives complain to other midwives about hospital practitioners. Dialogue between these groups is rare. Mostly, their members inhabit separate worlds that only intersect when a home birth goes awry and a transport is the necessary result.

From an anthropological point of view, U.S. direct-entry midwives elide and confound the usual international distinctions between professional and traditional midwives: some of the American home birth midwives who are professionally licensed and certified were trained through apprenticeship or self-study (Benoit et al. 2001; Davis-Floyd 1998); others are nurse-midwives trained in university-based programs. Despite these differences, and because of their mutual dedication to the welfare of women and belief in the safety and efficacy of home birth, it is fair to say that all home birth midwives in the United States are inspired by a transnational ideology of home birth and “sisterhood” in midwifery. All home birth midwives critique the failures and limitations of biomedicine and have a strong sense of mission about preserving home birth in the face of biomedical hegemony. They believe in women’s ability to give birth with little intervention most of the time, in the superiority of homes and birth centers as the sites of birth, and in the efficacy of their own knowledge systems and skills. They do not undertake transport unless they are convinced that the situation is truly in need of technomedical intervention, and when they do transport, their intent is to do all in their power to make the medical system respond in ways they consider appropriate. Thus, their transports usually involve at least two people from outside the biomedical realm: the mother who needs help, and the midwife who will not abandon her even when she is no longer in charge of her care.³

All midwives who practice out of hospital must occasionally transport. In the United States, home birth midwives have a transport rate of about 12 percent (Johnson and Daviss 2001).⁴ In other words, 88 percent of their clients give birth safely at home, while 12 percent are transported to the hospital during or after labor for various reasons: 6 percent (six out of 100) are transported for precautionary reasons like failure to progress in labor, meconium staining in the amniotic fluid (possibly but not necessarily a sign of fetal distress), or a retained placenta after the birth. 3.6 percent (3-4 out of 100) are transported for potentially life-threatening emergencies (Johnson and Daviss 2001). The transport stories I have culled from my interview data and selected to recount below cluster inside that 3-4 percent; I urge my readers to keep in mind that the circumstances they recount are quite rare and not representative of the vast majority of births. These experiences are most likely to be encoded in narrative because they are so unusual and also because of their heavy emotional charge. Stories give meaning and coherence to experience; midwives who transport under frightening circumstances often need to find that coherence and to evaluate through narrative, with the benefit of hindsight, their own actions and those of the mother and the biomedical personnel.

In transport situations, there are various ways in which things can go wrong: (1) the fact that transport is indicated means that the natural process of birth has in some way gone awry, or seems likely to; (2) the midwife may wait too long to summon transport, usually because of prior bad experiences with transport; (3) the hospital staff taking the call may not understand the urgency of the mother’s problems; (4) emergency medical technicians (EMTs) may fail to respond appropriately, or there may be disjunctive communication between the midwives and the EMTs; (5) arrival at the hospital can go awry for the mother and the midwife if either is ignored or mistreated; (6) even well-intended biomedical interventions can at times do more damage than they fix; and (7) not all natural disasters are fixable by biomedical means, so even with the very best of care, the death of the mother or baby can occur. Only some of these possible levels of awryness are illustrated in the stories I tell below. I selected these particular stories because they are typical: they represent the range of possible outcomes of transport and are emblematic of many other situations and possibilities I do not have room to treat here. Since I have no way of ascertaining the truth or untruth of these stories, for the purposes of this chapter I take them at face value and unpack them for what they reveal about midwives’ perceptions of, and the meanings midwives attribute to, events as they unfold.

The Stories

In this section, the stories as the midwives recounted them to me are italicized; these stories are not direct quotes but my summarized retellings (unless otherwise indicated). Contextualizing information, my analyses and interpretations, and the midwives’ additional comments, appear in regular font.

Dis-articulation

Carrie’s First Story: Unnecessary Delay

Carrie Smiley is a certified professional midwife (CPM) who has practiced in Atlanta, Georgia, for over 18 years, attending during that time over 850 births. Her practice is “unlawful” (meaning that it is punishable in the misdemeanor category). Most of the home births she attends are for white middle-class couples. She does prenatal care out of her own home, a two-story house at the edge of a small lake in an attractive Atlanta suburb. She began her birth career in the late 1960s working as a volunteer in labor and delivery, and then took training as a biomedical assistant, working in labor and delivery and for a pediatrician for several years. Starting in 1977 she began attending the home births of friends; in the early 1980s she undertook a year-and-a-half apprenticeship with another home birth midwife who later became her partner. The following episode took place in 1984, during the early years of Carrie’s home birth midwifery practice. But it should not be regarded as dated, as it typifies many transports that presently occur, especially in “illegal” states.

            Carrie and her partner are attending a mother pregnant with her first child, laboring at home and planning a home birth. After about eight hours of labor, the mother has reached ten centimeters dilation and is starting to feel the urge to push. Monitoring the baby’s heart tones, the midwives detect strong decelerations, a sign of fetal distress. Hoping to get the baby out quickly, the midwives ask the mother to push a few times to see if the baby will come down. When they realize that the mother is not going to be able to get the baby out with sufficient expediency, they get her to kneel in a knee-chest position, put her on oxygen, and call the EMTs. When ten minutes pass and the EMTs have not yet arrived, the midwives help the mother into their car, planning on driving her to the hospital themselves. Just as they are ready to go, the ambulance pulls up and blocks the driveway. Announcing, “We’re here now, we’ll take it from here,” the paramedics pull the mother out of the midwife’s car and help her into the ambulance. But they refuse to heed the midwives, who are urging that they must rush the mother to the hospital, insisting that first they have to get a history. Asking questions like “hHave you had any nausea during this pregnancy?” the EMTs are wasting precious time. Frantic at the delay, and knowing the baby might be suffering from oxygen deprivation, the midwives ask the paramedics to put the mother on oxygen. They refuse, wanting to continue with the history, so the midwives get their own oxygen tank out of the car, at which point the medics finally accede and hook the mother up to the ambulance oxygen tank. As the ambulance starts toward the hospital, the midwife riding with the mother asks her to get on her hands and knees to relieve any possible cord compression, but the paramedics get upset and turn the mother flat on her back. Knowing that this position will exacerbate cord compression and reduce blood and oxygen flow to the baby, the midwife compromises by turning the mother on her side, and continues to listen to the fetal heart tones.

            Arriving at the hospital, the midwives are told that there are several obstetricians present in the hospital, but only the one on call is allowed to treat a “walk-in” and he is not in-house and will have to be called. Increasingly frantic, the midwives insist to the nurse in the emergency room (ER) that the baby is in distress. The nurse auscultates the heart tones, records them at 130, announcing this to the midwives and the mother, and tells the midwives, “Everything is fine; we will take over from here.” She will not look at the records the midwives brought, which show the heart fluctuations, nor pay heed to their insistence that this is an emergency. The midwives are not allowed to remain with the mother in the ER or to accompany her to labor and delivery. Instead they are sent to the waiting room. Carrie says, “Every time we went outside the room, we noticed that everyone seemed to be looking at us and talking about us.”

            Terrified that they will be arrested and sent to jail, the midwives finally head home. Later they learn that it took the doctor on call one hour and 45 minutes to show up. In the meantime, the nurses caught the baby, who was stillborn. The cause of death was listed on the hospital record as “prolonged fetal distress.” The EMT records said that the mother had been antagonistic and refused oxygen, which the midwives insist is untrue. The nurses said the mother refused the electronic fetal monitor. The hospital pushes the mother to file criminal charges against the midwives, but the mother tells the hospital personnel that this death is clearly the hospital’s fault, that the midwives acted appropriately and bear no blame, and that if the hospital should try to harass the midwives in any way, she will sue the hospital, not the midwives.

In Carrie’s view, she and her partner did their best. Trained to detect fetal heart rate decelerations and to recognize which ones are dangerous, they responded appropriately to the signs of fetal distress. But in retrospect, Carrie wishes that they had taken the woman to the hospital themselves. When I asked her why they called 911 in the first place, Carrie responded, “We were really dumb—we thought that was the appropriate thing to do.”

From Carrie’s point of view, blocking the driveway and announcing, “We’ll take it from here,” demonstrated the EMTs’ arrogant and authoritative attitude, which at first glance seemed to leave no further role for the midwives to play. She feels that she and her partner demonstrated strength in their refusal to accept this dismissal. Rather, they flexibly and creatively tried to work with the EMTs to help the mother get what they felt she needed. Frustrated by their inability to convince the EMTs of the need for haste, they experienced their success in getting the mother back on oxygen as a small victory. They had good reason to believe that the baby was oxygen-deprived, so when the EMTs refused to act, the midwives resorted to the nonverbal but nonetheless eloquent strategy of getting their own oxygen tank out of the car, figuring that the EMTs would rather use their own oxygen than accept it from the midwives.

One possible reason for the baby’s lack of oxygen might have been that the cord was compressed. Cord compression is usually exacerbated when a woman lies flat on her back, so the midwives wanted to put the mother on her hands and knees in the ambulance, as this is the position most likely to take the most pressure off the cord. (In addition, the flat on the back position can cause supine hypotension ([low blood pressure]) in women because it occludes the vena cava, resulting in inadequate circulation of blood ([which carries oxygen]) to the placenta and baby.). But a woman on her hands and knees in an ambulance is a strange and unsettling sight and most likely did not match the medic’s internal maps of proper patient position or behavior, or of safety while driving. So the midwives had to give up on the most physiologic position; here again they creatively compromised, finding a position that minimizes both cord and vena cava compression while not challenging the medics’ views of how a patient should be positioned. For Carrie and her partner, these stand as examples of midwives’ ability to “think around” situations to get the system to meet the woman’s needs. Such creativity has been demonstrated to be typical of subaltern groups, who must be as aware of the features of the dominant group as of their own in order to successfully navigate inside the dominant system (Schaef 1980).

Several obstetricians present in a hospital, but only the one on call is allowed to treat “walk-ins,” and that one is not in the hospital: here Carrie’s voice dripped with sarcasm. For her, this situation evidences hospitals’ tendencies to be highly structured, category oriented, and rule-bound. Her outside gaze notes that people who have a place inside the biomedical system, having contracted with a private obstetrician, are more likely to get an immediate response than the anomalous, unplaced “walk-in.” The fact that the nurses would not look at the midwives’ records seems analogous to the medics’ refusal to heed the midwives’ insistence on haste. Instead, the EMTs wanted to take a history, which of course the midwives already had. But the information the midwives had obtained did not count for these biomedical personnel, who valued only the knowledge they themselves obtained. It seems to Carrie that reality as defined by biomedical categories (taking a history, allowing only one obstetrician to attend a walk-in, and counting only information obtained by biomedical personnel) was more salient here than reality as the midwives, the mother, and the stillborn baby experienced it.

Tragically, the mother’s refusal to be put on the electronic monitor denied the biomedical system an indicator on which it might have acted. This refusal probably stemmed from the distrust of the biomedical system and its technology that led the mother to plan a home birth in the first place. When the ER nurse announced that the heart tones were at 130, the mother took this news to mean that the problem had resolved itself and “everything was fine.” Carrie later learned that in the labor and delivery unit the fetal heart rate decelerations were noted and recorded by the nurses who were auscultating the mother, but for some reason they never told the mother that they could hear the decelerations, so she continued in the belief that the heart tones were still OK. Emphatically, Carrie stated that if the midwives been allowed to remain with the mother, they would have convinced her to allow the monitor; she said, “We would have done everything from cutting a huge episiotomy to jumping on her tummy to get that baby out. But we were sent away.”

Carrie’s sarcasm extends to the “lie” that the EMTs told on their official records, a lie she is sure they told to cover themselves in case of lawsuit. It is likely that the paramedics assumed that as biomedically trained practitioners, their word carried more authority and cultural weight than the words of the midwives and the mother, so their notes were more likely to be seen as valid. Practicing inside a hegemonic cultural space can facilitate one’s claim to truth. Practicing outside that space not only calls one’s veracity automatically into question, but also puts one at risk of legal action: Carrie and her partner feared being sent to jail since their practice is unlawful in Georgia. They have dealt with this threat through their excellent outcomes, on which they keep careful statistics; through obtaining CPM certification, which is not recognized in Georgia but at least shows that they have been tested and have demonstrated the requisite competence; and through publicity: every few years, a local paper publishes a several-page spread on Carrie and her practice, showing pictures of her and of the happy couples she has attended. She feels that this high level of visibility affords her far more protection in the form of community support than would remaining underground.

Reality is as one perceives it, and the effects of any given event depend not on the actual circumstances of that event but on how they are narrated. On both sides of this particular biomedical/midwifery//– biopower/counterpower fence, opinions were formed or reinforced by this experience. We can imagine that the story that circulated among hospital personnel about this birth was very different from the one the midwives tell: chances are it was a story about another botched home birth attended by irresponsible midwives. On the midwifery side, it was one more story about the absurdity of biomedical bureaucracies and the arrogance and narrowmindedness of biomedical personnel—nurses, physicians, and EMTs alike. And it was a story about the dedication and loyalty of the midwives’ clients: when I asked Carrie why the mother did not sue the hospital, she responded, “Because she knew that if she did, the hospital would come after us.”

Later Carrie added, “Before this experience, I always thought that if you have a problem, you call the paramedics. Now I know that if you want a problem, you call the paramedics.” She notes that this experience made her much savvier about the limitations of the biomedical system. Specifically, it taught her and her partner to always make sure they transported only to hospitals with on-call physicians in-house, and not to involve the paramedics if there was any way the midwives could transport the client on their own. And, as we will see below, it led Carrie over time to work to develop a network of relationships with individuals in the hospitals to which she now transports in order to enhance her ability to prevent this kind of disarticulation of systems, and to facilitate the kind of smooth articulation that can save lives.

Fractured Articulation

Lana’s Story: An Inaudible Voice

Lana Lane, an American direct-entry midwife, learned midwifery through a two-year apprenticeship in Fairbanks, Alaska, during which, with her mentor, she attended over 100 births. Shortly after finishing her training in 1985, she moved to Wasilla, Alaska, where she went into partnership with Susan Eakin. By then, the direct-entry midwives ofAlaska had achieved their legislation and were practicing legally. This story, told to me by Lana’s partner Susan, took place the following year.

            Arriving at the home of a woman in early labor who lived less than five minutes away from a tertiary care center in Anchorage, Lana performed a vaginal exam to check the degree of cervical effacement, dilation, and station (the position of the baby’s head), and suddenly found the umbilical cord in her hand. Susan said, “The cord was just below the baby’s head. Lana tried to slip it up away from the vaginal opening, hoping the head would block it, which can sometimes be done if too much cord doesn’t wash down. But the cord just kept slipping, so all Lana could do was keep the cord from being pinched (which would cut off the baby’s blood and oxygen supply) by splinting it between her fingers and pushing the head off it.” While the mother crouched on her knees and prayed, Lana maintained the head in place, telling her partners to administer oxygen to the mother and the father to call 911. He held the phone for Lana as she described the situation and begged them to have an operating room ready. At that point, the baby’s heart tones were fine. The ambulance arrived in two minutes. The EMTs were cooperative and did not question the midwife’s judgment. Lana straddled the stretcher below the mother, applying counterpressure to the baby’s head with one hand and with the other using the Doppler to monitor heart tones that were steadily dropping. They were inside the hospital within minutes. But upon arrival, they found that nothing had been done to prepare for the cesarean. For thirty minutes, Lana knelt on the stretcher holding the head in place and listening to the heart tones drop—50, 40, 30. She lost her voice from screaming for the hospital staff to hurry. But by the time the cesarean was finally performed, the baby had died.

A prolapsed cord is life threatening to the baby—when the cord is in front of the baby’s head, it is compressed, thereby cutting off blood and oxygen circulation to the baby. Unless the baby can be birthed immediately or a cesarean quickly performed, the baby is likely to die. In this situation, wherever it occurs, the mother must get into the knee-chest position, which takes the pressure off the cord, while the practitioner kneels behind her and applies counterpressure to the baby’s head so that the cord is not compressed between the head and the woman’s pelvis. Keeping her hand inside the mother’s vagina, the practitioner must hold up the baby’s head until the baby is removed by cesarean—a dramatic scenario to say the least, the success of which depends on how quickly the cesarean is performed.

This story resonates with pain; indeed Lana’s partner Susan, who first recounted it to me, was crying as she spoke. She did not know exactly why Lana’s pleas for speed were ignored, but she felt sure that it had something to do with the hospital staff’s disapproval of home birth. The worst-case scenario would interpret hospital personnel as deliberately ignoring this “walk-in” from outside to prioritize the women inside, to punish her for trying to give birth at home, or both. Prior and subsequent experiences have ensured that Susan holds this worst-case view. She said:

In my opinion, the reason no one came to the rescue is because it was a planned home birth gone bad. I don’t think they believed Lana knew a thing. More than once we’ve been forced to wait on circumstances they would normally be scampering to fix. I could tell you several stories in which the medical staff tried to hang us, instead of acknowledging that we transported appropriately.

In contrast, the scenario that attributes the best intentions to the hospital practitioners has to do with the logistics of hospital procedures. When a cord prolapse occurs in hospital, the practitioner who identifies it issues a crash call, the obstetrical team flies into action, and when all goes well the baby is delivered by cesarean within ten minutes. But getting everything in place for a cesarean is very expensive in terms of the personnel and equipment needed, and most hospitals have experiences of doctors, paramedics, nurses, and/or midwives telling them to prepare for a cesarean when one really isn’t needed. Setting up unnecessarily ties up rooms, obstetricians, and anesthesiologists and may keep them from being available if needed elsewhere. Thus, it is logical that a hospital would want to assess the situation before taking action, especially on the word of a person unknown to them (which might include a private physician).

This transport took place in 1986 but is far from anachronistic—similar scenarios still play out around the country, especially in states where midwives practice illegally but also in states where they are legal but not well accepted by biomedical practitioners. It illustrates the dysfunctions generated by partial, fractured articulations between the biomedical and home birth midwifery systems. The biomedical system’s first response was appropriate—the EMTs supported the midwife to continue her work and did not challenge the validity of her knowledge or approach. And on the phone the hospital promised a response. But somewhere between the promise and the mother and midwife kneeling on the stretcher in the hall, a fracture occurred in what had promised to be a system of smooth articulation, and it was the baby who fell through the crack. Both the worst-case scenario (that the hospital deliberately delayed action to punish the midwives and the mother for attempting a home birth) and the best-case scenario (that, given the expense and difficulty of preparing the Oroperating room, hospital practitioners didn’t feel they could risk taking these unknown midwives at their word) point up the importance of prior dialogue and relationship between the hospital and the midwives in order to establish mutual trust and systems of smooth articulation well in advance of this kind of emergency.

Dina’s Story: Home Birth as Child Abuse?

Dina Farraw, an American CPM from Arkansas, transported a client after a home birth for a retained placenta. The doctor did remove the placenta, but only after sternly telling the woman and her husband that it was “child abuse” to give birth at home with midwives. This insulting remark was most likely made out of sincere beliefs that midwives are ignorant and that home birth is a highly risky enterprise. The statistics on the safety of home birth in the United States are not taught in medical school, and most obstetricians are simply unaware of the good outcomes home birth midwives generally achieve (Rooks 1997:345–384). Of course, it is ironic that the doctor’s belief in the midwives’ ignorance stems from his own. The hegemony of obstetrics has forced midwives to educate themselves in its ideology and assumptions, protocols, and lexicon to enhance their chances of successfully interfacing with it and of being able to defend their actions in its terms. In contrast, the marginality of midwifery has allowed obstetricians to remain ignorant about it. Obstetricians tend to be unilingual in the language and technologies of biopraxis, while midwives tend to be multilingual. They manipulate the lexicons of both obstetrics and midwifery, as well as of various folk systems of practice and belief that inform the lifeworlds of the clients they attend (such as Latinas in theRio GrandeValley inTexas, or the Amish inPennsylvania andTennessee). Midwives thus transgress and elide professional boundaries on a daily basis, while obstetricians tend to reinforce them. Fractures in attempts at articulation (like this doctors’ insulting remarks) often result from this kind of obstetrical boundary reinforcement.

A few U.S. physicians are willing to elide and transgress professional boundaries in order to support home birth midwives. Such support can be costly: in the United States, some physicians have lost their hospital privileges, their insurance, and their ability to practice in their communities as punishment for working with home birth midwives. Of course, the more physicians supportive of home birth midwifery are marginalized within biomedicine, the less ability they have to create needed structures for smooth articulation.

Smooth Articulation

It is important to remember that for all the transports that go awry, many others go smoothly and most do not result in anyone’s death even when they are characterized by fractured articulations. Very few midwives in the United States ever lose a mother, but out of every 1,000 births, two or three babies will die no matter where they are born or who attends them. In the United States, home birth data indicate that babies whose births start out at home do not die at any higher rates than babies whose births start out in the hospital—there is no added risk to home birth (Rooks 1997; Macdorman and Singh 1998; Johnson and Daviss 2001). As I noted above, only 2 percent of transports are true emergencies; the same emergencies happen in hospitals. But clearly, transports that involve fracture or disarticulation between biomedicine and midwifery can amplify the problems already generated by the complication that motivated the transport; sometimes those disjunctures alone are enough to cause a death that would not otherwise have occurred. On the other hand, when a home birth transport is treated effectively, the chances for survival of mother and baby are greatly enhanced. This more positive scenario requires smooth articulation between the biomedical and home birth midwifery systems, which the following two stories will illustrate. They both come from Carrie Smiley, the aforementioned CPM fromAtlanta,Georgia.

A mother pregnant with her second child started bleeding during mild early labor. Although the baby’s heart tones were good, Carrie was concerned by the dark red color of the blood, which indicated that it was not from a superficial cause. She called the hospital and told the nurse-midwife that some kind of placental abruption might be occurring. Welcomed in the hospital, the mother labored for another three hours in the jacuzzi and on the birth ball. She pushed for about ten minutes, and delivered on her hands and knees while the nurse-midwife caught the baby. When Carrie and the nurse-midwife examined the placenta, they could see a five-centimeter clot on it—an indication that the placenta had partially detached in that area and had been bleeding from that place for a while. After the birth, the doctor told Carrie that she probably could have stayed at home for this one. And Carrie told him, “You have to realize that it’s important for me to transport sooner rather than later when I have the option.” And he said, “You are right—I don’t always see it from your side.”

A primary ingredient in Carrie’s willingness to transport early rather than late was the excellent relationship she has established over time with this doctor and this particular hospital. Carrie’s many positive experiences with the M.D. and the nurse-midwives who work with him illustrate how different kinds of articulations can happen in the same location as the actors come to know and develop trust in each other over time.

Brigitte Jordan’s (1993) call for the replacement of top-down, culturally inappropriate obstetrical systems with models of mutual accommodation between biomedical and indigenous systems is equally significant for postmodern home birth midwifery systems. Nurse-midwives are especially well placed to achieve such mutual accommodation, as they inherently straddle and bridge (and occasionally fall into the fissures between) biomedicine and home birth midwifery. Establishing close relationships with home birth midwives who are not legal is simultaneously a transgressive and a boundary-spanning act. The prior communication and relationship between Carrie, the nurse-midwives, and the supportive physician certainly facilitated the smooth articulation of systems that this story illustrates. In fact, the articulation between Carrie’s knowledge system and that of the hospital practitioners is so smooth that she is more than willing to transport even for situations that have nothing to do with risk:

            A mother giving birth for the first time had pulled a muscle in her back. Carrie spent hours trying to relieve her back pain with showers and warm compresses and massage. She said,

After a while we were running into brick walls as far as pain relief for the spasms, so we decided to go into the hospital where they have jacuzzis in the labor rooms. By the time we got there, she was 6 centimeters. The nurse-midwives who received us told her she was doing great. The jets did good counter-pressure on the back pain. They never started an IV and she had no pain medication. The baby’s heart tones always sounded great. I was able to catch the baby as “the grandmother” on the chart—the nurse working with us had had her babies at home, and the nurse-midwife was very supportive and felt this mom really deserved the continuity. The baby was fine and the family went home twelve hours after the birth.

As these two stories illustrate, smooth articulation between knowledge systems proceeds through points of overlap, transition, and communication that facilitate the seamless flow of information and linked, imbricated decision making in which the actions taken by one person or group build on the information supplied by another. The relationships between Carrie and the hospital-based CNMs encompass such points. When this kind of decision making takes place within the top-down biomedical system, such imbrication requires a rejection of its tendency to discount or dismiss as irrelevant other ways of knowing. Such rejections can and do take place at the level of the individual even when the system as a whole remains dismissive.

What motivates or inspires a physician to reject the top-down system and give credence to home birth midwifery knowledge? My observations are that the ingredients key to an individual MD’s predisposition to smooth articulation and mutual accommodation include (1) exposure to midwifery care, (2) exposure to midwives, and (3) attention to scientific evidence. I will briefly deal with each of these in turn.

Exposure to midwifery care. Some doctors train in hospitals where nurse-midwives practice and thus are able to observe firsthand the benefits of midwifery care, which can include birth in upright positions, without an episiotomy, and with a great deal of hands-on support. Nurturance and consideration tend to characterize the midwife’s approach to the mother; shared decision making takes place in a context of mutual respect. These trainees often become imbued with a desire to incorporate this humanistic approach into their own practices, and will be more likely to work with nurse-midwives in the future from a partnership, rather than a hierarchical, perspective.

Occasionally a brave physician will venture outside hospital bounds and observe a midwife-attended home birth—an experience that tends to be emotionally evocative and ideologically transformative (e.g., Wagner 1997). Clinicians judge other clinicians as individuals, not just as members of a class or category; individual judgments can overcome prejudices based on subcultural differences. Does a specific practitioner give good care, make good decisions, and communicate accurately? Individual practitioners decide the answers on the basis of experience. All clinical practitioners constantly gather experience and information, and react differently to a comment, order, or action from someone they trust as opposed to someone whose judgment has been faulty in the past or whom they do not know. Midwives work best with the doctors they have come to trust as a result of experience, and vice versa. But most doctors have little or no experience of working with home birth midwives, and the experiences they do have may be skewed if it they comes only during emergency transports. It’s a tautological circle: lack of experience with working together creates problems that exacerbate and perpetuate lack of experience with working together.

Exposure to midwives. It is accurate to say that in general, American home birth midwives have impressive personalities, a strong sense of commitment and dedication to serving women, a secure sense of their own self- and professional worth, and a large fund of knowledge about parturition that seamlessly permeates their conversation. Simply spending time with them can turn a hospital practitioner from an opponent to a supporter. In U.S. communities where smooth articulation characterizes transport, home and hospital midwives, and sometimes physicians, often participate in periodic potluck dinners where models of mutual accommodation begin to emerge over casseroles and drinks. Hospital midwives who develop respect for and good relationships with home birth midwives often transmit this trust to the physicians with whom they work, in a kind of spillover effect that paves the way for future smooth articulations during transport.

Attention to the scientific evidence. There is increasing emphasis these days on “evidence-based medicine” (Rooks 1999). As we have seen, midwifery tends to be more evidence based than obstetrics because midwives are generally less interventive than physicians (Frye 1995; Davis 1997; Gaskin 1990; Rooks 1997), and the scientific evidence (Rooks 1997:345–384; Macdorman and Singh 1998; Goer 1999; Enkin et al. 2001) shows that many common interventions do more damage than good. Any doctor who actually looks at the evidence instead of relying solely on what he is taught by biomedical tradition will take note of the benefits of midwifery care, and will thus be less likely to assume a blanket superiority for tradition-based obstetrics.

Cross-Cultural Perspectives on Transport

Midwives transport in hopes of resolving a situation they feel they cannot or should not handle at home, with hopes and prayers for a good reception most especially for the mother, but also for themselves. A positive reception in the hospital reinforces midwives’ sense of themselves as competent practitioners and elicits in them feelings both of pride in their good judgment and of gratitude toward the biomedical system for its efforts; a negative reception can leave the midwife (and the mother) emotionally scarred. Once burned, twice shy, they may in the future try too hard to avoid another transport, with potentially unfortunate results. Cross-cultural research provides multiple examples (e.g., Allen 2001; Barnes-Josiah, Myntti, and Augustin, 1999; Davis-Floyd 2003; Iskandar, Atom, Hull, Dharmaputra, and Aswar 1996; Graham, 1999; Kroeger, 1996). For one brief example that stands for countless others, Deborah Barnes-Josiah and her colleagues have shown that in Haiti, community midwives who have been badly treated in hospitals, or whose clients have received inadequate care after transport, try in the future to avoid transport by coping with emergencies at home as best they can, often until it is too late to seek help. If disaster befalls, the midwife is handed the blame, with no account taken of the prior experiences that generated her avoidance behavior.

The solution to the trouble with transport that the governments of developing countries have generally sought to implement usually involves the goal of eliminating home birth and traditional midwifery in favor of hospital or clinic birth attended by physicians and/or professional midwives trained in two-year, government-approved courses (Hsu 2002; Jenkins 2002; Sargent 1989). Yet for a variety of reasons (see Davis-Floyd 2000), women in many countries continue to choose their traditional attendants. Certainly, as Roger and Patricia Jeffrey pointed out in 1993, it is important not to romanticize indigenous midwifery and indigenous midwives: some indigenous customs are beneficial and some are not; some traditional midwives are competent practitioners within their own systems and some are not. Similar notes can be sounded about obstetricians: some intervene inappropriately, ignoring the evidence, while others exercise a more balanced and judicious approach. The transport stories I recount here should not be simplistically interpreted to indicate that all midwives are good and all biopowerful practitioners are bad or vice versa, but rather as ways of illuminating points of disjuncture and fracture, as well as models of smoothness, in the cross-boundary articulation of disparate knowledge systems.

Today in most developed countries, the home birth rate hovers around 1 percent. That home birth might be more widely chosen in the developed world if it were more readily available is indicated by the Netherlands, where the home birth rate has never dropped below 30 percent (Weigers 1997), and New Zealand, where in recent years it has risen to 12 percent as the result of a strong alliance between midwives and consumers that has generated active government support. These two countries stand as models of what I would name seamless articulation—their midwives practice, and their health care systems fully support, birth in all settings, creating ease of choice and continuity of care across what in most other countries can only be seen as the home/hospital divide (DeVries, van Teijlingen, Wrede, and Benoit, 2001). In Europe as in the United States, active movements seek to restore home birth as a viable option, with variable success. Meanwhile, in the developing world, home birth rates continue to decline in response to the pressures of modernization, yet millions of women still give birth at home, some because there is no other option, some out of active rejection of their region’s biomedical system, and others out of philosophical choice.

Home birth was both normal and normative for most of human history. But with the advent of biomedicine in the industrialized West, hospital birth became normative and home birth for most women ceased to exist as a viable or even thinkable option. In the developing world, this process is still unfolding; in many Third Worldcountries, it has already taken root to the extent that while home birth remains normative in rural areas, in the cities it has become an alternative and marginalized choice as it is in most of the developed world. Nevertheless, some women still make that choice, and traditional midwives continue to serve them,; only now, like American midwives, some of these urbanized traditional midwives are developing hybrid techniques that reflect the multiple systems of knowledge that intersect in their practices (Davis-Floyd 2001b, 2003). They value the knowledge systems they are creating and the sometimes lifesaving knowledge system of biomedicine; yet the biomedical system, generally speaking, values only itself. Thus for home birth midwives everywhere, biomedicine stands at once as the ultimate recourse and the ultimate enemy, often with no guarantees in any given transport as to which aspect will manifest.

The transport stories I recounted and analyzed here are fractals for thousands of others that shed light on the trouble- and stress-full interface between the worlds of biomedicine and home birth midwifery. Spiraling beyond the bounds of the specific situations they recount, they index both the myriad possibilities for tragedy inherent in one knowledge system’s closed dismissal of its marginalized competitor, and the enhanced possibilities for more positive outcomes when members of that system open its boundaries to admit the fingers of articulation extended by practitioners from the outside. When parallel fingers reach out from the inside, taking account of midwives’ information, acting on their recommendations, and encouraging them to remain with the mother to provide ongoing support, the result can be what Grossberg (1992:57) terms “active structures . . . that cut across domains and planes.” Further elaboration by medical anthropologists of such structures of smooth articulation could extend individualized links and nodes across the hospital/home divide, ending the disarticulations, and mending the fractures, that generate much of the trouble with transport.

Notes

I express my appreciation to the Wenner-Gren Foundation for Anthropological Research for its support of my midwifery research through grants #6015 and #6427.

1. Much of this chapter is adapted from Davis-Floyd (2003a).

2. Ideally, nurse-midwives’ transport experiences should be seamless but often are not. While there is are excellent data on the statistical outcomes of nurse-midwife-attended births in the U.S.United States, including home-hospital transports (Macdorman and Singh, 1998), I know of no research on American nurse-midwives’ transport experiences.

2. Medical practitioners who only see problematic home births that are transported to the hospital tend to think that all home births are “botched.” The rate of problems derives as a function of a numerator (number of cases with problems) and a denominator (total number of cases—the majority—that have good outcomes). If one only sees the numerator, it is impossible to realize that the rate of transports is actually very low compared to the number of successful home births.

3. A caveat: Tto my knowledge, most home birth midwives who transport enter the hospital and stay with their clients for as long as they are allowed to stay. But some hospital practitioners criticize home birth midwives who “dump their clients at the hospital door and take off.” Such midwives usually live in states where their practice is illegal or in places where local hospital personnel are known to be particularly negative and unreceptive. Leaving their clients at the door can be viewed as an extreme form of disarticulation stemming from midwives’ fear that any interaction with the hospital system at best will result in serious harassment and at worst will send them to jail—a powerful argument for the legalization of midwifery, which certainly facilitates the development of systems of smooth articulation.

4. In the United States, there were 23,232 home births in 1998 and 23,518 in 1999—an increase of 1.2 percent. Midwives are not the only practitioners who attend home births. Of 23,518 home births reported on U.S. birth certificates in 1999, 2,476 (10.5 percent) were attended by a physician, 12,123 (51.5 percent) by a midwife, and 8,524 (36.2 percent) by someone else. Some, but not all of the “other” attendants were probably midwives practicing without legal authority (Ventura et al. 2001).

References

Allen, D. R. (2002)  Managing Motherhood, Managing Risk: Fertility and Danger in Rural Tanzania.Ann Arbor:University ofMichigan Press.

Barnes-Josiah, D., C. Myntti, and A. Augustin. (1998). “The Three Delays as a Framework for Examining Maternal Mortality in Haiti.” Social Science and Medicine 46: 981–993.

Benoit, C., R. Davis-Floyd, E. van Teijlingen, S. Wrede, J. Sandall, and J. Miller. (2001). “Designing Midwives: A Transnational Comparison of Educational Models.” In Birth by Design: Pregnancy, Maternity Care, and Midwifery in North America and Europe, edited by R. DeVries, E. van Teijlingen, S. Wrede, and C. Benoit, 139–165.New York: Routledge.

Castro, Arachu. (1999). “Commentary: Increase in Caesarean Sections May Reflect Biomedical Control Not Women’s Choice.” British Medical Journal 319: 1401–1402. Accessed at www.bmj.com/cgi/content/full/319/7222/1397#resp2.

Davis, E. (1997). Heart and Hands: A Midwife’s Guide to Pregnancy and Birth, 3rd ed.Berkeley: Celestial Arts. (Originally published in 1983.)

Davis-Floyd, R. (1992). Birth as an American Rite of Passage.Berkeley:University ofCalifornia Press.

———. (1994). “The Technocratic Body: American Childbirth as Cultural Expression.” Social Science and Medicine 38, no. 8: 1125–1140.

———. (1998). “The Ups, Downs, and Interlinkages of Nurse- and Direct-Entry Midwifery: Status, Practice, and Education.” In Getting an Education: Paths to Becoming a Midwife, 4th ed., edited by J. Tritten and J. Southern, 67–118. Eugene, OR: Midwifery Today. Accessed at www.midwiferytoday.com.

———. (2000, March). “Global Issues in Midwifery: Mutual Accommodation or Biomedical Hegemony?” Midwifery Today, 12–17, 68–69.

———. (2001). “Las parteras de Morelos: The Strategic Negotiation of Knowledge Systems by Postmodern Midwives inMexico.” Paper presented at the annual meetings of the American Anthropological Association, November.

———. (2003). “Home Birth Emergencies in the USand Mexico: The Trouble with Transport.” In Reproduction Gone Awry (special issue), edited by Gwynne Jenkins and Marcia Inhorn. Social Science and Medicine 56(9): 1913-1931.

———. (2004). “Qualified Commodification: Consuming Midwifery Care.” In Consuming Motherhood, edited by J. Taylor, D. Wozniack, and L. Layne.New Brunswick,NJ:RutgersUniversity Press.

———. (2005). “The History, Ideology, and Politics of American Midwifery.” In Robbie Davis-Floyd and Christina Johnson, Mainstreaming Midwives: The Politics of Change.New York: Routledge, in press.

Davis-Floyd, R., S. Cosminsky, and S. L. Pigg, eds. (2001). Daughters of Time: The Shifting Identities of Contemporary Midwives. Medical Anthropology 20, no. 2-3/4 (special triple issue).

Davis-Floyd, R., and E. Davis. (1997). “Intuition as Authoritative Knowledge in Midwifery and Home Birth.” In Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives, edited by R. Davis-Floyd and C. Sargent, 315–349.Berkeley:University ofCalifornia Press.

Davis-Floyd, R., and C. Johnson, eds. (2005). Mainstreaming Midwives: The Politics of Change.New York: Routledge, in press.

DeVries, R., E. van Teijlingen, S. Wrede, and C. Benoit, eds. (2001). Birth by Design: Pregnancy, Maternity Care and Midwifery in North America and Europe.New York: Routledge.

Enkin, M., M. J. N. C. Kierse, J. Neilson, C. Crowther, L. Duley, E. Hodnett, and J. Hofmeyr. (2000). A Guide to Effective Care in Pregnancy and Childbirth, 3rd ed. New York: Oxford University Press.

Foucault, M. (1978). The History of Sexuality: An Introduction, vol. 1. Translated by Robert Hurley.New York: Random House.

Frye, A. (1995). Holistic Midwifery: A Comprehensive Textbook for Midwives in Home Birth Practice, vol. I: Care during Pregnancy. Portland, Oregon: Labyrs Press.

Fullterton, J., ed. (2000). “Skilled Attendance at Delivery: A Review of the Evidence.” Family Care International,New York.New York: Family Care International.

Gaskin, I.M. (1990). Spiritual Midwifery, 3rd ed.Summertown,TN: Book Publishing Company.

Goer, H. (1999). The Thinking Woman’s Guide to a Better Birth.New York: Penguin Putnam/Perigree.

Grossberg, Lawrence. (1992). We Gotta Get outa This Place: Popular Conservatism and Postmodern Culture.New York: Routledge.

Graham, S. (1999). “Traditional Birth Attendants inKaramoja,Uganda.” Ph.D. diss.,SouthBankUniversity,London.

Hsu, C. (2002). “Making Midwives: The Logics of Midwifery Training in St. Lucia.” In Daughters of Time: The Shifting Identities of Contemporary Midwives (special issue), edited by R. Davis-Floyd, S. Cosminsky, and S. L. Pigg. Medical Anthropology 20, nos. 2-3/4: 313–344.

Iskandar, M., B. Atom, T. Hull, N. Dharmaputra, and Y. Azwar. (1996). Unraveling the Mysteries of Maternal Death in West Java: Reexamining the Witnesses. Depok: Center for Health Research, Research InstituteUniversity ofIndonesia.

Jenkins, G. (2002). “Modernization and Postmodernization in the Changing Roles and Identities of Midwives in Rural Costa Rica.” In Daughters of Time: The Shifting Identities of Contemporary Midwives (special issue), edited by R. Davis-Floyd, S. Cosminsky, and S. L. Pigg. Medical Anthropology 20, nos. 2-3/4: 409–444.

Johnson, Kenneth C., and Betty Anne Daviss. (2001, October). “Results of the CPM Statistics Project 2000: A prospective study of births by Certified Professional Midwives In North America (Abstract).” American Public Health Association Annual Meeting,Atlanta.

Jordan, B. (1993). Birth in Four Cultures. Revised and updated by R. Davis-Floyd.Prospect Heights,IL: Waveland Press.

Jordan, B. (1997). Authoritative knowledge and its construction. In R. Davis-Floyd & C. Sargent (Eds.), Childbirth and authoritative knowledge: Cross-cultural perspectives (pp. 55-79).Berkeley:University ofCalifornia Press.

Kolenda, P. (1998). “Fewer Deaths, Fewer Births.” Manushi 105: 5–13.

Kroeger, M. (1996). Final Consultant Report. CHN III Project.Indonesia: Provincial Department of HealthCentral Java.

MacDorman, M., and G. Singh. (1998). “Midwifery Care, Social and Biomedical Risk Factors, and Birth Outcomes in the USA.” Journal of Epidemiology and Community Health 52: 310–317.

Rooks, J. P. (1997). Midwifery and Childbirth in America.Philadelphia:TempleUniversity Press.

———. (1999). “Evidence-Based Practice and Its Applications to Childbirth Care for Low-Risk Women.” Journal of Nurse-Midwifery 44, no. 4: 355–369.

Rothman, B. K. (1982). In Labor: Women and Power in the Birthplace.New York: W. W. Norton.

Sargent, C. (1989). Maternity, Medicine, and Power: Reproductive Decisions in Urban Benin. Berkeley: University of California Press.

Ventura, S. J., J. A. Martin, S. C. Curtin, R. Menacker, and B. E. Hamilton. (2001). “Births: Final Data for 1999.” National Vital Statistics Reports 49:1.Hyattsville,MD:NationalCenter for Health Statistics.

Wagner, M. (1997). “Confessions of a Dissident.” In Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives, edited by R. Davis-Floyd and C. Sargent, 366–396.Berkeley:University ofCalifornia Press.

Weigers, T. (1997). Home or Hospital Birth: A Prospective Study of Midwifery Care in the Netherlands. Ph.D. thesis,LeidenUniversity, NIVEL,Utrecht.

ORAL HISTORIES FROM THE PIONEERS OF

AMERICA‘S SPACE PROGRAM

An Oral History Project conducted in conjunction with

the Houston Chapter of the AIAA and Honeywell Corporation

Interviewers:

Dr. Robbie Davis-Floyd, Research Fellow, Dept. of Anthropology, University of Texas at Austin

Dr. Kenneth J. Cox, NASA Johnson Space Center

Interviewees:

Guy Thibodaux, Maxime Faget, Paul Purser, Clotaire  Wood, Josephine Dibella, Adelbert Tischler, Harry Finger, Chris Kraft, Eilene Galloway, Paul Dembling,

Ed Cortright, Walt Dankhoff

Copyright Robbie Davis-Floyd and Kenneth J. Cox, 1998.

All Rights Reserved.

            Official histories often make it appear that nations make big decisions based on thorough research and understanding. But when the individuals intimately involved in those big decisions are given voice, a very different story emerges–one of hops and skips, personality clashes and chats between friends, and bootlegged designs that lead to billion-dollar programs. With funding from the American Institute of Aeronautics and Astronautics, Houston Chapter, and from the Honeywell Corporation, Robbie Davis-Floyd and Kenneth J. Cox have embarked on the project of collecting oral histories from a number of  individuals who were intimately involved in the events leading to the formation of NASA and the early development of its space program. Our focus is not on the well-publicized astronauts, but on the inside stories of the engineers and administrators who worked behind the scenes.

INTERVIEWS 1 AND 2: THE SPACE CADETS

(Thibodaux, Faget, Purser)

Our first interview was with Guy Thibodaux, the engineer and rocket propulsion scientist responsible for the propulsion work on Mercury and many other space projects, at his home near Johnson Space Center in Houston/Clear Lake, on Sept. 9, 1996. The following day we met again at his home, this time to conduct a joint interview with Thibodaux and his colleagues Maxime Faget, who was instrumental in the design of the Mercury, Apollo, and Gemini spacecrafts and the early shuttle, and is widely considered the father of spacecraft design, and Paul Purser, engineer and manager at Langley Research Center in the Pilotless Aircraft Research Division, which formed the early nucleus of the space program. Brief biographies of these three space pioneers follow below.

BIOGRAPHIC INFORMATION

Joseph Guy Thibodaux Jr.

tibido@ghg.net

Guy Thibodaux graduated fromLouisianaStateUniversitywith a B.S. in Chemical Engineering in January 1943. He immediately reported for Active duty as 2nd Lt. in the U.S. Army Corps of  Engineers and was assigned as a training officer at Ft. Leonard Wood,Mo.He was transferred to the China Burma India Theater and assigned to the 45th Engineering Regiment, and built advanced fighter strips in the Burmese Jungle and worked on the construction of a road fromLedo,IndiatoKunming,China.

After returning home he was employed by the Langley Memorial Aeronautical Laboratory’s Pilotless Aircraft Research Division (PARD) inVirginia, where in a period of three years he became head of all propulsion and pyrotechnic activities atLangleyand its launching range atWallops Island,Virginia. He pioneered the redesign and modification of surplus military rockets to enhance the quality and types of aerodynamic data from free-flying supersonic rocket models and wind tunnels. He was responsible for the development of high temperature ceramic heated jets, electric arc heated tunnels, hypervelocity impact research, high vacuum technology, thermo-physics research, electron beam radiation, and oxidation resistant coating and thermal protection technology using ground and hypersonic reentry vehicles. He designed and operated an experimental solid rocket manufacturing plant and produced some of the highest mass fraction design spherical rockets from his own patented ideas, and developed novel manufacturing techniques. He conducted research on many solid fuel rocket operational problems which only occur in free flight. In 1958 he was a charter member of a committee which eventually planned the transition from the NACA to NASA and its first years’ programs. He was instrumental in starting the Scout,America’s only all solid propellant launch vehicle, and the first one ever developed by NASA; he managed development of all propulsion and pyrotechnic systems on that vehicle.

In 1964 he became Chief of theJohnsonSpaceCenter’s Propulsion and Power Division and was responsible for all propulsion, pyrotechnic, and cryogenic storage and supply systems, power generation and storage systems and hydraulic systems on all ofAmerica’s Manned Spacecraft. He was responsible for the operation of large test facilities at JSC and White Sands,New Mexico, needed for the development, testing, and evaluation of these systems.

He retired in 1980 after completion of work on the Space Shuttle and was a consultant to various industry and government organizations on such topics as solid and liquid rockets, free flight techniques, safety and hazards, and H-bomb simulation facilities.

BIOGRAPHIC INFORMATION

Maxime Faget

Max Faget graduated fromLouisianaStateUniversitywith a B.S. degree in Mechanical Engineering (aeronautics option) in June 1943. He immediately joined the Navy as a Naval Reserve Officer assigned to submarine service. He then became employed  at the Langley Laboratory of the National Advisory Committee for Aeronautics (NACA) in August 1946. He was assigned to the newly created Pilotless Aircraft Research Division (PARD), a division that was to fly rocket-powered models of aircraft and missiles at transonic and higher velocities to obtain aerodynamic data. During this period he did pioneering work on supersonic inlets and ramjets. He designed a compact (6-1/2″dia.) ramjet engine and a supersonic flight test vehicle which was powered by two of these ramjets. During a flight test in 1950 this vehicle accelerated under ramjet power in a climbing flight achieving  an altitude of 65,000 feet and a velocity of  M=3.2, setting unofficial speed and altitude records for vehicles powered by air-breathing engines.

While atLangley, he was appointed to the four man team that prepared the conceptual design and performance analysis of a research aircraft that could fly twice as fast and much higher than currently possible. The NACA then approached the Air Force to contract with industry to complete the design process and manufacture such an aircraft. This became the start of  the X-15 program. Faget was also appointed the NACA member of the Polaris Missile Steering Task Group where he proposed the aerodynamic shape that was employed for the reentry warhead. During the winter of 1957-58 he conceived the design and started development of the one-man spacecraft subsequently used in Project Mercury. Both the Gemini and Apollo spacecraft are derivations of the Mercury concept. When NACA was notified that it was chosen as the cadre from which a new civilian space agency would be formed, Faget was appointed a member of the transition team.

After NASA was formed, Faget was assigned to the Space Task Group (STG) organized to manage Project Mercury. Although Mercury was the main task at STG, there was great interest in follow-on programs. Consequently he devoted a large part of his time to heading a design and analysis team exploring manned flight to the vicinity and the surface of the moon. Because of this and other NASA studies, President Kennedy was able to commit theUSAto a lunar landing by the end of the decade. With the advent of Apollo, STG became the Manned Spacecraft Center (MSC). Faget was appointed Chief Engineer at MSC, responsible for the design, development and proof-of-performance of manned spacecraft and their systems. This responsibility included specifying the function and design of numerous engineering laboratories to be constructed as part of MSC. In April 1969, shortly before the first lunar landing, he organized a special preliminary design team to do an intensive feasibility study of a reusable manned spacecraft. This effort achieved program status whenJohnsonSpaceCenter(nee MSC) was given formal authority to develop the Space Shuttle. Subsequently, Faget gave prime emphasis in his personal activities and those of the organization toward solving the manifold problems in the development of the Shuttle. He retired from NASA after the Shuttle successfully completed its second test flight in 1981.

In 1982 Faget and severalHoustonbusinessmen founded Space Industries Inc. (SII). SII designed the Industrial Space Facility (ISF). The ISF was to be a manned-tended orbiting facility to be used for experiments in a high-quality micro-gravity environment with special emphasis on material processing. Westinghouse became a partner with SII in a joint venture for financing, construction and operation. Significant backing was obtained for an initial deployment in 1992. However, the aerospace industry, Congress and NASA feared it would curtail the Space Station program and consequently the ISF was never deployed. SII then manufactured a wide range of experiment support equipment that was flown on numerous Shuttle missions. The most significant was the Wakeshield built for theUniversityofHouston. This free-flyer was successfully deployed on two missions, providing the experimenters with an ultra-high vacuum environment for material processing.

BIOGRAPHIC INFORMATION

 PAUL E. PURSER

Paul E. Purser was born and raised inSoutheast Louisiana. He graduated fromLouisianaStateUniversityin 1939 with a B.S. in Aeronautical Engineering. He took the Civil Service Exam that spring in anticipation of a major growth in NACA (National Advisory Committee for Aeronautics) during the pre-World War II period, and worked briefly as a Junior Inspector at Glenn L. Martin, Co.Baltimoreon a twin-engine attack bomber being built for the French armed forces. In mid-October he received his NACA appointment and immediately departed for Langley Field.

During the prewar and WWII period, Purser carried out wind-tunnel research and evaluation work on practically every aircraft proposed for, or used in, WWII. At the end of WWII, he joined the Pilotless Aircraft Research Division (PARD) which was then being formed atLangley. There he and his colleagues carried out aerodynamic and structural research in flight using rocket-propelled models at Mach Numbers up to 15. Additionally, Purser headed up the development of various high-temperature ground facilities for research on materials, structures, and missile nose cones. During the major portion of the period between October 1957 and October 1958, he was a member of the small (12-man) team that conceived and “sold” the U.S. Manned Space Program and as part of the larger (75-man) team that planned and implemented the conversion of NACA to NASA.

From October 1958 to April 1970, Purser was Special Assistant to the Director of Project Mercury, which  developed into theMannedSpacecraftCenter(nowJohnsonSpaceCenter). During that same period he continued his membership in the American Institute of Aeronautics and Astronautics  (AIAA). In the early 1960s, he became a charter member of the American Society for Oceanography and a Member of the Marine Technology Society when the MTS and ASO merged. Also during the 1960s he was registered as a Professional Engineer inLouisianaandTexas. Purser was also invited to (and did) join 3 National Honor Societies Tau Beta Pi (Engineering), ODK (Leadership), and Sigma Gamma Tau (Aerospace Engineering.). During the 1968-69 academic year he was on loan to theUniversityofHoustonwhere, as Special Assistant to the President, he guided the development of theUH-ClearLakeGraduateCenter.

Upon his retirement from NASA in April 1970, he began consulting in various fields trying to apply what he had learned in NACA and NASA. In addition to various consulting tasks in the oil & gas industry, this led to a 10-year stint as Staff Consultant to the NAE/NRC Marine Board, overlaid with a 5-year stint as consultant to the Stanford School of Medicine Cardiology Division, about 5 years as a part-time Systems Engineer with the Gulf Universities Research Consortium (GUBC), and a 25+-Year association with CAPT W.F. Searle (USN-Ret.) on various tasks in the oceans industry. During this time he prepared and presented several technical papers at the Offshore Technology Conferences and the MTS Oceans Conferences.

INTERVIEW #1

Interviewee: Guy Thibodaux, NACA/NASA engineer and rocket propulsion expert, former Chief

                      of  the Propulsion and Power Division at the Johnson Space Center, Houston, TX.

Interviewers: Robbie E. Davis-Floyd and Kenneth J. Cox

Interview Dates: Sept. 9-10, 1996

This seven-hour long taped interview has been edited by both interviewers and by Guy Thibodaux himself for clarity, organization, and flow. Thibodaux (aka Tibby) has also added in extensive supplementary commentaries and additional information, all of which appear in italics or parentheses. [Editorial comments from Robbie Davis-Floyd or Ken Cox appear in brackets.]

Guy Thibodaux: It’s been a long time and the story hasn’t been told about how the space program and NASA really got started.  There are quite a few people still alive who are responsible for getting them going. I have a list of those that I know who are still alive with their addresses and phone numbers that you can use to contact them regarding further interviews.

I’ve never seen any references to the fact that some of us spent a lot of time up in Washington, going through the Pentagon like we owned it, coming up with what became the space program. It’s not documented, you see. I think the history, from the time the Space Task Group came down to JohnsonSpaceCenteris pretty well documented (even if it is wrong).  What I am really interested in is covering that gap, the transition between the NACA and the events leading up to that, up to the early years of the Space Task Group.

Robbie Davis-Floyd:  That’s what we’d like to focus on too.

Guy: I talked to Paul Purser and Max Faget and they’ll be down here tomorrow.

Robbie:  Good! Ken Cox said that you yourself have some great stories.

Guy:  Well, these are fairly interesting stories because  most of what went on is undocumented.  We never kept minutes at meetings.  Most of it was in verbal reports to our leaders and the results which were achieved speak for themselves.

Personal History: World War II, Model Airplanes, and LSU

Robbie: Tibby, before we get into the space program, tell us a little bit about yourself. Where were you born?

Guy: I was born in theLouisiana swamps.

Robbie: Where in theLouisiana swamps?

Guy: I was born at the F.B. Williams Lumber Camp in theAtchafalaya swamp on the west side ofLake Verret.  It is certainly a swamp. It was a big cypress logging organization. My father worked there. My birthplace was registered asNapoleonville,Louisiana which is twelve miles north ofThibodaux,Louisiana on Louisiana Highway 1 which parallels Bayou Lafourche.

Robbie:  Is that town named after your family?

Guy:  Yes.

Robbie:  Did you grow up there and go to school there?

Guy:  No, we left there and moved toNew Orleans when I was about five and I went to high school inNew Orleans and later on I went toLouisianaStateUniversity. The interesting part of it is that Paul Purser, Max Faget, and I were all LSU graduates. Max and I were college roommates. We ( Max and I)  had a pact that at the end of the war, if we both survived, we’d get together and go look for a job together.

Robbie:  What was your role in the war?

Guy:  I was an officer in the Corps of Engineers and I served in the China-Burma-India Theater building a road fromIndia intoChina and some advanced fighter strips. I was a white officer in a segregated Negro organization. I’m doing a lot of historical work on that right now, as a matter of fact.

Robbie:  So, when you went to LSU, did you go all the way through and get your degree in engineering from LSU?

Guy: I had that before I went into the service.

Robbie:  What was it in?

Guy:  Chemical Engineering.

Robbie:  What did you do when you came home from the war?

Guy:  Well, then I came back and I was sitting at home one day and Max called me and said, “Hey, my dad said I could borrow his car. Let’s go look for a job.” His dad had a little ’41 Chevrolet business coupe and it had airplane tires on it because you couldn’t get tires during the war for cars. We went back to the university and we went to our various departments and told the department heads we wanted to go look for a job, and asked who we might talk to about getting a job.

Robbie: In chemical engineering?

Guy: Whatever, I thought chemical engineering.

Robbie: What was Max’s degree in?

Guy: His degree was in Mechanical Engineering with an Aeronautical Engineering minor. Paul was the same way as Max–they were both in aero-engineering, mechanical engineering. Paul graduated about two years before, two or three years before we did.

I know Max as well as I know anyone and I knew him longer than anyone. When I met Max, he was a transfer fromSan FranciscoJunior College. He was already a sophomore, but he was a freshman in Military science. I was his platoon sergeant, and I thought he had two left feet! That’s how I first met him. Later on we got to know each other fairly well. I’m not sure why, we were both about the same size, and we’re both fromLouisianabut he’s not a Cajun. I am. I had to work to earn some of my school expenses and it took me four and a half years plus a summer school session  to finish because there was one required course I had to have that I could not schedule because of my work. During the summer school session,  Max and I roomed together. Then I had another semester that I had to finish so we roomed together again.

Comment: I think I first got to know Max because of Hank Bourgeois. Hank was a childhood friend who lived around the corner from me in New Orleans. He was a talented model airplane builder . I used to help him fly models in the huge Agricultural Auditorium building at LSU. Max was also an avid model builder and there were a few other cadets who shared the same hobby. Hank went on to become  a Marine Pilot and was Pappy Boyington’s wing man in the Black Sheep Squadron of  WWII. Hank stayed in the Service and still built models, this time radio-controlled models. He retired, worked in the Aviation Electronics Industry and became mayor of some town in New Jersey.

Ken Cox:  OK, so you roomed together.  That’s where you really got to know Max.

Guy:  We roomed together for two semesters and we used to wrestle and play handball, work out, and do all sorts of things together. I use to go up to the leper colony with him and spend weekends with him up there because they had a golf course, tennis courts, and a swimming pool for all the public health officers. It was only about thirty miles south ofBaton Rouge. Max’s father discovered the cure for leprosy. He served in the Public Health Service and was moved around the States to various Marine Hospitals. He (Max’s dad) had been assigned to head up a leper colony inCarville,Louisiana. Max went to high school inNorfolk, which is right across from Langley Field. And he began college when his dad was inSan Francisco. Max was very familiar with theNorfolk area. He used to build model airplanes and used to go over to Langley Field for model airplane contests with a friend, Woody Blanchard, back when they were high school kids.

There is an interesting story there, about how Caldwell Johnson [a technician who worked closely with Faget on spacecraft design for many years] got hired. The way they hired people atLangleywas they went to these model airplane meets because they knew that the kids who built the best model airplanes were the best craftsmen. WhenLangleywas hiring craftsmen, what they would do was go and check up on these kids who were winning all these model airplane meets. They would find out the kids who were building the best models and those were the ones they would try to convince that they ought to apply for a job to work in the shops out atLangley.

So, they convinceCaldwellhe ought to apply for this job. Ray Sharp is the guy who hired him–he was the head administrative honcho back atLangley. In order forCaldwellto meet the requirements for the job, he couldn’t be color-blind. SoCaldwellwas rejected by the doctor and he went in with his rejection slip, whatever it was the doctor gave him, and talked to Mr. Sharp with his tail hanging down between his legs and his chin down and said, “Mr. Sharp, I don’t qualify for a job. You can’t hire me.” Sharp said, ‘What the hell’s the matter, son? He said, “I’m color blind.” Sharp looks at the map on the wall and points over to thePacific Oceanand says, “Son, what color is that?”Caldwelltold me that everybody knows the ocean is blue, so he said, “Blue.” He said Sharp pointed to another ocean and said, “What color is that, son?”  “Blue.” He said, “Hell, you ain’t color blind, son. That doctor doesn’t know what the hell he’s talking about. You passed!” And he scratches it out the rejection and said, “You’re hired!”

Something like that you never could do today.Caldwelldidn’t even finish college, in fact. Here he is, this designer of American spacecraft, but he never finished college. He went a couple  of years, maybe. He went through the apprentice school and became–back then the top trades were engineering draftsmen and metal model maker and instrument maker. He was one of the top students in the class, so he became an engineering draftsman. Then he headed the section that designed all the little models we used to fly out onWallopsIsland.

Ken:  I didn’t realize it, but apparently model building, in those days, early maybe mid-50s or right after World War II, was really an area where a lot of people became craftsmen.

Guy:  Yes,  but during the 30s, 40s and  50s, they knew how to design airplanes. Model airplanes had to fly. Then you knew what had to be, and you knew about wing sections, and you knew about  stability and dihedral and all that other stuff.

There is a story about Max that is priceless.  When we first went up toLangley, Max was still a big model airplane builder. His friend Woody Blanchard eventually became the one of the top model airplane builders in theUnited Statesfor a number of years. We’d all go to meets together. I was what they called the gopher. You see, in order to win prizes you had to fly in a lot of different events. When you launch the airplane, it was up in the air for a long period of time. If you waited and ran and chased it down and came back–you had to fly it three times, then you’d have get to other events. The gopher was the guy who goes for it and gets it to bring it back while the other guy is entering some other event.

Anyway we were going up early in the morning to a meet, the New York Daily Mirror Flying Meet.  It was held at the Grumman Airfield inBethpage,Long Island. We were riding up toNew York, and we got up real early in the morning. The back of the car was filled with model airplanes. Max and I and Woody went to eat breakfast on the main street inNewport News,Virginia. At that time in the morning the street was totally empty. This car is a Chevrolet Coupe and it’s canary yellow, just as bright as can be. We walked over and had breakfast. Woody and I reached into our pockets and said, “I got the exact change, Max. You don’t have any change, do you?” He said no. And we said, “Well, we’ll leave it and you pay for the bill. We are going to go back to the car. Meet us there.” The car was parked right across the street.

Woody and I went and sat in the car. No Max, No Max. No Max. No Max. (laughter)  Pretty soon we look around and here comes Max walking right past the car. Woody starts to holler, but I said “Shhhh!” Max walked right past this canary yellow car. He walked all the way to the other end of town and came back. Then, when he came back and it had gotten a little bit lighter, he looked at us with this big grin and said, “Where you guys been?”

He just had his head in the clouds. He was thinking about the meet or something. He was that way about a lot of things. When we went to Langley, it was almost six months before he could find his way out to work. I used to have to tell him how to get to work every morning. (laughter) We roomed together and he’d get up in the morning and he’d go in the bathroom  and he’d blink in the mirror a few times. Next thing I know, he’s back in the sack!

Ken: What was it that attracted you early to a friendship with Max?

Guy:  I don’t know. We got along. We didn’t have too many common interests. We did share interests in sports. Max had been a quarter-miler–I wasn’t very athletic. I was kind of small. I couldn’t play with the big boys, but I did intramural pretty well. I shot on a varsity rifle team, I ran cross country, I played softball. Max and I used to wrestle a lot and play handball, one of the things that we liked. I love handball because you have to be ambidextrous. You have to develop coordination on both sides of your body. We played a lot of handball together. We were both very similar students. We didn’t take our college work that seriously. (laughs) We were pretty damn independent. No one told us what we had to do. The professors couldn’t manage us very well.

If we got a lousy grade (C) it was usually because the professor didn’t like us and he couldn’t manage us or that we just weren’t interested in the subject. That didn’t bother us. My whole attitude was I was there to learn something, not there to get a fancy grade. I found a lot of people who got fancy grades but who didn’t know a damn thing except they memorized stuff by rote and they could answer the test questions.

Oddly enough, I think with our school records, even though we had reasonable records, they’d have never hired Max and me today. We couldn’t even qualify to be hired over here [at JSC] today. That’s a fact.  No one would look at us if they looked at our college transcripts and resumes–neither one of us were honor society types or anything else. We flunked out more roommates than anyone I know because we never studied. When it was time for final exams we used to always go to the pool hall and shoot snooker all during the week while everyone else was boning up. I never took notes in college. I’d come home at night and I’d try to remember what I had heard and I’d do all my note taking at night. If I couldn’t remember it, it obviously wasn’t very important.

Ken:  You must have a pretty good memory.

Guy:  I had a pretty fair memory. Somewhere along the way I understood what I was good at and what I wasn’t good at. I was fortunate enough that the profession I took up was one which I was very happy I chose. The teaching methods they used in my department were better, far better than anything else I’ve seen. We were taught to think. The problems we had to solve were thinking problems, not multiplication and addition and stuff like that. We also taught team work. All of our labs were done by teams of people. We rotated the leadership and somebody had to figure out how to adjust all the valves so the thing would flow in the right direction. Somebody had to collect the samples. Somebody had to weigh them. We had to give assignments.

Guy [comment]: I had always thought I wanted to be a chemist, but at a career counseling session my senior year in high school, the Dean of Engineering at Tulane University convinced me that Chemical Engineering was a much better way to go. Like Paul, I couldn’t afford the tuition at Tulane. I also needed help to earn some money to help pay for my education. My dad knew some politicians who helped me get a NYA Scholarship at LSU which paid me 30 cents an hour. That paid for all my food, and I earned some extra money during summer vacations.

I never regretted the decision. The professors in the Chemical Engineering Department were outstanding. Most had industrial as well as academic experience. As one never knew what kind of industry he would work in, the curriculum had to be very basic. Paul Horton, Jesse Coats and Arthur Keller were my principal teachers. We were taught to think. Methodology was much more important than getting the arithmetic right. In Chemical Engineering Lab, we, with a few professionals, operated an experimental sugar mill for the Louisiana Cane Growers Association and got valuable experience. And with grants from the local petrochemical Industry, we did experiments using the type of equipment used in that field.

The cost of doing business was paramount and almost every project involved what is now known as “cost engineering.” While each student was required to write his own reports of the experiments we did, we were taught teamwork. Each assignment had a leader who was required to assign tasks to the other students on the team. I learned that to solve a problem, you didn’t start at the beginning, you started with the end result that you desired and worked backwards from that. The professors required enough from each student that merely to pass was an accomplishment. Less than 20 percent of those who wanted to be chemical engineers in their freshman year graduated in that field.

Guy: We had a lot of real problems. Nothing imaginary. The old department head just made us think. While we did our work as a team, we each had to write our own individual reports and submit them. They all had to be typed. He was a real great teacher, very demanding. He didn’t put up with any bull crap. He, I could tolerate, because I knew what he was up to. The other guys who told me I had to keep this notebook and I had to be neat and look this way–I didn’t pay much attention. (laughs) Max and I are really not that great for neatness.

Robbie (laughing): What did your dorm room look like?

Guy:  When I was a cadet it looked great because I would have been walking drill tours if it wasn’t. It was spit and polished and shined and the bed you could bounce quarters off of and the whole bit. But after I got out I got out of that–well, it was sanitary. It was a hall, that’s what it was. We lived in a stadium. They have  cheapest rooms on the inside of the stadium. They didn’t even have windows to the outside.  So it was kind of dark and dank and mildewy. There were three of us–Bobby Dreher, I guess it was. Billy Drake was another one. Billy is dead. He was a Grumman test pilot that got killed out at Edwards Air Force Base flying a new  Grumman airplane.  Bobby works up at Langley. They had trouble trying to keep up with us because they couldn’t shoot snooker during final exam week. They had to study. I could never do anything like boning up. If I didn’t know it before I went in there,  I wasn’t going absorb it in a two or three night period. I’ve been that way all my life. I was fortunate that I was born with two great assets. I was born lazy and with no ambition. (laughs)

Robbie:  You sure went a long way for somebody who is lazy and with no ambition!

Guy:  Those are two of my greatest assets. Because I was lazy, I became, I think, an outstanding supervisor because I didn’t mind letting other people do the work. I didn’t have to do the work, or try to be smarter than the sum of the guys in my division. But I knew enough to guide them. And because I had no ambition I was never a threat to any boss I had. I never walked over any of them. I walked around quite a few of them, but I never walked over any of them. And I never worried who got credit for the work.  I think I parlayed those two things other people think are not too hot into a pretty good career. And I had an awful lot of fun doing it. I don’t think anybody could have worked in anything more exciting than Max and I and Paul did. We were right in the forefront of everything.  We always had the best tools. We had tremendous support in everything we did.  You just couldn’t ask for a better deal.

Ken:  Paul went to LSU also. Did you know him there?

Guy:  I didn’t know Paul that well. I knew of him at school, but I didn’t know him. He graduated two  or three years ahead of us. Because he was working atLangley, he had an exemption from going into the service because he was working on defense related research. So, Paul didn’t go into the service. By the time we had gotten toLangley, Paul had been working there for six years and had kind of gone up the ladder. Gilruth had brought him in–Paul had headed up the small wind tunnel there at one time. He also headed up the fiscal office, the payroll office atLangley one time. We got Paul’s name from the head guy who taught Max aero-engineering.

The guy who headed up the aeronautical department at LSU was an old German from World War I, Ernst (Fritz) Maser. He designed some real fancy airplanes back in the ’30s. The fastest airplanes in the world had been designed by this guy. He came over to theUnited Statesand became a professor at LSU. He had a very small organization. He never had any more than ten or twelve students. He handpicked all of his students, so he knew they were all topnotch people before he accepted them. He knew they would get through.

Fritz designed racing planes on the side for Harry Williams and Jimmy Wedell  during the 1930s. These usually won the Cleveland Air Races and were piloted by Wedell. They were built inPatterson,Louisianaon Bayou Teche at a site which is now the Louisiana State Air andSpaceMuseum.  Harry is the son of Frank Williams who owned the logging operation where I was born.

Robbie:  And he was your professor?

Guy:  No, he wasn’t mine. He was Max’s. I knew him and I worked with him. I got to know him fairly well back in the early ’40s. Fritz was head of a Navy and Air Corp Cadet training program at LSU. As I already had my commission, but had not been called to active duty because I was being allowed to complete my education, I was hired at the enormous salary of $5.00 an hour to give these cadets military training. That’s really how and when I got to know Fritz.

Robbie:  And he taught Max aeronautics?

Guy:  He taught Max aeronautical engineering, as well as Purser. So he gave us Paul Purser’s name and I got a few leads in some sugar companies and various industries from the head of my department. It turns out that we were on our way to visit our other roommate who was a pilot on the Franklin D. Roosevelt, a new aircraft carrier just commissioned. Billy was still in the Navy as a Naval pilot.  He was atQuonset Point,Rhode Island. (Billy later became a Grumman test pilot and was killed in an airplane accident at Edwards Air Force base.)  We took off in this little car and we headed off to Quonset Point. On the way there we stopped inNorfolk,Virginia and Langley Field,Virginia

Robbie:  Paul was already atLangley?

Guy:  Paul had been there for about three years before the war. He was there all through the war and had been there three years prior to the war. Max and I spent almost three or four years during the war in the Army and the Navy during WWII. Paul didn’t go because he had an important civilian job. He got a deferment and didn’t have to go into the service. They may have inducted him as a private or something but never sent him.

Robbie:  So you drive up there in Max’s father’s car, and say “Hey Paul, we’re here?”

Guy:  No, he didn’t know we were coming up. We got there and the first person we met was Adeline. She was a pretty little thing. She was the receptionist in this fancy building. There was a rotunda and it had paintings of the history of flight on the large hemispherical dome. There was this big circular table and she sat there where you went in. She took one look at us and kind of turned her nose up for some reason–I guess because we looked like two bums. We were wearing very loud Hawaiian sport shirts and either kakhi or navy gray work pants . We had opened-toed sandals with no socks on. I think we slept in our clothes. We weren’t anything special looking. (Later on, she must have changed her mind because she asked us to give her a ride home after work.)

But they didn’t give a hoot–they didn’t care about that. They were totally informal. The whole operation was informal. Paul never wore a tie, in fact. He suffered with the heat so always in the hot summer he had a big towel wrapped around his neck. Whenever we had any distinguished visitors, he used to keep a old seersucker coat hanging on a tree in his office. This office was just one big office with everybody in there. Paul had a desk at the head of the room. He’d go grab some kid who had a tie and say “Hey, I want to use your tie” and take the tie off him and put it on and go to the meeting if he thought he had to be dressed up. (laughter)

Robbie: So when Paul saw you guys what did he say?

Guy: He was enthused because here are two young fellows who had engineering degrees looking for a job. They had hardly hired anybody with degrees. Most of the people had gone off to war. It wasn’t that easy to get good people. He made us an offer right on the spot. He said, “Sure, we’ll hire you” and we said, “We’ll let you know in July,” and we went up to visit Billy up in Quonset Point. We spent a little time up inNew York City and did a few other things. After we went back home, we decided one day, “Well, we didn’t get any better offers,” so we called up in July and said, “Hey, we’ll report the first of August.” That’s how we got to work up there.

Robbie:  What did he offer you?

Guy: A job working in the Pilotless Aircraft Research Division—PARD—under Bob Gilruth. He said he needed someone–both of us worked in propulsion for a time. This was the first place where they had offered us a real job that sounded interesting. They hired me to work on rockets and they hired Max to work on a type of propulsion called ram jet. Paul said to me, “You are a chemical engineer. We need someone who can work on things called liquid rockets.” Well, once I got up there, I found out that liquid rockets were not what we were supposed to use–solid rockets were so much easier and cheaper, and we could handle those  so much better.

Robbie:  Is that what got you interested in propulsion?

Guy:  Yes, I got interested. I taught myself with a bunch of books from the library. I set up test facilities and later on, I built myself an experimental solid rocket plant so I could try out some of my own ideas on high performance solid rockets that I had patents on. They had a bunch of surplus military rockets we were working with–little teeny things between two and five inches in diameter. I got interested in them and a lot of other things. I was part of a service organization–I provided a service to all the people there. I was not in the forefront like the other people. I kind of worked in the background.

Design and Experimentation at Langley/PARD

Guy: I found out a lot of things–that if they would let me make changes in the rocket designs, fix the rockets up and do things a little bit differently, I could help enhance quite a lot of the aerodynamic data we got. So I got in the business of cutting rockets in half, building bigger ones, gluing two of them together, putting them in a lathe and cutting them down, doing all sorts of things to change their performance characteristics, which would help the engineers get better information. We developed a bunch of little techniques.

One of Bob Gilruth’s real strong points was that he believed in absolute simplicity. He believed in using your head rather than the machine to do things. He would say, “Use your head!” I learned a very important lesson which I began to put together from him–that passive systems are much more difficult to design than active systems. Passive systems are where you press the button and everything happens according to the laws of physics and chemistry without any intrusion of anything–a valve that you have to adjust, something that has to turn something else off or on–he was real great for that. He never let you use a lot of complicated devices.

Robbie:  Why? Because there would be more stuff to break?

Guy:  Yes. They cost money and they can go wrong. They can fail. So what you do is use the laws of physics and chemistry and put those to work for you so that everything happens the way it’s supposed to happen on the way up. With the basic design, you design that into the system so that nothing active had to come in and intrude on it. It’s done–when you press the button, everything is preordained that is going to happen, you see?

I caught onto that real quick and that’s why Gilruth and I got along real well. One time he had us study the dynamic qualities of an airplane to make the airplane stable. If you pulled back on the stick and then you release it then your airplane goes through oscillations, and those oscillations tell you how stable your airplane is. He didn’t want anything to go bad so I said, “I can fix you up. I can put little rockets about so big–about a half inch in diameter and four inches long–that fire at right angles to the model, and that’s going to knock the nose down and make the thing oscillate. I can set those so they go off in one second intervals using delay fuses. I’ll put eight or ten of those and I’ll fire them all from the ground and they’ll all go off at different intervals, so as the airplane is slowing down, you get the  entire speed range from supersonic through subsonic.”  We started doing things like that.

There were a lot of other little things that people wanted. One of the guys said there was an aerodynamic quality they wanted to measure called damping in roll. He came and talked to me about it. He said, “I have to have something to make the airplane spin but I can’t use the rudder to make it spin.” He said, “If I had something to spin it—”  and I said, “Then I’ll design you a rocket to spin it, and I can tell you how much force the rocket’s using to spin it–will that help?” and he said “Sure.” So I designed those things–a lot of little things like that.

One of the guys in the wind tunnel called me one day and said, “Hey, we’d like to study something in the spin tunnel, but we can’t. There are a lot of things we can’t do.” The spin tunnel is a vertical tunnel –the air goes up. You throw a model in there and then you put it into a spin and you blow the air on it, enough so it keeps it floating there, you take pictures of it as it floats around as it spins. He said “Well, you really can’t tell very much about the aerodynamic forces on there or the other forces, because they are all  in the wash.  It spins around, it’s nothing but the air that is displaced that it’s spinning back into.  I can’t tell what  forces and what direction you need to apply to cause the airplane to recover from a spin—” But he said, “If I had a way that I knew what the forces are that cause the recovery, I might understand what I have to redesign in the airplane to make it recover from a spin.” And I said, “Well I’ll design you a little rocket that can provide a known force and moment you can put in there.”  And I built little rockets that fire a couple of seconds. They could fire those at all the various axes and cause it to de-spin. Then they could study the spinning characteristics, the forces and the inertia that it  went through in the tunnel. That was a big help.

Robbie:  You built rockets that were tiny?

Guy: They about a half inch in diameter and an inch long and produced three ounces of thrust for two seconds. They were mounted on a little model airplane in the tunnel and what they would have inside was a little switch. The tunnel had a large solenoid coil in its throat. When you energize that magnetic coil, you close this little switch to fire those little rockets without any external wires into it. There was a small battery and initiator inside the model.

We did all sorts of things. It was a kind of free-swinging outfit. When we tested airplanes in the wind tunnel you had these turbojets hanging on there, but there was no exhaust coming out. With no exhaust coming out, it doesn’t give you true conditions. The exhaust acts like a big solid body. It’s like trying to stick your finger into a hose. The jet exhaust pushes the free stream back out. John Stack asked my advice on installing something to simulate turbojet exhausts, so I suggested a hydrogen peroxide mono-propellant system which would give about the same exhaust characteristics as a turbojet. I helped John Swihart and Jack Runkel, both of them in the 16-foot wind tunnel, get this started.

I’ll tell you a little story about my rocket plant. That’s a good one. You see, Lewis was the propulsion research center andLangleywas supposed to be in aerodynamics.

Robbie:  What were you doing atLangley instead of Lewis if you were in propulsion?

Guy:  I was supportingWallopsIsland andWallopsIsland used rockets all the time.  I wanted to build this rocket plant. I had some ideas about a brand new spherical rocket that I thought would have some advantages. I wanted to be able to build one to prove it. So I needed to build a rocket plant.  Headquarters would absolutely not approve of building a rocket plant atLangley field.  They said, Oh no, only Lewis could have a rocket plant.

Bob Gilruth came to me and said, “My signature authority is worth $999.99.  If it’s over $1000, you’ll have to go to headquarters for approval. Can you buy every piece of equipment you need for that rocket plant for under $1000 per piece?” I said “I think I can.” He said, “Don’t worry about the building. We’ll call that a model assembly shop or something. We’ll build you the building.  That’s no problem.” I had to take some of the low bidders for equipment I needed. But, I built me a rocket plant. I bootlegged it! The next year, because of what I did with that plant, headquarters decided to give $225, 000 to build me a good one, a bigger one.

Robbie:  So in other words, you bootlegged it and then once you were doing it, then they gave you money for it!  What did you do with that rocket plant?

Guy:  I built these nice rockets.

Robbie:  The round ones?

Guy:  The round ones.

Robbie:  What did they do, how did they perform?

Guy:  They were the highest mass fraction rockets ever built in the country at that time. I could build them in any size. I built a lot of them for research–for studying meteors coming to the earth at extremely high speeds. They were very unique little things. Then they were used as retro rockets and the Japanese copied them. I got to go toJapan to give a paper. They started copying all the ideas that I had and a lot of other people got into the act. I designed and built another non-circular, non-spherical rocket that had some rather unique qualities to take advantage of filament wound rocket cases.

Robbie:  Are those designs still used or have they evolved into new designs?

Guy:  They’ve evolved.

Development of the American Space Program: Early History

GT written commentary:

To understand the space program you have to go back to a number of events during World War II and the ensuing years. Rockets have always been an interesting subject, but other than some crude early designs by Congreve and Goddard, they had little practical application other than for holiday pyrotechnic displays.  In America our use of rockets during World War II was restricted to small solid propellant rockets like the Bazooka (an anti tank weapon), barrage rockets, some air to ground weapons and a few applications in naval warfare. The Germans, under the leadership of Walter Dornberger and Wehrner von Braun, developed a long range liquid rocket bombardment system. This story is told in Dornburger’s book, which is entitled V-2.  At the end of the war, Operation Paperclip brought many of the German scientists from Penemunde to America to continue their work on rocket-powered weapons, first in El Paso, Texas, then in Huntsville, Alabama.

At the end of WWII, Robert Rowe (Bob) Gilruth began to use free flying rocket powered models to conduct aeronautical research at transonic and supersonic speeds at a remote location off the eastern shore of Virginia named Wallops Island. This started in 1945 with a small group of engineers at the National Advisory Committee for Aeronautics (NACA) Langley Research Center (LaRC) called the Auxiliary Flight Research Section. The work expanded and grew into the Pilotless Aircraft Research Division (PARD) in 1946.

In the ensuing years numerous things happened.  In the interests of obtaining higher and higher speeds, PARD developed a number of simple multi-staged solid propellant rocket vehicles which had  hundreds of successful launches with few failures. The International Geophysical Year brought together a number of scientists interested in the upper atmosphere. These simple launch vehicles were an ideal way to obtain the extremely high altitude this group was looking for. Bill O’Sullivan was PARD’s representative on this International Geophysical Year Committee. Some others were  James Van Allen of the University of Iowa, I.M. Levitt  of the Fels Planetarium, and I believe S. Fred Singer of the University of Maryland.  PARD engineers worked with these scientists to customize various systems including rockets launched  shipboard and from high altitudes on helium-filled balloons (Rockoons). This work led to the discovery of the Van Allen Radiation Belts, Standard Tables of Properties of the Atmosphere, etc.

With the Cold War heating up in the early and mid1950s, the emphasis shifted to Intercontinental Ballistic Missiles (ICBMs). The multi-staged research vehicles that we were launching were capable of achieving the speeds and altitudes near those reached by ICBMs and thus were ideal research tools to study aerodynamic heating and heat resistant materials needed to protect the warheads during atmospheric reentry at high speeds. Max Faget was on a Fleet Ballistic Missile (Polaris ) committee and Paul Hill was on a similar committee for the Army’s Pershing Missile.

The models were getting larger and more expensive. Paul Purser was given the task by Bob Gilruth to look into development of ground facilities to do more detailed studies of high temperature structures and reentry thermal protection systems and materials.  This led to the development of high temperature ceramic heated air jets, electric arc heated air jets and chemical jets (rocket exhausts). 

Further work resulted in facilities led by Bob Jewell which prepared oxidation resistant coatings such as borides, carbides, nitrides, oxides and silicides using a vapor deposition technique by bubbling hydrogen through metal halides and passing them over induction heated carbon models.

Later on we became involved in electron radiation in space using high voltage cascade rectifiers to accelerate the electron beams, micro-meteoroid damage using light gas guns developed by Alex Charters of Aberdeen Proving Grounds, high vacuum technology, and thermo-physics.

All of these technologies were at the forefront of those needed to understand what was required in order to send things and people safely into space. Every bit of this was conceived and executed by a small handful of people in NACA’s Pilotless Aircraft Research Division at Langley Research Center, and the supporting effort of everyone at the Center. This led management to recognize the expertise of this group in technologies which were precursors to going into space. The effort supported our country’s ICBM program and had a great influence on the shift from all liquid propellant launch systems to all solid propellant launch systems, along with the knowledge as to what the real size and weight of the hydrogen bomb was.

Guy: The space program  really got started back in 1957 with NACA, the National Advisory Committee for Aeronautics. I worked for the NACA in PARD, and what we did was aeronautical research using free-flying rocket-powered models, and that research had a great influence on the ballistic missile program, including the shift from big liquids to all solid.

With these small launch vehicles, we were getting up into the ionosphere, and at the same time getting a velocity that was short of orbital velocity, but pretty well up there. Just about the time Sputnik flew, in October of 1957, the Air Force had a program which was eventually called Dynasoar. Dynasoar was  either a winged bomber or a winged orbiting space surveillance aircraft. There were two versions of it  –one with a semi-global range–it could fly halfway around the world. Then they discovered that with available propulsion technology you could  actually go into orbit and fly it all the way around. The Air Force wanted to develop this winged space bomber to be able to fly and bomb anywhere in the world.

That program was the outgrowth of something happening in Germanyin World War II.  The Germans had developed the V2s, and were looking at the very large V2 they called A4 (or A10). Its purpose was to be able to  bomb New Yorkfrom Berlin. The way Dynasoar came into being was that the Army had gotten all the German scientists at the end of World War II. It had gotten von Braun because the Air Force did not exist at that time–it was still the Army Air Corps. The Air Force, once it did exist, was kind of miffed because the Army had gotten the group who were in the business of developing rockets which could bomb cities in direct competition with bomber airplanes.

Since the Army had von Braun, the Air Force decided on a little one-upsmanship. So they imported von Braun’s boss. That boss was one of the German generals in Hitler’s high command. His name was Walter Dornberger. He’s the one who wrote the book called V2, about how the V2 developed inGermany. He had a PhD in engineering and oddly enough was a very delightful person. He had a very nice quiet personality–not what one would expect of Hitler’s generals. The Air Force set him up at Bell Aircraft Systems inBuffalo,New York.

Robbie:  What year was this?

Guy:  This must have been in the early 50s.  He was Chief of Research, Chief Scientist at Bell Aircraft. The Air Force had some studies which were conducted under the code names Robo and Brass Bell.  They were top secret studies. They were basically on glide bombers, not like Dynasoar.  These studies eventually grew into a proposal to build some of these things.

In October 1957, the NACA was asked by the Air Force to convene a group of people and to take a look at this program they later called Dynasoar and to advise them of the feasibility of doing this program, possibly as a continuation of the high speed flight research program past the X-15. People from throughout the agency were invited to the NACA’sAmesResearchCenteratMoffett Field,Californiato sit in on these discussions. It was the week when Sputnik was launched. TheU.S.had its own satellite launching program—Vanguard–which was the responsibility of the Naval Research Laboratory.

That grew out of a program called Viking, which was a relatively large liquid-fueled sounding rocket that could probe the upper atmosphere and gather all the properties of the atmosphere–density, temperature, radiation and various other things that scientists were interested in measuring. This program wasn’t doing that well at the time. It was having many failures and was way behind schedule.

Anyhow, we got out toCalifornia–I don’t know the names of all the people who were present there, but the senior guy fromLangleywas a fellow named Floyd Thompson. He later became Director of Langley. He was a very, very interesting person in a lot of ways. He had a lot of talent, and then he had some shortcomings later on, I discovered. His shortcomings were that he didn’t know how to choose people to run the various organizations that were part ofLangleyafter people to began to leave and branch out. (To be fair, his problem there could well have been that almost all of the really innovative people who were capable of leading the Center into the Space Age had been assigned by Bob Gilruth to the Space Task Group.) Other than that, he was a real great guy.

And, there was myself, Paul Purser, Max Faget, Adolph Busemann, a scientist who we imported fromGermanywho  was a  supersonic and hypersonic  aerodynamics  specialist. I don’t remember everybody fromLangley. Dr. Dryden, who was head of the NACA, was there. There was Milton Ames who was head of the aeronautics programs for the NACA, and Clotaire Wood who was Dr. Dryden’s special assistant. He was a young fellow who took care of a lot of Dr. Dryden’s agenda.

There were many, many people fromAmesResearchCenter. There was Harvey Allen who later became Director of Ames, and Al Eggers. These were the two who were responsible for the blunt body ballistic missile nose cone re-entry development.There was Walt Williams ( Paul Purser’s classmate from LSU) who  at the time was Director of the High Speed Flight Research Station at Edwards Air Force Base, California, and later became NASA’s Chief Engineer and Deputy Director of the Manned Spacecraft Center for a while. I think his assistant De Beeler was also there.

I don’t remember all the other people, but since it was out atAmesthere were quite a fewAmesparticipants. There was a young X-15 test pilot named Neil Armstrong who was there too. We all flew out toCaliforniato Ames Research Laboratory nearMountain View. It’s in theSan Franciscoarea. We sat around for about three or four days and had a number of technical discussions about what the Dynasoar should do and what it should look like.

Another fellow named Hartley Soule fromLangleywas also there. Hartley was the guy who started the Flight Research Program at Edwards Air Force Base. The last big one they had was the X-15 Mach 6 research airplane. And Bob Piland was another young fellow who worked with us. ( I can pinpoint the date because Piland had his 30th birthday while we were there. It was also the 30th anniversary of Hartley Soule’s working for the NACA.)

We looked at Dynasoar and saw that there were a tremendous number of obstacles, but none of them were insurmountable. They were strictly engineering problems that somehow or another, if you worked hard enough and you did enough research in some specific areas, could be overcome. Nothing seemed to violate any laws of science as we understood them.

Ultimately we have proven that–the shuttle is nothing but a very large Dynasoar.  [Note: Max Faget disagrees with this assessment.] When you really look at it, the Dynasoar had a similiar shape. We didn’t have very large launch vehicles at the time. And the shuttle basically had wings just about like the Dynasoar.  It glides back in just like the Dynasoar was supposed  to do. You see, the Dynasoar was feasible, it’s just that there’s a lot of what I call collateral technology that has to be developed. You want to do things, but in order to do them something else has to happen to allow you to do those things. You have to develop the materials and understand the aerodynamic forces, heating, propulsion, structures, materials and guidance and control. And all those things you need have to be small and lightweight, and have to use little power and last a long time unattended .

Well, from 1957-1970, when we were working the space program on Mercury, Gemini, and Apollo we were developing all that technology which would allow Dynasoar to happen [i.e. the shuttle].

We had a few things we were interested in doing. I was interested in building an all solid-propellant launch vehicle. You see, most of the launch vehicles are liquid-propellant except that suddenly they shifted over from liquids into solids for the ballistic missile launch vehicles, for a lot of very good reasons. Many of the reasons were the results we got from launching these multi-stage solid- propellant rocket vehicles atWallopsIsland. We demonstrated a very high degree of reliability and very simple operation. Their simplicity, lack of much ground support equipment and instant readiness makes them much easier to do than the big liquid system.

Max had gotten interested in putting a man in space as a result of discussions with Al Eggers and  in addition to looking at Dynasoar. And it looked much easier to do than Dynasoar. The easy way looked  a lot like this ballistic missile nose cone technology. We would build a little blunt nose cone and it didn’t have to have all the controls or everything on it. It was going to be a very, very simple thing to do compared with doing a great big thing like Dynasoar and really a way to get man into space in a hurry.

So out there at Ames, Max and I cornered Dr. Dryden in the lobby and we were doing a little bit of lobbying ourselves, telling him that we were not going anywhere fast and if he would just give us a chance, we could develop this little launch vehicle–which later on became a four stage solid propellant rocket satellite launch vehicle called Scout. (The Scout had a very successful history. It’s no longer flown but it was flown up to about two years ago before the program  was cancelled.  During its lifetime it had the most reliable launch record of any launch vehicle.) And Max said we could put a man in orbit if we were given the authorization to do so.

GT commentary: I picked the Scout concept up in July of 1957 after coming back from a big rocket conference in Denver. I saw that the Navy was developing something called the Jupiter Jr. Jupiter was a big liquid rocket that was being developed by the Army in Huntsville. The Jupiter Jr. was going to be something the Navy would put in the water and that would float like a buoy with the nozzle down, and  be launched like a plumb bob flying right out of the water. Another option was to launch it from the deck of an aircraft carrier.  It was about the largest solid-propellant rocket that had been developed in the country at that time. The program was supplanted by the Polaris later that year.

I had looked at that and I looked at some other rockets that were available, things that were being developed for the upper stages of the Vanguard, which was going to be the first satellite put into space in the Navy program. And then there was another program called Hermes which had another large solid rocket. And taking a look at the size of these things I could see that when you put a third stage  in the stack, they all  come up almost to a perfect match where each upper stage was compatible with the total stages under it without relying on a monster size booster first stage. So you have three of them already being built and you don’t have to spend any  money to develop them and repeat a lot of mistakes–you only have to develop the fourth stage. (The third stage in this case. ) I looked at the propellants available, and at the case manufacturing technology and other possible improvements, and did a few calculations to show that four properly designed stages would put a lot more into orbit than the Vanguard.

And Dryden said well, Eisenhower had told him that the Naval Research Laboratory was the only one that was going to put a satellite into orbit. (Later it turned out that he had to recant, because the Navy got so far behind that von Braun launched the first little satellite with the Redstone and two stages of solid propellant rockets.) And then Max talked to Dryden about putting a man in space–he wanted to get a manned space program going. Dryden didn’t take too kindly to that. I think his comments were, “Shooting a man into space is like shooting a girl out of a cannon”–or something like that! And frankly, Al Shepard’s flight was about like that. I think when you really get honest about it, it was more about PR than anything else.

So Dryden said NO we are not going to do any of that. So we got back toLangleyand talked to Bob Gilruth and Bob said, “Well, you guys go ahead and work on it.” He said, “We won’t tell anybody.” Most of the greatest work we ever did is what we called “bootlegged.”  We got it started before we ever had authorization to do it. We would develop the concept, prove that it worked, and after we proved that it worked by bootlegging it, why then they’d give us authorization to do it. We always did think like that back in the old NACA days.

The NACA

Guy: The NACA was a very unique organization. We probably had somewhere around 7 to 8 thousand people in the organization–scientists, administrative people, and crafts people. We had a lot of very skilled people who could make anything you wanted. The machine shops–they could make anything that anybody could conceive of. We had instrument machine shops that could make instruments. We were completely self-sufficient, our organization, pretty much. We did not have to do a lot of outside contracting except for maybe the large construction. To manage that organization of 7000, the total headquarters/professional staff was 58 people inWashington! The proportions are quite a bit different these days. But the NACA was not a political organization. It wasn’t big enough that anyone would want to grab it. It really didn’t have to be defended, and there were a lot of people who supported it because it did nice work.

I wrote a Foreword to the commemorative album for the NACA’s fifth reunion. It will describe what the organization was really like and what made it great and why.

********************************************************************************************************************

NACA 1915-1958

Reunion V

Galveston Texas

October 19-20, 1991

Foreword, by Guy Thibodaux

            In the winter of 1915, Congress passed an Act attached as a rider to the Navy Appropriations Bill creating a new organization known as the National Advisory Committee for Aeronautics (NACA). The initial annual budget was $5000. This organization was to become the finest ever created by the U. S. Government. Its charter was “to supervise and direct the scientific study of the problems of flight with a view to their practical solution, and to direct and conduct experiments in aerodynamics.” The Act provided that the governing body be composed of those acquainted with the needs of aeronautical science, either civilian or military, or skilled in aeronautical engineering or its allied sciences. Vannevar Bush described the NACA as “unique among Federal Agencies in that its controlling body served without salary and had been composed of men of such high character and distinction as to render it completely free of political influence.”

            The committee was limited to fifteen members. As the work of the Committee grew, it added working groups also known as Committees to advise in those major subdivisions of the science of flight such as Propulsion, Stability and Control, etc. These were further divided into subcommittees depending on the degree of specialization. The members of the Committees usually served as subcommittee chairmen. They were served by an Executive Secretary who was a member of the Washington Office Technical Staff. All members were cautioned that they had been chosen for their personal reputation and expertise and were to represent their opinions and convictions rather than those of the organization that employed them.

            The product of these groups were the Resolutions, suggesting that specific areas of research should be increased or added. The minutes of these meetings were circulated to the Field Centers. It was left to the organizations and individuals what course of action to pursue and what resources would be allocated in support of these resolutions. Two documents were necessary to apply the resources of the various organizations, the Research Authorization (RA) and the Job Order (JO). This lack of unnecessary paperwork and bureaucracy left the individual researchers free to pursue the major goals of the agency without encumbrance. The absence of a body of documents and procedures regulating all of the Agency’s operations allowed the leaders to make the tough decisions based on what they felt was good for the Agency. Often their interpretations of the rules could be construed by others to violate other existing Government regulations. Individuals were recognized for their skill or expertise rather than the positions that they held. The engineer, scientist, administrator, designer, craftsman, or technician were all equal members of the teams that sprang up in response to the Agency’s goal.

            Henry Reid once said that a great error was made when his title was changed from Engineer-in-Charge to Director. He remarked that it was impossible to direct those bright, talented individuals who had attained national and international reputations in their fields and the accolades of their peers. Leadership and respect in the NACA was not conferred. It was earned.

            The change in world events leading up to World War II resulted in a major expansion of NACA’s facilities at Langley Field, Virginia. The center of the aircraft industry was moving from the east coast to the west coast. A new research center called Ames Aeronautical Laboratory was opened at Moffett Field near San Francisco in California. Another, called the Lewis Flight Propulsion Laboratory, was opened at Hopkins Airport in Cleveland, Ohio. The Langley Memorial Aeronautical Laboratory furnished the nucleus of people to supervise the design, construction, and staffing of these new centers. Further expansion in the postwar era resulted in the establishment of the High Speed Flight Research Station at Muroc, California and the Wallops Research Station on Wallops Island, Virginia. In this expansion, the NACA grew from one research center and a Washington office staff of 5 in 1939 to three Field Centers and two Field Stations numbering almost 7000 with a total headquarters staff of 135 by 1945. The agency had but one attorney on its staff, a General Counsel.

            The greatness of the Agency resulted from many factors. It had outstanding leaders who were men of vision and integrity. It did not compete with its major customers and in the same vein, it had no real competition from its customers. The NACA never designed a commercial or military airplane. The large, complex research facilities were too expensive for any one company to afford. The NACA operated as a self-sufficient organization reporting to the Independent Appropriations Office of the House of Representatives. It justified its own budget, allocated its own resources, designed and contracted for the construction of its facilities, developed its own research equipment and techniques, and scrupulously followed the rules of competitive acquisition of goods and services.

            The pay wasn’t that great, but the working conditions were outstanding. During the lifetime of the Agency, not one member of the leadership ever left seeking higher pay or a more satisfying work environment. At Reunion II, Bob Gilruth said that he would have been willing to work for room and board because it was such an honor to be accepted to work for the NACA after graduation. The “cream rises to the top” was true at the NACA. Everyone likes a winner. Those individuals who possessed the imagination and ingenuity to suggest practical ways to carry out the NACA’s mission had little trouble gaining support for their projects. They found an eager group of equally talented people from all support areas to assist them. The Agency never gave out trivial pieces of paper or hardware for individual achievement. The rewards were more responsibility, the ability to work on the most exciting projects, and the respect of their peers. It was said that one had to be superior just to work for the NACA. While these same bright, talented people were highly individualistic and had egos, these egos were suppressed for the good of the Agency. Everyone who had thoughts or ideas to contribute could be heard. There was little turnover of the most talented people. Long-term professional and personal friendships were developed that exist to this day. These are some of the reasons why after 33 years large groups of us gather to renew these friendships and pay tribute to the organization which all of us are proud to have served.

            Dr. Dryden expressed great concern that the environment that made the NACA what it was would be radically changed in the ensuing years under NASA. He feared that much of the spirit that was the NACA would be lost. The legacy of the NACA was passed on to the next generation under NASA with the talents and integrity of those who were the NACA’s leaders. Most of us participated in the transition from the NACA to NASA. The NACA spirit was carried into the Space Age by people who were NACA-trained, educated, and developed. The second generation is now retiring, and it remains to be seen how many of Dr. Dryden’s concerns are realized.

******************************************************************************************************************

Guy: The NACA was a funny outfit. I worked there for 17 years and I don’t know anybody who ever got an award from the organization, as I explained in my Foreword. The way you were awarded is you got to work on the best jobs. You got ideas heard, you got promoted. They didn’t give you a piece of paper or a plaque. Everybody knew who was doing the job and what would happen. Then, if you did something good, everybody in the organization who was good wanted to work with you on your team or on your ideas. It was “the cream rose to the top.” That’s the way the organization worked and everybody understood that. No one had to worry about anybody patting them on the back because they knew what they did and everybody else knew what was done. Occasionally somebody got a big award from some place outside the agency.  A modern parallel to the way the NACA operated is what happened in the computer industry inSilicon Valley in its early years.

Caldwell Johnson was another one of the wonderful people in the outfit. He designed spacecraft. He said his neighbor always asked him, “Well, I see all these military people getting all these outstanding ratings and superior performance awards–how come I never see any of you guys ever get one?” Johnson said, “Hell, you got to be superior just to work for the NACA!”

Somehow or another back in March of 1958, someone in the Eisenhower administration apparently decided they wanted a space agency. The troops in the trenches didn’t really know that much about it. But I think the NACA headquarters was told that they were going to become the nucleus of the space program. Most of that is a result of the work that we had done atWallopsIslandwith Bob Gilruth and his Pilotless Aircraft Research Division–that’s why we became a space program–the aeronautics part of course was fairly well established throughout the rest of the agency.

Formation of the NACA Space Committee

Guy: Gus Crowley, who was the deputy under Dryden, formed a little committee in the middle of March, 1958. Its job was to take a look at the NACA’s role in space.  [Shows a two-page piece of paper] That’s the committee that was formed–it’s a little innocuous-looking memo.

R (reading the memo): It says that the people appointed to the committee were Bruce Lunden from Lewis, Walter Olsen from Lewis, W.J. O’Sullivan, Jr., Paul E. Purser, Joe A. Shortal, Guy Thibodaux, Floyd L. Thompson. J. W. Crowley from NACA headquarters, Ray L. Zavasky, secretary, Clinton E. Brown, Ed C. Buckley, Robert Crane from Ames, and Max Faget and R. L. Krieger. What’s his first name?

Guy:  Bob Krieger.  Bob’s dead and Bob Crane’s dead.  Quite a few people have died. It was a long time ago. We got together–

Robbie:  Where did you meet?

Guy:  I think we met the first time atLangley. It’s been 50 years, I don’t remember exactly. There were many, many meetings that came on after that. This grew into almost a permanent type of affair. And not all the people from the original group stayed with the group. There were various reasons why a lot of them didn’t continue and various reasons why there were substitutions.

Robbie:  And what was the name of this group?

Guy:  It was a group to prepare a NASA space technology program for budget purposes.

Robbie:  Was this the Space Task Group?

Guy:  No, this was a year before the Task group. This was just a group of people mostly from Lewis and Langley who they thought were leaders in their fields who could come up with the program, and with enough convincing arguments, be able to get funding for it. It turns out, Lunden went to this one meeting. Ted Olsen was not a permanent member of the group. Bill O’Sullivan stayed with us. Paul Purser stayed with us. Joe Shortal was not a member–he didn’t stay with us. Joe was our Division Chief at the time. He had to run the Division. Floyd Thompson was an Acting Center Director at the time so he didn’t stay with us. Gus Crowley stayed with us. He was up in headquarters and we reported to him and Dr. Dryden. Zavasky stayed with us. He was a kind of top administrative assistant. He’d pull budgets together and he did a lot of other things.  Clint Brown stayed with us.

Here are the addresses of all the people who are still alive and their phone numbers. Josephine Dibella was Dryden’s secretary, either Dryden orCrowley’s secretary. She’s still alive. The secretaries usually know more than anyone else about what goes on.

Robbie:  That’s for sure!

Guy: Clotaire Wood was Dryden’s special assistant and it was me, Max, Paul. Zavasky was the top administrative guy. The two guys from Lewis, Ted Olsen might have come up once or twice with us.  Abe Silverstein, who was the Director of Lewis, realized something big was going on, and appointed himself in place of these two guys in this group. He was the acknowledged leader of the group at that time. Thompson appointed Bob Gilruth in his place and Bob was the Number Two guy in the organization at the time.

The other fellow who was added on there was Adelbert O. Tischler. [Robbie: We have subsequently conducted interviews with Clotaire  Wood, Josephine Dibella, and Tischler]. He was my counterpart from theLewisResearchCenter. There was Edgar Cortwright. He was another real bright guy. He was an outstanding speaker and was on this committee. He became some kind of Associate Administrator inWashington. Then they appointed him Director of theLangleyResearchCenter for a while.

Ed  Buckley was Chief of the Instrument Research Division and he elected not to go. He sent his deputy, Mort Stoller, which was a super choice, although Ed would have been a great choice himself. Solid guy. Both of them later became Associate Administrators in headquarters at one time. Mort  was very super guy. I didn’t really know him (Mort) that well. The few times we talked I felt he was very astute in almost every facet of what we discussed.

Bob Crane fromAmescontinued on but because he was so far out inCaliforniaand he didn’t have a lot of money to travel, he didn’t attend an awful lot of meetings.  Later on, he became Assistant Director for Space at theAmesResearchCenter. Al Eggers was the guy who worked withHarveythat developed this blunt body re-entry nose cone theory. Al Eggers came up only once or twice. Krieger didn’t participate. Krieger was runningWallopsIsland, although he did participate in some other activities relating to this group–on occasions we had special assignments.

The other guy who came up there, Charlie Zimmermann, was added to this group. He didn’t take anybody’s place–I don’t know whether he was Chief of Staff or what but he was the guy who found out everything going on in the Pentagon and let us know about it, as far as I remember. He had a little petty cash fund we could throw chits in and take out cash for taxi fares and things like that. I really don’t know everything that everybody did. They all somehow  did something they were supposed to do!

There was an area called  Stability and Control where Zimmermann was assigned to work. He had several new ideas. One of them was an airplane with a circular wing . Another was riding a thrust vector.  If you had a controllable thrust vector passing through your center of gravity and it exceeded your weight, you could just take off and fly anywhere you wanted.Bellmade a jet pack which accomplished it (best known as Captain Keds Rocket Belt) and people rode on top of rotating propellers which had lift in excess of a man’s weight.

Max Faget was very active on this committee and I don’t know if Paul was that active or not. Paul was kind of Gilruth’s Chief Executive Officer. He did everything Gilruth didn’t know how to do or didn’t want to do. Gilruth had some things that he was super at that he loved to do, but like all of us, we can’t do everything and he knew who to choose to do all those things that needed to be done that he wasn’t going to mess with. Paul was that type of person–in addition to being very good in his own field as a scientist, he was good at all kinds of planning and administrative stuff.

In addition, Bill  O’Sullivan was our resident egghead.  They call them nerds these days.  He was a kind of science type.  He’s the one who came up with this great big balloon, this hundred foot diameter balloon we launched in space called Echo. I don’t know if you have ever heard of that. You could see it from everywhere.  It was a real bright star and we had two of them up at once.

Robbie:  What did they do, monitor?

Guy:  Well, you could monitor radar signals, radio signals actually, sort of like a passive communication satellite except satellites now act so you can  send the signals to them, amplify them and retransmit them.  It was fundamentally something that everyone could see in space. It was a lot of good PR as well as for measuring the density of the atmosphere because the number of molecules up there is what slows the thing down so much. It was measuring the decay rate. It was huge and it weighed practically nothing, so it had a very measurable rate at which it could come back into the earth. There were a lot of things you could do with it. So it actually did something.

Robbie:  And it was good PR?

Guy:  It was big! Everyone could see it and the fact that you could bounce a radio signal off it–well after the Russians launched their Sputnik, someone drew this a cartoon–it showed Sputnik and our balloon like two children in baby buggies, and Eisenhower says to the Russian guy, “Ours can talk!” I could still pinpoint the exact day, the first time I came down here to Texas, that I had eaten a barbecue dinner over at a friend’s house, because that night at dusk I was watching and both of these two balloons crossed right overhead. There was only one time over that place that that could happen. I could go back and track down the date and hour.

Well, anyway, basically the task of the members of this committee was to find out what was going on in the military and the DOD that was space-related and see if those were the items that we wanted to budget. What we did is we caught an airplane from Langley on Monday morning, we went up to Washington beginning in April , almost every week through October, and we spent four days a week in Washington. I will tell you about that, too.

Robbie:  When you would tell your wife you were going to the meeting of this group, what would you call the group?

Guy:  I didn’t call it anything. I was just going to NACA headquarters to work on the space activity. If it had a name, I am not aware that it had a name. [In the following interview, it becomes clear that the informal name of this committee was the "Space Cadets."] We were not a very big formal organization. The other thing is I don’t think you’ll find any minutes to the meetings. Everything we did was verbally reported to our leaders until later on when we came up with the budgets. Then all our input was fed into Ray Zavasky who pulled the whole budget together and published a little booklet for Congress. We didn’t have a name and if we had a name I don’t know what it was. All I know was we were trying to pull together a space program for the NACA.

Basically we were cloistered. Nobody in the NACA headquarters except for Crowley, Dryden, and maybe Ira Abbott, who was one of the three senior people up there, and Clothaire Wood actually knew what was going on, and we did not speak to anybody else. We had a room up on the top floor. It was a big conference room. It might have been Dryden’s Executive Conference room or something.  We worked out of that.

Robbie:  Are we still in 1958?

Guy:  Yes, this is ’58, from March through October ’58. And usually we’d spend one day back at Langley trying to keep the store, you see. Max was a Branch Head which is a pretty important job.  Paul Purser was a Branch Head, and I had two sections in Paul Purser’s branch, which is unusual, but we couldn’t find anybody to do it, so I headed up two sections—the Rocket section and the Materials Research section in Purser’s High Temperature Branch. We were doing research on all the re-entry stuff, which turned out to be very valuable–you know all the protection systems and materials, things like that. We were working on that.

So the members of this committee–we all used to go up to DC and stay in this fleabag hotel called The Francis Scott Key. It was near Georgetown University and it was very inexpensive because government per diem at that time was about $8 a day–or maybe $12 a day, I am not sure, and we couldn’t afford very posh quarters. They didn’t have any bellhops–you took care of yourself. But they were nice in a lot of ways. They had a stove and a refrigerator in every room and then something called an open-cycle air conditioner. They had a great big shaft that they put a big box of ice in and they blew air over it and depending on how wide you’d crack your window is how much cold air flowed out. Some places that infrequently use air conditioning still use that technique.

NACA headquarters was on 17th and F, I think. It was right around the corner from Lafayette Square, by the White House, in fact. The Madison House became part of the NACA headquarters. They stayed in that building, so it was right on the square there by the White House. We used to eat breakfast early in the morning and walk through Lafayette Square right past the statue of old Thaddeus Kosciuszco and the bums sleeping it off on the park benches, going to work. We were supposed to find out everything DOD was doing in space and bring that into NASA, the new organization. It was going to be the exclusive organization to work on space activity, but we didn’t know it at that time.

Robbie:  So in this little group, you were ultimately talking about founding NASA..

Guy:  We didn’t know it! Some people knew we were talking about founding NASA. Dryden knew it, I think, and Crowley knew it, but no one told us when we went up there that’s what we were doing, that we were going to become NASA. We did find out later on. The fellow who wrote the Space Act was named Paul Dembling.  He was NACA’s General Counsel and the only attorney in the entire NACA practicing law.

Anyway, we had all the top security clearances that you needed to get in  the meetings going on in the Pentagon. Charlie Zimmermann would give us lists of meetings going on in the Pentagon and the Navy department and over there at the Atomic Energy Commission. Somehow the word got to these organizations that we would be permitted to attend to these meetings to listen, be quiet, or participate in the meeting.  Someone knew what was going on better than we did, apparently.

Robbie:  Who would that have been?

Guy:  It must have been Dryden and Crowley.  Maybe Bob Gilruth did and Silverstein. I didn’t know about it for quite a while. We’d go to all these meetings over in the Pentagon. I was interested in propulsion. That was my particular field since I headed up all the rocket work at Langley as well as the high temperature materials work. I got into high temperature materials research because rocket exhaust had the highest temperature of anything around at the time. So the earliest research work we did was using rocket jets with the materials and getting very, very high heat fluxes so you could test the high temperature materials. We’d go to the Pentagon, the Navy department or wherever these meetings were, and attend these meetings and find out what was going on and see what we wanted to include in the budget we were designing–what we thought we should budget for some of these items because the military was not going to be permitted to continue this work in these areas necessarily. Not as a space program per se.

Robbie:  How did the people at DOD and the Pentagon feel about having to give up the space program to civilians?

Guy:  I don’t know how they felt.

Robbie:  Did they ever express anger to you or frustration?

Guy:  They never said anything to me and I don’t think they knew what we were up to–the people at the meetings–anymore than we knew what we were up to.

Robbie:  What did you think you were up to?

Guy:  I had no idea.

Robbie:  So you were just going into this blind, having these discussions and meetings but without–

Guy: Well, we were to come up with a budget as though the NACA was going to be a space agency and was going to be active in space. It didn’t say we were going to be the exclusive thing in space.  We didn’t know we were going to be that exclusive about it at the time. We knew we were going to be active in it, but not exclusive.

Creating the Space Program: NACA to NASA

Robbie:  OK, so you have this group and you’re meetings go on through October and you come up with a budget.

Guy:  Through October and we come up with a budget. The way we reported the facts is that every night we would walk back through Lafayette Square. There was a liquor store on the way home and Bob Gilruth and Abe Silverstein always had their room on the first floor at the old fleabag, the Francis Scott Key Hotel, next to the coffee shop. We all got a bottle and the young kids told the old folks how the cow ate the cabbage and what we wanted to do. We sat around and had a few drinks and we discussed what the daily activities were. There were no minutes at the meetings.

That’s the way we communicated, at the hotel over a bottle. The young fellows would tell them what our opinions were about everything we’d gone through that day, whether we had been over at the Pentagon or out to the AEC and what programs we thought were good and bad. We would get some feedback. We did that almost every night.

Robbie:  Can you pick one of those nights and recreate the conversation? Do you remember any of them well enough?

Guy:  No, I don’t remember anything specific that we talked about. We’d all go out and eat too. We would go to a lot of nice restaurants, even though we weren’t real rich. The whole group would generally get together and we’d walk out or go get a taxi. Taxis were cheap in Washington. Sometimes we would go and eat at Jackie Kennedy’s favorite restaurant, Rive Gauche, over there in Georgetown.

Robbie:  And how old were you at this time?

Guy:  I was 37, I guess.

Robbie:  And how old was Gilruth?

Guy:  He was only about 7 or 8 years older than me.  I’m almost 75 and Gilruth is about 84 or 83.  He got out of college about, he had a Masters degree, maybe 6 or 7 years before I did and went to college two years longer.  He’s probably 8 years older than me.

Robbie:  And Dryden was not part of these discussions?

Guy:  Oh, yes.  Dryden was in on all of it. He wasn’t part of the discussions nightly at the hotel, but was informed later on. Dryden got reports from Crowley or Gilruth or Silverstein. Sometimes we talked to Dryden but not that frequently.

There was a time I guess by which we knew we were going to become the space agency. The big question was, who decides the NACA would become the space agency?  What other organizations are to be included ? There were no decisions made as yet as to what organization would comprise the space agency. One organization was the Naval Research Laboratory group that did the Vanguard and the Viking and did a lot of upper atmosphere research and science–would that become part of it? One of the decisions we had to make was we were we going to build another Center in the Washington area, and if so, where is that going to be?

The Army, the Air Force, and Wernher von Braun

Robbie:  So your group finished getting the budget together?

Guy:  We hadn’t quite gotten that far yet. Dryden got wind that there was a big power struggle between the Air Force and the Army on account of the ballistic missiles. There were two competing programs, the Air Force Thor program and the Army’s Jupiter program.  They were both about the same size and intended to do the same thing.

I will say something else that should be interesting and it has nothing to do with this. As I mentioned earlier, the US Air Force was originally part of the Army (the Army Air Corps). When it became a separate branch of the service, at first it didn’t have any organization.  It didn’t have any laboratories. The Army developed all of its stuff in-house through the use of arsenals. They developed tanks, and they developed guns and the Navy also had its organization that developed things. The Air Force didn’t have anything. But the Air Force had some smarts. They understood that a big bureaucratic organization cannot lobby for itself. The Air Force didn’t have any of this stuff, so what they did was they decided to get into bed with American industry. When Eisenhower left office, he was very concerned about that sort of thing, about the munitions manufacturers who worked with the German government.

But that’s the way the Air Force came into being. They set up building their own thing. What they did is they gave contracts to industrial organizations and said, “You scratch my back, I’ll scratch yours.” The Air Force had all the industry and all the money in industry to lobby for the Air Force. The Army didn’t have any of that, you see. It was its own bureaucracy. In the power struggle, the Army lost out on this big long-range ballistic missile. They were confined to what they called tactical missiles with a range of 500 miles or less.

But here you have this big organization down in Huntsville with von Braun building these Jupiters and Redstone ballistic missiles for the Army. The Defense Department didn’t know what to do with it. Von Braun was one of the biggest proponents of space I’ve ever seen. He was a master at public relations. He understood that big bureaucracy can’t be heroes in the public’s eyes. Only people can be heroes. He was the guy who took credit for everything that went on down in that organization. Wherever he went, when he stepped off the airplane people wanted to talk to him. He was the organization. That’s the way he played it and that’s how he kept on getting budgets and how he got Congress to listen to him–by becoming an international hero. Very few know how to deal with that, but he understood that.

Robbie:  Did people that work in his organization who had actually done some of the work he was taking credit for, did they resent that or did they understand it?

Guy:  No, no, that was all part of the deal. They understood that, I’m pretty sure. The upper hierarchy understood that, anyhow. He was always on what I called  the  “borscht circuit,” giving speeches at lots of rubber chicken, mashed potatoes and peas dinners. He was out selling space and missiles. He was a super salesman. That is what he was doing. He was selling himself, basically, but selling the program with himself. In fact, no one even knew who his deputy was. I could have talked to 95% of the people in the industry and ask them who von Braun’s deputy is and I would say 95% even of key people couldn’t tell me what the man’s name was. He’s the guy  (Eberhard Rees) who kept the store when von Braun was on the borscht circuit. All the Germans, he kept them in line. He was a very mild, meek little guy, at least outwardly. Anyway, they understood the name of the game. It was to their benefit. I don’t think any of them resented that.

I will tell you a story about going down to visit Dr. von Braun in Huntsville.  He didn’t know what we were up to either when we were working on that committee. I think by the time I went to see him, I did know what we were up to.

When Dryden got word that he was going to have to take in von Braun’s organization, which was the part of the Army Ballistic Missile Agency that later became Marshall Space Center, he asked me to go down there to Huntsville and case the joint. That was probably in July or August of 1958. At the time I was a GS-15–that’s the equivalent to a colonel in the Army, so it shook them up that I was the only person on the airplane. I had my own private airplane with a GS-15 pilot flying me into the Redstone Arsenal airport. That kind of shook them up a little bit–protocol you know. They were supposed to have at least a bird colonel meet me at the airport and show me around.

I went down there and found out how many people the Army was going to keep. I didn’t ask about that–the way I went about talking to people was to find out what was pretty much part of the Army and what was part of the Redstone or Jupiter and the other part of the program that von Braun was involved in. The Army had small launch vehicles and small tactical weapons systems and  anti-aircraft  missiles.  They had two separate organizations going. Von Braun headed one and somebody else headed the other.

Robbie:  And they were going to split because the Army was going to move out of space?

Guy:  They were going to split. The Army didn’t know they were going to be told to split but they were distinct and separate in a way that you could divide them pretty easily. Maybe some people were a cross between both and they could settle that later on. I think I found out they had somewhere between five and six thousand people in von Braun’s operation. Boy, Dryden was real excited because this thing he was going to have to take on was almost as big as his whole outfit. I don’t know how many we picked up, probably around five thousand people we picked up when they created the Marshall Space Flight Center. It was a very interesting time.

Von Braun didn’t know what I was up to but somehow or another someone sent the word that he was supposed to be nice to me. He met with me in his office and then we went to the executive dining room and had lunch. I had the funny feeling when I walked with him–as I walked down the hall with him it was as if I started to see all the Germans standing at attention clicking their heels and bowing to him even though they weren’t. They all froze as he walked out. If you ever experience that it is a very eerie feeling when you walk down and all of a sudden you can see all them pop to attention–you know how the Germans used to click their heels and bow like the Japanese did? You could sense that that was going on even though it wasn’t. And then when I got to the executive dining room, no one could pick up their fork and start eating until he started.

I will tell you another interesting story about how hierarchy works. I was up at Bell Aircraft one time and I was eating lunch with Walter Dornberger and Bill Gisel. Remember I told you earlier that Dornberger had been von Braun’s boss at an island off the European coast where the Germans developed the V-2s. Of course, Dornberger had reported directly to Hitler. He didn’t have anybody between him and Hitler. Von Braun happened to be up there at Bell that day and their eyes met, and all Dornberger did was raise his hand and crook his index finger and von Braun came over and stood at attention and clicked his heels and bowed. I thought that was kind of interesting—a graphic demonstration of how the hierarchy worked.

Anyhow, I came back from Huntsville and gave Dryden a verbal report on that and he was surprised he was going to have to take on so many people because that operation was two-thirds as big as the whole NACA was at the time.

And then later on, myself, Joe Shortal, and Bob Krieger, and Ray Hooker–Dryden sent us down to Cape Canaveral because we were looking for  launch sites, for launch pads. We all went down there and we talked with General Yates who was the commanding officer at Cape Canaveral at the time about launch sites and  I took a look at some of the ground operations and watched a Jupiter launch.

Later on, by the time October came along, we all had our input in as to what we wanted to do.  We wanted to start Scout, we wanted to start Mercury, I wanted to start large solid rocket programs. There were a number of liquid rocket programs that were ongoing that the military had that we were going to pick up. There was a lot of science work that went on too that we picked up at the time, mostly things as a follow-on to the International Geophysical Year from the scientists who participated in that program.

Gilruth’s organization had been doing very similar work with sounding rockets. Bill, our resident egghead, had been our delegate to the International Geophysical Year which was a year set aside to study the upper atmosphere. That’s where he had gotten the idea of the big balloon. Later on the Mercury program got started and we got the Scout program going.

Formation of the Space Task Group

Guy: March of 1958 was when our committe started meeting in DC. We became the space agency on October 1, 1958, when Congress authorized the creation of NASA. We had been bootlegging the space program from October ’57–the time we were out at Ames with the Dynasoar thing–until ’58. We were doing all the in-house study –getting prepared, finding out what it would take for us to accomplish all these tasks we wanted to do, how we were going to go about it, what the thing is going to look like, and how tough it might be to do it. We all worked on various aspects of those programs–the Scout and the Mercury program were the big things we did right in our own organization. Various other people worked with the people on space science and application. [See the subsequent interview for more detail on this time period, and on the early work of the STG]. By the time October ’58 came along and the Space Task Group was formed–

Robbie:  Now tell me how the Space Task Group was formed.

Guy:  This is the thing that followed the creation of NASA. They needed to have an organization to run the Mercury program. They weren’t going to let the Center run the space program, it was not going to be part of Langley. Langley was more like a research outfit. The other thing that came into being was the creation of Goddard. Some of the folks involved in this exercise (pointing to the list of people on the committee) and other people they brought in actually had looked for an area to build Goddard. There was a farming cooperative called Greenbelt Cooperative. They had some farmland up there between Washington and Baltimore called Greenbelt, Maryland–a farm co-op. That’s what was chosen as the site for the Goddard Center.

Robbie:  What was the purpose of Goddard, what was it for?

Guy:  For space science, basically is what it was supposed to be for. The Space Task Group was originally to be assigned up there. The person who created the Space Task Group was the Director of Langley. He didn’t need anybody’s permission–he just wrote a memorandum to create the Space Task Group and signed it “Floyd Thompson.” [Note: Gilruth actually signed the memorandum.]

Robbie:  Why was the Space Task Group needed? You guys already had your jobs at Langley.

Guy:  It needed to be identified as an organization that was going to manage this very large manned space program distinct from Langley. Headquarters was going to be involved in a lot of things. Langley had never been involved in public affairs, the whole bit. At Langley we didn’t have any Public Affairs office–we didn’t need one. The work we did, we thought spoke for itself. We didn’t have astronauts. There was going to be this big hullabaloo about this space program so they needed a separate organization.

And Thompson was very magnanimous. He vacated buildings for the Space Task Group and gave them space to house their offices over there and assigned people to the STG. He had a cute little way of doing things–Bob Gilruth’s memoirs kind of allude to it. Thompson said, “Bob, you can have a lot of people but what we are going to do is for every one you take, I’m going to give you one.”  So you have a balanced organization, I guess, was the inference–you are not going to grab up all the good people. [Note: This was also the policy between NACA Headquarters and the Centers. Whenever Headquarters wanted to pick some bright youngster and offer him a job in Washington, the next one they needed was the Center's choice.

Robbie:  Take the ones you want but I'll give some I don't want.

Guy:  For everyone you take, I'll get to give you one. It's like choosing sides in a kid's baseball team. Gilruth mentions that.

Robbie:  And did he actually do that?

Guy:  Yes. All the people who came down here [to JSC] were pretty proud of coming down here but not all of them knew which group they were in–the ones Gilruth picked or the ones Thompson made him take.

Robbie:  They didn’t know whether they were chosen or sent! (laughter)

Guy:  No. Most of them were very good but some of them were dull and not very bright.

The Leaders: Bob Gilruth, Abe Silverstein, and Joe Shea

Guy: I have something else you can borrow but you have to make a copy.  I’d like to get it back.  It’s Bob Gilruth’s memoirs telling about Wallops to Mercury, in other words, telling about the people. [See the following interview with Thibodaux, Faget, and Purser for excerpts from these memoirs.]

Robbie:  I am so glad he wrote this because he has Alzheimer’s now. How ill is he? Is there any hope of interviewing him?

Guy:  No, he’s totally out of it. That’s a shame. But you can talk to his wife. He might have told her a lot of things. She’s his second wife. His first wife died I think about 25 years ago.

Robbie:  What were the things that Bob Gilruth was good at?

Guy:  People.  He was one of the greatest people persons you ever saw.  He knew who to trust and who not to trust, who to appoint in key positions and how to let them do what they are supposed to do. He knew how to communicate with you. He was a very successful communicator. I worked with the man for most of my professional life, and he’d call me and we could discuss things. I had things that I wanted to talk to him about, and I’d say “I’d like to come down.” He was never formal. When I first met him he use to come around–we weren’t very fancy. We had old gray desks and no curtains, no rugs on the floor. Everyone had a wastebasket. He made a point almost every week to come by and talk to everybody in the organization. He always sat like he was sitting on a pot on my wastebasket and talked to me.

Robbie:  He’d sit on your wastebasket?

Guy:  Yes, he’d sit on my wastebasket.

Robbie:  Without turning it over?

Guy:  Without turning it over. It usually had trash in it–he’d turn it over if there was no trash in it.  He never once told me what I should do. I never once left not knowing what I should do. I don’t know how he did that. That’s that way I felt. I knew whatever I did, if I chose to do it when I walked out of there I had his full, unmitigated support. I don’t how he did that with everyone, but most of us, I think, kind of felt that way. He understood man-machine relationships, which made him great on the space program. He knew what the role of man was and how you were supposed to make his job easy,  and what had to be done in order for a man to fly. He had a gut feeling about all those types of things. He was great at that. But I think his greatest asset was gathering the right people and knowing who to trust and who not to trust.

He was an absolute gentleman, but I could always tell when he was angry with someone. If he began to squirm during a presentation, I knew the presenter was in trouble.  There’s not that many people who have that knack, but those of us who worked very close to him always knew when someone was in trouble. His favorite expression when things didn’t work out just right–he’d say “Well, I just don’t think we had enough talent on that job.” And that’s about all he’d ever say. That was the way he dealt with things. He never demeaned anybody. He was just a real gentleman, a real great man. He was kind of the overseer, he and Abe Silverstein.

Abe was a very domineering person, very bright guy too, very talented guy. Abe was an aircraft propulsion type, turbo jet and other aircraft engines. He became Director of the Lewis Research Center which is in Cleveland. Abe knew what he wanted and he was very demanding. He was very gruff and he tried to put the fear of God in everybody. Most of the people who worked for him really were afraid of him. Most of the people who closely worked for Bob Gilruth  loved him, you know. None  of us had any particular fear of him because he was such a gentleman in dealing with you.

Robbie:  But people were afraid of Silverstein?

Guy: Abe was pretty much opposite. Everybody that worked for Abe was afraid to express themselves or to say anything about Abe. Abe is in his, probably well up into his 80s by now, and also an Alzheimer’s victim. He was a tremendous individual, but he was so opinionated and gruff that he finally went back to Lewis because he couldn’t get along with anybody in DOD. That’s my personal opinion. He antagonized an awful lot of people. But he also did the country a lot of big favors. He’s the reason we have liquid hydrogen rockets and liquid hydrogen technology, because Abe pushed that real hard.

Ken: Was Abe heading one of the NACA centers?

Guy:  He was head of Lewis at the time this team–the Space Task Group–was formed. He decided that he was going to be the guy from Lewis. He took charge and he headed up the whole operation during this formative period. Gilruth was the Number Two guy. Silverstein was Number One. Then there were the rest of us.

Ken:  Now, how was he to work for?

Guy:  I found Abe very delightful to get along with. There is a very interesting thing. If you don’t work directly for someone– you see, I worked for Gilruth as far as I was concerned. If you don’t work for the other guy, you don’t really have to pay that much attention to him. I wasn’t afraid of him. But everyone that worked for him was deathly afraid of him. He was very positive about everything, he was bright, talented, good and everything, and he wasn’t as bad as Joe Shea, but he–

Ken:  He had a command and control style.

Guy:  Yeah, command and control. He wasn’t very much of a politician. He was very abrupt and direct.   I remember eating at that Armenian place in Washington, during those early days when we were attending meetings at the Pentagon, that I learned something from Abe Silverstein. I learned you always sit at a table–you never sit at a booth. It’s far more comfortable to sit at a table. Abe would never sit in a booth. He always insisted we sit at a table.

Robbie:  Why did he think a table is more comfortable?

Guy:  You can get up. There is no person pinned in against the wall or anything. You’ve got a lot more room all the way around. It is much easier to sit in chairs. You can move the chair around. There are a lot of reasons I find it more comfortable to sit at a table than a booth. I learned that from Abe.  If I learned anything from Abe, I learned that.

Robbie:  Not what you’d expect.

Guy:  Well, I learned quite a few things from Abe, I guess, like the fact that he could be buffaloed too. Like the time I went up to rescue the Scout from being transferred up to Washington, I had him right where I wanted him. They were going to transfer the Space Task Group up to Goddard. Abe wanted to put the Space Task Group up at Goddard where he could have it closer to Washington and have a little more control over it. He also wanted to transfer the Scout up there. The Scout was something we were doing at Langley.

Abe had a committee that said there ain’t no way on earth that we would ever fly that thing. It was too long and limber and we didn’t know enough about thrust vector control systems and about thrust misalignment and solid rockets, and the thing would never fly.  We didn’t pay much attention to them because we knew better. I’ve done a lot of research work on various things over the years related to such a vehicle design.

So Abe wanted to move the Scout up to Goddard. He told Floyd Thompson he was going to move it up there. At the time we had budgeted about $27 million dollars for the entire program. There was also a lot of talk about the fact that the Navy had some obsolete, surplus Polaris missiles there, submarine-launched guided missiles. They had a bunch of old Polarises they wanted to get rid of and someone was trying to force us to use those old Polarises to make a version of the Scout instead of using the Scout itself–a very expensive move.

We had some meetings at Langley and I finally convinced Floyd Thompson that we weren’t going to do anything like that.  Thompson said. “Well, if you want to do this program you have to get the money.” We needed about $8 million dollars to get this program started so Thompson said to me, “You go up there and talk to Abe and you get the money.” (Laughs) So I went up there and talked to Abe and that was another interesting thing.

By the time, I guess sometime after October until the spring of the next year, at headquarters there were a bunch of people from the Army, Navy and Air Force who transferred to NASA to get a grade raise. They  were very attached to military protocol. They wanted me to brief them and then they would go tell Abe about what was going on. They were going to be the intermediaries. I said, “No, we ain’t gonna work things that way. I’m up here and I’m going to talk to Abe.”  They said, “You’re only a GS-15 and we are much higher in the organization than you” And I said, “Well I don’t care about that  –I’m the Center Director as far as you’re concerned. I represent Floyd Thompson and Thompson didn’t tell me I had to talk to any of you people. I’m going to talk to Abe. And if you want to come, you’ll have to get Abe to invite you.” (He didn’t invite any of them.)

That’s the only time I’ve ever seen Abe Silverstein ranting and raving. He said “I told Floyd I’m going to transfer that thing up to Goddard” –the whole Scout program. I said, “What size boxes do you want them in?” He said, “What do you mean, boxes?” I said, “We don’t have many people assigned to work programs full time. They are spread out all over. None of us want to go to Goddard so if you want the program, just tell me what size boxes you want us to put the documents in.” And oh, he started ranting and raving and jumping up and down. That’s the only time I’ve ever seen him flustered.

Afterwards he got calm, he said, “All right, you go back and you tell Floyd I’ll send the money. But there’s one thing you’ll have to do before I send the money down. You are going to have to put a project office together and assign people to it and I’m  going to have to know who is working on it.” (laughs) So that was one of the agreements we had. And I went back and we created the Scout Project Office and that’s what ran the program. That’s how we kept the Scout back at Langley.

Ken:  Oh, what a story!

Guy:  That’s when Bill Stoney got to be named head of the program–the first Scout Project Manager. That was the one time I had Abe where I wanted him, and I knew it. He doesn’t remember that, you know. When I reminded him of that he said, “Oh, no, I would never do anything like that.”  I said, “How come, Abe?”  He said, “I would never take the baby away from its mother.” (laughter) I didn’t ask him if his middle name was Solomon. He was a good Joe, by the way. I think he was a good Center Director. He just had a different style of management.

In the same way that I got along with Abe because I didn’t work for him, I never had to pay any attention to Joe Shea–I worked for Max, you see. You know, Joe could be very vicious too. I never knew Joe that well, but he was mean to everybody. He browbeat everybody. He was the most insulting guy I ever saw–I felt sorry for the people who worked directly for him.

Ken:  Joe Shea was program manager for the early Apollo.

Guy:  I could have never tolerated that kind of behavior. I wouldn’t. He and I got along fine because I didn’t have to put up with any of it. But the people that worked directly for him–

Ken:  How did Max get along with Joe?

Guy:  Oh, fine. You heard about the big foot race? Max use to jog every morning, run a mile every morning. Joe Shea ran too. So, they went to La Porte and they had a big foot race over there. They ran a mile. They bet that they were going to beat each other. I asked Max, “How fast are you going to run?” He said, “Well, I’m going to run under six minutes.” I put a ten dollar bill on the table. I said, “If you run under six minutes, that’s yours. If it ain’t, you’re gonna match it.” (laughter) So George Low  was the referee. They went up there and they ran the race. When they came back, I asked Max, “How did you do?” He said, “Well, I didn’t do too bad. I came in second. Joe Shea came in second to last!” (laughter) To be fair, Max spotted Joe a few years.

There was another race. Pete Conrad had told Max he could run a mile in SkyLab. Max bet him he couldn’t. Remember, in the Skylab movies you’d see Pete running around the ring up there? Well, Pete ran around the ring for a mile. He called down and said, “Tell Max I ran my mile!”

Ken:  That sounds like Pete!

Paul Purser’s Contributions

Robbie:  You said that Gilruth delegated to Purser whatever Gilruth didn’t want to do.  What were Paul’s  strength and skills?

Guy:  Purser was a very rapid writer and he was very concise.  He could put it together real quick. He understood all the elements which you needed to get things done. And he could flood you with lots of ideas. In fact, it is in Gilruth’s memoirs that he didn’t know how to do any of this stuff. He wasn’t a business type. He wasn’t someone to build a big organization, to build a big empire. Paul didn’t build empires either. Paul built Johnson Space Center. He was so good at it, the University of Houston wanted him on loan. So Gilruth let him go. It was a great loss to the Center for him to leave. The reason you never heard of Paul in any of the more recent activities is that Paul was on loan for the University of Houston and he’s the guy who’s responsible for building the University of Houston at Clear Lake.

One reason why Paul never came back to JSC was that he had a  brain tumor. He was operated on and he was paralyzed on the left side of his face and it took quite a few years of therapy  and  reconstructive nerve surgery before he began to recover from that. He is about 90% recovered now. He still has a slight speech problem. Paul is the guy who is really responsible for the building of JSC. Gilruth didn’t like administrative work like building centers and hiring people and all that stuff.  He was much more interested in the program, and getting things going, and getting people working in that direction. Paul had many talents, and that was one of his real strong points—he was a good organizer. At one time, Paul was head of the fiscal office, the payroll office, because Langley used to have a unique way of dealing with engineers. They used to rotate the engineers around in various administrative jobs, to give them some breadth. They put an electrical engineer in procurement, for example, and he decided he was going to stay there. They used engineers, trained engineers, as administrators, so that they would learn the ropes.

Robbie: How long was each assignment?

Guy:   It was probably about a year or so. Long enough to get familiar with it.

Robbie:  When you say Paul built JSC, what do you mean?

Guy:  He was the one who got the people together from various organizations  to negotiate with  the organizations which designed and supervised the construction of the center. He understood how many administrative people you need, how many secretaries, how many pencils and paper, what types of facilities, all the little mundane things you have to have to make an organization work.

Robbie:  And how many buildings you need and what needs to be in each building?

Guy:  Yes. He had lots of experience building up new areas of technology and getting the necessary facilities to do the work back at Langley. Whenever you wanted anything done, you picked up the phone and called Purser and he took care of it. That’s the way it worked. You didn’t write memorandums. You won’t find anything documented. In fact, I never attended a meeting in the entire time I was over in NASA where there were minutes to the meeting documenting decisions being made. They didn’t want anybody second-guessing them.

Robbie:  Why not?

Guy:  I don’t know.  No minutes to any meeting I ever attended. There was a record of the decisions that were made but nothing about what the pros and cons were or why the decision was made or pretty much who did this and who did that. You’ll never hear that. The only reason you know that a decision was made was that they had to spend money on a contract and they had to issue a contract change and that contract change dealt with that decision.

Robbie:  Interesting.  So they never even issued memos saying what the decision was?

Guy:  I don’t know of any memos. Very few memos I have ever seen and I’ve never seen minutes to a meeting.  There were copies of briefing charts but if you looked at these and tried to fathom what decision was made and why it was made you’d most probably be wrong.  Paul kept some notes on what he did during this exercise in Washington.  He sent me a copy.  I’ll give you his notes later on and I’ll keep looking for more of them. Most of those notes are later in the program, about the time the agency became the Space Task Group.

End of an Era: Langley after the Space Task Group

Robbie:  So you were not part of the Space Task Group?

Guy: No, I didn’t have to be because I supported the Space Task Group while I was there at Langley until they moved down here [to JSC]. I was available to them for any of my particular specialties. They had what they called “Capsule Coordination Committees” up at McDonnell Aircraft, talking about all of the various aspects of the Mercury program, and I was one of the members of a Capsule Coordination Committee. I flew up to Saint Louis quite a lot during that time frame. Even though I was not part of the Space Task Group, I was available to them anytime they needed any expertise I had.

Robbie:  So, after the STG got formed–

Guy:  They came down here [to JSC] in ’62, I guess, and I was still back at Langley. I never knew what the deal was. I had a suspicion there that they were stealing so many people from our outfit that Thompson decided he needed to keep some continuity of experience, and so he wasn’t going to let Gilruth have me, even though I had worked on the program–I’m not sure. But I got a big reward out of that–I was one of the very few branch heads that had what they called an excepted position.  It might be equivalent to the Senior Executive Service. Right now it would be above the GS-15 level. Not too many at that time had that position.

Robbie:  So in other words, you got promoted at Langley?

Guy:  I got promoted at Langley. I think that was for me not raising a lot of ruckus wanting to leave.

Robbie:  Did you want to go with the Space Task Group?

Guy:  I suppose I wanted to go since it was all my old cohorts. There were some good people left. The real drivers were pulled into the Space Task Group–most of the people that Gilruth picked. He knew who he wanted.

Robbie:  What were you promoted to? What was your position?

Guy:  I got Purser’s old job. I became head of the High Temperature Branch. There were a lot of branch heads who didn’t have the same grade I did. I had the equivalent of two or three grades higher than most branch heads.

Robbie:  So they not only promoted you, but they raised your rank past G-15?

Guy:  Yes, they raised my grade past what any Branch Head would normally have. In fact, they had many Division Chiefs that didn’t have the grade I had.

Robbie:  That gave you, along with that, top security clearance and all that kind of stuff?

Guy:  No, in the space program you don’t want to have security clearance.

Robbie:  You don’t?

Guy:  No, there is nothing in the space organization that is classified. Some people, if they use secret Air Force technology, they have to be cleared. But the space program is in the public domain and there are absolutely no security clearances required in the space program. That way, you can’t goof up. They can’t prosecute you because you didn’t keep all these secrets. Plus, the fact that the stuff that they called administrative secrets–they just didn’t want anybody to know about the goof-ups they had. They don’t want anybody to know how they got the intelligence. They don’t want to disclose their sources for fear someone might get hurt.

Robbie:  So how did you feel when all your friends and buddies went off to the Space Task Group and you stayed at Langley?

Guy: I felt alright. I understood, pretty much, what the deal was.

Robbie:  How long did they stay physically at Langley?

Guy:  They stayed physically at Langley until ’62, then they came to Houston. At least I was working with them until ’62. The big problem was, as I pointed out, where I felt Floyd Thompson’s big shortfall was that instead of picking the right people—he got a bunch of people on the basis of seniority, old wind tunnel people, who had no appreciation for space, had no imagination or anything else, but they’d been around for a long time–he promoted them into key positions in the organization at Langley. They just weren’t the people that should have been in charge. They didn’t understand anything about space. They were aerodynamics oriented, and after all, that was Langley’s main mission.  Gilruth’s outfit, the PARD, was the outfit that was really doing all the pioneering and had all the space smarts.

Robbie:  What was the detrimental effect of Floyd Thompson’s appointing these people?

Guy:  They were real hard to talk to about anything. I have a feeling if you can’t pick a fight with your boss, if he’s too dumb to know what you’re talking about, you better get a new boss! I kind of got that feeling at times. There were things I wanted to do.

Joe Shortal, for example, was a kind of guy who wasn’t really that bright, but he never interfered with anything. He never started anything, but he’d let you do what you wanted to do–he didn’t help you a lot, but he didn’t stop you.  He was kind of passive.  He was a nice person, hands off. He had his own expertise in some areas. He had come to us from another organization–typically, Langley would move people in from one outfit, depending on–a guy could be a deputy from one outfit depending on what the organization needed.

When Gilruth first started out, he had a lot of construction going on up at Wallops Island to build this range and everything else which he knew nothing about.  So they took the Deputy Chief of the Construction Division and made him Deputy Chief in my outfit until that was over. Then we had some problems with another research division.  We didn’t feel like they understood what we were trying to do so we took the Chief of the Division and made him the Deputy in our organization.  Then we were kind of weak in an area called Stability and Control and that’s when Joe Shortal came over. When Gilruth got promoted Shortal became Division Chief to our division and he never left. (Note: I think that technique of reassignment is a wonderful management tool. The people involved have to understand and trust management’s judgement.  Floyd Thompson and I had a discussion regarding  similar transfers between Headquarters and the Centers. His comment was, “That’s a wonderful idea for everyone (pause) but you, and me, huh?)

Robbie:  Langley’s mission all this time was aeronautics?

Guy:  Yes, aeronautics.  Langley was a real top notch experimental aeronautical organization. Lewis started out as an aircraft engine research laboratory. It was basically a aircraft propulsion center. Ames was also an aircraft research center.  The Ames people were more of the theoretical people, Langley people were more the practical people.

Robbie:  Ok, so Langley was aeronautics, and what evolved into Marshall was launch vehicles.

Guy:  Yes, but they (all the other Centers) tried to get their hands into everything. And Ames was aerodynamics, although they tried to get involved in space. They were the ones who launched the monkey into space. Then the monkey died and Gilruth said “God, I’m sure happy they didn’t launch him before they launched a man!” (laughter) They had this satellite and this poor chimpanzee in there and he was highly upset. And they recovered him, but he died. The program manager was Charlie Wilson, also an LSU grad of our era. This was long after the first man was launched.  We launched a few monkeys out of Wallops island, namely Ham and Sam.

Robbie:  I have been dying to know about those monkeys. Did they have diapers on?

Guy:  Yes, they had diapers on and they were not up that long. They wanted to launch a pig, because a pig is very much like a person, but a pig can’t stand acceleration or lay on its back for long enough. So they had to launch monkeys.

Robbie:  So, it’s 1962 and they all move on down to Houston. You stayed at Langley for another 2 years and then what happened?

Guy:  I decided to leave Langley and go to work in industry.  I had an offer that sounded pretty good, chief engineer, stock options and all that good stuff with a medium sized solid rocket company.  I was just fed up with the fact that they were trying to reorient us in another direction.  We’d been doing great work. They tried to get everybody else in the space business, too. What bothered me was that I had too many activities going and not enough manpower to really make a dent in any of the activities and yet they kept on putting people in competition with me everywhere else in the organization.  I wanted to divest myself of some of these things that I had and put all the people together and let them all work so we would get enough manpower.

I had facilities that would turn out information that no one even looked at. I had so many facilities–like high temperature arc jets. I had guns that would shoot bullets twenty thousand feet a second. I had rockets that would propel payloads into space. I had an experimental rocket plant. I had centrifuges going to check up on some operational problems that occurred only during the flight of solid rockets. I had high vacuum chambers for doing high vacuum research. I had electron beam accelerators to do research on the effects of space radiation on materials.

What else did I have?  Oh, I had a thermal optical laboratory to take a look at thermal optical properties of materials that were necessary to find out how much heat stays in the space craft and how much gets radiated back in the various materials. I had all these things. But I didn’t have nearly enough manpower to get anything worthwhile out of any of them. Then they created the same types of facilities in other organizations who also didn’t have enough manpower in competition with me all over the place.

Robbie:  How counterproductive!

Guy:  They wouldn’t pull it together. I would have been perfectly willing and happy just to do my thing as good as I was doing it and let them take the manpower and take the facility and get rid of it or at least get something out of it. I couldn’t get anybody to listen. They couldn’t comprehend.

You see, back in the old days  the way you ran a wind tunnel, a wind tunnel section may have 60 or 70 people in it. The reason for that was to gather data was such a terrible problem. They had to actually use a scale just like Fairbanks Morse Scale. It would measure the force of one of the things with dials.  People had to read all that and take notes. They had manometers that would measure pressure from the mercury or colored liquid in the manometers. People would have to read the manometers. They had all these people and then people had to build the models. People had to put the models in the tunnel.  You had to have people reduce the data and analyze it.

They couldn’t comprehend that we needed more people to analyze the data and here it is going all to waste.  Each facility I had, with its modern high speed instrumentation, could crank out much more data than one of the old wind tunnels. They made richer people poor and yet they were creating organizations to do the same thing I was doing. I decided I had enough of that. I was ready to go off and go to work out in Phoenix, I guess. A rocket company wanted me to come out there and be chief engineer. I was almost ready to take that and then they called me from JSC, where they had had a big shakeup.

Thibodaux Rejoins his Space Task Group Colleagues at JSC

Guy: The project office at JSC had everything in it–all the various disciplinary organizations. They decided instead of having everybody to work this type of operation, to have the line organizations do all the work and support the project office.  They created the Engineering Directorate with all the various discipline organizations which required avionics and you had instrumentation, propulsion, and power, all sorts of materials, guidance and navigation, flight crew operations, building the space suits and life supports systems.  They created a bunch of organizations out of what they had. They didn’t have anybody that they felt could run the propulsion organization. It turned out that I was the second choice at NASA Headquarters but that didn’t bother me. The guy who was first choice didn’t come down.

Robbie:  So they hired you to run the Propulsion Division?

Guy:  Gilruth wanted to discuss it with George Mueller. Mueller didn’t know me so he had to do some research to find out if I knew something before he would sign off on it.

Robbie:  So you moved your  whole family down here?

Guy:  They were still in school there.  They moved down here in June after school was out.  I moved down here in January, the first of January.

Robbie:  And what was here in ’64?

Guy:  The Center wasn’t built yet.  We were spread out in buildings throughout the city of Houston.  My office was an old military barracks at Ellington field across from the Officer’s Club.  We had a few test facilities set up that were pretty decent. The Center was in the process of being built.  We moved in ten months later, I guess.  It took us maybe another year to get everything going because it was ’65 before we really got going and got everything operational.

Robbie:  Got the building straight and the equipment there–

Guy:  We had to do a lot of work! We had a lot of trouble getting the facilities right. The people who built them left them dirty.  We had to have them real clean–not clean for appearance’s sake: the things that we were working with were very hazardous and they reacted to a lot of different things and you couldn’t have a lot of junk left around in the pipes. The builders didn’t understand the necessities for all that. So, we had to go back and clean and verify everything. We had good people, very dedicated people. There was this bright young kid there who knew just  how to get the work done.  It’s just too bad there isn’t anybody  like him over there at JSC now.

Learning from Failure, Taking Acceptable Risks, Communicating Directly: When Work Was Fun

Guy: You see, I had all sorts of failures that I learned from. People don’t learn from failures anymore because they are so conservative in all the things they do. You used to  see rockets plants blowing  up and rockets with  pieces failing all over. Some of them still blow up.  I watched enough rockets spew fire out the sides and blow up that I learned why they blow up and why they don’t blow up.

Robbie:  And they don’t take risks anymore?

Guy:  No. The whole thing is, you have to take acceptable risks. You take the risks whether you know it or not. Sometimes you kid yourself about risk-taking.  They won’t learn from their experiences.  For example, we have been flying that shuttle now for 16 years and they haven’t learned a thing.

Robbie:  What is there to learn that they haven’t learned?

Guy:  They could learn, for example, that good design matters more than bureaucratic procedure. What Max and I proposed at first was that the solid rocket would be made in one piece, not with these joints like the Challenger failed with. If you built it at a site where you could transport it to the Cape it would all be in one piece. But that wasn’t allowed, because then it couldn’t be put up for bids. The only company that could have built it in one piece was right next to the Cape. Anywhere else and you couldn’t transport it, it would be too big. So the whole reason it was cut in half and made in two pieces was so more than one company could bid on it, because that’s the bureaucratic rule.

The other thing is that the thing which causes it to steer–that’s the most expensive task in a solid rocket, to make the steering right.  They had molten aluminum oxide, forty percent by weight of the rocket jet’s molten aluminum oxide. You had to protect it from this intense heat, between 5000 and 6000 degrees Fahrenheit . You have this pressure, 1000 psi pressure, and it has to last withstanding that with no cooling for 120 seconds or more.  It had to be able to wobble and not lock up.  In order to make it wobble it’s got to move around, back and forth, through pressure changes and there are all sorts of terrible things that could occur that you have to make work. There is no reason why it couldn’t have been designed  differently–it didn’t even have to be moved. They said, well what if one of the liquid rockets goes out?

What I know about that liquid rocket, if it goes out then there won’t be anything else to worry about. You can forget it because most of the liquid engine modes are generally catastrophic. You shut an engine down to keep it from failing when the instrumentation tells you that its operation is out of tolerance, but you’re not sure that it would fail if you kept on going.  You could have designed the Shuttle without the need for a moveable solid rocket booster nozzle. There are simpler ways to control the thrust vector.

The problem is that the control people overspecify their requirements by a factor of four or five. When we proposed the program, it was to have fixed nozzles. We flew things like that at Wallops Island with no control systems at all. They  worked pretty good.  That would save billions of dollars in the program because you have to recover the solid rocket. The back end of that solid rocket has probably got about ten or fifteen million dollars worth of stuff in it every time. I’d get rid of all that.

Robbie:  You made this proposal numerous times and nobody listened?

Guy:  Oh, yes, no one ever listened.  In fact one of the bidders there bid it that way. They had a good proposal actually, and that would saved a lot of money. There are many other things that they could have done that would have saved the program a lot of money.

Robbie:  Back in the early days, if you had made that kind of proposal, you would have been listened to.  It would have been listened to.  It would have been acted on.

Guy:  Oh, yes.  Back in the early days I think that I’d have gotten my way.  I got my way up to a certain point.  Then after that, after the forming part of the program came, Gilruth retired.  It’s funny when you lose your power base.  Mine was as a Division Chief.  There were many Division Chiefs, thirty or forty division chiefs, but I was–

Robbie:  But you were a Division Chief under Gilruth personally.

Guy:  I was one of the IN guys. I was a member of the club.  If you don’t know you are a member of the club then you ain’t. Well you see, it’s like the good old boys, sort of like that. You have influence by picking up the phone. You don’t write memorandums or things like that. If you want to do things you pick up the phone and get things done. For example, whenever I’d have problems, Paul was Gilruth’s special assistant and I would say, “Paul, how about handling it?”  “Sure, I’ll take care of it.” I got a guy I needed to get rid of and I needed some help getting rid of him. So I called Paul up, “I got this problem.” Paul was good. Paul knew how to handle things. If he had to gather information, he’d send someone up to look at it or something.

Robbie:  You told me that Gilruth used to go around to talk to all his employees and sit on the trash can without turning it over at each one’s desk to check on how he was doing and find out what he needed.

Guy:  Yes, once a week he would stop by. I used that technique over at my Division at JSC all the time. I knew everybody in my Division, and everybody knew me. That’s the difference. I got along fine. I could tell you something about everybody and their families and everything in my Division. I found out I could go and talk to them in their offices much better–they felt much more comfortable than if I called them up and asked them to come and talk to me. They would all wonder, well what the hell is he going to want? So I would go to them, and sit around and listen to them. I’ll tell you what I was doing–I was leaving post-hypnotic suggestions, is what I did when I went around.

Robbie:  What do you mean, post-hypnotic suggestions?

Guy:  Well, what I wanted to do was I would do to them like Gilruth did to me.  When I wanted them to do something, I didn’t have to tell them I wanted them to do it. I would leave a post-hypnotic suggestion. Then what they would do was they would go ahead and do it that way, maybe even thinking it was their own idea.

Robbie:  Exactly how would you do that?

Guy:  There are all sorts of techniques, some of which I am good at doing in that environment.  I’m a lousy salesman. One is called “grooming” and other things, where you kind of talk all around it and then you make polite chit-chat, and then, pretty soon, you home in on what they should do–you kind of lead them down the path you want and then you kind of drop them off. (laughs)

This was a very effective way of managing my Division. Rather than run it from my office, I found it much easier to run it from some of the Branch Heads’ offices or the individual offices. That way I got to know everybody and they got to know me. They understood I was the boss. But I was also a friend. They could talk to me about anything. They realized that whatever problems they had they could always talk to me about them. They didn’t have anything they had to cover up. It worked fine.

Robbie:  How many people were under you in that Division?

Guy:  At a peak, directly under me probably 220 people directly reporting to me. Probably a few thousand contractors, including support for our facilities and working on the things I was responsible for . One time, I had 1100 people at White Sands when it was a Branch in my Division. Most people don’t realize that. White Sands was once a Branch in my Division.

Ken:  I didn’t know it was a Branch!

Guy:  It was once a Branch. If you go look at EP you’ll find out there is an EP2, EP4, EP5, and EP6.  There was no EP3.  EP3 used to be White Sands.  There is still no letter, branch letter number, in between. I did something unheard of. I divested myself of the biggest part of my empire.

Ken:  How did that come about?

Guy:  It came about because I had to get rid of the guy who was running it. I’ll never forget. He was messing up everything. I had a big test operation out at White Sands for the big rocket engines.  The guy I had was supposed to be running the place. He had two subordinates. He had them fighting each other all the time. He’d tell a story about the other behind their back. They finally caught on. One day he was talking to one of them and the guy got the other guy on the phone and said, “Listen to this.” I found out about that. I said we have got to get rid of him. He said our guy would troubleshoot for us and live out there for a couple of weeks. So we came back and got rid of him. He said, “I told you I had a troubleshooter.” I said, “Well I don’t know why it took him two weeks to find what it took me ten minutes to find.”

After I got rid of him, in order to attract someone who might be worthy of the job, it couldn’t be just a Branch in my Division. It really shouldn’t have been. It had a Public Affairs Office involved in New Mexico politics. It had 800 contractors working at the site. It had a Payroll Office.  It was huge—1100 people. The Senator from New Mexico was interested in it. They were interested who got the contracts–it was already almost a separate Center.  It didn’t belong in my operation. When I got rid of the guy who I had to get rid of, then we had to prosecute the call for someone who was going to run the place. We had to find someone. We had to create the job where it would be attractive to someone, a big enough job that someone would take it.

We had trouble finding someone for it and then we–One day it was raining, Paul and I were running across to the cafeteria and it was raining and Paul looked at me and said, “Raines.” I said, “It’s really raining. ” Paul said, “No, Raines.” I said “Yes, it’s raining!” He said, “Marty Raines!  Do you remember Marty Raines?”  I said yes.  He said, “What do you think about him running White Sands?”  He doesn’t remember that but I remember that very well.

So the guy who we picked to run White Sands was a fellow named Marty Raines.  Raines was a captain or a major. Alan Shepard flew on a Redstone–that was an army ordinance vehicle The Army Ballistic Missile Agency- ABMA had a  liaison office at the Space Task Group.  Raines headed that office. He went later on to run some big operations  at Kwajelin during the Hydrogen Bomb Tests and he was a colonel in the Pentagon at the time.  I said, “Yes, I think he would be a pretty good guy to do that.”  He said, “Well let’s find out where he is.”  So he called and located him in the Pentagon and he offered him the job.  He came out and took the job. He happened to get hired because it was raining one day. He might have gotten hired another way but that’s a true story!

I remember Stan White—he was one of the first astronauts’ physicians, one of the few doctors who understood engineering pretty well. He was real good to talk to and he knew about engineering  aspects of the human body. You could talk to him about engineering. Most doctors you can’t talk to. I remember flying on an airplane one time back. I was sitting next to him and we had real rough weather. They had turned the seatbelt light on and the airplane was yawing just wildly. I had my head glued to the back of the seat. At about that time I saw the sign move. I leaned over and I said, “Sam, are my eyeballs stabilized in space?”  He said, “Hell, yes.”  He said the sign had “apparent motion.” He said, “Your eyeballs are fixed on a straight line–that’s part of your equilibrium. If you ride on a bumpy road and the road is going like this (makes up and down motion) and you look at the horizon, the horizon doesn’t move. Your eyes are fixed on that and they stabilize even though your head may be bobbing.”  The seat belt sign had apparent motion. The airplane wasn’t bending. There were many little things like that that I talked to Sam about. He understood the engineering aspects of the human body better than most of the other people I had talked to. We had fun. That’s why I retired–it quit being fun.

Robbie:  What year did Gilruth retire?

Guy:  Right after the Apollo program, I guess.  Before the shuttle started. He decided he didn’t want to get involved. He didn’t like all the crap he had to take.

Robbie:  And how did you and Kraft get along?  Did you have any kind of personal relationship with him?

Guy:  Well, we all didn’t have a problem getting along, but Kraft and his other guy ruined the center for us, as far as I’m concerned.

Robbie:  How did they ruin the center?

Guy:  Well, Kraft came up from the operations part. Operations was one of the big parts. These are the people that interface with the astronauts. The flight controllers, for example–the flight controller is the guy who gets to wave the baton, but he cannot write the music and play the instrument, is the way to look at it. They were always trying to dictate policy into how all these things have to behave.  They tried to tell the engineers what they have to do and all that other stuff. They would come up with a lot of wasteful ideas and it would take a long time to convince them that you shouldn’t do that–spend a lot of money.  He was so afraid they were going to ship flight operations to the Cape, that he totally destroyed the engineering operations. My outfit went from about a peak of two hundred guys directly under me down to less than a hundred and many were transferred to flight operations. When they got there, there was nothing for them to do.

Ken: In those early days when everything was going great, did you have any premonition that in the future it would become more bureaucratic and so forth?

Guy:  Oh, yes. If you’ll read that little preamble I wrote for the NACA reunion album [see above], you’ll see that the one thing Hugh Dryden was very astute about was that he was very concerned about the NACA becoming the NASA. That was his main concern, that he thought the whole flavor of the organization was going to change. That little article I wrote alludes to the fact that he mentioned this to us a number of times, and to me personally. I had private conversations with him about his concern. This was back when we became NASA. We didn’t start going downhill until about the seventh year. I began to sense something about the seventh year, that the agency was falling–

Ken:  Now, let’s see.  The space agency was formed in ’58, so we’re talking mid-60′s here?

Guy:  Yes, Apollo was on its way but I could sense that things were changing. We were getting a different class of people in charge all of a sudden. I sensed a tremendous change when Mr. Webb left. He’s the only guy we ever had that deserves the title of administrator, as far as I’m concerned.  The rest of these people, they are all nice people perhaps, but I don’t think any of them had any particular talents.

James Webb as NASA Administrator, and

Thibodaux as Chairman of the Source Procurement Board

Ken:  What were Webb’s characteristics that lead you to say that?

Guy: He was the greatest audience I ever spoke to. The guy hung on your every word. He was the most attentive person when you made a presentation to him. If he had other things he had to do, he’d raise his hand and stop you. Then he’d go tell someone–he gave Harry Finger writer’s cramp taking down notes about things he heard you say that he liked. He’d make Harry, he’d say, “You write this down. Maybe we ought to try that out here.”

When he would finish, he’d tell you to go ahead. He looked you right square in the eye and he heard every word you’d say. He understood what his job was. His job was not to be technical and not to worry about the program or the agency. His job was to sell the program to Congress and the American public. He surrounded himself with people who could take care of technical details. He had Bob Seamans, I guess from MIT Engineering school, or something.  He surrounded himself with some pretty talented people.  He had a tremendous background. He was the Director of the Bureau of the Budget under Harry Truman–I don’t know if most people understood that. He’d been the President of a university. He was Bob Kerr’s Chief  of staff when Kerr  was in Congress. He was the Senator  from Oklahoma, you see.  He handled all that type of activity. He really knew how to deal with that part of the operation.

Ken:  So, he was politically smart.

Guy:  He was extremely politically smart as well as being smart in a lot of ways. The guy must have had a tremendous IQ. He seemed to understand what you were talking about. It wasn’t like you felt like you could give him a technical snow job. I didn’t get that feeling at all. He was very astute. I had a few occasions when I was pretty much left alone to speak with him on the source board I was on.

I was the senior guy from the Center on the Source Evaluation Board for the Backup LEM Ascent Rocket Engine Injector. I was Chairman of that Source Board, but they didn’t send anyone else up with me.  So  I had to go help him make the big decision of who we were going to give the job to. That was very interesting.

Ken:  Clearly, knowing what I know now, you didn’t have all this advice from Procurement and–

Guy:  No, no. When I was Chairman of the Source Board, I was God. I could do anything.

Ken:  You came up and said here’s what we did, and…

Guy:  Not only that, I didn’t have to report to Max. As Chairman of the Source Board I didn’t report to anybody at the Center until I was ready. It was set up that way. If I didn’t like anybody they assigned, I’d throw him off. I had to get rid of a few I didn’t want on the Board. You followed the procedures, but if by following the procedures, it didn’t look like you were doing the right thing, well what you did is you’d kind of bend them. The whole purpose of a Source Board was to get what I felt was the best deal for the United States government. It didn’t matter what was the lowest bid price or anything else. It was what’s going to get you there the cheapest way in the long run, not what the guy tells you is going to work.

That time I went up with Webb, that was one of the most interesting challenges. The Scout was one of the things that I’m very proud of doing–that was NASA’s first in-house launch vehicle. The second project I enjoyed working on the most was Apollo. We were in real deep trouble on the ascent engine and Bell wouldn’t do what they were supposed to do, and Grumman wasn’t doing what they were supposed to do. We were a year from launching the Apollo, and the engine was going unstable. We were afraid it was going to burn up.

George Low, Bob Gilruth and I had flown up to Grumman in the Gulfstream.  Then we flew over to Bell to talk with Bill Gisel, the president of Bell, and tried to get him to do something. We weren’t getting anywhere. Coming back after a few martinis, someone asked me, “What do you think we ought to do?” I said, “We ought to get a backup.” George Low said, “Well, how much is it going to cost? And how long will it take?” I said “We can do it in a year and it will cost about a million dollars a month.” He said, “Go get it.” Just like that. On the airplane. He said, “You go get it.” He said, “How long do you think it will take you to get everything going?” I said give me a month and I’ll be ready to talk to Webb.

So, I picked up the phone and I called the Presidents of all three major rocket companies, told them what I was up to, and that we were going to have a bidders’ briefing down here and that we were going to have an honest bid. We were going to do everything kosher, according to regulations. That we were going to get a statement of work prepared to present to them.  They were to go home, and if they wanted to bid on it, they were to be given one week to prepare the proposals. The proposals were to be no more than seventy-five pages. So I ran a major Source Board and I had a decision by the administrator in thirty days after I got off the airplane. Now, that has never been done before or since. When I told George that, he got me on Webb’s schedule right away.

Ken:  I hadn’t heard that story!

Guy:  Very few people have ever heard it and most people would never believe it. I’d gone up to Washington. I had one of these little brown square briefcases like everybody carried. It looked like a little cardboard thing. I went up to the Continental Airlines President’s Club in Hobby Airport.  I set the briefcase down, and I had a couple of martinis. I picked up the briefcase and got on the airplane and went to Washington. When I started to review what the hell I was going to present, none of my material was in my briefcase. (laughter)

Boy, was I worried.  Here’s all this top secret–this is really confidential information because it told all about NASA and who we were going to recommend for the job. I was really worried. God, I was on the phone trying to chase that thing down. But I wasn’t the guy who was really worried! When I opened the briefcase, it had about three million dollars in cashier’s checks to pay off some sort of insurance claim. (laughter) It’s the other guy who finally chased me down. We arranged to have Continental Airlines send someone in a taxi to pick it up, swap ‘em, and carry it back and get it back to Dallas, because he was up in Dallas.  That’s a true story.

Robbie:  So, what did you do at this meeting without your material?

Guy:  I got the material that night, about two or three o’clock in the morning before the meeting. Let me tell you what happened. Not only did I tell Webb I chose the highest bidder and it wasn’t anybody I expected to choose, but that I was going to jack him up to three times the price he bid before I was going to let him have the contract.

Ken:  Because it wasn’t realistic?

Guy:  Because it was not realistic and if I was going to try to run that contract that way, all I would be doing is haggling about contract changes. One of the things they don’t know how to do, Procurement doesn’t understand, is that if you don’t size the job right, if you spend all your time haggling about contract changes while he’s sitting on his butt doing nothing, you are haggling over 10% of the fee for him but 90% of your money is going down the tubes while you’re doing all this haggling! That goes on. That’s the biggest waste of money I ever saw. That’s what I told Webb. He bought it lock and stock. He said, “All right!” Old man Hoffman who ran Rocketdyne, said that’s the finest contract he ever had with the United States government.

Ken:  And they could do it right.

Guy:  He did it right and he said “We made every cent of profit we bargained for.” And I considered that part of my job, to see that if they did an honest job, they got all the profit they bargained for. Those people over there don’t understand–I doubt that many of the Center people understand that.

Ken:  Was that backup engine ever used?

Guy:  That’s the one that flew to the moon. The other one I think we could probably have made work, I’m not sure.

Ken:  But you were struggling with it.

Guy:  We were struggling with it and we couldn’t get it right–Joe Gavin just wouldn’t put the pressure on Bell. Bell had the total capability in their plant on some work they were doing for the Air Force to do what the hell we needed done, but they were not willing to do that. I’m sure they had some union pressure and various other things. We had a good astronaut working with us too–Charlie Duke was on our team.

Ken:  Charlie’s a great guy.

Guy:  Charlie lived with us. We gave him a desk over in the Division and he sat there and he attended every meeting we had. He worked with us all the time.

Ken:  Charlie was very conscientious.

Guy:  Charlie I think is one of the finest of the astronauts.  He’s a prince of a guy. He’s also still married to Dottie, too.

Ken:  Are they living in San Antonio?

Guy:  They are living in New Braunfels. They have a house overlooking the #1 hole on Landa Park Golf course.

Ken:  Charlie and Dottie were friends of my wife and myself because we went to the same church here in Nassau Bay.

Guy:  Joe Allen, my next door neighbor, is also a prince of a guy–of course he’s up in Washington now.

Hiring by Talent, Not by Degree: A Better Way

Guy: The top aerodynamic scientist the NACA and NASA was a guy named Bob Jones. I don’t know if you have ever heard of Bob. Bob Jones was an elevator boy in the old NACA headquarters. A high school kid. He talked to them and they found out he was right smart so they hired him and made him a damn aeronautical research scientist from a high school kid elevator boy. You don’t do that these days.

I did things like that around here because Purser was here. Things that you don’t do these days. I had a technician working in my test area who was smarter than most of the engineers. So we made an engineer out of him. You could do that. You could still do it if people had courage enough to do it. You hold what you call an unassembled examination. Me and Paul got together and decided he was going to be an engineer.  That was the unassembled examination. They have a different classification in the civil service–600′s series rather than 800′s like most of the professionals did. He became  one of the branch heads.  He’s the guy who designed the heart pump for DeBakey.  Dick Bozeman’s his name.  He doesn’t have a college degree.

Ken:  I didn’t know that.

Guy:  He was teaching digital electronics over at San Jacinto College.  It wasn’t very hard to see that he was bright. So he didn’t have a college degree, so what? Why go backwards if he doesn’t have a piece of paper saying he’s smart when you know that he is. I also told every kid out there and every technician that I had, that if you could get me a certificate from any college that you lack only one year to get your degree, that I would see that the government pays you like they pay these kids to go get their doctorates. I said that doesn’t require a doctorate degree. I’d even apply it to Bachelor’s degrees in my outfit. There were three of them I sent off to college for a year at full pay and they all got their degrees and then became professional people.

You don’t see anybody interested in doing things like that over there any more. Personnel people–I called that the anti-personnel department that we used to run. He was more interested in sucking up to Washington than he was in taking care of the people down here at JSC. The way they treated secretaries was atrocious.  Even with temporaries.

Ken:  That would have bothered me.

Guy:   I don’t know why they put up with it. They ought to get a good union over there.  Personnel and management. We had one guy who was good. He left there.  He thought he was going to become an administrative head of HUD or one of the other government agencies in Washington.  Do you remember Wes Hjornevik?

Ken:  Yes, I remember Wes.

Guy:  Wes was great. Wes was sharp as a tack. He was a real great . I judge people by how worthy an adversary they are. Somebody you can do battle with and feel comfortable after you’ve done it. We used to have lunch and go round and round. The reason everybody gets a frame with every certificate they get–I got those for them. I took Wes on over that. I said, “Don’t send me any of those cheap pieces of paper if you ain’t got enough money to buy me a frame to hang it in.” I sent him a few other suggestions. He sent them back. One time he sent one of my suggestions back and he had a picture of this big ape glaring at me.  It said, “All management decisions are not stupid.”  I turned it over on its back and I wrote, “Sorry but your program does not authorize me to order a picture frame to hang your likeness in my office.”  We used to have fun!

Ken:  Who took Webb’s place? What was the change after Webb left? –because in effect you said NASA went downhill.

Guy:  Hell I don’t even know or care. That’s how important the guy was.  All I knew was that Mr. Webb was an administrator and the rest of the people that after him–they were all political appointees. Webb didn’t quit. Lyndon fired him, in fact.

Robbie: Why did Lyndon fire him?

Guy:  Lyndon was paranoid. Lyndon was crazy. The Vietnam thing got him to where he was a raving maniac half the time. I think Webb was over there talking to him about space programs, or something, and I think Webb told him that he was going to resign after Apollo flew. He said, “Well, I will take your resignation right now,” or something like that. People who were there told me about it. Gilruth said that after one of the flights, he went up to Johnson’s ranch and Johnson was just a ranting and raving maniac about telling super secret things and everything else to everybody in there and stomping the floor. I didn’t know him. You know, that’s hearsay. The story about Webb I’m pretty sure is true. Who did follow Webb?  Was it the same guy who came back twice? We had so many of them I can’t remember.

Ken:  Was it Paine?

Guy:  Paine and the Mormon from Utah.

Ken:  Fletcher.

Guy:  Fletcher, he was up there twice, I believe.  A guy named Frosch came in for a while.

Ken:  Yes, and he was a scientist type.

Guy:  I don’t know what kind of scientist he was. Who else? Oh, Beggs. Beggs was a nice guy, but I never found him to have a lot of courage like Webb did. I really shouldn’t say much about them as I had little or no personal contact with them.  I just observed them in action or inaction. Webb was decisive. He’d back you. That’s the other thing. You felt that you were talking to someone who understood what you were talking about and when a decision was made, you were going to have all the damn backing you needed.  After Apollo, the space program went to hell in a hand-basket. Those who basked in the glory of the moon landing were either gone or no longer supported NASA, so I guess these guys had a tougher time than Webb.

The Bureaucracy Takes Over

Lang was good procurement officer. Whitbeck, I didn’t think too much of him.  The other thing that the Center did terribly is that they always tried to accommodate every situation.  Whenever two people couldn’t get along, they split the organization up to make each of them head of one.  Did you ever notice that?

Ken:  Yes.

Guy:  Max couldn’t even deal with that in his own organization.  We had a big proliferation.  If you had three outfits there, GNC, IESD, and even Comp and Data Analysis, all would be arguing about turf and everything else.  Max split IESD up into two outfits because of some fact that he couldn’t deal with the situation at one time. You never accommodate false things that are not good. Trying to accommodate people is no good. In the seventeen years I headed up my outfit, I’m the only one who never had a single organizational change.

Ken: That’s interesting.  I didn’t know that.

Guy:  The same number of branches, the same number. When I shrunk down, I had to reduce the number of sections. Everybody worked. It was organized so functionally, that all the branches worked under the same mechanical things. There was never any transfer of responsibility between branches.  They were all functional and they all worked only on the specific hardware assigned to them. There was always some interchange of ideas between branches.  My outfit’s the only one that worked  that way. I had three branches. I had Primary Propulsion, which took care of the big engines. I had Power Generation, which took care of the fuel cells and cryos, and all other power generation systems.  I had Reaction Control and Pyrotechnics which took care of reaction controls, hydraulic power and pyrotechnics and explosives. Those were the same for the entire time I was over there. I never got sucked into making false changes to accommodate.  People always asked me when I was going to make a change. I said, “Whenever it gets necessary to change.” It was never necessary.

The other thing that I told Robbie was I never attended a meeting in all of NASA that there were ever minutes of the meeting.  I’ve never seen minutes to any meeting.

Ken:  I think that is probably right.

Robbie:  Is that your experience too?

Ken:  That’s been my experience.

Robbie:  Why is that?

Guy:  They don’t want to be second guessed.

Ken:  That’s right. I think part of it is because who is going to write the minutes, who is going to write the interpretations?

Robbie:  So they just don’t have anybody do any of it.

Ken:  Well, they end up, most meetings do end up with follow-on actions.

Guy:  The contract changes authorization involved spending money, affecting the cost.

Ken:  Yes, anytime you spend money you have to write it up and send the forms in.

Guy: Then the contract changes, that is the net result of the meetings we had.  How anybody ever arrived at that decision, if you reviewed all the charts that were presented, you’d draw, some time, the opposite conclusion.

Robbie:  But if you don’t have any minutes then how do you remind everyone of what was agreed at the meeting?

Guy:  Some people are presenters and then there were other members.  Most of the people that were at those meetings are not necessary. They have no business ever being there. They are being paid.

Ken:  I think what probably really happens, Robbie, was that the people who really had the power in the meetings, what to do about this meeting and so forth, get together behind a door and say what do we do now?

Guy:  Yes, there are people who get involved and there are people who don’t get involved in the decisions. You don’t necessarily know who.

Ken:  I think that what could be said is that so often within a government organization, the decision gets made quite frequently after the meeting.  People have reflected and the key people get together and say, “Well all right, what are we going to do with it?” But, it’s not in the open meeting where everybody is attending and watching.

Guy:  I never attended any of those meetings but when I would show up, Thompson would say, “What the hell you doing over here, Thibodaux? I’d say, “I want to see what is going on at the circus today.” He said, “How come you never come to a meeting?  I said, “I’m at every meeting you have.”  He said, “No, you’re not!  I said, “If anybody from my Division is there, then I am there. They are going to tell me what happened. So I don’t have to be there. I don’t have to waste my time sitting there like all these others.”

I got one other good story to tell.  Apollo 8 was having trouble with the fuel cell. The radiator temperature kept cycling. No one knew what that meant. I’m sure I know what happened now, but it was never one of those things we reached a final decision on.  We had the manufacturer down. Pratt and Whitney came down and we discussed everything. It came down to a little valve in there which is nothing more than like the thermostat on a car. The active element in it is bee’s wax. The bees have excellent quality control–they make the same kind of wax all the time so that it behaves very consistently in its expansion characteristics.

There was a lot of talk about this valve being the cause of the problem. We had this up on the ninth floor. Von Braun was there, and George Mueller, Chuck Matthews, Gilruth, the whole schmeer. The cheapest guy in there, I don’t even think there was a GS-15, maybe less than that. The guy who was making the presentation was Shelby Owens. Shelby was about maybe a 13 then. All of a sudden all these guys decided they were the engineers. They sat there haggling about how you were going to redesign this stinking little valve.  Max and I were sitting there in amazement watching all these guys put their two cents in about how the valve ought to be redesigned. This goes on for two hours. We ain’t getting anywhere. We broke for lunch.  We came back after lunch and same damn thing goes on. They are still designing the valve. George looks over at me and he says, “Thibodaux, this is your department. What would you do about it?”  I said, “I’d find a GS 7 who knows a hell of a lot more about valve design than anybody at this table and tell him to go fix it.”

That did it! They all quit designing the valve and said, “Next item.” That took care of that. It wasn’t the valve that was the problem. Turns out it was a zero-G problem. The condenser has these very small passages and as water begins to condense out it fills this thing out through capillary action. That acts as an impediment. You have very little delta p across it. It takes a while to build up enough pressure to blow all that water out. Then it begins to transfer heat and cycling. What it’s doing is really flooding and unflooding that condenser. It had nothing to do with that little valve.

I’ve been retired for 17 years and what have they accomplished in the 17 years I’ve been retired? We’ve flown into a Russian space station and we launch almost all of our commercial satellites on foreign launch vehicles now.  And we’re buying rocket engines from foreigners. That’s what we’re doing now.  No one can dispute that.

Robbie:  In other words, you don’t regret retiring when you did, because JSC hasn’t done anything significant since then anyway.

Guy:  No, nothing significant.  I began to see the handwriting on the wall.  They became an  experiment in social and political change and lost sight of what they were supposed to do. Their bureaucracy took over–the White House staff basically controls all personnel who run NASA. The Congressional staff controls all the programs that NASA does, and the lobbyists, and everything else. It just got to be where it wasn’t any fun. Most of the other people I know would say the same thing.

Robbie:  How long were things good at Johnson Space Center?  How long was it before the bureaucracy took over and you felt that you were not happy?

Guy:  It was the beginning of Apollo. The shuttle program was passable but it lacked a lot of real talent.  The people in charge felt they were working for industry rather than for the agency. Their decisions were based pretty much on what industry wanted–a lot more than what we told them to do. There are a lot of ways we could have saved us some men and a lot of money. The Air Force got involved with requirements and other big operations which they called flight operations. They got to be so ultraconservative that they put all sorts of ridiculous requirements on things. Then they won’t watch what’s going on and see that there are things you can change here. It changes your attitude, really. That is how you go about things. Contingencies, for example, and redundancy, and many of those things. You would have to use it even if you could prove you didn’t need it and that you could simplify the system.

For example, Max and I saw that happen with the big solid rocket propellant on the shuttle. I started that back atLangleyback in ’58, in the era of big, big solid rockets. I got the thing going and the first thing  they did was turn it over toLewisResearchCenter. I never got to work on it. Then when they got to the shuttle they letMarshallrun the solid rocket thing.Marshallhad been anti-solid rocket their entire life. They were strictly liquid propellant people. A lot of things like that go on now, very inefficient.

*           *           *           *           *           *           *           *           *           *           *           *

Ken:  Is Max still coming?

Guy:  I called Max tonight. I called him the other day and he said he would come.  He’ll never make it on time.  He’s going to put in his will that his body is supposed to be late for the funeral! (laughter)  When we flew on the Gulfstream, Gilruth used to get so angry.  He would threaten to leave Max about almost every morning.  He never got there on time. He did seem to make it on time when we were going home.  He never gets anywhere on time. My wife and I went out with him here within the last year, and he picked us up on time. I think that was the first time in his life he had ever been on time. I’m the godfather to most of his kids, and I was the best man at his wedding. We were late for the wedding. I think he was late for the christenings of all of his kids.

Purser and Faget arrive, right on time. See next file.

For further information, Guy Thibodaux can be reached at tibido@earthlink.net

This article appeared in Social Science and Medicine
38(8):1125-1140, 1994

Abstract
The dominant mythology of a culture is often displayed in the rituals with which it surrounds birth. In contemporary Western society, that mythology–the mythology of the technocracy–is enacted through obstetrical procedures, the rituals of hospital birth. This article explores the links between our culture’s mythological technocratic model of birth and the body images, individual belief and value systems, and birth choices of forty middle-class women–32 professional women who accept the technocratic paradigm, and eight homebirthers who reject it.

The conceptual separation of mother and child is fundamental to technocratic notions of parenthood, and constitutes a logical corollary of the Cartesian mind-body separation that has been fundamental to the development of both industrial society and post-industrial technocracy. The professionals’ body images and lifestyles express these principles of separation, while the holistic ideology of the homebirthers stresses mind-body and parent-child integration. The conclusion considers the ideological hegemony of the technocratic paradigm as potential future-shaper.

Key words: childbirth, mythology, technocracy, professional women, home birth.

Introduction

Technology is a universal function of human society, but technocracy is a culturally specific system of myth and ritual, developed and disseminated in Europe and North America from the 17th to the 21st centuries.

– Peter C. Reynolds Stealing Fire: The Mythology of the Technocracy

Although a society’s core value system is visible in many areas of cultural life, it is nowhere more evident than in the cultural treatment of the human body, most especially when that body is giving birth to the new social members that will ensure the future of the society into which they are born. Ensuring a society’s future means ensuring not only its physical continuation but also the continuation of the belief system that shapes the way its members cognize the world around them. Some part of that belief system is bound to deal with the question of how that society defines itself in relation to the natural world and to the natural reproductive forces upon which its continued existence depends. Thus we might expect to see this belief system intensively exhibited in the cultural arena of birth.

As shown in a previous article of mine in this journal, “The Role of Obstetrical Rituals in the Resolution of Cultural Anomaly” [1], obstetrical procedures are rituals that attempt to resolve certain conceptual dilemmas with which American society is confronted by the natural process of birth, thereby enabling us to continue to place our faith in the fragile model of reality that constitutes the central mythology of our culture. The present article concentrates more specifically on the paradigm of birth that derives from this mythology–the mythology of the technocracy–which I have called the technocratic model of birth [2].

Like all cohesive and hegemonic mythologies, the technocratic model functions as a powerful agent of social control, shaping and channelling individual values, beliefs, and behaviors. After describing this model, this article investigates the relationships between this model and the individual belief and value systems of forty women, thirty-two of whom gave birth in the hospital in complete accord with technocratic mythology, and eight of whom gave birth at home in complete resistance to it.

Technocratic Mythology: The One-Two Punch

In Stealing Fire: The Mythology of the Technocracy [3], Peter C. Reynolds analyzes modern high technology as emergent from a mythological system that depends on the ritual transformation of nature to conform to culturally constructed images. In Reynold’s analysis, “technological progress” is a folk term for the ritual process of replacing “natural” bodies, conceptualized as primitive, terrestrial, “female,” and polluting, with man-made bodies, conceptualized as advanced, purified, celestial, and “male.”

Reynolds uncovers the primal act of ritual transformation in technocratic culture, labelling it simply the “One-Two Punch.” Take a highly successful natural process (e.g., salmon swimming upstream to spawn). Punch One: render it dysfunctional with technology (dam the stream, preventing the salmon from reaching their spawning grounds). Punch Two: fix it with technology (take the salmon out of the water with machines, make them spawn artificially and grow the eggs in trays, then release the baby salmon downstream near the ocean). Reynolds identifies this One-Two Punch–destroy a natural process, then rebuild it as a cultural process–as an integral result of technocratic society’s supervaluation of science and technology over nature (3, pp. 3-5). He explains that

technocracy [denotes] the ideology of modern industrial society, in which social policy and political debate presume scientific models of nature and society, and knowledge itself is reduced to scientific research and description [3, pp. 10-11].

And the essence of scientific research and description is separation–of elements from the whole they compose, of humans from nature, of mind from body, of mother from child. Such conceptual distinctions are implemented through ritual acts that produce physical embodiments of the underlying worldview:

If we think of the human body as a kind of machine, doctors of the future will be like mechanics, simply replacing those parts that can’t be fixed….Succeeding generations of artificial devices will perform as well as their natural counterparts and may prove more reliable. For instance, gains in microelectronics will lead to a bionic heart with an internal power pack….The circuits controlling man-made limbs and hands will be packed with more computing power, making the prosthetics increasingly dextrous….Tiny TV cameras mounted on eyeglass frames will transmit electronic images directly to the visual cortex of the brain, bringing limited vision to the sightless [4, p. 57].

Prosthesis is a term used in medicine for artifacts that replace lost bodily functions and parts, but in technocratic rituals, the culture first produces the mutilation of nature that the prosthesis is designed to replace. For example:

In a recent article on what the authors refer to as “the top 10 coming attractions” in biotechnology, among the innovations listed are genetically engineered crops that contain genes for making pesticides–mutilation and prosthesis folded into one; and genetically engineered bacteria that will clean up oil spills and chemical dumps by eating the pollutants–a man-made fix for man-made mutilation. In some cases, both phases of the One-Two Punch are implemented by the same organization. In an advertisement for the DuPont corporation, one of the major purveyors of munitions in the Viet Nam War, a Viet Nam veteran plays basketball on artificial legs manufactured by DuPont. Industrial society is a master of the One-Two Punch: send nature reeling with a hard Right, then finish it off with the Left. Industrial society destroys natural cycles with one hand while building fabrications of them with the other, but the integrated operation of these two disparate processes is almost invisible to people. [3, p. 5]

Reynolds shows that when the One-Two Punch of mutilation and prosthesis is culturally recognized, as in the building of the salmon hatcheries, it is usually dismissed as an accidental byproduct of industrialization or embraced as a compromise solution to unfortun-ately competing demands. But taking off from Ellul [5], who pointed out that “technological society” is not defined by its tools and techniques at all, for these are always changing, but by the system of values that organizes the underlying process of technological develop-ment, Reynolds demonstrates that “the dominant value of contemporary industrial society is in fact the One-Two Punch itself”[3, p. 7]–the creation of dysfunctions in nature through technical intervention and their replacement by fabricated analogs of natural processes. I suggest that the cultural management of American birth is a perfect example of the One-Two Punch, and that as such, it is a complete cultural expression of our technocratic core value system.

Mutilation and Prosthesis:
The Technocratic Model of Birth

The uterus is a muscular organ that is covered, partially, by peritoneum, or serosa. The cavity is lined by the endometrium. During pregnancy, the uterus serves for reception, implantation, retention, and nutrition of the conceptus, which it then expels during labor.

– Cunningham, Macdonald, and Gant Williams Obstetrics, 18th edition

I present this overview to contextualize the experiences and statements of the professional and homebirth women whom I will describe below. This overview will thus be but a brief and bare-bones description of the technocratic model of birth, which I have described in great detail in earlier works [1,2,6]). Before I begin, I wish most emphatically to acknowledge that there are many medical practitioners and health care professionals working within the technocratic system to humanize and otherwise transform that system. There is simply no space in this short section to allow the multiplicity of their dissenting voices to speak.

As I and others [7-9, 12, 14, 15, 27, 28] have shown, the technocratic model of the body has been differentially applied to women and men, so that the male body is metaphorized as a better machine than the female body. In form and function it is more machine-like–straighter-lined, more consistent and predictable, less subject to the vagaries of nature (i.e., more cultural and therefore “better”), and consequently seems less likely to break down. Males, because they are the most machine-like, not only set the standard for the properly functioning body-machine, but also are thought best-equipped to handle its maintenance and repair.

Because of their extreme deviation from the male prototype, uniquely female anatomical features such as the uterus, ovaries, and breasts, and uniquely female biological processes such as menstruation, pregnancy, birth, and menopause are seen as inherently subject to malfunction. It is thus understandable that the woman in whose body such degenerative processes take place is often seen, under the technocratic model, as better off without them. As a number of physicians and social scientists have pointed out, our medical system has done a thorough job of convincing women of the defectiveness and dangers inherent in their specifically female functions [8-14]. The hysterectomy is the most commonly performed unnecessary operation in theUnited States(one out of every three American women has a hysterectomy by the time she reaches menopause [8, p. 287]), with the radical mastectomy in second place [11]. It has been a recurrent theme in American medicine that to remove a woman’s sexual organs is to restore her body to full health and greater potential for productive life. In short, under the technocratic model the female body is viewed as an abnormal, unpredictable, and inherently defective machine.

During pregnancy and birth, the unusual demands placed on the female body-machine render it constantly at risk of serious malfunction or total breakdown. This belief, the foundation of modern obstetrics, can be found behind the lines of much early obstetrical literature:

It is a common experience among obstetrical practitioners that there is an increasing gestational pathology and a more frequent call for art, in supplementing inefficient forces of nature in her effort to accomplish normal delivery [17, p. 531].

More recently, the 1985 issue of the New England Journal of Medicine includes an editorial on the potential advantages of universal prophylactic Cesarean section [18]. The authors question whether, since birth is such a dangerous and traumatic process for both woman and child, the best obstetric care should perhaps come to include complete removal of the risks of “normal” labor and delivery. A still more recent article in Female Patient asserts that natural childbirth is associated with “maternal death, infant death, and maternal tissue destruction….Some practitioners are asking whether an even higher Cesarean rate may be appropriate. Should we not offer the ultimate in pelvic and birth-canal protection to the mothers?” [19].

Although most modern obstetrical texts do give lip service to pregnancy as a natural and intrinsically healthy process, this is usually done in a paragraph or two. For example, the 18th edition of Williams Obstetrics, the preeminent text in the field, states:

The expectant mother has been commonly treated as if she were seriously ill, even when she was quite healthy. All too often she has been forced to conform to a common pathway of care that stripped her of most of her individuality and much of her dignity….Too often the expectant mother has felt that her fate and the fate of her baby were dependent not so much on skilled personnel but upon an electronic cabinet that appeared to possess some great power that prevailed above all others [20, p. 6].

Meanwhile, most of the next 900 pages are devoted to a detailed discussion of everything that could possibly go wrong and of how to use the “electronic cabinet” to solve these problems. This electronic cabinet serves, in Reynold’s terms, as a prosthetic device that has become integral to the mutilation and prosthesis of birth–in other words, to its technocratic de- and reconstruction.

Punch One is accomplished by birth’s dissection into components–the stages of labor–and by the application to these components of standardized measurements and rules (e.g., Friedman’s curve) that say how each stage should proceed, plus diagnostic technologies (e.g., external and internal electronic fetal monitors) that investigate whether or not these stages are proceeding as they should, plus remedial technologies (pitocin, episiotomies, Cesarean sections) to make them proceed as they should if they aren’t. (See [2] for detailed description and analysis of obstetrical procedures as rituals that enact the technocratic model of birth.) Birth is thus a technocratic service that obstetrics supplies.

The most desirable end product of the birth process is the new social member, the baby; the new mother is a secondary by-product:

It was what we all were trained to always go after–the perfect baby. That’s what we were trained to produce. The quality of the mother’s experience–we rarely thought about that. Everything we did was to get that perfect baby. [38-year old male obstetrician]

This focus on the production of the “perfect baby” is a fairly recent development, a direct result of the combination of the technocratic emphasis on the baby-as-product, the multiplicity of new technologies available to assess fetal quality, and the powerful economic and legal incentives to use them. As Rothman has pointed out,

Diagnostic technologies, from the most routine ultrasound to the most exotic embryo transplant, work toward the construction of the fetus as a separate social being….The history of Western obstetrics is the history of technologies of separation. We’ve separated milk from breasts, mothers from babies, fetuses from pregnancies, sexuality from procreation, pregnancy from motherhood….It is very very hard to conceptually put back together that which medicine has rended asunder. I find that I have a harder and harder time trying to make the meaning of connection, let alone the value of connection, understood. [21]

The conceptual separation of mother and child chartered by the technocratic mythology of birth parallels the Cartesian doctrine of mind-body separation. This separation is given tangible expression after birth as well when the baby is placed in a plastic bassinet in the nursery for four hours of “observation” before being returned to the mother; in this way, society demonstrates conceptual ownership of its product. The mother’s womb is replaced not by her arms, but by the plastic womb of culture.

This idea of the baby as separate, as the product of a mechanical process, is a very important metaphor for women because it implies that the technocracy ultimately can become the producer of that product, as of so many others. The current cultural debates over surrogate motherhood and fetal vs. maternal rights dramatically illustrate how fundamental is this separation to technocratic notions of parenthood. Moreover, as Rothman points out above, mind/body//

mother/child separation forms the ideological basis of the new reproductive technologies, from court-ordered Cesareans to artificial wombs [8, 33, 44]. For example, the February 1989 cover story of Life magazine, “The Future and You,” predicts “Birth without Women”:

By the late 21st century, childbirth may not involve carrying at all–just an occasional visit to an incubator. There the fetus will be gestating in an artificial uterus under conditions simulated to recreate the mother’s breathing patterns, her laughter and even her moments of emotional stress [4, p. 55].

Although current magazine advertisements tout a smorgasbord of options for birth, from jacuzzis to home-like birthing suites, in fact the vast majority of birthing women are constrained by the basic processes of the technocracy to the same realities faced by the dammed up rivers and those thousands of salmon trying to swim home. The question arises, if this One-Two Punch of technocratic de- and reconstruction is in fact so integral to American society that it must be enacted a thousand times a day in the ritual production of new social members, to what extent does it define women’s own perceptions of the proper cultural treatment of their pregnant bodies? Women’s own conceptualizations of those bodies? In other words, how do the women to whose bodies these technologies are applied think about the relationships between their bodies and these technologies? And given that as conscious human agents they may have more choices than the salmon and the rivers, what do they choose?

The Technocratic Body and the Organic Body:
Differing Cultural Models for Women’s Birth Choices

In recent works, Emily Martin [7, 22] shows that middle- and working-class American women hold contrasting images of the body and birth that center around the issue of control. The middle-class women in Martin’s study sought to wrest control of birth away from the medical establishment, striving not only for control of their birth settings and attendants, but also, and most fundamentally, for control of themselves as they labored and gave birth. Meanwhile, their working-class sisters rejected this middle-class emphasis on self-control, saying “They were talking about breathing and panting and–what are you talking about? It hurts!”

The differences between the two groups in my study are more extreme, perhaps because they stem from philosophical differences even more fundamental than those between Martin’s middle-class and working class groups. The women in both of my study groups are all relatively affluent members of the white middle-class between the ages of 28 and 42: the fact that they hold so many other things in common makes all the more noteworthy the dramatic contrasts in their images of body, birth, and motherhood, and in the relationships of these images to the technocratic model.

When I first began research on American birth in 1981, most women I spoke with said they wanted some form of “natural childbirth in the hospital,” in resistance to the consciousness obliterations their mothers experienced as they gave birth from the 1930s to the 1960s. Given this desire for natural childbirth, I expected to find, as Martin did, that most women would resent and resist the increasing number of impersonal intrusions of technology into birth, and what I and others [23-28] perceived as women’s concomitant loss of their power as birth-givers. But when that initial study was completed several years later, I instead found that 70% of my 100 interviewees, if not exactly thrilled, were at least rather comfortable with their highly technologized obstetrical experiences, and were not much interested in resistance [2].

Of these seventy women, nine seemed especially to have actively sought and been personally empowered by the technocratic interventions in their births [29]. Although this earlier study did not specifically focus on occupation, I noticed that these nine women were all high-powered professionals in positions of prestige and authority. When they hired an obstetrician, they were hiring another professional to perform a service. From him or her they expected the same sort of professionalism and competence in matters of the body as they expected from themselves in their own areas of expertise. They seemed to see technology as integral to all areas of American life, and they fully expected that the very best in the modern technology of the body would be brought to bear on their pregnant bodies and the babies within them in order to ensure that their births were competently managed and controlled, and therefore safe.

I was both surprised and intrigued by the attitudes and desires these professional women expressed, and by their ability to manipulate technocratic mythology and procedures to their advantage. On the other hand, I was equally intrigued by the near-total resistance to such mythology of the women I came across who had chosen to give birth at home. I was fascinated to see that the women in both these categories actively defined themselves, in myriad ways, as future-shapers. It seemed to me that these two groups represented fruitful ground for further study. From 1988 to 1991, I conducted in-depth interviews with both professional women and homebirthers, focusing on the physical changes of pregnancy and the symbolic aspects of motherhood in relation to their conceptions of body and self [30]. I chose these particular groups as a means for exploring the notion of the technocratic model as an agent of social control because they represent the extremes of women’s responses to that control–from total acceptance to total resistance–and thus define the spectrum. Throughout my analysis, I utilize italics to highlight the correspondences with or divergences from the technocratic model as they emerge in these women’s words.

The Technocratic Body of the Pregnant Professional

When it came time for Susan Blume to deliver her baby, she was blessedly calm. No sweat soaked her brow, no pain lined her face. She uttered not a sound. As the baby squeezed down the birth canal, Blume [anesthetized by an epidural] lay placidly on her side, reading People magazine and robbing the gods of one more woman bringing forth children in sorrow.

– Elaine Herscher, San Francisco Chronicle

The thirty-two professionals who chose hospital birth hold a wide range of occupations. Four are mid-level managers for banks, and three for insurance companies, two head up fund-raising for political campaigns, one is a museum curator, two realtors, two are physicians, three college professors, two regional sales managers, six managers or directors of large government agencies, one is a CPA, one a high-level manager for a major airline, and five own their own companies. Most of them make as much or more money than their husbands.

The Professional/Personal Split

During the interviews, it quickly became apparent that these women live their lives in terms of a fundamental and clearcut distinction between the personal and professional realms. How these women primarily define themselves in relation to society at any given moment is usually a function of what realm they are in. In the professional realm they are their roles: professor, division manager, CEO. Secure in their professional identities, in the personal realm many of these women seem to actually be amused to define themselves as “John’s wife,” or “Suzie’s mother,” almost as if being John’s wife or Suzie’s mother was a sort of game that they played sometimes.

Presence in either the personal or professional realm is expressed through bodily adornment. Leah explained:

I see [the body] as a way to have people respond to you….The way I dress reflects the level of professionalism that I have and the type of response I get from other people. I don’t dress in flounces and frills, I dress very tailored and that is reflected even in the glasses I wear. They are pretty much straightforward and businesslike….I like to give a straightforward presentation so that people can deal with me straight.

I found it noteworthy that when I interviewed these women in their homes, they almost invariably would glance down at their casual sweats and tennis shoes and laughingly comment, “You are seeing my other self, my home self”–but when I went to their offices, they never said, “You are seeing my professional self.” For most, the professional self was the primary self.

In general, any overlap between the personal and professional realms went one way: personal aspects, like children, relationships, emotional display, did not belong at work, while professional aspects, like paperwork, faxing, and phone calling, often were taken home. Enforcing the boundaries of this one-way street did not present much of a problem for most of these women at first; even those who dated and/or married male colleagues were usually able to keep these relationships separate from their everyday professional activities.

Pregnancy as a Violation of the Professional/Personal Split

Pregnancy perforce entails a violation of the conceptual boundary separating these personal and professional realms of life. Sexuality and children are plainly part of the personal domain; they do not belong at work. But pregnant women visibly and obviously not only take their children into the workplace, but also to even the most important meetings! Predictably, many of these women worried about how this boundary violation would affect their work relationships with their colleagues and superiors:

[Q. Were you worried about how your colleagues might react to your pregnancy?]

Yes, that’s an unqualified yes….they look at me as the President, and I….was worried that they might start thinking about me not as much as a professional, but as a woman, and that shouldn’t necessarily be bad, but I was worried that it might affect the respect level….it’s kind of more obvious that you’re a woman, I think, if you’re pregnant….It wasn’t something I wanted them to think about, because I wanted them to think about me as a business kind of guy.

However, in contrast to what I had originally expected to find, very few of these women found their fears to be justified. Only three reported that they suffered any sort of job discrimination as a result of their pregnancy, while most others reported the joyful discovery of unexpected benefits from their physical blurring of the personal/professional distinction:

When I was pregnant for the first time, I was working in a large corporation. Always it was to dress for success–you were very much on guard as a woman. As soon as I revealed I was pregnant, people who were not friends of mine, executives many levels up on the corporate ladder, just opened up their personal lives. They identified so strongly with being a father or having a wife who was pregnant….I was stunned at how open and personal everything became when they were around a woman who was bearing a child.

As it evolved for most of these women, the conflict between work and pregnancy was not between their pregnant bodies and their male colleagues, as most had expected, but between their own expectations for their work performance and the biological realities of those pregnant bodies. Catherine said:

I hated it that people were always wanting to have personal conversations with me about how I was feeling. I was not interested in that at all, and so I made it very plain right at the start that…when I’m at work I am strictly business. I think the reason I didn’t have any problems with how I was treated… was that I made it so clear that there was no difference.

[Q. Did pregnancy pose any problems at all for you at work?]

I would sometimes get so tired that I would tell my secretary to hold my calls, and put my head down on my desk and just sleep for an hour. But I never let anyone know about it, and I made sure that I always got just as much work done anyway, even if that meant I had to stay there longer. [Catherine]

The Centrality of Control

This tension between the professional and personal domains is often heightened by the woman’s own perception of herself in relation to her body. Just as with the middle-class women in Martin’s study (1990), an overriding concern of these professional women is control. They hold the strong belief that life is controllable, and that to be strong and powerful in the world, one must be in control. As long as these women feel in control, they are “happy,” “everything is fine.” They achieve control over their lives through careful planning and organization of their time and activities [31]. Control over their bodies is achieved through regularly scheduled exercise– most were very athletic in school. They achieve control over their own destinies through reaching positions of independence and importance in the wider society. Interestingly, those who admitted to wanting and enjoying power insisted that it was not power over others that appealed to them, but power to make things happen in the world. Lina said:

I didn’t want to be like my mother…I didn’t want to be picked on by my husband all the time, and be powerless. [Q. What did you do to be powerful?] I got a PhD and a job.

The Self/Body Split: Pregnancy and Birth as Out-of-Control

These professional women seem to judge every situation by the degree of control they feel they can maintain over it. Even their pregnancies are usually carefully controlled, planned to occur at just the chosen time in their careers. But once those processes were set in motion, they became uncontrollable, and thus presented these women with a division within their most treasured notions of self, between the cultural, professional parts within their control, and the personal, biological processes outside of it. Lina experienced this division so intensely that she could hardly believe it when she became pregnant:

Deep down inside of me I believed that I had desexed myself by being the successful professional….I thought I would have a hard time getting pregnant because I thought I would have to pay for what I had gotten away with….I have succeeded at a man’s game….A couple of my male faculty colleagues, when they would see me on the campus with the baby, would constantly say, “I can’t believe you are a Mother, I can’t believe you are such a good mother–you are like my mother. I can’t believe it.” What they were really saying to me is, “I thought you were a guy.”

This separation of self from biology is clearly reflected in the body concepts held by many of these women. I asked each one,”"How do you think about your body? What is your body?” I was interested to notice that most, instead of giving me a definition, immediately began to talk about how they judged their bodies–as too fat, not in good enough shape, or healthy, in good shape. Such statements reflect their shared belief that the body is imperfect:

I think it’s pretty functional [but]….it’s fat around the middle, and my boobs are too small. [Lou]

Women, unless we’ve had it greatly enhanced by plastic surgery, I don’t think we like it. I don’t know anybody who likes their body. [Louise]

The words of most of those who did provide definitions expressed the additional and equally fundamental belief that the body is separate from the self:

You know, I think there is me and then there is what I’m like physically which can be changed or modified–clothes, makeup, exercise, hairstyles, food. [Georgia]

My body is a vehicle that allows me to move around, a tool for my success in the world. [Joanne]

A vehicle. Something that moves me from place to place. A repository for thought, for creation, for beliefs, philosophies. [Leah]

My body is the recipient of the abuse from the lifestyle that I choose….It’s my weakest link–it’s like you have to pay the price somewhere–I’m out of shape, overweight, and not eating right–my body to me is what has paid the price for this career.

[Q. Can you describe your relationship with your body?]

Abusive. [Beth]

Predictably, then, the physical state of pregnancy was problematic at best for some of these women. For intrinsic to the notion of the body as a vehicle, a tool for the self, are the corollary ideas that the body is worth less than the self it houses, which, being worth more, should control the body, should be “in charge.” Concomitantly, most of these hospital birthers experienced the bodily condition of pregnancy as unpleasant because it is beyond the control of the self, or, as they put it, “out of control.” Here is how they expressed that feeling. Linda said:

I think there are a lot of women who love being pregnant and they would say that. My sister, the Earth Mother, did. Especially before I got pregnant, I thought, “Maybe I’ll get into it.” But I didn’t get into it. I felt bad and large and awkward and nauseated. And oh, I love having the baby, but I wish there were an easier way.

To the question, how did you feel about your body while you were pregnant?, Lina responded:

I didn’t like it. It just overwhelmed me, the kinds and the variety of sensations, and the things that happen to your body because of the pregnancy. I didn’t like it at all. I felt totally alienated from my body.

Even Leah’s positive experience of pregnancy is expressed in terms of separation and a feeling of lack of control:

I really did feel very healthy. It was different being so focused in my body. That’s what was so curious. I was watching all this happening. It was something taking control all over me and it was all good. To a certain extent I try to live outside my body so it doesn’t control me. Only in this case it was very much controlling me. And that’s ok–it was guiding me.

Joanne added:

I was real apprehensive about going into labor. It kind of terrified me, mostly because I like to be in control….and you don’t have any control when that happens. I used to have nightmares about standing in front of the president and making a presentation and having my water break.

And here is how Beth experienced birth:

I mean, it’s like a demon to me. There’s another being in your body that has to get out and it’s looking for a way to get out. And all of a sudden, it’s like my center of control left my brain and went to this, this thing in my body….I like to think that I can control whatever happens. But….all I was doing was lying there–I had to do whatever this other being said was going to happen. And it was my body that it was happening to. That was the thing I liked the least.

As they viewed the body as a vehicle for the mind or soul, so these women tended to see the pregnant body as a vessel, a container for the fetus (who is a being separate from the mother) and to interpret its growth and birth as occurring through a mechanical process in which the mother is not actively involved. (Sarah flatly stated, “You’re just a vessel. That’s all you are, just this vessel.”) These beliefs were behaviorally expressed in myriad ways during pregnancy. For example, the evidence these women relied on for proof of the baby’s health and growth was objective, coming primarily from ultrasound photographs and electronic amplification of the fetal heart rate. They understood the importance of nutrition, and knew that they had to eat well so the baby would be well-nourished. But, unlike the homebirthers, they saw this in terms of a simple, mechanical cause-effect relationship. If they ingested good foods, the necessary nourishment would travel to the baby through the placenta, enhancing overall development and especially brain growth. Excessive ingestion of alcohol or junk food, however, might result in a child with less-than-optimal brain capacity. Thus, eating well was a mother’s duty to her unborn child and one of the most important things, along with ultrasound and amniocentesis, that she could do to ensure optimal growth conditions. Although most experienced giving up alcohol and junk food as something of a burden, to them it was also a logical necessity, something they did as a matter of course. But it did not, conceptually speaking, entail their active participation in growing the child. It merely made them into the best possible “vessels.”

In keeping with these attitudes, most of these women did not view the processes of labor and birth as intrinsic to their feminine natures. Said Linda, “If my husband could do it the next time instead of me, that would be just fine. Added Joanne:

Even though I’m a woman, I’m unsuited for delivering….and I couldn’t nurse….I’ve told my mother–I just look like a woman, but none of the other parts function like a mother. I don’t have the need or the desire to be biological….I’ve never really been able to understand women who want to watch the birthing process in a mirror–just you know, I’m not, that’s not–I’d rather see the finished product than the manufacturing process.

The Mind/Body Split: Mind Over Biology

Emergent in Joanne’s words we see the technocratic notions that birth is a mechanical process and that there is no intrinsic value in giving birth “naturally,” because technology is better than nature anyway. Thus we can understand when Joanne says that she enjoyed her Cesarean birth because her anesthesiologist explained what was happening step by step, and because, since she felt no pain, she was able to be so intellectually present to the birth that she could watch the time to see which of her many friends who had placed bets on the time of the birth would win the $18 in the pot. She stated:

[I liked that because] I didn’t feel like I had dropped into a biological being….I’m not real fond of things that remind me I’m a biological creature–I prefer to think and be an intellectual emotional person, so you know, it was sort of my giving in to biology to go through all this.

Here Joanne expresses a view common among the women in this group:

The ideal, whole woman is intellectual and emotional, but not necessarily biological. (Some behavioral ramifications of this notion will be discussed later on.)

Like Joanne, Katie preferred the sense of control provided by a Cesarean, and in no way saw this as as a disempowering loss, but only as an empowering gain because it was something she had caused to happen. When her baby was two weeks overdue and labor had not begun, she told her doctor, who was urging restraint, “I am really getting sick of this. Please schedule [the Cesarean].” In response to the question, “How did you feel about yourself after the birth?” she responded, “I felt pretty special. Proud….I felt as if I had accomplished quite a bit.”

Kathy, who also described her Cesarean as personally empowering, said:

I don’t feel like I missed out on anything. With my first two I was put to sleep. With my third, Bryan, I was given an epidural. Heaven! I would never do it any other way. A Cesarean with an epidural. I was awake, everything. Ah, it was just wonderful…. I would have to say, hey, I participated in it. I was awake and I felt the pulling and the tugging. I did not push or anything. But I was definitely a part of what was going on.

Elaine summarized:

Well they induced labor and I wasn’t very good at my relaxation techniques and my breathing and after about four hours of labor I decided I would prefer to have a Cesarean and so that’s what we did….I know some women get all uptight about that, that it wasn’t a normal delivery, but I didn’t feel the least bit cheated and I feel my birth experience was just as happy as it would have been. I was very happy when I heard my baby cry, and it was a very pleasant experience.

In their words we hear again the belief these women strongly hold, that the mind is more important than the body, that as long as their minds are aware, they are active participants in the birth process. We hear this expressed even in Clara’s recounting of her rapid and unmedicated vaginal delivery:

Travis came in a little over an hour and that was just not enough time to get mentally prepared. I felt….my body was pushing me into having this baby. My mind was not there to work with it. I needed more time to be able to get on top of it and be there.

As a corollary of the idea that technology is better than nature, most of the hospital birthers in this study felt rather strongly that labor is naturally painful, that pain is bad, and that not to have to feel pain during labor is good and is their intrinsic right as modern women. To the question, what did you want out of the birth experience?, Joanne responded:

Out of the birth experience itself I wanted no pain. I wanted it to be as simple and easy and uncomplicated as most everything else has been for me.

Said Leah, “I made the decision–I had two hits of Demerol in the IV. I controlled the pain through that.” Beth, who “had planned for but did not end up with natural childbirth,” was nevertheless very pleased to feel that she also was in control of the decisions that were made. She had expected a long labor with little pain. When the pain became severe, she asked for relief, “and you know, even though I hadn’t planned on an epidural, they were very responsive when I said I wanted one.” The next time around, Beth planned for an epidural:

When I got there, I was probably about five centimeters, and they said, “Uh, I’m not sure we have time,” and I said, “I want the epidural. We must go ahead and do it right now!” So, we had an epidural.”

And Elaine stressed:

Ultimately the decision to have a cesarean while I was in labor was mine. I told my doctor I’d had enough of this labor business and I’d like to have a Cesarean and get it over with. So he whisked me off to the delivery room and we did it.

In keeping with this high value on making their own decisions, the major discontents these women expressed with the medical handling of their labors and deliveries resulted not from the administration of anesthesia, but from its witholding. Kay reported:

I [asked] for an epidural at one point, but they said they didn’t have time to do it….I was awfully uncomfortable and I had remembered how wonderful it was [with my fist birth] and that I had instantly felt terrific….I was mad that I was in so much pain, and then they would tell me something like “we don’t have time,” you know–that just drove me wild. I didn’t like that at all–I wanted to have it when I wanted to have it.

Another woman expressed outrage that a friend of hers in advanced labor had been denied anesthesia for the same reason as Kay, saying earnestly, “No one has the right to tell you that you have to go through that kind of pain.” Although a good bit of evidence exists on the depressive effects of analgesia and anesthesia on the baby during labor and birth [2], most of these women felt very strongly that they had an absolute right to the mind-body separation offered by such drugs, especially the epidural. Lina spoke for the majority:

I read all this stuff that told me I would be a complete asshole to have an epidural and I revolted. [The books said that] I would be able to see that it’s much better for the baby and it’s a natural experience, and there’s just all this pressure….I quit smoking, ate meat, drank milk for months and months–I had been such a good girl. A couple of hours of whatever an epidural was going to do to me, tough. You can put up with it, kid.

Later on Lina insisted that her physician would be the one to know if the drugs used in labor posed any dangers. She and many others stated firmly that they did not believe that their doctors would let any harm come to their babies. In this belief is illustrated yet another technocratic precept: Medical knowledge is authoritative [32, 33]. In contrast to the home birthers, as we shall see in a moment, none of the thirty-one hospital birthers reported much respect for or reliance on their own intuition or “inner knowing.”

The Separation of Mother and Child

About leaving her six-week-old baby at a day care center, Linda the pediatrician had this to say:

[Q. Do you feel that it would be better for your baby to be with you?]

Possibly. On the other hand, I also feel like I probably wouldn’t be very happy. I’d probably start climbing the walls, and in a way that would be a bad thing to do to him, to say well alright, I’m going to throw away twenty years of education to stay home with you so that you can be the perfect child.

Thus we arrive at a central question for most of these women: where are they going to put their bodies, carriers of their selves, in relation to their children, the products of those bodies? The answer in general is that as the children were thought of as separate in the womb, so this separation achieves near-immediate geographical reality after birth. The majority of these women work ten-hour days, and so see their children only for a maximum of one-and-a-half to two hours per day. This situation is a logical extension of their own body images and is in perfect harmony with the chartering mythology of the technocracy, based as it is on the separation of wholes (a river, the birthing body, the family) into their component parts, and on the cultural management of the parts (damming the river, sectioning the body, enculturating children at school). Their perceptions and experiences of this parent/child separation are varied, and, due to space limitations, will be addressed in future publications. I will simply add here that to rationalize the time/attention differential between work and parenting, most of these women hung their hats on the popular notion of “quality time”–a notion that easily lends itself to interpretation as a prosthetic device for the technocratic reconstruction of the continually deconstructed (mutilated) American family [34].

Home-Birthers and the Organic Body: A Cultural Alternative

The contractions kept coming. Each one of them pushed….I tried joining in, very carefully. I pushed with my stomach muscles, just a little…but whoa, my uterus grabbed me and drove me along with itself. I couldn’t push just a little. It had to be a lot….It was so powerful and uncontrollable. I might push myself inside out if I went too far. But who cares? I didn’t try to hold back any more. I pushed hard. I grabbed onto Vic, onto the folds of his clothes. I held my breath and pushed as hard as I could and it felt good. It felt better. The contractions didn’t hurt as much any more. It was exciting. I’m pushing!

– Janet Isaacs Ashford, “Doing It Myself”

We will turn now to consideration of the body images and worldviews of the eight home birthers in my study. Four of these– Kristin, Ryla, Karen, and Liza–were the most extreme proponents of what I have called the holistic model of birth [2]. These four, like Linda’s sister, were the sort of women that Linda would call “Earth Mothers.” They did not have professional careers in the business or academic worlds, but worked out of their houses as “New Age” counselors and rebirthers, and devoted a large proportion of their waking hours to motherhood. The other four–Tara, Susan, Elizabeth, and Sandra–are professionals of the same ilk as the hospital birthers (Tara and Susan run political campaigns, Elizabeth teaches at a university, and Sandra manages a store.)

Self/Body Integration

Interesting differences emerge between the body images of these two subsets of home birthers. The women in the first group (the home-workers) place no distance between self and body, saying “I am my body,” or “My body is the physical expression of me.” In so saying, they are expressing the very un-Cartesian notion that self and body are One.

Differing in many ways from these “Earth Mothers,” the four professionals in this study who gave birth at home share much with their hospital-birth sisters, most notably including their desire to be in control and their feelings that body and self are separate. Yet somehow they sense that these notions are inconsistent with their choice of birthplace and the philosophy that accompanies it, as well as with their lived experiences of pregnancy and birth. You can hear them struggling with this inconsistency in the way they discuss their relationship with their bodies. Tara gets herself halfway toward wholeness, saying “I think that probably 50% of who I am is my body.” And Susan shows us how her lived experience of pregnancy contradicted and changed her former notions. She stated:

I used to see my body as the vehicle in which I can run around and project myself to the world….I never thought about my body as being me until I did get pregnant. And then you feel very much in tune because you can feel everything that is going on….and now I am so much more comfortable with my body, and more and more I see it as part of my Self.

These home birthers, like Martin’s working class women [22], tended to reject medical definitions and value judgments in favor of their own lived experience. Experiencing the body as the self, or as part of the self, they came to stress in belief and behavior the body’s organic interconnectedness, as opposed to its mechanicity, and to view the female body as normal, attractive, and healthy:

Before, I was very uncomfortable with my body–the way I looked, the way I felt, just everything. Since I gave birth, it’s just not a problem any more….I kind of like the way I look. [Susan]

These homebirthers felt deeply and strongly that female physiological processes, including birth, are healthy and safe:

[She]…said “Sandra, are you still thinking about having this baby at home?…I think you’re absolutely insane. What if something happened?” I said, “Are you not going to drive your car because you could have a wreck? You’ve got a higher risk doing that than having a baby at home.” My friends think I’m crazy. But I think they are. I mean really, they are–they’re the ones that have missed the whole birth experience, not me.

Letting Go of Control

In dramatic contrast to the high value placed on control by the hospital-birthers, the non-professional, spiritually-oriented Earth Mothers in my study felt that giving up control was far more valuable in birth and in life than trying to maintain it–a philosophical position again arrived at through lived experience. Said Liza:

I was brought up in the mainstream, and I used to knock myself out trying to control everything. Then I got sick, and I realized that I actually can’t control anything or anyone. As soon as I let go of trying, and just began to surrender to what is, everything in my life started to work. I got well, I got married, I had a baby. And if the lesson needed reinforcing, labor did it. That is a force beyond control, a powerful wave that will drown you if you fight it. Better then to dive into it, to relax, let it carry you. Whenever I tried to control my labor or myself during labor, I was in agony. But when I let go and surrendered to the waves, they carried me.

Again, we see Tara and Susan moving in that philosophical direction through their lived experience. To the question, “How important is it to you to be in control?” Susan responded:

You know the answer to that! It’s more important than it should be. Because I get very carried away with it sometimes, and [I need to learn to let it go]. I’ve been a lot happier since I started practicing that.

Tara put it this way:

I always had in my mind that morning sickness was psychological and that basically I could control all these things. If I did things right, ate the right things and treated my body the right way then I wouldn’t have to worry about kinds of morning sickness that people have and I could have a quick and easy labor. I exercised a lot, you know, I paid attention to my diet and everything and I realized, finally, after nine months and a birth, that there are a lot of things you just don’t have control over. But it took me that long to admit it.

Tara’s kinship with the professional women discussed in the prior section is reflected in her early desire for control over the birth process, and her belief that she could achieve such control by doing all the “right” things in preparation for the birth. Her holistic view of birth kept her from wishing to utilize the technocratic forms of control so important to her professional sisters. Unlike them, she was willing to give up her desire for control to the experience that such control was not and had never been hers.

Pregnancy as Integration

As we might expect, Tara and Susan, like Linda’s “Earth Mother” sister, enjoyed pregnancy’s constant changes, and came to value their lack of control over these changes. Tara declared, “I loved being pregnant. I just loved all of it. I liked looking at my body in the mirror. I couldn’t wait to see what would happen next.” Susan said, “I was in awe…Being pregnant was fascinating….It isn’t when you’re barfing in the toilet bowl every morning, but when that part is over, you feel good. You feel better than you ever had in your life.”

To the direct question, “Other women I have interviewed experienced their body changes during pregnancy as being out of control, meaning that they didn’t have control. Why didn’t you?” Susan responded:

Whenever anything like that happened to me, I had already read up or talked to midwives and I knew it was coming. I knew that that was going to happen next and it was all part of this wonderful experience of getting pregnant. It felt like it was natural. It was what your body was supposed to do. One step closer to having that baby there.

This response and others like it show that these home birth women place just as much importance on their minds as do the hospital birthers in this study, but in a rather more integrated way that sees the body and its changes as equally important, and holds body and mind to be equally important parts of the whole.

According to the holistic model espoused by these homebirthers, like self and body, mother and baby are essentially One–that is, they form part of an integrated system that can only be harmed by dissection into its individual parts. Much more than a passive host, or “vessel,” the mother sees herself as actively growing the baby. Susan said:

Especially when you’re actually actively doing all the exercises you’re supposed to be doing and you’re actively eating and drinking what you’re supposed to be eating and drinking, then you really feel like you are nourishing and growing the baby.

For Kristin, this feeling of active involvement in pregnancy combined with experiences that generated in her sensations of, and then belief in, the reality of active communication, unity, and partnership with her unborn baby:

When I was about two months pregnant…suddenly, from somewhere inside of the front of my head I heard these words, “I’m here, I’m a girl, and my name is Joy Elizabeth”….One night [much later on], I had a Braxton Hicks contraction and I heard a voice inside say “I’m scared.” I told her I was scared too and that everything would be okay because we were partners and we would do this thing together.

Elizabeth described her experience of active communication and sense of partnership with her unborn as follows:

Two weeks before he was born, he was still breech. My midwives felt confident about a breech delivery, but I….very much wanted him to turn. I went to a therapist who was good at visualization, and asked her to help me get in touch with him. We did the visualization…I could see him so clearly…and I asked him to turn. By the time I woke up the next morning, he had completely turned, and he stayed that way until he was born!

Mind-Body Integration: Active Agency and Inner Knowing During Birth

For these home birthers (as, in their very different way, for the hospital birthers) this active and participatory role was key. Near the beginning of her first pregnancy, during her very first interview with an obstetrician, Susan became angry because his response to her questions was, “You don’t need to worry about that. I’ll take care of that.” She said, “He thought he knew more about it than I did!” When I asked her, “Why didn’t you assume that he did know more than you?” she replied:

Well, I didn’t consider having a baby something I wasn’t supposed to take part in. That I was just there to grow this baby and he was going to take it out of me…I knew better than that. I knew that it was me 100% that was going to get this baby through the birth canal and out into the world. That was my job, and I wanted somebody who would work with me to do the best job I could.

Just as these homebirthers see themselves as actively growing their babies, so they also see labor and birth as hard work that a woman does. This holistic view that does not separate the woman from the process of labor accepts pain as an integral part of that process. To eliminate that one part would interfere with the systemic whole, and would begin a cycle of interference that might have unforeseen results. When I asked, “Did it mean anything to you that you went through the pain?” Tara responded:

Oh yes. It’s part of the whole experience….Even though during labor I remember feeling it was almost unbearable, it never entered my mind to wish I had “something for the pain”….I wanted the pain to stop, but not because somebody gave me something….Wonderful physical and emotional stuff goes on at the same time as the pain. If you took drugs for the pain, you would change all the rest of it, too.

Brigitte Jordan defines authoritative knowledge as “legitimate, consequential, official, worthy of discussion, and useful for justifying actions by people engaged in accomplishing a certain task or objective” [35, p. 319]. Under the technocratic model, only technologically obtained medical knowledge is said to be authoritative. But homebirthers operating under the holistic model often regard a woman’s intuition or “inner knowing” more highly than the objectively obtained information of tests.

For example, late in labor Elizabeth’s midwife became concerned because the baby’s heart tones were dropping, and muttered under her breath about possibly going to the hospital. Elizabeth heard her, and was “flooded with the total certainty that her baby was fine.” She leaned forward between pushing contractions, and whispered this inner knowing to the midwife, who immediately and visibly relaxed. Later, when asked about this response, the midwife replied, “Over my years of doing home birth, if I have learned anything it is to trust what mothers know.”

On the subject of whose knowledge to trust, Susan expressed herself very strongly. She said:

I went to an OB when I found out I was pregnant. And I told him, son of a bitch, that I was pregnant, and he said, “Let’s test you and see.” And I said, “No, I am pregnant and I’m trying to pick an OB.” And he said, “Let’s pee in the little cup and let me see.” And that infuriated me….[And then I called a lay midwife] and we just hit it off like that. Instantly I knew that this was what you were supposed to do. This was the way to have a baby.

In technocratic reality, not only are mother and baby viewed as separate, but the best interests of each are often perceived as conflicting. In such circumstances, the mother’s emotional needs and desires are almost always subordinated to the medical interpretation of the best interests of the baby as the all-important product of this “manufacturing process.” Thus, individuals operating under this paradigm often criticize home-birthers as “selfish” and “irresponsible” for putting their own desires above their baby’s needs. But under the holistic paradigm held by these home birthers, just as mother and baby form part of one integral and indivisible unit until birth, so the safety of the baby and the emotional needs of the mother are also One. The safest birth for the baby will be the one that provides the most nurturing environment for the mother. Said Tara, “The bottom line was that I felt safer [at home]. It seemed strange to me that some people feel safer with drugs.” Elizabeth confirmed, “My safest place is my bed. That’s where I feel the most protected and the most nurtured. And so I knew that was where I had to give birth.” And Ryla added:

I got criticized for choosing a home birth, for not considering the safety of the baby. But that’s exactly what I was considering! How could it possibly serve my baby for me to give birth in a place that causes my whole body to tense up in anxiety as as soon as I walk in the door?

According to the technocratic model, the uterus is an involuntary muscle, and labor proceeds mechanically in response to hormonal signals. All eight homebirthers were attended at home by midwives who see the uterus as a responsive part of the whole, and who therefore believe that the best labor care will involve attention to the mother’s emotional and spiritual desires, as well as her physical needs. The difference between these two approaches is clearly illustrated by the responses of a physician and a midwife to the stopped labor of a client. The physician said, “It was obvious that she needed some pitocin, so I ordered it,” and the midwife said, “It was obvious that she needed some rest, so she went to sleep, and we went home.” Here is Susan’s story:

Nikki [the midwife] kind of got worried towards the afternoon, because it just kept going on and nothing was changing. And she took me to the shower and said, “Just stay in there till the hot water goes away.” And then Nikki asked my friend Diane, “What’s the deal with Susan? Is she stressed out about work?” And Diane said, “Well, yeah, I think she’s afraid to have the baby…that she’s not going to be able to go back to her job.” So when I came back out Nikki said, “Right now your job is not important. What you have to do right now is have this baby. This baby is important.” And I just burst into tears and was screaming at her and crying and I could feel everything just relax. It all went out of me and then my water broke and we had a baby in thirty minutes. Just like that.

It is important to understand that the holistic ideology held by these women both potentiates and explains these dramatic experiences of mind-body and mother-child connectedness. Such experiences are common in the narratives of home-birthers [2, 36-38], as are experiences of birth as enhancing that integration. Kristin said:

Pregnancy and birth changed my whole view of myself. I had never valued myself as a woman. I valued the masculine aspects of my personality, but I considered my womanly traits weak and counterproductive. [Birth was] an incredible discovery of the power of my intuition, and of the value of trusting myself.

Integration as a Life Principle

Just as so many domains of life for the hospital-birthers in this study are chartered by a mythology based on separation, so the principles of integration and interconnectedness that these home-birthers internalize through pregnancy and birth spill over into many other areas of their lives. Many of them work in family enterprises centered around the home and some also homeschool their children. (One told me that she often thinks of her children as little moons in constant orbit around her sun, with all of them together, including the big planet, her husband, encompassed within the body of one solar system.) Even those who work in the professional world do the best they can to minimize the separation of the personal and professional realms; for them, that separation is a not a fundamental organizing life principle but a “necessary evil.” For example, Susan reports that she is learning to utilize the principle of giving up control in the office, and is finding that the results include lowered stress levels and improved relationships with subordinates, who feel freer to innovate and take on more responsibility as she becomes less controlling, less separating of herself and her position from them. Elizabeth began experimenting with the same principle in her teaching, and finds that when she gives up trying to control her students by making them see things her way, potential confrontations transform into mutually productive discussions. Likewise, when her children become ill, Elizabeth rarely takes them to a doctor:

Since I learned so much about mind-body integration from giving birth, I know that most of the time, they can heal themselves, if I can just listen well enough to help them figure out what’s really wrong emotionally. Once we handle that, usually their bodies can quickly take care of the rest.

Susan uses her experience of birth to conceptualize more concretely her link to all of life:

I would prefer that birth remain as natural as possible….Birth is what ties us to other forms of life, creates a bond between human women that goes back hundreds of generations, and bonds us to other species as well. The more technological birth becomes, the more it differentiates us, and the more unlike other species–and other members of our own species–we become.

Table 1. The Technocratic and Holistic Models of Birth Compared

This table presents a comparison of the basic tenets of the hegemonic technocratic model and the alternative holistic model as they have emerged from the words and behaviors of the women in this study.

Some Commonalities

In my efforts to make clear the profound differences in how these two groups of women relate to the dominant technocratic model, I have no doubt overemphasized the polarities which, although real, can obscure some important commonalities that need to be acknowledged. Most salient, I think, especially regarding the concept of the technocratic model as an agent of social control, is the fact that all of these women are far from resembling the passive victims of technocracy that many of their mothers may have been. All were active agents in their birthgiving, albeit in radically different ways–and in their relationships, pro or con, to the hegemonic technocratic model. For both groups, curiously enough, that agency took the form of control. We have seen the importance of control to the hospital-birthers; we might also note its importance to the homebirthers. For although they gave up trying to control their bodies, they very actively sought to retain control of other sorts of things, most particularly of their birthspace. “Nosy neighbors,” “nervous parents,” and “medical types” were to be kept out; besides partners and children, only carefully selected midwives and certain friends were allowed in. As Elizabeth put it, “I had to control my birth environment, so that nobody would control my birth.”

I find other important commonalities: the separation so pervasive in the lives of the professionals was also an issue for the homebirthers, some of whom had to deal with the same issues of separation from their children during working hours, even when they were working at home. Concomitantly, the integrative principles so important to the homebirthers were also much in evidence in the lives of some of the professionals. Their techniques of integration included breastfeeding and bringing their children to the office both before and after birth. Most, even if they devalued feminine biological processes, did place high value on what they saw as the feminine qualities of nurturance and emotionality, and sought to bring these qualities into the workplace in order to “humanize” the office environment. For example, Louise, when asked what she thought about applying corporate strategies to family life, replied that it was more a question of applying family strategies to the business world:

I treat my clients as if they were as important to me as my family, and it pays off. They really respond, and I have turned this business around from losing to making money in less than a year because of it.

When Janis was head of the electric customer service office, she often worked intensively one-on-one with delinquent bill payers to help them develop an overall economic plan that would work for them. She said,

I still get visits from people who tell me that I turned their lives around for good, because instead of being their adversary, I nurtured them, and I’m proud of that. I think being a mommy makes me a better professional.

These women’s integrative efforts not only included creating more personalized relationships with clients and employees, but also friendlier environments–they redecorated sterile office buildings with softer colors, warmer lighting, conversational areas, artwork, and potted plants, finding that such efforts repeatedly paid off in increased productivity and enhanced intraoffice relationships.

The Technocratic Model as an Agent of Social Control/
Professional Women as Agents of Technocratic Control

We recognize that the kinds of liberatory fantasies that surround new technologies are a powerful and persuasive means of social agency, and that their source to some extent lies in real popular needs and desires.

– Constance Penley and Andrew Ross,
Technoculture

Both anthropologists and feminists have interpreted birth practices as involving control over women’s bodies, postulating a dichotomy between control by women and control by male-dominated institutions. But for the women in my study, this dichotomy misleads. The homebirthers see the letting go of bodily control as essential to giving birth, whereas the professionals define their bodies as separate entities that need to be controlled. They do not see themselves as being controlled by the medical establishment, but rather as manipulating its technocratic resources to control their own bodily experiences. Emily Martin suggests that such feelings of being “empowered and in control” are illusory, and that “losing control” in birth “can mean having one’s body physically penetrated, as the Cesarean section rate….is now over 20% in many states” [22, p. 309]. But for these professional women (one of whom scheduled her Cesarean to take place between conference calls), having a Cesarean is not losing control but gaining it–given the models of reality they individually hold. Regardless of how they came to believe in the value of technocratic control, the fact that they do believe in and value such control is not an illusion, and their feelings of empowerment when they achieve such control through the agencies of the professionals they have hired for that purpose–their physicians–are not illusions either. Although I may personally perceive technocratic birth as disempowering for birthing women, as an anthropologist I know that those who participate most fully in a society’s hegemonic core value system, as these women do, are most likely to feel empowered by and to succeed within that system, as these women have.

In “Society and Sex Roles,” Ernestine Friedl postulates that

in any society, status goes to those who control the distribution of valued goods and resources outside the family…Only as managers, executives, and professionals are women in a position to trade goods and services, to do others favors, and therefore to obligate others to them. Only as controllers of valued resources can women achieve prestige, power, and equality. Within the household, women who bring in income from jobs are able to function on a more nearly equal basis with their husbands [39, p. 218].

Certainly, these professional women confirm Friedl’s hypotheses–they are highly successful in the wider society as controllers of “valued goods and resources,” and at home all but one reported that their marriages were extremely egalitarian. (While the “Earth Mothers” in my study define themselves as successful, the criteria of the technocracy would judge them less so than the professionals, as they are not in general controllers of “valued goods and resources,” although they do enjoy egalitarian marriages with husbands who share the same alternative worldview as they). These highly successful women are in large part so successful because of that emphasis on control–in spite of the inevitable setbacks, they do seem to succeed at controlling much of what they set out to.

While some American women find value in the ideal of surrendering to the natural process of childbirth, these particular women do not. They want plenty of education and personal attention, but not when it is framed under a holistic paradigm; in fact, they perceive the holism of the homebirthers described above as frightening, irresponsible, limiting, and disempowering. While homebirthers see the hospital as out-of-control technology running wild over women’s bodes, these professionals experience the hospital and its technology as a liberation from the tyranny of biology, as empowering them to stay in control of an out-of-control biological experience.

In Reynold’s analysis of technocratic mythology [3], the purified “male” body is constructed through a series of ritual acts that cut off the “natural” and polluting elements and replace them with scientifically chartered prosthetic devices. The effect of these rituals is to split holistic processes into a hierarchy of conceptually distinct parts arranged on a scale of “primitive” to “advanced.” The technocratic mythology enacted in these rituals thus produces an increasingly fragmented world in which intellect is separated from body, one’s own body from other bodies, and human bodies from the rest of organic nature.

Proponents of a mythological system tend to both create and experience the world in its image. Childbirth educators and midwives today often speak of the nineties as the age of the “epidural epidemic”–an apt metaphor. The deeper we probe into the correlations between technocratic mythology and the beliefs of these professional women about birth and their female bodies, the more we can understand why this is so. As the epidural numbs the birthing woman, eliminating the pain of childbirth, it also graphically demonstrates to her through her lived experience the truth of the Cartesian maxim that mind and body are separate, that the biological realm can be completely cut off from the realm of the intellect and the emotions. This microcosmic mirror of our technocratic society casts its reflection in ever-widening ripples in the pond of social life. As the babies so mechanically birthed are carried off to the nursery and placed in their separate bassinets, and spend much of infancy in their separate cribs and plastic carriers, so in later years they will be carried off to day care and to school. Ours is a nation founded on principles of separation, and we enact and transmit those principles to each other in the spatial and interactional patterns we have developed between mind and body, mother and baby, parents and child.

Conclusion:
The Technocratic Model as a Template for the Future?

The technocratic model of nature and society…is a folk system of belief, with no more claim to universal validity than any other theory created by savages.

– Peter C. Reynolds,
Stealing Fire: The Mythology of the Technocracy

In American hospital birth, socially constructed categories of gender have been reified by Western medicine both through the definition of pregnancy as a dysfunctional mechanical process and through the selective application of medical technologies for the de- and reconstruction of that process–the One-Two Punch. Thus, the medical management of birth has become a cultural expression of the core values of the technocracy. Fortunately, birth itself is an amazingly resilient natural process. Midwives can guide and nurture its natural course, or physicians can dissect and technocratically reconstruct it; either way, it will still turn out well almost all of the time. The real issue is not what is “best” in any absolute sense, but what aspects of culture are expressed and perpetuated, what cultural lessons are taught and learned during the production of new social members. (As I have shown in an earlier work [2], the issue is not even one of safety–planned, midwife-attended home birth does not increase risk.) Salmon will still spawn either way, but those ways have vastly different meanings. One exists apart from us and the other because of us. It is easy to see which one infuses our own existence with the most meaning. In the first situation, we are, as in the Native American view, a small integral part of a vast systemic whole–God’s creation. In the other, we are the creators, we are god. To technocratize a natural process is to create it in the image we have chosen as the guiding metaphor for our own evolution, and thus to confirm that evolutionary path as the right one. In other words, Punch Two reifies our cultural system and deifies us, allowing us the illusion of a degree of control heretofore unkown on the planet.

As feminists, we have fought for the right to make our bodies our own, to metaphorize, adorn, and technologize as we please. Our culturally shaped and embedded choices have granted us huge successes in technocratic society and highly technocratized bodies in which the biological processes of pregnancy, birth, and motherhood can take place at some distance from our emotional and nurturing selves. The intensifying quest of many women for distance from these processes leads inevitably to the question: as women increasingly try to break out of the confines of the biological domain of motherhood, will/should our culture still define that domain as primarily belonging to women? What do we want? As we move into the 21st century, will the options opened to us by our technology leave equal conceptual room for the women who want to be their bodies, as well as for the women for whom the body is only a tool? In the new society we are making, will the homebirthers and the homeschoolers, the goddesses and the Earth Mothers, have equal opportunity to live out their choices alongside those who want to schedule their Cesareans, and those who want their babies incubated in a test tube? As researchers like Ehrenreich and English [9, 40], Corea [8], Rothman [27, 41], and Spallone [42] have shown, the patriarchy has been and is only too willing to relieve us of the necessity for our uniquely female biological processes. To what extent do we desire to give up those processes that since the beginning of the species have defined us as women, in order to merge into the technocracy and succeed on its terms?

When asked about her vision for the future of American birth, Joanne, the professional who did not want to “drop into biology,” spoke of the benefits of genetic engineering, saying, “I think people in the future are going to expect medicine and science to have more answers.” Her prediction is echoed in Life [4, p. 57]:

Nothing will have more of an impact on the future than medical science….Anyone thinking of starting a family will begin with a Sears catalogue of options: A woman wishing to postpone childbearing for career development may want to freeze a few eggs for later use; a woman who is unable to conceive may want to “adopt” an embryo deposited by an anonymous donor at a frozen embryo bank, then carry it in her own body.

In contrast to such futuristic scenarios of separation, Tara’s vision for the future makes an explicit connection between the ecological principles of the environmental movement and home birth:

How do we change this trend toward more drugs for birth, more machines?….If we get back to caring about the Earth, being caretakers, it would be difficult not to translate that into other parts of our lives. Sooner or later people will ask themselves how they can give birth drugged and hooked up to machines, when they are trying to stop treating their own Mother Earth that way.

Ryla, an ecofeminist like Tara, is engaged in research on water birth, and on swimming in the ocean with dolphins in order to tap the potential of interspecies communication–two futuristic extremes she was drawn to by the holistic model’s emphasis on interconnectedness. Others such extremes of interconnectedness are represented by those who attempt to conceive babies consciously [43] and to enhance psychic communication between mother and child [44]. Many such holistically-oriented individuals are consciously attempting to counterbalance the disembodied future towards which the technocratic model seems inexorably to be leading us.

Extremes, on both ends of the spectrum, play an important role in defining the outer edges of the possible and the imagined. Most especially, those at the extreme of conceptual opposition to a society’s hegemonic paradigm–the radical fringe–create much more room for growth and change within that society than would exist without them. How much more technocratic might hospital birth look, if no one in this country believed that mother and baby are One, that there is an inner knowing that can be tapped, that fulfilling the emotional needs of the mother is the best approach to the health of the child?

But as Reynolds points out, the technocratic paradigm is intrinsically hegemonic, and it sees its own survival in an endless and accelerating race to transform nature into man-made analogs. Technocratic assumptions pervade medical practice and guide almost all reproductive research, so no middle-class woman who gives birth at home can fail to be aware that she is battling almost overwhelming social forces that would drive her to the hospital. The homebirthers in my study who espouse the holistic model do so in direct and very conscious opposition to the dominant technocratic mythology and its ritual One-Two Punch. They represent the fewer than 1% of American women who choose to give birth at home. I suggest that the importance to American society of this tiny percentage of alternative model women is tremendous, for they are holding open a giant conceptual space in which women and their babies can find mythological room to be more than mechanistic antagonists. Homebirthers I have interviewed use rich images to describe pregnancy, labor and birth that work to humanize, personalize, feminize, and naturalize the processes of procreation. They speak of mothers and babies as unified beings, complementary co-participants in the creative mysteries, entrained and joyous dancers in the rhythms and harmonies of life. They talk of labor as a river, as the ebb and flow of ocean waves, as ripened fruit falling in its own good time. They search for myths from indigenous cultures that honor the deep, dark, bloody secrets of birth:

For example, Changing Woman dancing with the bloody scalp evokes an immediate image of the bloody birth opening through the pubic hair. That this image is evoked as a dance of triumph and joy, rather than as a loss of body and soul integrity, is healing. Death in this image is depicted as integral to birth. What can occur in the birthdance is a dying to the Self, a transcendence of the egoic control that forever seeks to separate us from our experience. So freed, the birthing woman now has the possibility to experience the Mystery [45, pp. 13-14].

Home birthers in the United States are an endangered species. (As part of a fundraising effort, a group of local midwives is selling T-shirts with whales painted on the front; the caption underneath reads “SAVE THE MIDWIVES!”) Should they cease to exist, the options available in American society for thinking about and treating pregnancy, birth, and the female body would sharply decrease, and our society would be enormously impoverished. Should they thrive, we will continue to be enriched by the alternative mythologies they are actively engaged in creating.

The potential significance of those mythologies is heightened by the conclusion of Stealing Fire [3]. After a careful review of technocratic developments in physics and biology, Reynolds ominously notes:

A logically consistent eschatology, couched in the terminology of biological science, is currently building in the subculture of laboratories, medical institutions and government agencies, both in the United States and in other countries with a heavy commitment to the imagery of technocracy. Although the system is not yet institutionalized…[its] constellation of beliefs can be summarized as follows: * Human nature must be superseded if the species is to advance, so we need to take control of the evolutionary process by means of molecular biology. *However, sexual coupling between men and women for reproductive purposes is a primitive technique that perpetuates sexist relationships. *To be liberated from sexism, women must abandon childbirth in favor of asexual reproduction based on more modern, scientific procedures.

Reynolds concludes that the technocracy is ultimately antithetical to both sexes, as it seeks to replace biological evolution, with its messy blood and mucous, with “a bloodless, fearless, and disembodied state in which ‘nature’ is transformed into radiant energy” [3, p.201]. Reynolds predicts widespread disenchantment with technocratic mythology when it finally becomes apparent that this ultimate evolutionary step is forever beyond the abilities of science and technology to achieve. I am not convinced that the technocratic scenario will unfold as Reynolds suggests, but should such disenchantment come to pass, perhaps at that point our culture will turn toward those who never aspired to the technocratic goal for alternative mythologies–organic mythologies that can charter a vital and vitalizing dance to the music of an embodied earth.

References

1. Davis-Floyd R. E. The role of obstetrical rituals in the resolution of cultural anomaly. Social Science and Medicine 31, 2, 175-189, 1989.

2. Davis-Floyd R. E. Birth as an American Rite of Passage. University of California Press, Berkeley and London, 1992. Birth practitioners and social scientists usually refer to this paradigm as “the medical model.” In earlier works [1, 6, 21, 48] I have called it “the technological model” in order to stress its connections to the technologically-oriented core value system of American society. But all societies have technologies, and Reynold’s work [3] has made me realize that the term “technocratic” is a more precise representation. “Technocracy” connotes a society that supervalues and organizes itself in terms of its technologies and is bureaucratic, autocratic, and hierarchical; thus this term is an apt referent for contemporary American society. Websters defines a technocracy as a “society managed by technical experts.” American birth is likewise defined by its management by technical experts, and thereby the hegemony of the technocratic model is extended into the cultural shaping of childbirth.

3. Reynolds P. C. Stealing Fire: The Atomic Bomb as Symbolic Body. Iconic Anthropology Pres, Palo Alto, Ca, 1991.

4. Life Magazine. “Visions of Tomorrow,” February, 1989, pp. 50-94.

5. Ellul J. The Technological Society. Translated by John Wilkinson. Vintage Books, New York, 1964. (First published in French in 1954.)

6. Davis-Floyd R. E. “The Technological Model of Birth” J. Am. Folklore 100, 479-495, 1987.

7. Martin E. The Woman in the Body. Beacon Press, Boston, 1987.

8. Corea G. The Mother Machine: Reproductive Technologies from Artificial Insemination to Artificial Wombs. Harper and Row, New York, 1985.

9. Ehrenreich B. and English D. Complaints and Disorders: The Sexual Politics of Sickness. The Feminist Press, Old Westbury, NY, 1973.

10.Leavitt J. Brought to Bed: Childbearing in America 1750-1950. Oxford University Press, New York, 1986.

11.Mendelsohn R. A. Mal(e)Practice: How Doctors Manipulate Women. Contemporary Press, Chicago, 1981.

12.Oakley A. The Captured Womb: A History of the Medical Care of Pregnant Women. Basil Blackwell, New York and Oxford, 1984.

13.Payer L. Medicine and Culture: Varieties of Treatment in the United States, England, West Germany, and France. New York, Henry Holt and Co., 1988.

14.Wertz R. W. and Wertz D. C. Lying-In: A History of Childbirth in America, 2nd edition. Free Press, New York, 1989.

15.Nolen W. A. How doctors are unfair to women. In Culture, Curers, and Contagion, ed. Norman Klein. Chandler and Sharp Publishers, Inc., Novato, Calif., 1979.

16.Abramson M., and Torghele J. R. Weight, temperature change, and psychosomatic symptomatology in relation to the menstrual cycle. American Journal of Obstetrics and Gynecology 81, 223, 1961.

17.Ritter C. A. Why pre-natal care? American Journal of Gynecology 70, 531. November, 1919.

18.Feldman G. and Freiman A. Prophylactic Cesarean section at term? New England Journal of Medicine 312, 19, 1264-1267, 1985.

19.Beecham C. T. Natural childbirth: A step backward? Female Patient 14, 56-60, 1989.

20.Cunningham F. G., Macdonald P. C. and Gant N. F. Williams Obstetrics, 18th edition. Appleton and Lange, Norwalk CT, 1989. For a detailed cultural analysis of the first seventeen editions of Williams Obstetrics, see Hahn, R. A., Divisions of labor: Obstetrician, woman and society in Williams Obstetrics, 1903-1985. Medical Anthropology Quarterly 1, 3, 256-282, 1987.

21.Barbara Katz Rothman, Plenary Address, Midwives Alliance of North America Conference, New York City, November 1992.

22.Martin E. The ideology of reproduction: the reproduction of ideology. In Uncertain Terms: Negotiating Gender in American Society (Edited by Ginsburg F. and Tsing A. L.), pp. 300-314. Beacon Press, Boston, 1990.

23.Arms S. Immaculate Deception. Bantam Books, New York, 1981 (orig. pub. 1975).

24.Hazzell L. D. Commonsense Childbirth. Berkeley Medallion Books, New York, 1976 (orig. pub. 1969).

25.Haire D. The cultural warping of childbirth. International Childbirth Education Association, Minneapolis, MN, 1977.

26.Romalis S. (Ed) Childbirth: Alternatives to Medical Control. University of Texas Press, Austin, 1981.

27.Rothman B. K. In Labor: Women and Power in the Birthplace. Norton, New York, 1982. (Reprinted in paperback under the title Giving Birth: Alternatives in Childbirth. Penguin Books, New York, 1985.

28.Shaw N. S. Forced Labor: Maternity Care in the United States. Pergamon Press, New York, 1974.

29.The results of this study, reported in detail in Birth as an American Rite of Passage [2, Chapter 5] can be summarized as follows. Out of 100 women interviewed: 70 were comfortable with their technocratic births to varying degrees 42 of them had started out with the expressed intention of “doing natural childbirth,” but ended up with (and were quite accepting of) highly technocratic births instead 28 wanted technocratic births to begin with, and were generally satisfied with the ones they got; 15 desired and achieved natural childbirth in the hospital; 9 desired natural childbirth but did not achieve it, and were seriously disturbed as a result; 6 gave birth at home.

30.Fifteen of these interviews were conducted and transcribed by the following students: Kim Durham, Michelle Gomez, Melody Hatfield, Courtney Hollyfield, Lori Pressley, Erin Rogers, and Mark Thompson. I wish to express my appreciation to these students for their hard work, their enthusiasm, and their continuing inspiration, and to Adela Popp for her excellent tape transcriptions.

31.I asked all of the professionals about the notion of applying corporate management techniques to family life, such as scheduling family summit meetings, etc. A few thought this strategy would detract from the unstructured flow that they saw as the essence of the personal, as opposed to the professional domain, but most heartily approved of the idea as “time-efficient.”

32.Jordan B. and Irwin S. The ultimate failure: court-ordered cesarean section. In New Approaches to Human Reproduction (Edited by Whiteford L. and Poland M.), Westview Press, Boulder, 1989.

33.Jordan B. “Technology and the Social Distribution of Knowledge.” In Anthropology and Primary Health Care (Edited by Coreil J. and Mull D.). Westview Press, Boulder, 1990.

34.Please note that I am not preaching here, just analyzing–my own family life pretty well reflects this model.

35.Irwin S. and Jordan B. “Knowledge, practice, and power: court- ordered Cesarean sections,” Medical Anthropology Quarterly 1, 3, 319-334, 1987.

36.Ashford J. I. Birth Stories: The Experience Remembered. The Crossing Press, Trumansburg, NY, 1984.

37.Davis-Floyd R. E. “Intuition as Authoritative Knowledge in Midwifery and Home Birth,” Medical Anthropology Quarterly, Special Issue on The Social Production of Authoritative Knowledge in Childbirth, forthcoming 1994.

38.Richards L. The Vaginal Birth after Cesarean Experience. Bergin and Garvey, South Hadley, MA, 1987.

39.Friedl, Ernestine. Society and sex roles. In Anthropology: Contemporary Perspectives (Edited by Whitten P. and Hunter D.), pp. 215-219. Scott Foresman, Glenview IL, 1990 (orig. pub. 1978).

40.Ehrenreich B. and English D. Witches, Midwives, and Nurses: A History of Women Healers. Feminist Press, OldWestbury,New York, 1973.

41.Rothman B. K. Recreating Motherhood: Ideology and Technology in Patriarchal Society. W.W.Norton,New York, 1989.

42.Spallone P. Beyond Conception: The New Politics of Reproduction. Bergin and Garvey Publishers,Granby, M.A., 1989.

43.Parvati-Baker J. Conscious Conception: Elemental Journey through the Labyrinth of Sexuality. Freestone Publishing,Monroe,Utah, 1986.

44.Peterson G. Birthing Normally: A Personal Growth Approach to Childbirth. Mindbody Press, Berkeley, 1981.

45.Parvati-Baker J. The shamanic dimensions of childbirth. Journal of Pre- and Perinatal Psychology, 1992, in press.

This article appears in
Conformity and Conflict: Readings in Cultural Anthropology, 8th ed.,
David McCurdy, ed., HarperCollins, New York, 1994, pp. 323-340.
Permission is hereby granted by the author and copyright holder, Robbie E. Davis-Floyd, to reproduce this article for educational purposes.

Why is childbirth, which should be such a unique and individual experience for the woman, treated in such a highly standardized way in theUnited States? No matter how long or short, how easy or hard their labors, the vast majority of American women are hooked up to an electronic fetal monitor and an IV (intravenously administered fluids and/or medication), are encouraged to use pain-relieving drugs, receive an episiotomy (a surgical incision in the vagina to widen the birth outlet in order to prevent tearing) at the moment of birth, and are separated from their babies shortly after birth. Most of them also receive doses of the synthetic hormone pitocin to speed their labors, and give birth flat on their backs. Nearly one quarter of them are delivered by Cesarean section.

Many Americans, including most of the doctors and nurses who attend birth, view these procedures as medical necessities. Yet anthropologists regularly describe other, less technological ways to give birth. For example, the Mayan Indians of Highland Chiapas hold onto a rope while squatting for birth, a position that is far more physiologically efficacious than the flat-on-your-back-with-your-feet-in-stirrups (lithotomy) position. Mothers in many low-technology cultures give birth sitting, squatting, semi-reclining in their hammocks, or on their hands and knees, and are nurtured through the pain of labor by experienced midwives and supportive female relatives. What then might explain the standardization and technical elaboration of the American birthing process?

One answer emerges from the field of symbolic anthropology. Early in this century, Arnold van Gennep noticed that in many societies around the world, major life transitions are ritualized. These cultural rites of passage make it appear that society itself effects the transformation of the individual. Could this explain the standardization of American birth? I believe the answer is yes.

I came to this conclusion as a result of a study I conducted of American birth between 1983 and 1991. I interviewed over 100 mothers, as well as many of the obstetricians, nurses, childbirth educators, and midwives who attended them. (1) While poring over my interviews, I began to understand that the forces shaping American hospital birth are invisible to us because they stem from the conceptual foundations of our society. I realized that American society’s deepest beliefs center around science, technology, patriarchy, and the institutions that control and disseminate them, and that there could be no better transmitter of these core values and beliefs than the hospital procedures so salient in American birth.

Rites of Passage

A ritual is a patterned, repetitive, and symbolic enactment of a cultural belief or value; its primary purpose is alignment of the belief system of the individual with that of society. A rite of passage is a series of rituals that move individuals from one social state or status to another as, for example, from girlhood to womanhood, boyhood to manhood, or from the womb to the world of culture. Rites of passage transform both society’s perception of individuals and individuals’s perceptions of themselves.

Rites of passage generally consist of three stages, originally outlined by van Gennep: (1) separation of the individuals from their preceding social state; (2) a period of transition in which they are neither one thing nor the other; and (3) an integration phase, in which, through various rites of incorporation, they are absorbed into their new social state. In the year-long pregnancy/childbirth rite of passage in American society, the separation phase begins with the woman’s first awareness of pregnancy; the transition stage lasts until several days after the birth; and the integration phase ends gradually in the newborn’s first few months of life, when the new mother begins to feel that, as one woman put it, she is “mainstreaming it again.”

Victor Turner, an anthropologist famous for his writings on ritual, pointed out that the most important feature of all rites of passage is that they place their participants in a transitional realm that has few of the attributes of the past or coming state. Existing in such a non-ordinary realm, he argues, facilitates the gradual psychological opening of the initiates to profound interior change. In many initiation rites involving major transitions into new social roles (such as military basic training), ritualized physical and mental hardships serve to break down initiates’ belief systems, leaving them open to new learning and the construction of new cognitive categories.

Birth is an ideal candidate for ritualization of this sort, and is, in fact, used in many societies as a model for structuring other rites of passage. By making the naturally transformative process of birth into a cultural rite of passage, a society can ensure that its basic values will be transmitted to the three new members born out of the birth process: the new baby, the woman reborn into the new social role of mother, and the man reborn as father. The new mother especially must be very clear about these values, as she is generally the one primarily responsible for teaching them to her children, who will be society’s new members and the guarantors of its future.

The Characteristics of Ritual

Some primary characteristics of ritual are particularly relevant to understanding how the initiatory process of cognitive restructuring is accomplished in hospital birth. We will examine each of these characteristics in order to understand (1) how ritual works; and (2) how the natural process of childbirth is transformed in theUnited Statesinto a cultural rite of passage.

Symbolism

Above all else, ritual is symbolic. Ritual works by sending messages in the form of symbols to those who perform and those who observe it. A symbol is an object, idea, or action that is loaded with cultural meaning. The left hemisphere of the human brain decodes and analyzes straightforward verbal messages, enabling the recipient to either accept or reject their content. Complex ritual symbols, on the other hand, are received by the right hemisphere of the brain, where they are interpreted holistically. Instead of being analyzed intellectually, a symbol’s message will be felt through the body and the emotions. Thus, even though recipients may be unaware of incorporating the symbol’s message, its ultimate effect may be extremely powerful.

Routine obstetric procedures are highly symbolic. For example, to be seated in a wheelchair upon entering the hospital, as many laboring women are, is to receive through their bodies the symbolic message that they are disabled; to then be put to bed is to receive the symbolic message that they are sick. Although no one pronounces, “You are disabled; you are sick,” such graphic demonstrations of disability and illness can be far more powerful than words. One woman told me:

I can remember just almost being in tears by the way they would wheel you in. I would come into the hospital, on top of this, breathing, you know, all in control. And they slap you in a wheelchair! It made me suddenly feel like maybe I wasn’t in control any more.

The intravenous drips commonly attached to the hands or arms of birthing women make a powerful symbolic statement: they are umbilical cords to the hospital. The cord connecting her body to the fluid-filled bottle places the woman in the same relation to the hospital as the baby in her womb is to her. By making her dependent on the institution for her life, the IV conveys to her one of the most profound messages of her initiation experience: in American society, we are all dependent on institutions for our lives. The message is even more compelling in her case, for she is the real giver of life. Society and its institutions cannot exist unless women give birth, yet the birthing woman in the hospital is shown, not that she gives life, but rather that the institution does.

A Cognitive Matrix

A matrix (from the Latin mater, mother), like a womb, is something from within which something else comes. Rituals are not arbitrary; they come from within the belief system of a group. Their primary purpose is to enact, and thereby, to transmit that belief system into the emotions, minds, and bodies of their participants. Thus, analysis of a culture’s rituals can lead to a profound understanding of its belief system.

Analysis of the rituals of hospital birth reveals their cognitive matrix to be the technocratic model of reality which forms the philosophical basis of both Western biomedicine and American society.

All cultures develop technologies. But most do not supervalue their technologies in the particular way that we do. This point is argued clearly by Peter C. Reynolds in his book, Stealing Fire: The Mythology of the Technocracy (a technocracy is a hierarchical, bureaucratic society driven by an ideology of technological progress). There he discusses how we “improve upon” nature by controlling it through culture.

The technocratic model is the paradigm that charters such behavior. Its early forms were originally developed in the 1600s by Descartes, Bacon, and Hobbes, among others. This model assumes that the universe is mechanistic, following predictable laws that the enlightened can discover through science and manipulate through technology, in order to decrease their dependence on nature. In this model, the human body is viewed as a machine that can be taken apart and put back together to ensure proper functioning. In the 17th century, the practical utility of this body-as-machine metaphor lay in its separation of body, mind, and soul. The soul could be left to religion, the mind to the philosophers, and the body could be opened up to scientific investigation.

The dominant religious belief systems ofWestern Europeat that time held that women were inferior to men–closer to nature and feebler both in body and intellect. Consequently, the men who developed the idea of the body-as-machine also firmly established the male body as the prototype of this machine. Insofar as it deviated from the male standard, the female body was regarded as abnormal, inherently defective, and dangerously under the influence of nature.

The metaphor of the body-as-machine and the related image of the female body as a defective machine eventually formed the philosophical foundations of modern obstetrics. Wide cultural acceptance of these metaphors accompanied the demise of the midwife and the rise of the male-attended, mechanically manipulated birth. Obstetrics was thus enjoined by its own conceptual origins to develop tools and technologies for the manipulation and improvement of the inherently defective, and therefore anomalous and dangerous, process of birth.

The rising science of obstetrics ultimately accomplished this goal by adopting the model of the assembly-line production of goods as its template for hospital birth. Accordingly, a woman’s reproductive tract came to be treated like a birthing machine by skilled technicians working under semiflexible timetables to meet production and quality control demands. As one fourth-year resident observed:

We shave ‘em, we prep ‘em, we hook ‘em up to the IV and administer sedation. We deliver the baby, it goes to the nursery and the mother goes to her room. There’s no room for niceties around here. We just move ‘em right on through. It’s hard not to see it like an assembly line.

The hospital itself is a highly sophisticated technocratic factory; the more technology the hospital has to offer, the better it is considered to be. Because it is an institution, the hospital constitutes a more significant social unit than an individual or a family. Therefore it can require that the birth process conform more to institutional than personal needs. As one resident explained,

There is a set, established routine for doing things, usually for the convenience of the doctors and the nurses, and the laboring woman is someone you work around, rather than with.

The most desirable end-product of the birth process is the new social member, the baby; the new mother is a secondary by-product. One obstetrician commented, “It was what we were all trained to always go after–the perfect baby. That’s what we were trained to produce. The quality of the mother’s experience–we rarely thought about that.”

Repetition and Redundancy

Ritual is marked by repetition and redundancy. For maximum effectiveness, a ritual concentrates on sending one basic set of messages, repeating it over and over again in different forms. Hospital birth takes places in a series of ritual procedures, many of which convey the same message in different forms. The open and exposing hospital gown, the ID bracelet, the intravenous fluid, the bed in which she is placed–all these convey to the laboring woman that she is dependent on the institution.

She is also reminded in myriad ways of the potential defectiveness of her birthing machine. These include periodic and sometimes continuous electronic monitoring of that machine, frequent manual examinations of her cervix to make sure that it is dilating on schedule, and, if it isn’t, administration of the synthetic hormone pitocin to speed up labor so that birth can take place within the required 26 hours.(2) All three of these procedures convey the same messages over and over: time is important, you must produce on time, and you cannot do that without technological assistance because your machine is defective. In the technocracy, we supervalue time. It is only fitting that messages about time’s importance should be repeatedly conveyed during the births of new social members.

Cognitive Reduction

In any culture, the intellectual abilities of ritual participants are likely to differ, often markedly. It is not practical for society to design different rituals for persons of different levels of intellectual ability. So ritual utilizes specific techniques, such as rhythmic repetition, to reduce all participants to the same narrower level of cognitive functioning. This low level involves thinking in either/or patterns that do not allow for consideration of options or alternative views.

Four techniques are often employed by ritual to accomplish this end. One is the repetition already discussed above. A second is hazing, which is familiar to undergraduates who undergo fraternity initiation rites but is also part of rites of passage all over the world. A third is strange-making–making the commonplace appear strange by juxtaposing it with the unfamiliar. Fourth is symbolic inversion–metaphorically turning things upside-down and inside-out to generate, in a phrase coined by Roger Abrahams, “the power attendant upon confusion.”

For example, in the rite of passage of military basic training, the initiate’s normal patterns of action and thought are turned topsy-turvy. He is made strange to himself: his head is shaved, so that he does not even recognize himself in the mirror. He must give up his clothes, those expressions of his past individual identity and personality, and put on a uniform identical to that of the other initiates. Constant and apparently meaningless hazing, such as orders to dig six ditches and then fill them in, further breaks down his cognitive structure. Then through repetitive and highly symbolic rituals, such as sleeping with his rifle, the basic values, beliefs, and practices of the Marines are incorporated into his body and his mind.

In medical school and again in residency, the same ritual techniques that transform a youth into a Marine are employed to transform college students into physicians. Reduced from the high status of graduate to the lowly status of first-year medical student, initiates are subjected to hazing techniques of rote memorization of endless facts and formulas, absurdly long hours of work, and intellectual and sensory overload. As one physician explained:

You go through, in a six-week course, a thousand-page book. You have pop quizzes in two or three courses every day the first year. We’d get up around 6, attend classes till 5, go home and eat, then head back to school and be in anatomy lab working with a cadaver, or something, until 1 or 2 in the morning, and then go home and get a couple of hours sleep and then go out again.

Subjected to such a process, medical students often gradually lose any broadminded goals of “helping humanity” they had upon entering medical school. A successful rite of passage produces new professional values structured in accordance with the technocratic and scientific values of the dominant medical system. The emotional impact of this cognitive narrowing is aptly summarized by a former resident:

Most of us went into medical school with pretty humanitarian ideals. I know I did. But the whole process of medical education makes you inhuman….you forget about the rest of life. By the time you get to residency, you end up not caring about anything beyond the latest techniques and most sophisticated tests.

Likewise, the birthing woman is socialized by ritual techniques of cognitive reduction. She is made strange to herself by being dressed in a hospital gown, tagged with an ID bracelet, and by the shaving or clipping of her pubic hair, which symbolically de-sexualizes the lower portion of her body, returning it to a conceptual state of childishness. (In many cultures, sexuality and hair are symbolically linked.) Labor itself is painful, and is often rendered more so by the hazing technique of frequent and very painful insertion of someone’s fingers into her vagina to see how far her cervix has dilated. This technique also functions as a strange-making device. Since almost any nurse or resident in need of practice may check her cervix, the birthing women’s most private parts are symbolically inverted into institutional property. One respondent’s obstetrician observed, “It’s a wonder you didn’t get an infection, with so many people sticking their hands inside of you.”

Cognitive Stabilization

When humans are subjected to extremes of stress and pain, they may become unreasonable and out of touch with reality. Ritual assuages this condition by giving people a conceptual handle-hold to keep them from “falling apart” or “losing it.” When the airplane starts to falter, even passengers who don’t go to church are likely to pray! Ritual mediates between cognition and chaos by making reality appear to conform to accepted cognitive categories. In other words, to perform a ritual in the face of chaos is to restore order to the world.(3)

Labor subjects most women to extremes of pain, which are often intensified by the alien and often unsupportive hospital environment. They look to hospital rituals to relieve the distress resulting from their pain and fear. They utilize breathing rituals taught in hospital-sponsored childbirth education classes for cognitive stabilization. They turn to drugs for pain relief, and to the reassuring presence of medical technology for relief from fear. One woman expressed it this way:

I was terrified when my daughter was born. I just knew I was going to split open and bleed to death right there on the table, but she was coming so fast, they didn’t have any time to do anything to me…I like Caesarean sections, because you don’t have to be afraid.

When you come from within a belief system, its rituals will comfort and calm you. Accordingly, those women in my study who were in basic agreement with the technocratic model of birth before going into the hospital (70%) expressed general satisfaction with their hospital births.

Order, Formality, and a Sense of Inevitability

Its exaggerated and precise order and formality set ritual apart from other modes of social interaction, enabling it to establish an atmosphere that feels both inevitable and inviolate. To perform a series of rituals is to feel oneself locking onto a set of “cosmic gears” that will safely crank the individual through danger to safety. For example, Trobriand sea fishermen described by anthropologist Bronislaw Malinowski regularly performed an elaborate series of rituals on the beach before embarking. The fishermen believed that these rituals, when carried out with precision, would obligate the gods of the sea to do their part to bring the fishermen safely home. Likewise, obstetricians, and many birthing women, feel that correct performance of standardized procedures ought to result in a healthy baby. Such rituals generate in humans a sense of confidence that makes it easier to face the challenge and caprice of nature.

When women who have placed their faith in the technocratic model are denied its rituals, they often react with fear and a feeling of being neglected:

My husband and I got to the hospital, and we thought they would take care of everything. I kept sending my husband out to ask them to give me something for the pain, to check me, but they were short-staffed and they just ignored me until the shift changed in the morning.

Hospital rituals such as electronic monitoring work to give the laboring woman a sense that society is using the best it has to offer–the full force of its technology–to inevitably ensure that she will have a safe birth.

However, once those “cosmic gears” have been set into motion, there is often no stopping them. The very inevitability of hospital procedures makes them almost antithetical to the possibility of normal, natural birth. A “cascade of intervention” occurs when one obstetric procedure alters the natural birthing process, causing complications, and so inexorably “necessitates” the next procedure, and the next. Many of the women in my study experienced such a “cascade” when they received some form of pain relief, such as an epidural, which slowed their labor. Then pitocin was administered through the IV to speed up the labor, but pitocin very suddenly induced longer and stronger contractions. Unprepared for the additional pain, the woman asked for more pain relief, which ultimately necessitated more pitocin. Pitocin-induced contractions, together with the fact that the mother must lie flat on her back because of the electronic monitor belts strapped around her stomach, can cause the supply of blood and oxygen to the fetus to drop, affecting the fetal heart rate. In response to the “distress” registered on the fetal monitor, an emergency Caesarean is performed.

Acting, Stylization, Staging

Ritual’s set-apartness is enhanced by the fact that it is usually highly stylized and self-consciously acted, like a part in a play. Most of us can easily accept this view of the careful performances of TV evangelists, but it may come as a surprise that those who perform the rituals of hospital birth are often aware of their dramatic elements. The physician becomes the protagonist. The woman’s body is the stage upon which he performs, often for an appreciative audience of medical students, residents, and nurses. Here is how one obstetrician played to a student audience observing the delivery he was performing:

“In honest-to-God natural conditions babies were sometimes born without tearing the perineum and without an episiotomy, but without artificial things like anesthesia and episiotomy, the muscle is torn apart and if it is not cut, it is usually not repaired. Even today, if there is no episiotomy and repair, those women quite often develop a rectocoele and a relaxed vaginal floor. This is what I call the saggy, baggy bottom.” Laughter by the students. A student nurse asks if exercise doesn’t help strengthen the perineum….”No, exercises may be for the birds, but they’re not for bottoms….When the woman is bearing down, the leveator muscles of the perineum contract too. This means the baby is caught between the diaphragm and the perineum. Consequently, anesthesia and episiotomy will reduce the pressure on the head, and hopefully, produce more Republicans.” More laughter from the students. (3)

Cognitive Transformation

The goal of most initiatory rites of passage is cognitive transformation. It occurs when the symbolic messages of ritual fuse with individual emotion and belief, and the individual’s entire cognitive structure reorganizes around the newly internalized symbolic complex. The following quote from a practicing obstetrician presents the outcome for him of such transformative learning:

I think my training was valuable. The philosophy was one of teaching one way to do it, and that was the right way….I like the set hard way. I like the riverbanks that confine you in a direction….You learn one thing real well, and that’s the way.

For both nascent physicians and nascent mothers, cognitive transformation of the initiate occurs when reality as presented by the technocratic model, and reality as the initiate perceives it, become one and the same. This process is gradual. Routine obstetric procedures cumulatively map the technocratic model of birth onto the birthing woman’s perceptions of her labor experience. They align her belief system with that of society.

Take the way many mothers come to think about the electronic fetal monitor, for example. The monitor is a machine that uses ultrasound to measure the rate of the baby’s heartbeat through electrodes belted onto the mother’s abdomen. This machine has become the symbol of high technology hospital birth. Observers and participants alike report that the monitor, once attached, becomes the focal point of the labor. Nurses, physicians, husbands, and even the mother herself become visually and conceptually glued to the machine, which then shapes their perceptions and interpretations of the birth process. One woman described her experience this way:

As soon as I got hooked up to the monitor, all everyone did was stare at it. The nurses didn’t even look at me anymore when they came into the room–they went straight to the monitor. I got the weirdest feeling that it was having the baby, not me.

This statement illustrates the successful conceptual fusion between the woman’s perceptions of her birth experience and the technocratic model. So thoroughly was this model mapped on to her psyche that she began to feel that the machine was having the baby, that she was a mere onlooker. Soon after the monitor was in place, she requested a Caesarean section, declaring that there was “no more point in trying.”

Consider the visual and kinesthetic images that the laboring woman experiences–herself in bed, in a hospital gown, staring up at an IV pole, bag, and cord, and down at a steel bed and a huge belt encircling her waist. Her entire sensory field conveys one overwhelm-ing message about our culture’s deepest values and beliefs: technology is supreme, and the individual is utterly dependent upon it.

Internalizing the technocratic model, women come to accept the notion that the female body is inherently defective. This notion then shapes their perceptions of the labor experience, as exemplified by one woman’s story:

It seemed as though my uterus had suddenly tired! When the nurses in attendance noted a contraction building on the recorder, they instructed me to begin pushing, not waiting for the urge to push, so that by the time the urge pervaded, I invariably had no strength remaining but was left gasping and dizzy….I felt suddenly depressed by the fact that labor, which had progressed so uneventfully up to this point, had now become unproductive.

Note that she does not say “The nurses had me pushing too soon,” but “My uterus had tired,” and labor had “become unproductive.” These responses reflect her internalization of the technocratic tenet that when something goes wrong, it is her body’s fault.

Affectivity and Intensification

Rituals tend to intensify toward a climax. Behavioral psychologists have long understood that people are far more likely to remember, and to absorb lessons from, those events that carry an emotional charge. The order and stylization of ritual, combined with its rhythmic repetitiveness and the intensification of its messages, methodically create just the sort of highly charged emotional atmosphere that works to ensure long-term learning.

As the moment of birth approaches, the number of ritual procedures performed upon the woman will intensify toward the climax of birth, whether or not her condition warrants such intervention. For example, once the woman’s cervix reaches full dilation (10 cm), the nursing staff immediately begins to exhort the woman to push with each contraction, whether or not she actually feels the urge to push. When delivery is imminent, the woman must be transported, often with a great deal of drama and haste, down the hall to the delivery room. Lest the baby be born en route, the laboring woman is then exhorted, with equal vigor, not to push. Such commands constitute a complete denial of the natural rhythms of the woman’s body. They signal that her labor is a mechanical event and that she is subordinate to the institution’s expectations and schedule. Similar high drama will pervade the rest of her birthing experience.

Preservation of the Status Quo

A major function of ritual is cultural preservation. Through explicit enactment of a culture’s belief system, ritual works both to preserve and to transmit the culture. Preserving the culture includes perpetuating its power structure, so it is usually the case that those in positions of power will have unique control over ritual performance. They will utilize the effectiveness of ritual to reinforce both their own importance and the importance of the belief and value system that legitimizes their positions.

In spite of tremendous advances in equality for women, theUnited Statesis still a patriarchy. It is no cultural accident that 99% of American women give birth in hospitals, where only physicians, most of whom are male, have final authority over the performance of birth rituals–an authority that reinforces the cultural supervaluation of patriarchy for both mothers and their medical attendants.

Nowhere is this reality more visible than in the lithotomy position. Despite years of effort on the part of childbirth activists, including many obstetricians, the majority of American women still give birth lying flat on their backs. This position is physiologically dysfunctional. It compresses major blood vessels, lowering the mother’s circulation and thus the baby’s oxygen supply. It increases the need for forceps because it both narrows the pelvic outlet and ensures that the baby, who must follow the curve of the birth canal, quite literally will be born heading upward, against gravity.

This lithotomy position completes the process of symbolic inversion that has been in motion ever since the woman was put into that “upside-down” hospital gown. Her normal bodily patterns are turned, quite literally, upside-down–her legs are in the air, her vagina totally exposed. As the ultimate symbolic inversion, it is ritually appropriate that this position be reserved for the peak transformational moments of the initiation experience–the birth itself. The doctor–society’s official representative–stands in control not at the mother’s head nor at her side, but at her bottom, where the baby’s head is beginning to emerge.

Structurally speaking, this puts the woman’s vagina where her head should be. Such total inversion is perfectly appropriate from a social perspective, as the technocratic model promises us that eventually we will be able to grow babies in machines–that is, have them with our cultural heads instead of our natural bottoms. In our culture, “up” is good and “down” is bad, so the babes born of science and technology must be delivered “up” toward the positively valued cultural world, instead of down toward the negatively valued natural world. Interactionally, the obstetrician is “up” and the birthing woman is “down,” an inversion that speaks eloquently to her of her powerlessness and of the power of society at the supreme moment of her own individual transformation.

The episiotomy performed by the obstetrician just before birth also powerfully enacts the status quo in American society. This procedure, performed on over 90% of first-time mothers as they give birth, expresses the value and importance of one of our technocratic society’s most fundamental markers–the straight line. Through episiotomies, physicians can deconstruct the vagina (stretchy, flexible, part-circular and part-formless, feminine, creative, sexual, non-linear), then reconstruct it in accordance with our cultural belief and value system. Doctors are taught (incorrectly) that straight cuts heal faster than the small jagged tears that sometimes occur during birth. They learn that straight cuts will prevent such tears, but in fact, episiotomies often cause severe tearing that would not otherwise occur. These teachings dramatize our Western belief in the superiority of culture over nature. Because it virtually does not exist in nature, the line is most useful in aiding us in our constant conceptual efforts to separate ourselves from nature.

Moreover, since surgery constitutes the ultimate form of manipulation of the human body-machine, it is the most highly valued form of medicine. Routinizing the episiotomy, and increasingly, the Caesarean section, has served both to legitimize and to raise the status of obstetrics as a profession, by ensuring that childbirth will be not a natural but a surgical procedure.

Effecting Social Change

Paradoxically, ritual, with all of its insistence on continuity and order, can be an important factor not only in individual transformation but also in social change. New belief and value systems are most effectively spread through new rituals designed to enact and transmit them; entrenched belief and value systems are most effectively altered through alterations in the rituals that enact them.

Nine percent of my interviewees entered the hospital determined to avoid technocratic rituals in order to have “completely natural childbirth,” yet ended up with highly technocratic births. These nine women experienced extreme cognitive dissonance between their previously held self-images and those internalized in the hospital. Most of them suffered severe emotional wounding and short-term post-partum depression as a result. But fifteen percent did achieve their goal of natural childbirth, thereby avoiding conceptual fusion with the technocratic model. These women were personally empowered by their birth experiences. They tended to view technology as a resource that they could choose to utilize or ignore, and often consciously subverted their socialization process by replacing technocratic symbols with self-empowering alternatives. For example, they wore their own clothes and ate their own food, rejecting the hospital gown and the IV. They walked the halls instead of going to bed. They chose perineal massage instead of episiotomy, and gave birth like “primitives,” sitting up, squatting, or on their hands and knees. One woman, confronted with the wheelchair, said “I don’t need this,” and used it for a luggage cart. This rejection of customary ritual elements is an exceptionally powerful way to induce change, as it takes advantage of an already charged and dramatic situation.

During the 1970s and early 1980s, the conceptual hegemony of the technocratic model in the hospital was severely challenged by the natural childbirth movement which these twenty-four women represent. Birth activists succeeded in getting hospitals to allow fathers into labor and delivery rooms, mothers to birth consciously (without being put to sleep), and mothers and babies to room together after birth. They fought for women to have the right to birth without drugs or interventions, to walk around or even be in water during labor (in some hospitals, Jacuzzis were installed). Prospects for change away from the technocratic model of birth by the 1990s seemed bright.

Changing a society’s belief and value system by changing the rituals that enact it is possible, but not easy. To counter attempts at change, members of a society may intensify the rituals that support the status quo. Thus a response to the threat posed by the natural childbirth movement was to intensify the use of high technology in hospital birth. During the 1980s, periodic electronic monitoring of nearly all women became standard procedure, the epidural rate shot up to 80%, and the Caesarean rate rose to nearly 25%. Part of the impetus for this technocratic intensification is the increase in malpractice suits against physicians. The threat of lawsuit forces doctors to practice conservatively–that is, in strict accordance with technocratic standards. As one of them explained:

Certainly I’ve changed the way I practice since malpractice became an issue. I do more C-sections…And more and more tests to cover myself. More expensive stuff. We don’t do risky things that women ask for–we’re very conservative in our approach to everything….In 1970 before all this came up, my C-section rate was around 4%. It has gradually climbed every year since then. In 1985 it was 16%, then in 1986 it was 23%.

The money goes where the values lie. From this macro-cultural perspective, the increase in malpractice suits emerges as society’s effort to make sure that its representatives, the obstetricians, perpetuate our technocratic core value system by continuing through birth rituals to transmit that system. Its perpetuation seems imperative, for in our technology we see the promise of our eventual transcendence of bodily and earthly limitations–already we replace body parts with computerized devices, grow babies in test tubes, build space stations, and continue to pollute the environment in the expectation that someone will develop the technologies to clean it up!

We are all complicitors in our technocratic system, as we have so very much invested in it. Just as that system has given us increasing control over the natural environment, so it has also given not only doctors but also women increasing control over biology and birth. Contemporary middle-class women do have much greater say over what will be done to them during birth than their mothers, most of whom gave birth during the 1950s and 1960s under general anesthesia. When what they demand is in accord with technocratic values, they have a much greater chance of getting it than their sisters have of achieving natural childbirth. Even as hospital birth still perpetuates patriarchy by treating women’s bodies as defective machines, it now also reflects women’s greater autonomy by allowing them conceptual separation from those defective machines.

Epidural anesthesia is administered in about 80% of American hospital births. So common is its use that many childbirth educators are calling the 1990s the age of the “epidural epidemic.” As the epidural numbs the birthing woman, eliminating the pain of childbirth, it also graphically demonstrates to her through lived experience the truth of the Cartesian maxim that mind and body are separate, that the biological realm can be completely cut off from the realm of the intellect and the emotions. The epidural is thus the perfect technocratic tool, serving the interests of the technocratic model by transmitting it, and of women choosing to give birth under that model, by enabling them to use it to divorce themselves from their biology:

Ultimately the decision to have the epidural and the Caesarean while I was in labor was mine. I told my doctor I’d had enough of this labor business and I’d like to…get it over with. So he whisked me off to the delivery room and we did it. (Elaine)

For many women, the epidural provides a means by which they can actively witness birth while avoiding “dropping into biology.” Explained Joanne, “I’m not real fond of things that remind me I’m a biological creature–I prefer to think and be an intellectual emotional person.” Such women tended to define their bodies as tools, vehicles for their minds. They did not enjoy “giving in to biology” to be pregnant, and were happy to be liberated from biology during birth. And they welcomed advances in birth technologies as extensions of their own ability to control nature.

In dramatic contrast, six of my interviewees (6%), insisting that “I am my body,” rejected the technocratic model altogether. They chose to give birth at home under an alternative paradigm, the holistic model. This model stresses the organicity and trustworthiness of the female body, the natural rhythmicity of labor, the integrity of the family, and self-responsibility. These homebirthers see the safety of the baby and the emotional needs of the mother as one. The safest birth for the baby will be the one that provides the most nurturing environment for the mother.(4) Said Ryla,

I got criticized for choosing a home birth, for not considering the safety of the baby. But that’s exactly what I was considering! How could it possibly serve my baby for me to give birth in a place that causes my whole body to tense up in anxiety as soon as I walk in the door?

Although homebirthers constitute only about 1% of the American birthing population, their conceptual importance is tremendous, as through the alternative rituals of giving birth at home, they enact–and thus guarantee the existence of–a paradigm of pregnancy and birth based on the value of connection, just as the technocratic model is based on the principle of separation.

The technocratic and holistic models represent opposite ends of a spectrum of beliefs about birth and about cultural life. Their differences are mirrored on a wider scale by the ideological conflicts between biomedicine and holistic healing, and between industrialists and ecological activists. These groups are engaged in a core value struggle over the future–a struggle clearly visible in the profound differences in the rituals they daily enact.

Conclusion

Every society in the world has felt the need to thoroughly socialize its citizens into conformity with its norms, and citizens derive many benefits from such socialization. If a culture had to rely on policemen to make sure that everyone would obey its laws, it would disintegrate into chaos, as there would not be enough policement to go around. It is much more pratical for cultures to find ways to socialize their members from the inside, by making them want to conform to society’s norms. Ritual is one major way through which such socialization can be achieved.

American obstetrical procedures can be understood as rituals that facilitate the internalization of cultural values. These procedures are patterned, repetitive, and profoundly symbolic, communicating messages concerning our culture’s deepest beliefs about the necessity for cultural control of natural processes. They provide an ordered structure to the chaotic flow of the natural birth process. In so doing, they both enhance the natural affectivity of that process and create a sense of inevitability about their performance. Obstetric interventions are also transformative in intent. They attempt to contain and control the process of birth, and to transform the birthing woman into an American mother who has internalized the core values of this society. Such a mother believes in science, relies on technology, and recognizes her inferiority (either consciously or unconsciously) and so at some level accepts the principles of patriarchy. She will tend to conform to society’s dictates and meet the demands of its institutions, and will teach her children to do the same.

Yet it is important to note that human beings are not automatons. Human behavior varies widely even within the restraints imposed by particular cultures, including their rituals. As one woman sums it up:

It’s almost like programming you. You get to the hospital. They put you in this wheelchair. They whisk you off from your husband, and I mean just start in on you. Then they put you in another wheelchair, and send you home. And then they say, well, we need to give you something for the depression. [Laughs] Get away from me! That will help my depression!

Through hospital ritual procedures, obstetrics deconstructs birth, then inverts and reconstructs it as a technocratic process. But unlike most transformations effected by ritual, birth does not depend upon the performance of ritual to make it happen. The physiological process of labor itself transports the birthing woman into a naturally transitional situation that carries its own affectivity. Hospital procedures take advantage of that affectivity to transmit the core values of American society to birthing women. From society’s perspective, the birth process will not be successful unless the woman and child are properly socialized during the experience, transformed as much by the rituals as by the physiology of birth.

Endnotes

1. The full results of this study appear in Robbie Davis-Floyd, Birth as an American Rite of Passage (U. of California Press, 1992).

2. InHolland, by way of contrast, most births are attended by midwives who recognize that individual labors have individual rhythms. They can stop and start, can take a few hours or several days. If labor slows, the midwives encourage the woman to eat to keep up her strength, and then to sleep until contractions pick up again.

3. Nancy Stoller Shaw, Forced Labor: Maternity Care in the United States.New York: Pergamon Press, 1974, p. 90.

4. For summaries of studies that demonstrate the safety of planned, midwife-attended home birth relative to hospital birth, see Birth as an American Rite of Passage, Chapter 4.

Robbie E. Davis-Floyd

This chapter appeared in Feminist Theory in the Study of Folklore, eds. Susan Tower Hollis,

Linda Pershing, and M. Jane Young, U. of Illinois Press, pp. 297-326, 1993.

“But is the hospital necessary at all?” demanded a young woman of her obstetrician friend. “Why not bring the baby at home?”

“What would you do if your automobile broke down on a country road?” the doctor countered with another question.

“Try and fix it,” said the modern chaffeuse.

“And if you couldn’t?”

“Have it hauled to the nearest garage.”

“Exactly. Where the trained mechanics and their necessary tools are,” agreed the doctor. “It’s the same with the hospital. I can do my best work – and the best we must have in medicine all the time – not in some cramped little apartment or private home, but where I have the proper facilities and trained helpers. If anything goes wrong, I have all known aids to meet your emergency.”

–Century Illustrated Magazine, February 1926

Anybody in obstetrics who shows a human interest in patients is not respected. What is respected is interest in machines.

– Rick Walters MD, February 1986

Why is a birthing woman like a broken-down car, and whence comes this mechanistic emphasis in obstetrics? For the past eight years, I have been researching the sociocultural implications of the obstetrical “management” of birth in American society 1. This research has led me to conclude that both of these questions have the same answer: since the early 1900s, birth in the United States has been increasingly conducted under a set of beliefs, a paradigm, which I have labelled “the technocratic model of birth.” 2 I use the word `paradigm’ here in the sense of both a conceptual model of and a template for reality. Such a template can only mold reality to fit its conceptual contours when these contours are specifically and consistently delineated and enacted through ritual. In this article I will attempt to explicate the basic tenets of this paradigm, to hint at its historical roots, to demonstrate how it is both delineated and enacted through the rituals of hospital birth, and to consider its sociocultural and folkloristic implications.

Data for this article were obtained through interviews with 100 mothers and many obstetricians, midwives, and nurses in Chattanooga, Tennessee, Austin, Texas and elsewhere in the United States. Their names, wherever used, have been changed to protect their privacy. The majority of the people in my study were middle-class, mainstream American citizens. I was seeking to understand the processes at work in childbirth as it is experienced, not by any particular minority, but by the majority of American women, regardless of ethnicity. Although my study included few women from lower socio-economic groups, I can say with certainty that the technocratic model analyzed here is applied even more intensively to the poor than to the women I interviewed, for middle-class women who pay for private obstetricians can afford to have some choice in their birthways, while poor women who must go through hospital clinics simply have to take what society chooses to give them (Lazarus, 1988; Scully, 1980; Shaw 1974).

The birth process as it is lived out in contemporary American society constitutes an initiatory rite of passage for nascent mothers (Davis-Floyd, 1992) 3 Rites of passage are accomplished through ritual. A ritual may be defined as a patterned, repetitive, and symbolic enactment of a cultural belief or value. Such enactments may be both ritual and  instrumental or rational-technical (Leach, 1979; Moore and Myerhoff, 1977:15). In my analysis of hospital birth I shall show that the obstetrical routines applied to the “management” of normal birth are also transformative rituals that carry and communicate meaning above and beyond their instrumental ends.

Ritual works by sending messages through symbols to those who perform and those who receive or observe it. The message contained in a symbol will often be experienced holistically through the body and the emotions, not decoded analytically by the intellect, so that no conceptual distance exists between message and recipient, and the recipient cannot consciously choose to accept or reject the symbol’s message. Thus the ultimate effect of the repetitive series of symbolic messages sent through ritual can be extremely powerful, acting to map the model of reality presented by the ritual onto the individual belief and value system of the recipient, thereby aligning the individual cognitive system with that of the larger society (Munn, 1973:606). Below, I will demonstrate how routine obstetrical procedures, the rituals of hospital birth, can work to map a technocratic view of reality onto the birthing woman’s orientation to her labor experience, thereby aligning her individual belief and value system with that of American society.

But first, I must point out that my interviewees did not constitute an identifiable “folk group,” except insofar as they are all participants in “American culture.” The technologically-oriented belief system within which most of them gave birth can be considered a folk model only under an expansive definition of folklore–one which stresses, not its artistic/aesthetic dimensions (Kirshenblatt-Gimblett, 1988), but its expression of the underlying paradigms of a given group.  In this country, the term “folklore” usually has been used to identify the expressive forms of smaller sub-groups within the dominant society. But in Germany and Finland, primary countries of origin for the field of folklore scholarship, the original motivation behind the search for “folklore” was the conceptual unification of the country as a whole. Active performance and propagation of this folklore was consciously encouraged by the governments of those two countries as a means of first creating and then enacting a mythic reality model in which the emergent nations could find their conceptual grounding and sense of national identity.

In the United States today our sense of national identity is grounded in our technology. The technocratic model of birth is not the “folk model” of a small subgroup, but part of the larger technocratic model of reality which forms a conceptual cornerstone of American society. The rituals of hospital birth enact and transmit this model in ways that affect every American woman, no matter what her ethnicity or small-group affiliation.

Those scholars who identify as folklore the expressive forms of small-scale, low-technology societies often balk at applying the same logic to the expressive forms of large, complex, high-technology societies like that of the contemporary United States. Concomitantly, the medical profession convinced the public seven decades ago that moving birth into the hospital represented the de-ritualization of what had heretofore been a primitive process, managed by backwards midwives and laden with “folkloristic” superstition and taboo. I submit, however, that American society is no less dependent upon ritual (a traditional expressive form which folklorists have long claimed as part of their purview) than any other society. On the contrary, our exaggerated dependence on technology and our accompanying fear of natural processes has led to the “re-ritualization” of birth under the technocratic model in a manner more elaborate than anything heretofore known in the cultural world. When a society’s dominant reality model is tacit, largely outside of conscious awareness, as is the technocratic model, its rituals need to be even more intensely elaborated than those enacting explicit belief systems (such as Catholicism), for it is only through ritual and symbol that such tacit models are transmitted. The cross-cultural ethnographic literature on childbirth yields nothing to compare with the number and intensity of symbolic interventions in the birth process developed by the physicians of Western society to enact and transmit its technocratic model.

The Technocratic Model and American Obstetrics

Because the belief system of a culture is enacted through ritual (McManus, 1979; Wallace, 1966), an analysis of ritual may lead directly to an understanding of that belief system. Analyses of the rituals of modern biomedicine (Fox 1957, Henslin and Biggs 1971, Miner 1975; Parsons, 1951) reveal that it forms a microcosm of American society that encapsulates its core value system, a condensed world in which our society’s deepest beliefs stand out in high relief against their cultural background. American biomedical cures are based on science, effected by technology, and carried out in bureacratic institutions founded on principles of patriarchy and the supremacy of the institution over the individual. These core values of science, technology, patriarchy and institu­tions are derived from the technocratic model of reality on which our society is increasingly based.

As Carolyn Merchant demonstrates in The Death of Nature (1983), this model, originally developed in the 1600s by Descartes, Bacon, Hobbes, and others, assumed that the universe is mechanistic, following predictable laws which those enlightened enough to free themselves from the limitations of medieval superstition could discover through science and manipulate through technology in order to decrease their dependence on na­ture:

These philosophers transformed the body of the world and its female soul….into a mechanism of inert matter in motion. The resultant corpse was a mechanical system of dead corpuscles, set into motion by the Creator, so that each obeyed the law of inertia and moved only by external contact with another moving body….Because nature was now viewed as a system of dead, inert particles moved by external, rather than inherent forces, the mechanical framework itself could legitimate the manipulation of nature. [1983:193]

In this model the metaphor for the human body is a machine:

The application of a technological model to the human body can be traced back to Rene Descartes’s concept of mind-body dualism….The Cartesian model of the body-as-machine operates to make the physician a technician, or mechanic. The body breaks down and needs repair; it can be repaired in the hospital as a car is in the shop; once fixed, a person can be returned to the community. The earliest models in medicine were largely mechanical; later models worked more with chemistry, and newer, more sophisticated medical writing describes computer-like programming, but the basic point remains the same. Problems in the body are technical prob­lems requiring technical solutions, whether it is a mechani­cal repair, a chemical rebalancing, or a “debugging” of the system. [Rothman, 1982:34]

After my stepfather’s recent heart attack, a cardiologist gave me an update on this metaphor of the body-as-ma­chine:

Don’t worry about him! Just think of it this way – he’s like an old Cadillac that has broken down and needs repair. He’s in the shop now, and we’ll have him just as good as new in no time. We’re the best Cadillac repairmen in town!

As it was developed in the 17th century, the practical utility of this metaphor of the body-as-machine lay in its conceptual divorce of body from soul, and in the subsequent removal of the body from the purview of religion so it could be opened up to scientific investigation. During this time period, the dom­inant Catholic belief system of Western Europe held that women were in­ferior to men–closer to nature, with less-developed minds and little or no spirituality (Ehrenreich and English, 1973; Kramer and Sprenger 1972 (1486)). Consequently, the men who established the idea of the body-as-machine also firmly established the male body as the prototype of this machine. Insofar as it deviated from the male standard, the female body was regarded as abnormal, inherently defective, and dangerously under the influence of na­ture, which due to its unpredictability and its occasional mon­strosities, was itself regarded as inherently defective and in need of constant manipulation by man (Merchant, 1983:2). The demise of the midwife and the rise of the male-attended, mechani­cally manipulated birth followed close on the heels of the wide cultural acceptance of the metaphor of the body-as-machine in the West, and the accompanying acceptance of the metaphor of the fe­male body as a defective machine–a metaphor that eventually formed the philosophical foundation of modern obstetrics. Obstet­rics was thus enjoined by its own conceptual origins to develop tools and technologies for the manipulation and improvement of the inherently defective and therefore anomalous and dangerous process of birth:

In order to acquire a more perfect idea of the art, [the male midwife] ought to perform with his own hands upon proper machines, contrived to convey a just notion of all the difficulties to be met with in every kind of labour; by which means he will learn how to use the forceps and crotchets with more dexterity, be accustomed to the turning of children, and consequently, be more capable of acquitting himself in troublesome cases. [Smellie, 1756:44]

It is a common experience among obstetrical practitioners that there is an increasing gestational pathology and a more frequent call for art, in supplementing inefficient forces of nature in her effort to accomplish normal delivery. [Ritter, 1919:531]

The rising sci­ence of obstetrics ultimately accomplished this goal by adopting the model of the assembly-line production of goods–the template by which most of the technological wonders of modern society were being produced–as its base metaphor for hospital birth. In accordance with this metaphor, a woman’s reproductive tract is treated like a birthing machine by skilled techni­cians working under semi-flexible timetables to meet production and quality control demands:

We shave ‘em, we prep ‘em, we hook ‘em up to the IV and administer sedation. We deliver the baby, it goes to the nursery and the mother goes to her room. There’s no room for niceties around here. We just move ‘em right on through. It’s hard not to see it like an assembly line. [4th year male resident]

The hospital itself is a highly so­phisticated technological factory (the more technology the hospital has to offer, the better it is considered to be). As an institution it constitutes a more significant social unit than the individual or the family, so the birth process should conform more to institutional than personal needs. As one physician put it:

There was a set, established routine for doing things, usually for the convenience of the doctors and nurses, and the laboring woman was someone you worked around, rather than with.

This tenet of the technocratic model–that the institution is a more significant social unit than the individual–will not be found in obstetrical texts, yet is taught by example after example of the interac­tional patterns of hospital births (Jor­dan, 1980; Scully, 1980; Shaw 1974). For example, Jordan describes how pitocin (a synthetic hormone used to speed labor) is often administered in the hospi­tal when the delivery-room team shows up gowned and gloved and ready for action, yet the woman’s labor slows down. The team members stand around awkwardly until someone finally says “Let’s get this show on the road!” (1980:44).

The most desirable end product of the birth process is the new social member, the baby; the new mother is a secondary by-product:

It was what we all were trained to always go after – the perfect baby. That’s what we were trained to produce. The quality of the mother’s experience – we rarely thought about that. Everything we did was to get that perfect baby. [38-year old male obstetrician]

This focus on the production of the “perfect baby” is a fairly recent development, a direct result of the combination of the technocratic emphasis on the baby-as-product with the new technologies available to assess fetal quality. Amniocentesis, ultrasonography, “antepartum fetal heart `stress’ and `non-stress’ tests…and intrapartum surveillance of fetal heart action, uterine contractions, and physiochemical properties of fetal blood” (Pritchard and MacDonald, 1980:329) are but a few of these new technologies:

The number of tools the obstetrician can employ to address the needs of the fetus increases each year. We are of the view that this is the most exciting of times to be an obstetrician. Who would have dreamed, even a few years ago, that we could serve the fetus as physician? [Pritchard and MacDonald, 1980:vii]

The conceptual separation of mother and child basic to the technocratic model of birth parallels the Cartesian doctrine of mind-body sepa­ration. This separation is given tangible expression after birth as well when the baby is placed in a plastic bassinet in the nursery for four hours of “observation” before being returned to the mother; in this way, society demonstrates conceptual ownership of its product.4 The mother’s womb is replaced not by her arms, but by the plastic womb of culture. As Shaw points out, this separation of mother and child is intensified after birth by the as­signment of a separate doctor, the pediatrician, to the child (1974:94). This idea of the baby as separate, as the product of a me­chanical process, is a very important metaphor for women because it implies that men ultimately can become the producers of that product (as they already are the producers of most of Western society’s technological wonders), and in­deed it is in this direction that reproductive technologies are headed (Corea 1985), as we will briefly investigate in the conclusion.

            The Enactment and Transmission of the Technocratic Model 

through the Rituals of Hospital Birth

Hospital delivery as a whole may be seen as a ritual enactment of this technocratic model of birth. Once labor has begun, a variety of “standard procedures” will be brought into play in order to mold the labor process into conformity with technological standards. These various interventions may be performed by obstetrical personnel at different intervals over a time period that varies with the length of the woman’s labor and the degree to which it conforms to hospital standards. The less conformity the labor exhibits, the greater the number of procedures that will be applied in order to bring it into conformity. These interventions, aimed at producing the “perfect baby,” are thus not only instrumental acts but also symbols that convey the core values of American society to women and their attendants as they go through the rite of passage called birth. Through these procedures the natural process of birth is deconstructed into identifiable segments, then reconstructed as a mechanical pro­cess. Birth is thereby made to appear as though it confirms, instead of challenges, the technocratic model of reality upon which our so­ciety is based.

Shortly after entry into the hospital, the laboring woman will be symbolically stripped of her individuality, her autonomy, and her sexuality as she is “prepped”–a multi-step proce­dure in which she is separated from her husband, her clothes are removed, she is dressed in a hospital gown and tagged with an ID bracelet, her pubic hair is shaved or clipped (conceptually returning her body to a state of childishness), and she is ritually cleansed with an enema. 5 Now marked as insitutional property, she may be reunited with her husband, if he chooses to be present, and put to bed. Her access to food will be limited or prohibited, and an intravenous needle may be inserted in her hand or arm. Symbolically speaking, the IV constitutes her umbilical cord to the hospital, signifying her now-total dependence on the institution for her life, telling her not that she gives life, but rather that the institution does.

The laboring woman’s cervix will be checked for degree of dilation at least once every two hours and sometimes more often. If dilation is not progressing in conformity with standard labor charts, pitocin will be added to the intra­venous solution to speed her labor (80 percent of the women in my study were given pitocin, or “pitted”). This “labor augmentation” indicates to the woman that her machine is defective, since it is not producing on schedule, in conformity with production timetables (labor time charts). The administration of analgesia and/or anesthesia (which almost all of the hospital birthers in my study received, in various forms) further demonstrates to her the mechanicity of her labor; epidural anesthesia, which can numb a woman from the chest down, produces an especially clear physiological separation of her mind from the body-machine which produces the baby.

The external elec­tronic fetal monitor intensifies this message. This machine is attached to the woman’s body by large belts strapped around her waist to monitor the strength of her contractions and the baby’s heartbeat. An obstetrical resident commented, “The vision of the needle travelling across the paper, making a blip with each heartbeat, [is] hypnotic, often giving one the illusion that the machines are keeping the baby’s heart beating” (Harrison, 1982:90). The internal monitor, attached through electrodes to the baby’s scalp, communicates the additional message that the baby-as-hospital-product is in potential danger from the inherent defective­ness of the mother’s birthing machine.

If we stop a moment now to see in our mind’s eye the images that a laboring woman will be experiencing–herself in bed, in a hospital gown, staring up at an IV pole, bag, and cord on one side, and a big whirring machine on the other, and down at a huge belt encircling her waist, wires coming out of her vagina, and a steel bed, we can see that her entire visual field conveys one overwhelming perceptual message about our culture’s deepest values and beliefs–technology is supreme, and you are utterly dependent on it and on the institutions and individuals who control and dispense it:

At Doctor’s Hospital I attached the woman to the monitor, and after that no one looked at her any more. Held in place by the leads around her abdomen and coming out of her vagina, the woman looked over at the TV-like screen displaying the heartbeat tracings. No one held the woman’s hand. Childbirth had become a science. [Harrison, 1982:91]

These routine procedures speak as eloquently to the obstetrical person­nel who perform them as to the women who receive them; the more physicians, medical students, and nurses see birth “managed” in this way, and the more they themselves actively “manage” birth this way, the stronger will be their belief that birth must be managed this way:

Why don’t I do home births? Are you kidding? By the time I got out of residency, you couldn’t get me near a birth without five fetal monitors right there, and three anesthesiologists standing by. [female obstetrician, one year in practice]

As the moment of birth approaches there is an intensification of the ritual actions performed on the woman. She is transferred to a delivery room, placed in the lithotomy position, covered with sterile sheets, and doused with antiseptic, and an episiotomy is cut to widen her vaginal opening. These procedures cumulatively make the birthing woman’s body the stage on which the drama of society’s production of its new member is played out, with the obstetrician as both the director and the star (Shaw, 1974:84). The lithotomy position, in which the woman lies with her legs el­evated in stirrups and her buttocks at the very edge of the de­livery table, completes the process of her symbolic inversion from autonomy and privacy to dependence and complete exposure, expressing and reinforcing her powerlessness and the power of so­ciety (as evidenced by its representative, the obstetrician) at the supreme moment of her own individual transformation. The sterile sheets with which she is draped from neck to foot en­force the clear delineation of category boundaries, graphically illustrating to the woman that her baby, society’s product, is pure and clean and must be protected from the inherent unclean­ness of her body.

The delineation of basic social categories is furthered by the episiotomy, which conveys to the birthing woman the value and importance of the straight line – one of the most fundamental markers of our separation from nature (because it does not occur in nature). Of equal significance, the episiotomy transforms even the most natural of childbirths into a surgical procedure; routinizing it has proven to be an effective means of justifying the med­icalization of birth. (Estimates of episiotomy rates in first-time mothers (primagravidas) range from 50-90 percent; large teaching hospitals often have primagravida rates above 90 percent. Multi-gravida rates are estimated at 25-30 percent. In contrast, in the Netherlands episiotomies are performed in only 8 percent of births (Thacker and Banta 1983).)

The obstetrician instructs the mother on how to push, catching the baby and announcing its sex, then hands the baby to a nurse, who promptly baptizes “it” through the technocratic rituals of inspection, testing, bathing, diapering, wrapping, and the administration of a vitamin K shot and antibiotic eye drops. Thus properly enculturated, the newborn is handed to the mother to “bond” for a short amount of time (society gives the mother the baby), after which the nurse takes the baby to the nursery (the baby really belongs to society). The obstetrician then caps off the messages of the mother’s mechanicity by extracting her placenta if it does not come out quickly on its own, sewing up his episiotomy, and ordering more pitocin to help her uterus contract back down. Finally the new mother, now properly “dubbed” as such through her technocratic annointings, will be cleaned up and transferred to a hospital bed.

These routine obstetrical procedures cumulatively work to map the technocratic model of birth onto the birthing woman’s orientation to her labor experience, thereby producing a coherent symmetry (Munn, 1973:593) between her belief system and that of society. Diana experienced this process as follows:

As soon as I got hooked up to the monitor, all everyone did was stare at it. The nurses didn’t even look at me any more when they came into the room–they went straight to the monitor. I got the wierdest feeling that it was having the baby, not me.

Diana’s statement illustrates the successful progression of conceptual fusion between her perceptions of her birth experience and the technocratic model. So thoroughly was this model “mapped onto” Diana’s experience that she began to feel that the machine itself was having her baby, and that she was a mere onlooker. (Soon after the monitor was in place, Diana requested a Cesarean section, stating that there was “no more point in trying.”)

Merry’s internalization of one of the basic tenets of the technocratic model–the defectiveness of the female body–is observable in the following excerpt from her written birth story:

It seemed as though my uterus had suddenly tired! When the nurses in attendance noted a contraction building on the recorder, they instructed me to begin pushing, not waiting for the urge to push, so that by the time the urge pervaded, I invariably had no strength remaining, but was left gasping, dizzy and diaphoretic. The vertigo so alarmed me that I became reluctant to push firmly for any length of time, for fear that I would pass out. I felt suddenly depressed by the fact that labor, which had progressed so uneventfully up to this point, had now become unproductive.

Merry does not say, “the nurses had me pushing too soon,” but “my uterus had suddenly tired” and labor “had now become unproductive.” These responses reflect a basic tenet of the technological model of birth – when something goes wrong, it is the woman’s fault:

Yesterday on rounds I saw a baby with a cut on its face and the mother said, “My uterus was so thinned that when they cut into it for the section, the baby’s face got cut.” The patient is always blamed in medicine. The doctors don’t make mistakes. “Your uterus is too thin,” not “We cut too deeply.” “We had to take the baby,” (meaning forceps or Cesarean) instead of “The medicine we gave you interfered with your ability to give birth.” [Harrison, 1982:174]

The obstetrical procedures briefly described above fully satisfy the criteria for ritual: they are patterned and repetitive; they are symbolic, communicating messages through the body and the emotions; and they are enactments of our culture’s deepest beliefs about the necessity for cultural con­trol of natural processes, the untrustworthiness of nature, and the associated defectiveness of the female body. They also reinforce the validity of patriarchy, the superiority of science and technology, and the importance of institutions and machines. Furthermore, these procedures are transformative in intent – they attempt to contain and control the inherently transformative natural process of birth, and to transform the birthing woman into a mother in the full social sense of the word – that is, into a woman who has internalized the core values of American society: one who believes in science, re­lies on technology (and on those in charge of ordering/operating it), recognizes her inferiority (either con­sciously or unconsciously), and so at some level accepts the prin­ciples of patriarchy. Such a woman will tend to conform to society’s dictates and meet the demands of its institutions, and will raise her children to do the same. These birth rituals also transform the resident who is taught to do birth in no other way into the obstetrician who performs them as a matter of course: “No – they were never questioned. Preps, enemas, shaves, epi­siotomies – we just did all that; no one ever questioned it” (Dr. Stanley Hall).

Of course, there are many variations on this theme. Many younger doctors are dropping preps and enemas from their standard orders (although several complained to me that the nurses, also strongly socialized into the technocratic model, frequently administer them anyway). Increasing numbers of women opt for deliv­ery in the birthing suite or the LDR (labor-delivery-recovery room), where they can wear their own clothes, do without the IV, walk around during labor, and where the options of side-lying, squatting, or even standing for birth are increasingly available. (The fact that many of the procedures analyzed above can be instrumentally omitted underscores my point that they are rituals.) Yet in spite of these concessions to consumer demand for more “natural” birth, a basic pattern of consistent high-technological intervention remains: most hospitals now require at least peri­odic electronic monitoring of all laboring women; analgesias, pitocin, and epidurals are widely and commonly administered; in spite of decades of research that clearly demonstrate its severe physiological detriments (Johnstone et al., 1987; McKay and Mahan, 1984), the lithotomy position is still the most commonly used position for birth; and one in four American women will be delivered of their babies by Cesarean section. Thus, while some of the medicalization of birth drops away, the use of the most powerful signifiers of the woman’s dependence on science and technology intensifies.

Obstetrics, unlike other medical specialties, does not deal with true pathology in the majority of cases it treats: most pregnant women are not sick. It is, therefore, uniquely vulnerable to the challenges to its dominant paradigm presented by the natural childbirth and holistic health movements, for these movements rest their cases on that very issue – the inherent wellness of the pregnant woman versus the paradoxical insistence of obstetrics on conceptualizing her as ill, and on managing her body as if it were a defective machine. Over the past two decades, childbirth activists and younger doctors aware of this paradox have succeeded in increasing the number of birthing options available to women. Thus obstetrics is no longer as reliable as it once was in the straightforward transmission and perpetuation of American society’s core value system. To deal with this challenge, our society has gone outside the medical system, utilizing the combined forces of its legal and business systems to keep obstetricians in line.

Over 70 percent of all American obstetricians have been sued, a percentage higher than that of any other medical specialty (Easterbrook, 1987). Malpractice insurance premiums in obstetrics began their dramatic rise in 1973, just at the time when the natural childbirth movement was beginning to pose a major threat to the obstetrical paradigm. A common cultural response to this type of threat is to step up the performance of the rituals designed to preserve and transmit the reality model under attack (Douglas, 1973:32, Vogt, 1976:198). Consequently, the explosion of humanistic and wholistic options that challenged the conceptual hegemony of the technocratic model was paralleled by a stepping up of ritual performance, in the form of a dramatic rise in the use of the fetal monitor (from initial marketing in the sixties to near-universal hospital use today [Ob.Gyn News 1982]), accompanied by a concurrent rise in the Cesarean rate, from 5 percent in 1965 to almost 25 percent nationwide today (National Bureau of Vital Statistics 1987), reaching 50 percent in many teaching hospitals. Although technically not a routine procedure, the Cesarean section is well on its way to becoming one.6 A number of studies have shown that increased monitoring leads to increased performance of Cesareans (Banta and Thacker, 1979; Haverkamp and Orleans, 1983; Young, 1982:110). These dramatic increases in the ritual use of machines in labor and in the ritual performance of the ultimately technological birth, delivery “from above,” are at least partially attributable to the coercive pressure brought to bear on obstetricians by the pervasive threat of lawsuit.

In their quest for the perfect babies and safe births they feel they are owed under the technocratic paradigm, most women sue because of the underuse of technology, not because of its overuse. Most obstetricians interviewed perceived electronic monitoring as a means of self-protection, confirming that they are far more likely to perform a Cesarean than not if the monitor indicates potential problems, because they know that the risk of losing a lawsuit is lower if they cleave to the strict interpretation of the technocratic model. If they try a more humanistic approach–that is, if they try to be innovative, less technocratic, and more receptive to the woman’s needs and desires, they place themselves at greater risk. As one obstetrician put it:

Certainly I’ve changed the way I practice since malpractice became an issue. I do more C-sections – that’s the major thing. And more and more tests to cover myself. More expensive stuff. We don’t do risky things that women ask for – we’re very conservative in our approach to everything…In 1970 before all this came up, my C-section rate was around 4 percent. It has gradually climbed every year since then. In 1985 it was 16 percent, then in 1986 it was 23 percent.

These legal and financial deterrents to radical change powerfully constrain our medical system, in effect forcing it to reflect and to actively perpetuate the core value and belief system of American society as a whole. From this perspective, the malpractice situation emerges as society’s effort to keep its representatives, the obstetricians, from reneging on their responsibility for imbuing birthing women with the basic tenets of the technocratic model of reality.

From a more personal perspective, the value of careful adherence to form in ritual must be appreciated in order to understand the powerful appeal the repetitive patterning of obstetrical procedures has for obstetrical personnel. Moore and Myerhoff observe that order and exaggerated precision in performance, which set ritual apart from other modes of social interaction, serve to impute “permanence and legitimacy to what are actually evanescent cultural constructs” (1977:8). This establishment of a sense of “permanence and legitimacy” is particularly important in the performance of obstetrical procedures because of the limited power the obstetrician’s technocratic model actually gives him or her over the events of birth.

Although through ritual a culture may do its best to make the world appear to fit its belief system, divergent realities may occasionally perforate the culture’s protective filter of categories and threaten to upset the whole conceptual system. Thus obstetricians and nurses, who have experienced the agony and confusion of maternal or fetal death or the miracle of a healthy birth when all indications were to the contrary, know at some level that ultimate power over birth is beyond them. They may well fear that knowledge. In such circumstances, humans use ritual as a means of giving themselves the courage to carry on (Malinowski, 1954). Through its careful adherence to form, ritual mediates between cognition and chaos by appearing to restructure reality. The format for performing standard obstetrical procedures provides a strong sense of cultural order imposed on and superior to the chaos of nature:

“In honest-to-God natural conditions,” [the obstetrician] says [to the students observing the delivery he is performing], “babies were sometimes born without tearing the perineum and without an episiotomy, but without artificial things like anesthesia and episiotomy, the muscle is torn apart and if it is not cut, it is usually not repaired. Even today, if there is no episiotomy and repair, those women quite often develop a retocoele and a relaxed vaginal floor. This is what I call the saggy, baggy bottom.” Laughter by the students. A student nurse asks if exercise doesn’t help strengthen the perineum….”No, exercises may be for the birds, but they’re not for bottoms….When the woman is bearing down, the leveator muscles of the perineum contract too. This means the baby is caught between the diaphragm and the perineum. Consequently, anesthesia and episiotomy will reduce the pressure on the head and, hopefully, produce more Republicans.” More laughter from the students. [Shaw, 1974:90]

To say that obstetrical procedures are “performed” is true both in the sense that they are done and in the sense that they can be “acted” and “staged,” as is evident in the quotation above. Such ordered, acted and stylized techniques serve to deflect questioning of the efficacy of the underlying beliefs and forestall the presentation of alternative points of view (Moore and Myerhoff, 1977:7) by the medical and nursing students as they undergo the process of their own socialization into the technological model. 7 This model has internal logic and consistency; once these medical initiates have absorbed its basic tenets, including, as we see above, the notions of the defectiveness of nature and the female body and the superiority of the technological approach, they will come to perceive all the other aspects of the obstetrical management of birth as reasonable and right. Thus the system becomes tautological, and its self-perpetuation is ensured.

Women’s Rites: The Politics of Birth

            “In a traditional philosophical opposition,” writes Jacques Derrida, “we have not a peaceful coexistence of facing terms but a violent hierarchy. One of the terms dominates the other (axiologically, logically, etc.) and occupies the command­ing position” (1981:56-57). Feminist scholar Helene Cixous states that the man/woman opposition may well be the paradigmatic opposition in Western discourse (1975:116-119). Inherent in this opposition, as in our entire social discourse, is a “violent hierarchy” in which the value-laden male dominates the devalued female.

Shifting needs in our society enable women to work in a man’s world, sometimes for equal pay, but no matter how early in life a woman begins her career, nor how successful she is, she will still be living and working under the constraints of her conceptual denial by the technocratic model of reality. Based as it is on a fundamental assumption of her physiological inferiority to men, that model guarantees her continued psychologi­cal disempowerment by the everyday constructs of the culture-at-large, and her alienation both from political power and from the physiological attributes of womanhood.

It came as a shock to me, then, to discover that fully seventy percent of the one hundred women in my study expressed varying degrees of contentment with their technocratic births. As I explored the reasons behind this finding, I came to realize that the technocratic rituals of hospital birth, notwithstanding the philosophy that underlies them, do of course provide the same sense of order, security and power to birthing women as they do to physicians and nurses. Moreover, that philosophy itself is not so alien to today’s women as I had imagined. Although forty-two of these seventy women did enter the hospital with the expressed intention of “doing natural childbirth,” this philosophical goal faded in importance as labor progressed–or “failed to.”8  As these women gradually became convinced of the defectiveness of their birthing machines or of the birth process, they came to interpret the interventions they experienced as appropriate (albeit sometimes unpleasant) and so clearly stated that they felt “okay with” or “good about” the technocratic births they ended up with. The other twenty-eight entered the hospital already convinced that the way of technology was better than the way of nature. They initially wanted technocratic births and were generally satisfied with the ones they got. I consistently found that such women, who generally wish to live within American society’s dominant core value system, will feel slighted if their births are not marked by the procedures that they themselves view as ritually appropriate:

My husband and I got to the hospital, and we thought they would take care of everything. We thought that we would do our breathing, and they would do the rest. I kept sending him out to ask them to give me some Demerol, to check me – anything–but they were short-staffed and they just ignored me until the shift changed in the morning. [Sarah Morrison]

Because the technocratic model of birth encapsulates the core values of the wider culture, in many ways it offers to modern women the opportunity to further integrate themselves with that wider culture. The technocratic model itself replaced an earlier and narrower paradigm of birth that still retains a certain symbolic force–a paradigm that held both birth, and women’s place, to be in the home. Hospital birth was eagerly sought by women in the earlier part of this century as a powerful step in their liberation from the “confinement” of the home, as was bottle-feeding. As one mother put it to her daughter in a novel written in 1936, “The bottle was the battle cry of my generation” (quoted in Wertz and Wertz 1989:150). More­over, middle-class women themselves campaigned for the acceptance in America of scopolamine-induced “twilight sleep” as a further means of freeing themselves from what they were increasingly beginning to perceive as enslavement to their biological processes.

Therefore, it should come as no surprise that many of today’s postmodern women would wish to identify with their earthy biological selves and the confines of the domestic realm even less than their turn of the century sisters who paved the way for them. Unlike these historical sisters, to whom adequate contraception was unavailable, most of the women in my study chose to have only one or two children, and placed a great deal of emphasis on being present to the experience of giving birth. While the total personal obliteration of a scopolamine birth would have been anathema to all of them, many nevertheless did seek a high degree of detachment from the biology of birth through epidural anesthesia. Joanne put it this way:

Even though I’m a woman, I’m unsuited for delivering….and I couldn’t nurse….I just look like a woman, but none of the other parts function like a mother. I don’t have the need or the desire to be biological….I’ve never really been able to understand women who want to watch the birthing process in a mirror – just, you know, I’m not, that’s not – I’d rather see the finished product than the manufacturing process.

Joanne, like many others in my study, preferred epidural  anesthesia for both of her Cesarean births, as it allowed her to be intellectually and emotionally present, while physically detached:

[I liked that because] I didn’t feel like I had dropped into a biological being….I’m not real fond of things that remind me I’m a biological creature–I prefer to think and be an intellectual emotional person, so you know, it was sort of my giving in to biology to go through all this.

Such attitudes, increasingly common especially among professional women, have generated what many childbirth practitioners are calling the “epidural epidemic” of the 1990s. (Sixty percent of the women in my study, and eighty percent of the women in a recent study by Sargent and Stark (1987) received epidurals.) As the epidural numbs the birthing woman, eliminating the pain of childbirth, it also graphically demonstrates to her through her lived experience the truth of the Cartesian maxim that mind and body are separate, that the biological realm can be completely divorced from the realms of the intellect and the emotions. 10 The epidural is thus the perfect technocratic tool, serving the interests of both the technocratic model (by transmitting it) and of the women giving birth under that model, who usually find that they benefit most not from rejecting that model but from using it to their own perceived advantage:

When I got there, I was probably about five centimeters, and they said, “Uh, I’m not sure we have time,” and I said, “I want the epidural. We must go ahead and do it right now.!” So, we had an epidural. [Beth]

Ultimately the decision to have the epidural and the Cesarean while I was in labor was mine. I told my doctor I’d had enough of this labor business and I’d like to…. get it over with. So he whisked me off to the delivery room, and we did it. [Elaine]

While the majority of women in my study, like Joanne, Beth and Elaine, found some degree of empowerment in technocratic conformity, fifteen percent successfully avoided conceptual fusion with the technocratic model by adhering to and achieving their goals of “natural childbirth” in the hospital. In contrast to the majority, these fifteen women were personally empowered by their resistance to the technocratic model. They tended to view technology as a resource that they could choose to utilize or ignore, and often consciously subverted their socialization processes by replacing technocratic symbols with self-empowering alternatives (e.g. their own clothes and food, perineal massage instead of episiotomy):

The maternity room sent somebody down with a wheelchair. I didn’t have any need for a wheelchair, so we piled all of the luggage into it and wheeled it up to the floor [Patricia].

Giving birth was really satisfying….I felt incredibly powerful and absolutely delighted. I felt that I knew exactly what was happening….My perception of it was that I was in charge and these other people were my assistants….[Teresa]

Another nine percent of my interviewees entered the hospital believing strongly in the benefits of natural childbirth and in their ability to give birth naturally, but came out feeling “like a failure,” and “totally disempowered” by the highly technocratic births they actually experienced. The messages of helplessness and defectiveness that they received from these births engendered considerable conflict between the self-images they previously held, and those they internalized in the hospital:

After the birth I felt just miserable, agonizingly miserable. When I was relating to the baby, I was totally happy–I was so thrilled with her. But all the rest of the time I felt so sad–gray around the edges. Just sad and gray….and ashamed. I felt so ashamed of myself for….not being able to do it….And I had so many questions that I started to read some more. More and more. And I started to admit to myself that I felt humiliated by my birth. And then when I realized that I probably hadn’t even needed a Cesarean, I started to realize that I felt raped, and violated somehow, in some really fundamental way. And then I got angry. [Elise]

When I began this research, I nurtured the illusion that women like Elise would be in the majority. I thought women everywhere would be rising up in resistance to their technocratic treatment. But I found, to summarize, that twenty-eight women did not want anything to do with natural childbirth, and forty-two, while initially giving what apparently was lip service to the ideal of natural childbirth, quickly and easily adapted to technocratic interventions, expressing no resistance to or resentment of those interventions. 11 Only twenty-four women out of the one hundred in this study actually succeeded at “natural childbirth” or were distressed when they did not succeed. This low number of women deeply committed to the philosophy of natural childbirth is quite representative of the fate in the 1990s of the natural childbirth movement of the 1970s and 1980s–much of its force has been redirected (some would say subverted and coopted (Rothman 1982)) from educating women to resist technocratic birth into educating women to feel comfortable with and even empowered by birth under the technocratic paradigm. Many childbirth educators, who used to make it a point to serve as a primary counteracting force to technocratic socialization, are finding that there is no longer much reason to rail against technocratic abuses in their classes. 12 (The cover on a recent childbirth education magazine asks plaintively, “Have epidurals made childbirth education obsolete?” (Simchak 1991).)

Opposition to technocratic birth has thus become much more polarized than before. Women who seek true alternatives to the technocratic model, finding them generally unavailable in the hospital, often choose to give birth in midwife-attended free-standing birth centers or at home. 13

The Holistic Alternative

Six of the women in my study (six percent) gave birth at home. The alternative paradigm these women adopted is based on systems theory and offers a wholistic, integrating approach to childbirth as well as to daily life–an approach that stresses the inherent trustworthiness of the female body, communication and oneness between mother and child and within the family, and self-responsibility (Davis-Floyd, 1986, 1992; Rothman, 1982; Star, 1986). Tara expresses one aspect of their systemic view:

Pain? It’s part of the whole experience. In this society, we try not to experience pain. We take lots of drugs, I mean legal things. And I feel that’s why a lot of people get into other forms of drug abuse….Even though during labor I remember feeling it was almost unbearable, it never entered my mind to wish I had “something for the pain”….I wanted the pain to stop, but not because somebody gave me something. I guess part of it is….the wonderful physical and emotional stuff that is going on at the same time as the pain. If you took drugs for the pain, you would change all the rest of it, too.

These homebirthers sought, not a return to the “motherhood as defining feature” paradigm of the 19th century, but rather an expanded vision of womanhood that encompasses both the gains achieved in the workplace under the technocratic model and a renewed sense of the value of women’s experiences. As one woman put it, “It’s a spiral, not a circle. We’re not going backwards to `women’s domain,’ but forward, to a space where all our attributes can be celebrated.”

In technocratic reality, not only are mother and baby viewed as separate, but the best interests of each are often perceived as conflicting. In such circumstances, the mother’s emotional needs and desires are almost always subordinated to the medical interpretation of the best interests of the baby as the all-important product of this “manufacturing process.” Thus, individuals operating under this paradigm often criticize home-birthers as “selfish” and “irresponsible” for putting their own desires above their baby’s needs. But under the holistic paradigm held by these home birthers, just as mother and baby form part of one integral and indivisible unit until birth, so the safety of the baby and the emotional needs of the mother are also one. The safest birth for the baby will also provide the most nurturing environment for the mother. Said Tara:

The bottom line was that I felt safer [at home], and I think that’s what it boils down to for most people. That’s why it didn’t seem unusual to me. It seemed strange to me that people feel safer with the drugs and that type of thing because I’m just not that way.

Elizabeth said, “My safest place is my bed. That’s where I feel the most protected and the most nurtured. And so I knew that was where I had to give birth.” And Ryla said:

I got criticized for choosing a home birth, for not considering the safety of the baby. But that’s exactly what I was considering! How could it possibly serve my baby for me to give birth in a place that causes my whole body to tense up in anxiety as as soon as I walk in the door?

According to the technocratic model, the uterus is an involuntary muscle, and labor proceeds mechanically in response to hormonal signals. Proponents of the holistic model see the uterus as a responsive part of the whole, and therefore believe that the best labor care will involve attention to the mother’s emotional and spiritual desires, as well as her physical needs. The difference between these two approaches is clearly illustrated by the reponses of a physician and a lay midwife to the stopped labor of a client. The physician said, “It was obvious that she needed some pitocin, so I ordered it,” and the midwife said, “It was obvious that she needed some rest, so she went to sleep, and we went home.” Here is Susan’s story:

Nikki [the midwife] kind of got worried about it towards the afternoon. Because it just kept going on and nothing was changing. And she took me to the shower and said, “Just stay in there till the hot water goes away.” And Ira went with me to massage me and try to get everything relaxed. And then Nikki asked my friend Diane, “What’s the deal with Susan, what’s going on? Is she….stressed out about work?” And Diane said, “Well, yeah, I think she’s afraid to have the baby….[that] she’s not going to be able to go back to her job and all that.” So when I came back out….Nikki started in on me about it. She said, “Right now your job is not important. What you have to do right now is have this baby. This baby is important.” And I just burst into tears and was screaming at her and started crying and I could feel everything when I started crying just relax. It all went out of me and then my water broke and we had a baby in 30 minutes. Just like that.

The Technocratic Model and the Future

            Our cultural attachment to the technocratic model is profound, for in our technology we see the promise for our society of eventual transcendence of both our physical and our earthly limitations (already we build humanlike robots, freeze bodies in cryogenic suspension, and design space stations). In the cultural arena of birth, the technocratic model’s emphasis on mechanicity, separation, and control over nature potentiates various sorts of futuristic behavioral extremes. These include, among many others: court-ordered Cesareans–cases in which the mother refuses to have a Cesarean, but is forced to do so by the courts against her will (Irwin and Jordan 1989; Shearer 1989); surrogacy–a contractual arrangement in which the womb of one woman is rented to incubate someone else’s child (Sault, 1989); sex preselection–using various techniques to try to ensure that the baby will be a boy or a girl, using amniocentesis to determine which it is, and then aborting if it isn’t the desired sex; and genetic engineering–altering genes to select for certain desired traits or eliminate undesirable ones. (It is worth remembering that such futuristic reproductive technologies are envisioned, invented, and “chosen” in a sociocultural context which values them more than the female bodies they act upon.) How far can this trend carry us? The February 1989 issue of Life magazine’s cover story, “The Future and You,” predicts “Birth Without Women”:

By the late 21st century, childbirth may not involve carrying at all–just an occasional visit to an incubator. There the fetus will be gestating in an artificial uterus under conditions simulated to recreate the mother’s breathing patterns, her laughter and even her moments of emotionsl stress (1989:55).

The paradigm which makes such futuristic options seem not only possible but also desirable presents real dangers to those who conceptually oppose it and act on their convictions. Across the country, would-be homebirthers and the lay midwives who attend them report harrassment and sometimes prosecution by the medical and legal establishment, as do women who attempt to refuse obstetrical interventions, including court-ordered Cesareans. Such interventions are often ordered because the technocratic paradigm grants no legitimacy to women who value their own “inner knowing” more than technologically-obtained information about what is “safe”:

In a 1981 Georgia case, doctors told the court there was a 99% chance of fetal death and a 50% chance of maternal death unless a scheduled Cesarean section was performed, since two ultrasounds indicated a complete placenta praevia [a potentially life-threatening situation in which the placenta lies under the baby, blocking the entrance to the birth canal]. The mother steadfastly believed in her ability to give birth safely. After the court order was granted, a third ultrasound showed no praevia at all. Either the placenta had moved late in pregnancy or the ultrasound machine had been wrong (Shearer, 1989:7).

Extremes, on both ends of the spectrum, play an important role in defining the outer edges of the possible and the imagined. Most especially, those at the extreme of conceptual opposition to a society’s hegemonic paradigm create much more room for growth and change within that society than would exist without them. Because the technocratic paradigm is hegemonic, pervading medical practice and guiding almost all reproductive research, no middle-class woman who gives birth at home can fail to be aware that she is battling almost overwhelming social forces that would drive her to the hospital. The homebirthers in my study who espouse the holistic model do so in direct and very conscious opposition to the dominant technocratic model. They represent the fewer than one percent of American women who choose to give birth at home. I suggest that the importance to American society of this tiny percentage of alternative model women is tremendous, for they are holding open a giant conceptual space in which women and their babies can find metaphorical room to be more than mechanistic antagonists. Home birthers I have interviewed use rich metaphors to describe pregnancy, labor and birth that work to humanize, personalize, feminize, and naturalize the processes of procreation. They speak of mothers and babies as unified energy fields, complementary co-participants in the creative mysteries, entrained and joyous dancers in the rhythms and harmonies of life. They talk of labor as a river, as the ebb and flow of ocean waves, as ripened fruit falling in its own good time.

Home birthers in the United States are an endangered species. Should they cease to exist, the options available in American society for thinking about and treating pregnancy, birth, and the female body would sharply decrease, and our society would be enormously impoverished. Should they thrive, we will continue to be enriched by their alternative visions.

As feminists, we fight for the right to make our bodies our own, to metaphorize, care for, and technologize as we please. The intensifying quest of many postmodern women for distance from female biology leads inevitably to the question: as women increasingly break out of the confines of the biological domain of motherhood, will/should our culture still define that domain as primarily belonging to women? What do we want? As we move into the 21st century, will the options opened to us by our technology leave equal conceptual room for the women who want to be their bodies, as well as for the women for whom the body is only a tool? As researchers like Ehrenreich and English (1973), Corea (1985), Rothman (1982, 1989), and Spallone (1989) have shown, the patriarchy has been and is only too willing to relieve us of the necessity for our uniquely female biological processes. To what extent do we desire to give up those processes in order to compete with men on their terms and succeed? In the new society we are making, will the home birthers and the home schoolers, the goddesses and the Earth Mothers, have equal opportunity to live out their choices alongside those who want to schedule their Cesareans, and those who want their babies incubated in a test tube?

Because the birth process forms the nexus of nature and society, the way a culture handles birth will point “as sharply as an arrowhead to its key values” (Kitzinger 1980:115). Any changes in these values and in the model of reality which underlies them will thus be both reflected in and effected by changes in the way that culture ritualizes birth. The existence of core value options is of critical importance for the future directions our society will take; changes in the hegemonic values transmitted through birth could profoundly alter those directions. In times of rapid change such as these, a society’s adaptive capacity lies in its conceptual diversity just as surely as in its genetic diversity. As the natural childbirth movement of the 70s and 80s has been largely coopted and subsumed into the service of technocratic hegemony, so the holistic models of lay midwives and homebirthers could be completely overrun by the technocratic paradigm. I believe that it is the responsibility of feminist scholars everywhere to track the cultural treatment of birth, to register the disappearance of old options and the opening of new ones, and to work to make us all aware of their implications for the kind of culture that future generations of our society will acquire through the ritualization of birth.

ENDNOTES

Acknowledgments

I wish to express my appreciation to M. Jane Young, Linda Pershing, and Susan Hollis for their hard work and for the endless patience it has taken to see this volume through to publication, and to Bruce Jackson for his excellent editorial assistance on the first version of this article.

1. The full results of this research appear in Birth as an American Rite of Passage (University of California Press, 1992).

2. This present article is a revised version of an article entitled “The Technological Model of Birth” previously published in the Journal of American Folklore, 100:398. In this version I have changed “technological” to “technocratic” because 1) technology is pervasive in all human cultures; and 2) I seek through this label to link this model to the core value system of American culture. We live today in a technocracy–a post-industrial society organized around an ideology of technological progress (Reynolds 1991). Webster’s (1979) defines “technocracy” as “management of society by technical experts”; hospital birth is likewise defined by its management by technical experts.

3.  My interview questions for this article were primarily focused on first births.

4.  In most hospitals the scientific rationale for this standard separation period involves the need to keep the baby warm and to monitor its condition. According to one obstetrician, this routine separation of mother and child was instituted during the period of the routine use of scopolamine for labor and birth, when the mother was quite literally unable to care for her baby for some time after its delivery. Routine continuance of the separation period today reflects both past precedent and current events–many mothers are still too anesthetized after their births to care well for their babies, and it is a fact of institutional life that nurses have to process a good deal of paperwork concerning the baby, which they are best-equipped to do in the nursery. However, mothers who give birth in “birthing rooms” are allowed to keep their babies with them continually; because standard sterile procedures are not used in these birthing rooms, these babies are considered “contaminated” and therefore are not allowed in the nursery.

5. The underlying justification for the symbolic interpretations summarized here can be found in Davis-Floyd 1992.  Portions of this analysis appear in Davis-Floyd 1987, 1988, 1989.

6. In my ongoing interviews with new mothers and childbirth practitioners, I have recently noticed a new trend. Obstetricians are under intense pressure to reduce the Cesarean rate, so in lieu of Cesareans, they are increasingly resorting to reliance on epidurals, large episiotomies, and forceps. The last three women I have interviewed were delivered in this manner; they all said proudly, “I didn’t have to have a Cesarean!”

7. Detailed analysis of obstetrical training as an initiatory rite of passage appears in Davis-Floyd, 1987.

8. “Failure to progress” is a catch-all diagnosis in obstetrics, applied when women’s labors “fail” to conform to standardized labor time charts. Such a diagnosis usually leads first to the administration of pitocin to speed labor, and then to the performance of a Cesarean section.

9. Ironically, scopolamine, which reduced the birthing woman to an animalistic state (but then erased all events from her memory), was quickly coopted by the medical profession into providing the rationale for claiming complete control of the birth process. This drug, once a symbol of women’s liberation from the pain of childbirth, became for the childbirth activists of the 1970s and 1980s a symbol of women’s subjugation to the medical profession. Even its replacement by the epidural is symbolic: the calm, controlled “awake and aware” Lamaze mother with the epidural fits the picture of birthing reality painted by the technocratic model far better than the “scoped-out” screaming “wild animal” of the 50s.

10. Physiological advantages of the epidural include excellent pain relief that leaves the woman alert and aware throughout labor, and small (but unknown) risk to the baby. Disadvantages include an increased incidence of Cesarean section, forceps delivery, urinary tract infection (from the urinary catheterization that must be done every few hours), and long-term backache; dependence on others for basic physical needs because the women must stay in bed with her head slightly elevated; constant electronic fetal monitoring; and frequent blood pressure monitoring. The result of an epidural, thus, is the elimination of the possibility of the activities a woman herself can do to facilitate labor and delivery: using a comfortable upright position, changing position frequently, emptying her bladder often, and walking (which greatly facilitates the effectiveness of contractions and cervical dilation) (Simchak, 1991:16).

11. Close examination of the birth narratives of these forty-two women reveals that, prior to entering the hospital, their belief systems showed a relatively high degree of correspondence with the technocratic model (Davis-Floyd, 1992, Ch. 5). Intensive socialization into a paradigm that one already more or less agrees with is certainly less painful a procedure than socialization into a paradigm radically different from one’s own.

12. It is still possible to find childbirth educators in most cities who are truly committed to teaching the philosophy and methods of natural childbirth. Most notably, instructors trained in the Bradley method tend to take an uncompromising stance:

In the Bradley method, when we say successful outcome, we mean a totally unmedicated, drug-free natural childbirth without routine medical intervention that enables the woman to exercise all her choices in birthing and give her baby the best possible start in life. And we expect this over 90% of the time. [McCutcheon-Rosegg, 1984:8]

In this technocratic age, it is fascinating to note that this expectation has consistently been fulfilled in over 90% of the birth experiences of the over 4000 low- and high-risk couples taught the Bradley method by American Academy of Husband-Coached Childbirth founders Jay and Margie Hathaway.

13. Alternative birthing centers (ABCs) within hospitals became widespread in the 1980s. Although in their homelike and cosy appearance they seem to offer the best of both worlds, in most hospitals few of the women who start out in such centers actually end up giving birth there, as most labors do not conform closely enough to technocratic standards to be allowed to remain in the ABC. On the other hand, a recent study of 11,814 births in free-standing birth centers (Rooks et al., 1989) showed clearly that the physical lack of connection to a hospital is accompanied by a conceptual lack of connection to the technocratic model. Births in such centers tended to be intervention-free, with outstanding outcomes: the Cesarean rate was 4.4 percent, and the perinatal death rate was 1.3 per 1000 (the national average is 10 per 1000).

Available statistics indicate that midwife-attended planned home birth is safer than hospital birth. In several recent studies (Marimikel Penn, personal communication; Sullivan and Weitz, 1988; Tyson 1991), the Cesarean rates for midwife-attended births planned to occur at home are consistently around 4 percent; hospital transfer rates range from 8-11 percent; perinatal mortality rates range from 1-5/1000. (Maternal mortality is almost nonexistent in planned home birth.) In further summary, I quote a recent study from Holland on far larger numbers than are generally available:

The PNMR [perinatal mortality rate] was higher for doctors in hospital (18.9/1000 [83,351 births]) than for doctors at home (4.5/1000 [21,653 births]), which was in turn higher than for midwives in hospital (2.1/1000 [34,874 births]) than for midwives at home (1.0/1000 [44,676 births])…. [These results show] that care by obstetricians is not only incapable, save in exceptional cases, of reducing predicted risk, but even that it actually provokes and adds to the dangers….[They confirm] that midwives, practising their skills in human relations and without sophisticated technological aids, are the most effective guardians of childbirth and that the emotional security of a familiar setting, the home, makes a greater contribution to safety than does the equipment in hospital to facilitate obstetric interventions in cases of emergency (Tew, 1990:267).

(For a more detailed discussion of the relative safety of home vs. hospital birth, see Davis-Floyd 1992 (Ch. 4).)

tabl>?? t8?? 8Z? ve pressure brought to bear on obstetricians by the constant threat of lawsuit. Most obstetricians interviewed perceived constant electronic monitoring as a means of self-protection, and confirmed that they are far more likely to perform a Cesarean than not if the monitor indicates potential problems, because they know that the likelihood of lawsuit is lower if they cleave to the strict interpretation of the technological model, whereas if they try the humanistic approach – i.e. if they try to be innovative, less technological, and more receptive to the woman’s needs and desires, they place themselves at greater risk. As one of them puts it,

Certainly I’ve changed the way I practice since malpractice became an issue. I do more C-sections, that’s the major thing. And more and more tests to cover myself. More expensive stuff. We don’t do risky things that women ask for – we’re very conservative in our approach to everything….In 1970 before all this came up, my C-section rate was around 4%. It has gradually climbed every year since then. In 1985 it was 16%, then in 1986 it was 23%.

These legal and financial deterrents to radical change powerfully constrain our medical system, in effect forcing it to precisely reflect and to actively perpetuate the core value and belief system of American society as a whole. From this perspective, the malpractice situation emerges as society’s effort to keep its representatives, the obstetricians, from reneging on their responsibility for imbuing birthing women with the basic tenets of the technological model of reality. As I discuss elsewhere (Davis-Floyd 1986b), our cultural attachment to this model is profound, for in our technology we see the promise for our society of eventual transcendence of both our physical and our earthly limitations (already we grow babies in test tubes, freeze bodies in cryogenic suspension, and build the first space station). In enlisting American obstetricians as guardians of technology, and in watchdogging that guardianship with its legal system, American society is doing its utmost to protect our shared cultural dream of transcendence through technology.

Acknowledgements

I wish to acknowledge the outstanding editorial assistance of Robert Hahn and Alan Harwood. Thanks also are due to Brigitte Jordan and Beverly J. Stoeltje for their consistent and much-appreciated support.

1. The characteristics of ritual outlined here are adapted from the following sources: Moore and Myerhoff 1977; d’Aquili, Laughlin and McManus 1979; Munn 1973; Turner 1967, 1969; Abrahams 1973.

2. Because most of the practicing obstetricians in the country, as well as in my study, are male, it seems appropriate to use the gender-specific pronoun “he” in this article, except, of course, where the referent is a woman. All obstetricians quoted without mention of their sex are male.

3. The underlying justification for the symbolic interpretations summarized here can be found in Davis-Floyd 1986b. Portions of this analysis will appear in Davis-Floyd 1987.

4. Upon reading this quotation, an obstetrician in my study commented, “It is this type of humor, so common as a teaching technique, that stamps the impression on the soul. The humor feeds into the discomfort the medical students feel over trying to deal with `perineums,’ and allows them to detach in a derisive way.”

5. It might be argued that my emphasis on the redundancy of obstetrical rituals ignores the high value placed in residency on mastery of `the latest’ techniques. I would like to suggest, however, that no matter which new techniques are incorporated into the obstetrical management of birth, as long as they are technological in method and orientation, `the latest,’ symbolically speaking, is just ‘more of the same.’

6. In contrast to this view, proponents of home birth point to improvements in the standard of living and nutrition as the major causes in the decline of the infant mortality rate. They further claim that the rate would be far lower if birth were de-technologized (Stewart and Stewart 1976, 1977, 1979, 1981).

7. Various studies from “mainstream medicine” (for example, Mendez-Bauer 1975, Schwartz et al 1979 (1977)), have demonstrated that standing and walking increase the effectiveness of contractions and decrease maternal pain, resulting in shorter labors.

8. This obstetrician went on to provide the following examples of “typical resident behavior.” (A discussion of his humanistic philosophy of birth, and that of others like him, is presented in the conclusion.)

This woman came to me recently – she had been told by a resident in the clinic that she would never get rid of her chronic vaginal infection because she was too fat. She wasn’t obese or anything like that – only weighed about 160. Finally she came to me and all she had was a simple yeast infection that he had misdiagnosed. I gave her some Monistat and she was fine the next day. The worst thing was that she believed him for a while, so of course she was feeling terrible about herself because of what he had said.

Here’s another example, told to me by a patient I saw yesterday:

Woman to ob/gyn: I have been keeping track of my symptoms and I think I have PMS.

Ob/gyn (just out of residency): The problem with you is that you have an obsessive compulsive neurosis, evidenced by the way you keep track of your menses.

And she went back to him! But finally she came to me, and she was right – she does have PMS and it’s responding to treatment.

I’ll give you an example of a conversation I heard recently:

Female patient to OB after hysterectomy: It hurts more on the left side, doctor. Should I be worried?

OB to female patient: No, dear, we did more work on that side.

Resident to OB outside of patient’s room: Why did you tell her that? I was there, and I didn’t see you do more work on that side.

OB to resident: Of course not, son, but look how much better she feels now!

This is how these residents learn to treat women!

One of the teachers most respected by the residents here is so respected because he can do a Cesarean in twelve minutes. His complication rate is horrendous because you can’t help but butcher the woman when your emphasis is speed, but the residents don’t seem to notice that. No residents scrub in on my deliveries because I don’t do much, don’t use the machines, so they think they have nothing to learn from me – they don’t want to know about truly normal birth.

9. A futher trend in obstetrics is the increasing percentage of women who will be practicing this specialty: half the students in many medical schools today are female. In 1986 69% of U.S. medical school graduates who said they would choose obstetrics were women, compared to 34% in 1982 (Wall Street Journal, 1987). Thus far, female obstetricians, constrained to overcompensate in medical school for being female, have in general made no significant changes in the conduct of American birth. What differences the power of increasing numbers will make remains to be tracked by students of the American way of birth. One “radical” obstetrician offered this observation:

I was recently amazed when several OB residents who are female stated that they wanted their epidurals by the third contraction. It’s so interesting that these women, usually placed on a pedestal by feminists….really don’t know what it is to give birth and don’t stand a chance of finding out. They learn from their experience in the hospital that birth is only okay if it is technologically controlled. Rarely if ever will they participate in a truly normal birth. That’s perceived as boring because they don’t learn any skills from it….If a female resident never sees normal, of course she’s going to want an epidural!

10. The Childbirth Alternatives Quarterly states, “The national Cesarean rate was 22.7% in 1985, up 1.6% from 1984, as reported in unpublished statistics compiled by the National Center for Health Statistics” (Ashford 1986-7, Winter).

References Cited

Abrahams, Roger D.

1973 Ritual for Fun and Profit (or The Ends and Outs of Celebration). Paper delivered at the Burg Wartenstein Symposium No. 59, on “Ritual: Reconciliation in Change,” New York: Wenner-Gren Foundation for Anthropological Research.

Arms, Suzanne

1981[1975] Immaculate Deception. New York: Bantam Books.

Ashford, Janet Isaacs, ed.

1986-7 The Childbirth Alternatives Quarterly. Winter.

Babcock, Barbara, ed.

1978 The Reversible World: Symbolic Inversion in Art and Society. Ithaca NY.: Cornell University Press.

1980 Reflexivity: Definitions and Discriminations. Semiotica 30:1-14.

Banta, H. David and Stephen B. Thacker

1979 Costs and Benefits of Electronic Fetal Monitoring: A Review of the Literature. U.S. Dept. of Health, Education, and Welfare, National Center for Health Services Research, DHEW Pub. No. (PHS)79-3245, Washington, D.C.: U.S. Government Printing Office.

Beuf, Ann Hill

1979 Biting Off the Bracelet: A Study of Children in Hospitals. Philadelphia: University of Pennsylvania Press.

Brackbill, Yvonne, June Rice, and Diony Young

1984 Birth Trap: The Legal Low-Down on High-Tech Obstetrics. St. Louis: Mosby.

Carver, Cynthia

1981 The Deliverers: A Woman Doctor’s Reflections on Medical Socialization. In Childbirth: Alternatives to Medical Control. Shelly Romalis, ed. Pp. 122-149. Austin: University of Texas Press.

Corea, Gena

1980 The Cesarean Epidemic. Mother Jones, July.

1985 The Hidden Malpractice.

1985 The Mother Machine. 1985.

d’Aquili, Eugene G., and Laughlin, Charles D.

1979 The Neurobiology of Myth and Ritual. In The Spectrum of Ritual: A Biogenetic Structural Analysis. d’Aquili, Eugene, Charles D. Laughlin, and John McManus, eds. Pp. 152-182. New York: Columbia University Press.

d’Aquili, Eugene G., Charles D. Laughlin, and John McManus,

1979 The Spectrum of Ritual: A Bio-Genetic Structural Analysis. New York: Columbia University Press.

Davis-Floyd, Robbie E.

1986a Afterword. In The Healing Power of Birth, by Rima Beth Star, Pp. 119-135. Austin, TX: Star Publishing.

1986b Birth as an American Rite of Passage. Ph.D. dissertation, Department of Anthropology/Folklore, University of Texas at Austin. University Microfilms Publication No. 86-18448.

1986c Routines and Rituals: A New View. Nurses Association of the American College of Obstetrics and

Gynecology Update Series, Princeton, NJ: Continuing Professional Education Center, Inc.

1987 Obstetric Training as a Rite of Passage. Woman, Physician and Society. Special Issue of the Medical Anthropology Quarterly. Vol. 1, no 3.

1988 Birth as an American Rite of Passage. In The Anthropology of Childbirth in America, Karen Michaelson, ed. Beacon Hill, MA: Bergin and Garvey.

Douglas, Mary

1973 Natural Symbols: Explorations in Cosmology. New York: Vintage Books.

Easterbrook, Gregg

1987 The Revolution in Medicine. In Time Magazine. Pp. 40-74. January 26.

Fox, Renee

1957 Training for Uncertainty. In The Student Physician: Introductory Studies in the Sociology of Medical Education. Robert K. Merton, George G. Reader, and Patricia L. Kendall, eds. Cambridge MA: Harvard University Press.

Hahn, Robert A.

1987 Divisions of Labor: Obstetrics, Woman and Society. In Williams Obstetrics, 1903-1985. Woman, Physician, and Society, Robert A. Hahn, ed. Special Issue, Medical Anthropology Quarterly 1:2, September.

Harrison, Michelle

1982 A Woman in Residence. New York: Random House.

Harwood, Michael.

1984 The Ordeal: Life as a Medical Resident. The New York Times Magazine, June 3.

Haverkamp, Albert D. and Miriam Orleans

1983 An Assessment of Electronic Fetal Monitoring. In Obstetrical Intervention and Technology in the 1980s, Diony Young, ed. Pp. 115-134. New York: The Haworth Press.

Henslin, J. and Biggs, M.

1971 Dramaturgical Desexualization: The Sociology of the Vaginal Exam. In Studies in the Sociology of Sex, ed. J. Henslin, pp. 243-72. NY: Appleton-Century-Crofts.

Kitzinger, Sheila

1980 Women as Mothers: How They See Themselves in Different Cultures. NY: Vintage Books.

Sexuality of Birth

Leach, Edmund

1979[1966] Ritualization in Man in Relation to Conceptual and Social Development. In Reader in Comparative Religion, 4th edition, William A. Lessa and Evon Z. Vogt, eds. Pp. 229-233. NY: Harper and Row.

LeBaron, Charles

1981 Gentle Vengeance: An Account of the First Year at Harvard Medical School. New York: Richard Marek.

Lex, Barbara

1979 The Neurobiology of Ritual Trance. In The Spectrum of Ritual: A Biogenetic Structural Analysis. d’Aquili, Eugene, Charles D. Laughlin, and John McManus, eds., Pp. 117-151. NY: Columbia University Press.

Luria, A.R.

1966 Higher Cortical Functions in Man. NY: Basic Books.

Malinowski, Bronislaw

1954[1925] Magic, Science, and Religion. In Magic, Science and Religion and Other Essays. Pp. 17-87.

NY: Doubleday/Anchor.

McManus, John

1979a Ritual and Ontogenetic Development. In The Spectrum of Ritual: A Biogenetic Structural Analysis. d’Aquili,

Eugene, Charles D. Laughlin, and John McManus, eds. Pp. 183-215. NY: Columbia University Press.

1979b. Ritual and Human Social Cognition. In The Spectrum of Ritual: A Biogenetic Structural Analysis. d’Aquili, Eugene, Charles D. Laughlin, and John McManus, eds. Pp. 216-248. NY: Columbia University Press.

Mendez-Bauer, C. J.

1975 The Upright Position for Labor. Journal of Perinatal Medicine 3. Pp. 89-95.

Merchant, Carolyn

1983 The Death of Nature: Women, Ecology, and the Scientific Revolution. San Francisco: Harper & Row.

Miner, Horace

1975[1956] Body Ritual among the Nacirema. In The Nacirema: Readings on American Culture. James P. Spradley and Michael A. Rynkiewich, eds. Pp. 10-13. Boston: Little, Brown & Co.

Moore, Sally Falk and Barbara Myerhoff, eds.

1977 Secular Ritual. Assen, The Netherlands: Van Gorcum.

Munn, Nancy D.

1973 Symbolism in a Ritual Context: Aspects of Symbolic Action. In Handbook of Social and Cultural Anthropology, John J. Honigmann, ed. Pp. 579-611. Chapel Hill: Rand McNally.

Oakley, Ann

1984 The Captured Womb: A History of the Medical Care of Pregnant Women. New York: Basil Blackwell.

Ob.Gyn. News

1982 Every Woman Probably Should be Monitored During Labor. 17(20):1.

Ornstein, R. E.

1972 The Psychology of Consciousness. San Francisco: Freeman Press.

Odent, Michel

1984 Birth Reborn. New York: Pantheon Books.

Parsons, Talcott

1951 The Social System, Glencoe, Ill.: Free Press.

Peterson, Gayle and Lewis Mehl,

1984 Pregnancy as Healing: A Holistic Philosophy for Pre-Natal Care, Vols 1, 2. Berkeley: Mindbody Press.

Pritchard, Jack A., and Paul C. MacDonald,

1980 Williams Obstetrics. 16th edition. New York: Appleton-Century-Crofts.

Rothman, Barbara Katz

1982 In Labor: Women and Power in the Birthplace. New York: W.W. Norton and Co. (Reprinted in paperback under the title Giving Birth: Alternatives in Childbirth. New York: Penguin Books, 1985.)

Schwartz, R., A.G. Diaz, R. Fescina and Roberto Caldeyro-Barcia

1979 Latin American Collaborative Study on Maternal Posture in Labor. Birth and the Family Journal 6:1. Pp. 22-31

Scully, Diana

1980 Men Who Control Women’s Health: The Miseducation of Obstetrician-Gynecologists. Boston: Houghton-Mifflin.

Shaw, Nancy Stoller

1974 Forced Labor: Maternity Care in the United States. New York: Pergamon Press.

Star, Rima Beth

1986 The Healing Power of Birth. Austin, Tx: Star Publishing.

Stewart, David and Stewart, Lee, eds.

1976 Safe Alternatives in Childbirth. Marble Hill, MO: National Association of Parents and Professionals for Safe Alternatives in Childbirth.

1977 21st Century Obstetrics Now!. Vols 1,2. Marble Hill, MO: National Association of Parents and

Professionals for Safe Alternatives in Childbirth.

1979 Compulsory Hospitalization or Freedom of Choice in Childbirth? Vols. 1,2,3. Marble

Hill, MO: National Association of Parents and Professionals for Safe Alternatives in Childbirth.

1981 The Five Standards for Safe Childbearing. Marble Hill, MO: National Association of Parents and Professionals for Safe Alternatives in Childbirth.

Thacker, Stephen B. and H. David Banta

1983 Benefits and Risks of Episiotomy. In Obstetrical Intervention and Technology in the 1980s, Diony Young, ed. Pp. 161-178. New York: The Haworth Press.

Turner, Victor W.

1967 The Forest Of Symbols. Ithaca, NY: Cornell University Press.

1969 The Ritual Process: Structure and Anti-Structure. Chicago: Aldine.

1979[1964] Betwixt and Between: The Liminal Period in Rites de Passage. In Reader in Comparative Religion, 4th edition, William A. Lessa and Evon Z. Vogt, eds. Pp. 234-243. New York: Harper and Row.

van Gennep, Arnold

1966[1908] The Rites of Passage. Chicago: University of Chicago Press.

Vogt, Evon Z.

1976 Tortillas for the Gods: A Symbolic Analysis of Zinacanteco Rituals.Cambridge,MA:HarvardUniversityPress.

Wallace, Anthony F.C.

1966 Religion: An Anthropological View.New York:Random House.

Wall Street Journal

1987 Obstetrics and Gynecology. P. 1. Jan. 26.

Wertz, Richard W. and Dorothy C. Wertz

1977 Lying-In: A History of Childbirth inAmerica.New York: The Free Press

Young, Diony

1982 Changing Childbirth.RochesterNY: Chilbirth Graphics.

1992 “MANA Statement of Values and Ethics,” MANA News 10(4):10-12.

1994 “MANA Core Competencies,” MANA News 12(1):24-27.

Poincare, Howard

1913 The Foundations of Science. New York: Science Press.

Prentice, A. and T. Lind

1987 “Fetal Heart Rate Monitoring During Labor–Too Frequent Intervention, Too Little Benefit.” Lancet 2:1375-1877.

Quinn, Daniel

1993 Ishmael. New York: Bantam and Turner.

Rooks, Judith P., Norman L. Weatherby, Eunice K. M. Ernst, Susan Stapleton, David Rosen, and Allan Rosenfield

1989 “Outcomes of Care in Birth Centers: The National Birth Center Study,” New England Journal of Medicine 321 (26):1804-1811.

Rothman, Barbara Katz

1982 In Labor: Women and Power in the Birthplace. New York: W. W. Norton.

1989 Recreating Motherhood: Ideology and Technology in a Patriarchal Society. New York: W. W. Norton.

Rubinstein, Robert A., Charles D. Laughlin, Jr., and John McManus

1984 Science as Cognitive Process: Toward an Empirical Philosophy of Science.Philadelphia: University of Pennsylvania Press.

Sandmire, H.F.

1990 “Whither Electronic Fetal Monitoring?” Obstetrics and Gynecology 76(6):1130-1134.

Sargent, Carolyn

1989 Maternity, Medicine, and Power: Reproductive Decisions in Urban Benin. Berkeley: U. of California Press.

Schlinger, Hillary

1992 Circle of Midwives: Organized Midwifery in North America. Independently published by Hilary Schlinger.

Shy, Kirkwood, et al.

1990 “Effects of Electronic Fetal Heart Rate Monitoring, as Compared with Periodic Auscultation, on the Neurological Development of Premature Infants,” New England Journal of Medicine 322(9):588-593.

Singer, Linda

1992 “Feminism and Postmodernism.” In Feminists Theorize the Political, J. Butler and J. W. Scott. New York: Routledge.

Slaatte, Harold A.

1983 The Creativity of Consciousness: An Empirico-Phenomenonological Psychology. New York: University Press of America.

Sorokin, Pitirim A.

1941 The Crisis of Our Age. New York: E. P. Dutton.

Sosa, R., J. Kennell, S. Robertson, and J. Urrutia

1980 “The Effect of a Supportive Companion on Perinatal Problems, Length of Labor, and Mother-Infant Interaction.” New England Journal of Medicine 303:597-600.

Sperry, Roger W.

1974 “Lateral Specialization in Surgically Separated Hemispheres.” In The Neurosciences: Third Study Program, eds. P.J. Vinken and G. W. Bruyn. Cambridge MA: MIT Press.

1982 “Some Effects of Disconnecting the Cerebral Hemispheres.” Science 217: 1223-1226.

Sprenger, Jally and George Deutsch

1981 Left Brain Right Brain. San Francisco: W. H. Freeman.

Starhawk

1988 Dreaming the Dark: Magic, Sex, and Politics. Boston: Beacon Press.

1989 The Spiral Dance: A Rebirth of the Ancient Religion of the Great Goddess. HarperSanFrancisco.

1993 The Fifth Sacred Thing. New York: Bantam Books.

Sullivan, Deborah and Rose Weitz

1988 Labor Pains: Modern Midwives and Home Birth. New Haven: Yale University Press.

Susie, Deborah Ann

1988 In the Way of Our Grandmothers: A Cultural View of Twentieth-Century Midwifery in Florida. Athens: University of Georgia Press.

TenHouten, Warren

1978-1979 “Hemispheric Interaction in the Brain and the Propositional,

Compositional, and Dialectical Modes of Thought,” Journal of Altered States of Consciousness 4(2):129-140.

Vaughn, Francis E.

1979 Awakening Intuition. Garden City, NY: Anchor Books.

Wagner, Marsden

1994 Pursuing the Birth Machine.Camperdown,Australia:ACE Graphics.

Weil, Andrew

1972 The Natural Mind.Boston: Houghton-Mifflin.

Westcott, Alan

1968 Toward a Contemporary Psychology of Intuition.New York: Holt, Rinehart, and Winston.

An Interview with Betty Sue Flowers

This chapter appeared in Corporate Futures,
Volume V of the Late Editions Series,
George Marcus ed.
Chicago: University of Chicago Press, 1998.

Introduction

This chapter contains two interviews that I conducted with Betty Sue Flowers about her writing and editing of Shell International’s 1992 and 1995 futures-planning scenarios. I first met Betty Sue at a men’s conference (a la Robert Bly and the mythopoetic men’s movement) in Austin, Texas, where she and I were two of only four women speakers, and the only two present the night we met. It took me a while to spot her in a huge ballroom filled with 800 men and two women–she sat on the back row wearing a businesslike gray dress with black buttons, and as a result (in spite of her shoulder-length blonde hair) was nearly invisible–by choice, I later found out. Standing out is not her style.

After the evening’s presentations ended, I could hardly wait to find her, introduce myself, and ask her what she thought of the event and how she had felt as one of only two women in a room full of 800 men. We headed for the hotel bar, where we found a cozy sofa and chatted late into the night, about Robert Bly and the men’s movement, about women and men, about her work and mine. She was an English professor who had specialized in Victorian literature, I an anthropologist who had specialized in cultural constructions of childbirth. We found common ground in our mutual fascination with myth. For me, myths are creation stories in which it is possible to read and identify a culture’s fundamental assumptions about reality. I want to understand myth because I want to understand culture, and it is in myth that culture is encoded. To Betty Sue a myth is “a story that organizes experience through telling something explicitly about meaning–where we’re going, where we came from, or who we are.” When I asked her, “How did you get interested in myth in the first place?” she responded,

There are a lot of ways to tell this story, but if you were going to be psychoanalytical about it, I would say that my parents were very different in how they saw the world. I observed my father making one story about the same event and my mother making another, and that it was her story that would cause her grief or discomfort, and that my father’s story actually created smooth sailing for him. I realized that the difference lay not in what was happening to them, but in something very different in the way that they were thinking about it. And that taught me to be on the alert for the stories people were telling to interpret their experiences.

Thus, Betty Sue is less intested in the culture encoded in myth, and more interested in the power of the story to influence human thought and action–a focus she was able to convey (in a way that caught on with the culture) in the title she chose for Joseph Campbell’s book, The Power of Myth.

It was therefore logical for her to be intrigued when Shell approached her about writing stories that would be explicity designed to have this power in the business world. And it was logical for me, once she completed those stories, to be dying of curiosity about her experience of consciously creating living myths designed explicitly to make people think about the kind of future their culture–in this case, the culture of an international oil company, one of the largest in the world–would create. I was teaching at Rice when George Marcus first spoke to me about the theme of LE V, “Corporate Futures,” and I knew right away what my contribution was going to be.

I interviewed Betty Sue twice. The first time (September 1993), she met me in her office in the English Department on theUniversityofTexascampus, where we talked for two hours about the process of her writing and editing of the 1992 Shell scenarios. Two years later, I conducted a short follow-up interview with her about the aftermath of those first scenarios and about Shell’s plans to bring her back to write a second set. This time, the tables were turned: Betty Sue had just finished interviewing me (about childbirth and cyborgs) for an episode of a television show she was hosting–”Conversations with Betty Sue Flowers.” After we finished taping, we sojourned to the boardroom of the television station so I could once more interview her.

As you will see in these interviews, Betty Sue was bound by Shell not to reveal much about the content of the stories. But she told me in the second interview that the man who had hired her at Shell, Joe Jaworksi, was in the process of writing a book (with Shell’s permission) that does give the full text of the 1992 scenarios. That book, which Betty Sue edited, has since appeared under the title Synchronicity (Jaworski 1996).

There is no ending to this story: throughout the fall and spring of 1996-1997 Betty Sue made monthly trips to Geneva to write global scenarios for a group of fifty large multinational corporations concerned about the fate of the planet and its human inhabitants; they want to use these scenarios to help them imagine and then work to create a viable human future in which they can do business without destroying the enviroment in which we all must live. Such scenarios may become a nexus for the merging of myth and reality. In their creation I begin to glimpse the ephemeral possiblity that the human myth of a better world may eventually result in the human reality of achieving it.

…night has fallen,
and the Barbarians have not come.
And some of our men, just in from the border,
say there are no barbarians any longer!
Now, what is going to happen to us without
the Barbarians? They were, those people, after all,
a kind of solution.

–C.P. Cavafy

Cover quote from Shell’s Global Scenarios 1992-2020, edited by Betty S. Flowers

Betty S. Flowers received her Ph.D. in English from the Universityof London; she is Professor of English at the Universityof Texas. Author of two volumes of poetry, including Extending the Shade (1990), she collaborated, in the role of editor, with Bill Moyers on World of Ideas (1989), and on the books and public television series Joseph Campbell and The Power of Myth (1988) and Healing and the Mind (1993). Her primary interest is myth. She spends much time in the business world as a consultant, and at the time of our first interview was serving as editor (midwife, as she terms it) to books on diverse topics: the poetry of Christina Rosetti, the dreams of Vietnam vets, the life and times of a Texas artist, new visions for leadership in America (Jaworski 1996).

In the spring of 1992, Dr. Flowers was asked by a representative from Shell International to serve as Editor for myths the company was consciously creating, stories Shell wanted to write about the future, to be backed up by the research data collected from around the world by a team of twenty economists who had been working on this scenario project for three years. She spent four months inEnglandover the summer, working intensively to write and refine these scenarios. They were successfully produced, and were treated as top corporate secrets. Shell disseminated them to its managers world-wide in carefully orchestrated seminars. In early 1995 the Shell management asked Betty Sue to return toLondon, again in the summer, to produce another round of scenarios; my second interview with her was conducted shortly before she left for that second round.

The point of these scenarios is to teach Shell managers to think mythologically and causally, to see every major local or world event as potentially located in a story, and to make on-the-spot business and policy decisions based on what they know about where that story would lead if allowed to play itself out. Thus these scenarios play an integral role in Shell’s futures planning.

Two publications¹ in particular detail the process of scenario-building developed by Shell International over the past twenty years–Peter Schwartz’s The Art of the Long View (see below) and. “The Gentle Art of Re-Perceiving,” written for the Harvard Business Review by Pierre Wack, retired head of the Business Environment Division of the Royal Dutch/Shell Group Planning Division, and Senior Lecturer in Scenario Planning at the Harvard Business School. In cooperation with Edward Newland, Wack developed the Shell system of scenario planning–a process which he sees as one of managerial assumption-smashing:

It is extremely difficult for managers to break out of their worldview while operating within it. When they are committed to a certain way of framing an issue, it is difficult for them to see solutions that lie outside this framework. By presenting other ways of seeing the world, decision scenarios allow managers to break out of a one-eyed view. Scenarios give managers something very precious: the ability to re-perceive reality…(Wack 1986:31).

Wack recounts the process through which he came to understand the necessity for the scenarios, so grounded in the “outer space” of the world outside the corporation–a world of supply and demand, shifting prices, new technologies, competition, business cycles, and so on–to come alive in “inner space,” the manager’s microcosm where choices are played out and judgment exercised. Three decades ago, in the early days of their work with scenarios, Shell planners initially developed “first generation” scenarios which simply quantified alternative outcomes of obvious uncertainties (for example, the price of oil may be $20 or $40 a barrel in a given year). Managers found such scenarios to be useless for long-term planning and decision-making, as they provided nothing more than a set of plausible alternatives that included no reason to assume that one or another would come about, offering no basis on which managers could exercise their judgment. Such scenarios resembled the straight-line forecasting that Shell and other companies had engaged in for years, and ultimately rejected as inadequate for the complexities of the contemporary world.

Back at the drawing board, the Shell planners, led by Wack, zeroed in on the notion that there are forces at work in the world that seem well-nigh inevitable, unstoppable save by a major miracle or worldwide disaster that would mean the end of life as we know it.They called such forces predetermined elements, and sought in their futures planning to identify such elements and carry them through each of the scenarios they developed, sorting them out carefully from uncertainties. The art of scenario development, they found, revolves around careful research out in the world to identify the predetermined elements, and only then to weave stories around the interaction of these predetermined elements with the myriad of uncertainties future-seers must face.

For example, in the early 1970s, a period of recession in the oil industry because of low prices resulting from an oil surplus after the development of huge fields in the Middle East, Shell planners began to look at the world from the point of view of the oilmen of the Middle East whose countries, small and sparsely populated, did not have the means to absorb all of the wealth flowing into them from their one valuable resource. That growing surplus of cash would have to be reinvested, but where? No bank holding, or piece of real estate, could appreciate in value as fast as the oil in the ground, especially if less oil were produced in order to keep the price high. Thus the Shell team was able to predict the emergence of OPEC and the rising price of oil as predetermined elements for the 1970s, forces that would drive the global system. Repercussions of these predetermined elements would of necessity involve shock waves to the economies of countries dependent on oil imported from theMiddle East.

Uncertainties involved various countries’ likely attempts at solutions, such as price freezes, or simple inaction, which would result in an energy crisis. So the Shell planners presented to top management, in 1972, a set of scenarios which took these predetermined elements and uncertainties into account. These scenarios varied so sharply from the implicit worldview then prevailing at Shell–explore and drill, build refineries, order tankers, and expand markets–that the planners realized they were unlikely to be taken seriously. So they constructed another set of “challenge scenarios” that postulated a continuation of present trends and business as usual.

These challenge scenarios included “miracles” in exploration and production, such as the discovery of major new fields in non-OPEC nations, willingness on the part of oil producers to deplete their resources at the will of the consumer to keep prices low, and no natural disasters or wars that would generate a need for spare production capacity. The sheer improbability of these events forced the Shell management to realize that their business-as-usual mentality was blinding them to the inevitability of the coming changes. As a result, during the 1970s Shell was better positioned to handle the oil embargo and the dramatic rise in oil prices and in the power of the OPEC cartel than many of its competitors.

In the early 1980s, one of the scenarios written by the Shell planners foresaw the likelihood of a rapid and dramatic decrease in the price of oil as the result of the discoveries of new fields outside of the OPEC sphere of influence, in combination with the energy conservation measures increasingly taken by consumers who did not want, after the debacle of the 1970s, to remain overly dependent on imported oil, and who were increasingly aware of the finite nature of “non-renewable” resources such as oil. Positioning itself accordingly, Shell rose from fourteenth to second place among the oil multinationals during the mid-1980s as prices fell and other companies, heavily overinvested, lost billions.

On Shell’s scenario team at the time was Peter Schwartz, brought in because of his years of futures planning at the Stanford Research Institute in California. The Art of the Long View, published in 1992, recounts the work of Schwartz and his team at SRI on scenario building, Schwartz’s subsequent tenure at Shell, and his eventual creation of the Global Business Network–a web of individuals and organizations engaged in ongoing information-sharing and scenario-based futures planning. This book in particular shows the ever-widening role of scenario-building in the business world, making clear the importance to even small businesses of understanding the forces at work in the global economy.

For example, in the mid-1970s Schwartz was hired by Smith and Hawken, an English company that produces hand-made garden tools, to create scenarios that would help them decide whether or not to undergo the initial capital investment of exporting their tools to the United States. The scenarios had to answer the large question: “Is there a market in the U.S. for hand-crafted, high-priced garden tools that last a lifetime?” along with the myriad small questions that accompany the large one (should the tools be sold in stores, or by mail-order, or both?) Schwartz and his team at GBN created three alternative scenarios about the future of the U. S. economy. The first, the “Official Future” scenario, envisioned a world of high economic growth and increasing wealth, in which maturing baby boomers made a lot of money and spent a good bit of it on houses. In this world, consumption and materialism were driving forces. The “Depression Scenario” saw a world marked by a worsening of the severe economic troubles of the 1970s, with low growth, declining prosperity, rising oil prices, and environmental crises. Life would be about surviving in hard times. The third “Social Transformation” scenario imagined a fundamental social change–a shift in values to ecological consciousness, involving holistic medicine and natural foods, pursuing inner growth rather than material possessions.

It was clear immediately that the baby boom was a major predetermined element in all three scenarios–a large number of people were coming of age, marrying, and setting up households. Many would garden, as would the parents of the baby boomers, who were approaching retirement. In the “Official Future” scenario, people would garden for recreation and show. They would want expensive tools, because they could afford the best. In the “Depression” scenario, people would garden for food they might not otherwise be able to afford. They would need sturdy tools that did not require frequent replacement. In the “Social Transformation” scenario, people would garden as a source of organic food, of contemplation, healing, contact with nature. They would appreciate the value of fine hand-crafted wooden tools.

And so Schwartz and his associates were able to assure Smith and Hawken that the U. S. market would be an excellent one for them to enter, no matter which future unfolded. They were also able to show that in the “Official Future” scenario, retail space and overhead would be extremely high and in the depression scenario, the deterioration of cities could make retailing very problematic. But in all three scenarios, it was clear that mail order would do well: it would save time for busy people in the prosperous world, save precious capital in a depression, and work to reach the Whole Earth Catalogue community in the social transformation scenario.

Reality as it happened in the 1980s turned out to be a combination of all three scenarios–the yuppies rose to social and financial prominence even as homelessness went large-scale and social problems, especially in the inner cities, increased. The environmental and holistic health movements grew. And Smith and Hawken’s mail-order business, in combination with one small retail outlet in Northern California, prospered accordingly.

This scenario process represents a fascinating and visionary merging of business and myth, which holds the simultaneous possibilities of foreseeing several possible futures while acting to consciously create one particular future, to choose the story in which one will ultimately live. In late August of 1993 I asked Dr. Betty S. Flowers, who had just returned from a short trip to London doing follow-up work for Shell, for permission to interview her about her role in writing and editing the 1992 Shell scenarios. After receiving Shell’s permission to describe the process of creating them, she readily agreed.

September 10, 1993
Interviewer: Robbie Davis-Floyd
Interviewee: Betty S. Flowers
Subject: The Shell International Futures Scenarios

Davis-Floyd: Betty Sue, I know that you have spent a good bit of your life studying myths and mythology. To begin, can you tell me how you define a myth?

Flowers: I think a myth is a story that organizes experience through telling something explicitly about meaning–where we’re going, where we came from, or who we are. That’s why I say things like “the economic myth,” even though economics by definition doesn’t have a linear timeline–it’s a story without much juicy narrative at all, except for “progress” and “growth.”

Davis-Floyd: What is the economic myth?

Flowers: It’s the myth we’re in now. In the West I think we’ve been shaped in the past by a heroic myth, a religious myth, and a democratic myth; and I think now, we’re in the economic myth. That myth doesn’t have the kind of old fashioned “once upon a time” story we’re used to; it doesn’t have in Campbellian terms a hero’s journey–there’s no journey part to it. It has a dynamic and it has implicit values on measurements–number, quantity, growth. It’s got an inherent bias towards a series of evolutions that are additive–like we get better and better, we grow more and more. It doesn’t tell a very coherent story. But it has a thrust and a power to it. I could be more specific if you ask me what the economic myth says about X or Y or Z.

Davis-Floyd: Well, what would the economic myth say about the directions that American business is taking, for example?

Flowers: It would say exactly what American business is doing because they’re in touch with it most, which is to downsize in order to economize. The economic myth is very short term, so it would not talk about investing for long-term growth, but about meeting the next quarter’s numbers. It’s very present-oriented, which is why it doesn’t have a very good narrative story about the past or the future. It’s a measuring device for now.

Davis-Floyd: Is that myth articulated differently in Japan?

Flowers: No, what Japan has is another myth that’s very powerful underlying it–a myth you could call Confucianism–at least the East Asians Center at Harvard tends to talk about it as “Confucianism.” It’s a myth of community based on a kind of onion of enlarging circles, starting with individual duty and then the family and then the community and then the company and then the world. This community myth is not incompatible with the economic myth. You can have two myths, but the economic myth tends to take precedence.

So in this culture, say, we have a light dose of Christian myths still going on, but when it comes down to the bottom line, it’s the economic myth that’s the myth of value. And I think that’s true in Japan too. When people say that the whole century was one long world war between three ideologies–fascism, communism, and democracy–and that now democracy has won, and the century of war is over, I disagree. I don’t think democracy has won, I think it’s economics–that’s the ideology that has won. So you can have a very repressive regime, such as in Singapore or China, and still have an economic, free- market-capitalism myth that is the myth of value.

Davis-Floyd: How do you feel about, what is your personal judgment about the economic myth, about its usefulness?

Flowers: Well, there are a lot of limitations. The obvious one is that it doesn’t make any distinctions among goods that are good for us and goods that aren’t, or long-term good versus short-term gain. It has nothing to say about quality. It has nothing to say about values that might not be economic. We know how to compete to get the best services in hospitals, but not how to get every child immunized. What it does is have us set up a society which seems quite skewed when we look at other values that we might have, like human life.

Those are some of the down sides, but there are some up sides, which I think are very hopeful and empowering. One is that it’s a universal myth, it’s the first time we’ve had the potential for a truly global myth, that has within it enormous capacity for all kinds of things, like the end of war. Now I’m really being visionary–you know, there is a possibility there, that we will become so intertwined with each other’s business that we’re never really fighting against anyone. It’s interesting that the wars now are “ethnic”–many of them are now fought in the old qualitative terms of the religious myth. Another thing is–and I think this is very much tied with the environmental movement–that the economic myth encourages a systems approach to things, encourages us to look at how one part of the system affects the whole, to look ecologically at our world. The economic myth has no value placed on saving nature, I don’t mean that, but it does look from the perspective of a total system and how it all interacts. So that, to me, is very hopeful.

Davis-Floyd: How do you see the economic myth reshaping itself in the immediate future? Do you see any reshaping of it going on?

Flowers: Yes, because it’s so complex. The heart of its implicit belief system is the notion that numbers have a life of their own, and money has a life of its own, and that it’s best left alone. But we see now such complications and entanglements with the different monetary systems around the world that there’s another way–or theme–that’s being superimposed onto that kind of “invisible hand” mentality. This theme is more like a systems approach or more like chaos theory, where you can’t predict any individual thing, much as we try, but you can see patterns. You can’t predict these patterns, you can only observe them, because structures are so complex. And you can assume that if you influence one side of the pattern, you’re influencing it all. So you can’t make decisions in a less than global context. Companies are just now beginning to realize that they can’t make decisions for themselves or even for their country. They can only make decisions in a global context.

Davis-Floyd: Is that why Shell hired you?

Flowers: You could say that that’s why Shell does its scenarios. Why they hired me in particular is another, perhaps longer story which has to do with the head of that project seeing the need for this global contextualization and wanting a writer who had a kind of poetic vision, and who perhaps wouldn’t be totally seduced by the economists on the team [laughs].

Davis-Floyd: [Laughing] What do you mean by “seduced by the economists”?

Flowers: Well, lots of people on the team were economists, even though they were from all over the world. There were a couple of historians, and a mathematician, but most of them were economists–and they wanted to talk about things in terms of GNP and arguments about PPP vs. GNP. They wanted to tell a story that didn’t have any kind of implicit moral. Even if the moral appeared to emerge naturally they wanted to squelch it.

Davis-Floyd: Tell me the story of all of that from the beginning–of how it was first conceived of and how you were brought in and what happened.

Flowers: Well, about 20 years ago, Shell started doing scenarios instead of straight-line forecasting. Most companies did straight-line forecasting based on the past. You extrapolate into the future, you know, those graphs?–we did them in high school. And then you would base your planning around that. And you would take it with a slight grain of salt because you knew the future was never what the past was. There were always “contingencies.” Well, Shell’s planning department started thinking about this, especially given that in the oil business you have to make enormous investments twenty years in advance–you have to build refineries that are not on line for years. So you’re really just taking enormous risks with blocks of capital, all the time.

And they said, well, it’s actually not only false to have straight-line forecasting, but it’s dangerous because you can be lulled into thinking you do know the future, that you have the story for the future, and that the future is the past, put into the future. So what they decided to do instead was to build self-conscious stories, that is, they would call them “stories,” and to build two of them, equally persuasive, based on the same statistical beginning point and statistically told, that is, told in economic language, for thirty years into the future. They would spend three years putting this together with a team of twenty or so from all over the world, and then they’d spend the next year disseminating them in workshops around the world, so that what you got was a common culture based on not a story about the future but two stories about the future.

Davis-Floyd: Why two, instead of three, or one?

Flowers: Well, at times they have had three, I think one year they even had four. The last round of scenarios before the one I worked on had three stories. But it turns out that when you have three stories, people end up choosing “the right one,” and they will choose the one in the middle. It’s just human nature to want to say okay, here are three stories, which is the best? If you have two stories, you don’t have a middle to choose from.

Davis-Floyd: So do people usually choose one or the other?

Flowers: Oh, they can’t help it. The idea is to make them hover, but human nature being such, people tend to pick one over the other just because we don’t like ambiguity. We feel like we need to settle on something. One of the stories we told this time was very difficult for the team at first to buy into. They said it was too good to be true, it couldn’t really happen this way. But then when we started fiddling with the “real” story, the other story, it turned out so disastrously, so depressing that they began to look at the other story with new eyes, saying, “Well, not only might it turn out that way, it had better turn out that way.”

So for the first time we had a kind of good story/bad story, which they try not to have, but when you take the stories down the line, one ends up with some short-term sacrifices–well, we quit using the term “sacrifice,” because the so-called “good story” requires people to take a long-term view of their self-interests and to make decisions based on horizontal linkages that empower poor countries. The other story was more business-as-usual, but with people pulling back and barricading themselves against change and diversity, and the painfulness of change. The so-called “good story” is extremely painful, very turbulent, but the bad story just kept getting worse…

Davis-Floyd: Are these stories still corporate secrets, or are you able to tell me–?

Flowers: They’re sort of gradually being leaked out but I can’t tell you more than that, nor would you be that interested because, you know, you go into the price of coal in China in 2015 and see what that has to do with cars there and stuff like that. It gets really interesting for certain sectors of the company in terms of detail, working with the little details. People like to take the story, their part of it–like if they’re in the chemical division, you take the chemical story and then spin fantasies on that. Well, if it happened this way, what would this happen? and what would happen over here? So part of it is an excuse to sit down and spin the smaller stories that link on to the larger ones.

Davis-Floyd: But it’s safe to say overall that the good story has environmental consciousness in it, a sense of the ecosystem and of the interconnectedness of things, and the bad story is more oriented to short-term profit-making, exploiting the environment?

Flowers: Yes.

Davis-Floyd: Exactly why did Shell want you? What was your role in constructing the stories?

Flowers: I wrote them. Which means I would do a draft of several pages every day and have the team tear them apart–they would argue over it–over the story, not so much the writing, but the story. Then I would go back and try to reflect the argument in the next version of the story. These are highly nuanced stories so every word mattered in the summary book. I did two books–the longer book, which was about 200 pages and is full of tables and figures, and then the summary book, about 65 pages. Then I did a video, and then I did a really short book to hand out when they were doing presentations at the UN, and places like that, which was only, maybe, 10-15 pages.

Davis-Floyd: You talk about the team that helped you. Would you describe the team?

Flowers: They were mostly from Shell. There were some outsiders drawn in just for that three-year period, including the head of the scenario process. There was a Canadian physicist, an Argentine economist, an American economist, a Belgian sociologist, an Oxford-trained mathematician, someone who spent the last some-odd years in Venezuela who was a historian, a Scottish economist, someone from Singapore, someone from Africa, someone from Japan, someone from Germany, someone from Australia. They shifted in and out. There were about twenty in all, counting some support people.

Davis-Floyd: So how did this process start–you got a letter or a phone call from Shell?

Flowers: Yes, from Joe Jaworski, the head of the scenario process. And he said, I want you to come over to London and write the scenarios. He said, there has to be an editor. And I want you to do a video, and design it.

Davis-Floyd: Did you know this man already?

Flowers: I knew him, although not well–we’d only met twice. I had worked with him on a book he is writing, called Predictable Miracles: The Inner Dimensions of Leadership.² It’s about a successful lawyer in Houston who was doing fine until his father, Leon Jaworski, confided in him about Watergate–he was the Watergate prosecutor. And Joe had this incredible sense of anguish about the leadership in this country. And he gave up his very high-powered job as a lawyer–in fact, he helped to build up a firm–he was in the top one percent of litigators in the country. And he gave all that up, sold everything he had. And he ended up going on this amazing journey, this quest for how could you train leaders? He sold everything he had, and thought through it, and founded a Leadership Forum for the training of leaders in a different way. Which has had powerful effects in a few selected cities where it exists, but which mostly is a kind of paradigm of what one individual can do who is inspired by a vision and is willing to put a successful career at risk in order to join a larger game that he can’t possibly win in the end. And it’s from that position, as head of the American Leadership Forum, that Joe was chosen to head the Shell scenario planning process, for three years. But the way I had worked on the project before I suppose made him think that I shared a vision about the possibilities for the future that made him trust me as a writer. Because it was such a contentious process, he had to imagine that someone could imagine or see his vision.

Davis-Floyd: What was his vision?

Flowers: He very much saw a different–you could say a third–level to these scenarios which, in fact, the team began to see, almost like a far-off glimmery thing, by the end. Which was, that when you tell stories about the future, even if you’re not claiming to forecast, there’s some sense…that actually the future is the story you choose. Now that, that is very un-economic in its basis. It’s not the “invisible hand” working out invisibly, like a machine. It’s human beings coming in and saying “I choose Scenario A, not Scenario B.” It’s a different emphasis–it puts the human being more in the center, in very nuanced ways, instead of these huge impersonal forces. It’s very subtle. But it makes a big difference. Because to tell an economic story in economic language, in which human choice is important, is very difficult.

Davis-Floyd: What was Joe’s title at Shell?

Flowers: He was the Director of Scenarios.

Davis-Floyd: So they actually had a position “Director of Scenarios”?

Flowers: Yes!

Davis-Floyd: I mean, that’s quite incredible. I don’t think most companies have one on staff!

Flowers: No! Shell is the only one I know of who does it to such an extent. Now while we were there, and this is kind of interesting–you know, when we began doing sanctions against South Africa all over the world, Shell was one of the companies that decided to stay. They got lots of flack for that. But they decided they would stay and actively try to work in the country for change. They put up big billboards against apartheid, pretty strong stuff. One of the things they did was to do scenarios for South Africa. One of the fun things to do was helping to try to sort out how the workshops to disseminate these scenarios would run. We got to the table amazing people–the Minister of Finance, and far right wing separatists, and ANC people, and Inkatta people. What was interesting about the scenarios for South Africa was that the guy who spearheaded them, Adam Kahane, was so inspired by the process and by what it did–the fact that these scenarios generated so many conversations in South Africa that helped people work together better, because the scenarios are so non-threatening (it’s just a story, after all)–he quit his job at Shell, after the scenarios, and moved to South Africa to do the scenarios full time.

Davis-Floyd: When Shell invited people to the table to discuss the South African scenarios, what did they tell them– did they literally say, “We’re inviting you to come help us make up stories” ?

Flowers: Um-hm, about the future. And they made up four stories, and they had very unthreatening names of birds. One was “Icarus” which is a rapid ride and then crash. Another was “Ostrich”—stick your head in the sand, not paying attention, hoping it will all go away. The good one was called “Flight of the Flamingoes.” Everyone takes off together but slowly. The fourth was the “Lame Duck”–this would mean a long and wishy-washy transition. Then if you look at any particular event, and you say, “Well, what scenario is this event likely to lead to?” people can say “Well, I think that would lead to an Ostrich scenario, that belongs to the Ostrich scenario.”

The Ostrich Scenario

The Ostrich depicts a government that does not want to face realities. An ostrich supposedly hides its head in the sand when danger threatens. The ostrich does not want to see, and cannot fly away, but has to lift its head in the end.

As a result of the steps taken by the De Klerk government and the outcome of the white referendum, the international community becomes more tolerant toward South Africa, and the National Party in particular. In light of this, the Government hardens its negotiating position. The liberation movements come to be perceived as too radical and lose support internationally, but maintain their bottom line nevertheless. A standoff results and constitutional negotiations break down. The government decides to form a new “moderate alliance” government which is unacceptable to the liberation movements. This results in mass resistance which the State suppresses by force.

Although large scale sanctions are not reimposed, the economy remains in the doldrums because of massive resistance to the new constitution. This resistance leads to escalating repression and violence, and the business climate worsens. This in turn leads to economic stagnation and decline, accompanied by a flight of capital and skills.

The government also fails to deliver on the social front. Resistance and unrest render effective social spending impossible and large outlays are required merely to maintain the status quo. Because the society’s major inequalities are not addressed, the vicious cycle continues. Eventually the various parties are forced back to the negotiating table, but under worse social, political, and economic conditions than before.

The Lame Duck Scenario

The Lame Duck envisages a formal, protracted transition lasting for most of the coming decade, like a bird with a broken wing that cannot get off the ground, and thus has an extremely uncertain future.

In this scenario, various forces and considerations drive the major parties towards a negotiated settlement. The present government, for example, recognizes the necessity or inevitability of extending full political rights to the disenfranchised, but fears irresponsible government. This fear is shared by some of the major international actors. On the other hand, the liberation movements fear a return to repressive minority rule if they do not make significant compromises. Such considerations lead to a transitional arrangement with a variety of sunset clauses, slowly phasing out elements of the present system, as well as minority vetoes and other checks and balances aimed at preventing “irresponsible” government.

Such a long transition of enforced coalition is likely to incapacitate government because of the probability of lowest common-denominator decision-making, resulting in indecisive policies. It purports to respond to all, but satisfies none. In consequence, the social and economic crisis is inadequately addressed. Even if the transitional government succeeds in bring goal-directed and effective, it will still be incapacitated because of the logic of a long transition. Uncertainty will grow regarding the nature of the government to emerge after the transition.

Regardless of how moderate the declarations of the majority parties in the coalition may be, fears of radical economic policies after the long period of transition will remain. Investors will hold back, and there will be insufficient growth and development. Ironically, the unintended consequence of a long transition is to create uncertainty rather than to enhance confidence in the future.

The Icarus Scenario

The third scenario is one of macro-economic populism–of a popularly elected government which tries to achieve too much too quickly, like the youthful Icarus flying too close to the sun. It has noble origins and good intentions, but pays insufficient attention to economic forces.

The government embarks on a massive spending spree to meet all of the backlogs inherited from the past. It implements food subsidies, price and exchange controls, and institutes other “quick fix” policies. The initial results are spectacular growth, increased living standards, improved social conditions, little or no increase in inflation, and increased political support. But after a year or two the program runs into budgetary, monetary, and balance of payment constraints. The budget deficit well exceeds ten percent. Depreciations, inflation, economic uncertainty, and collapse follow. The country experiences an economic crisis of hitherto unknown proportions which results in soclal collapse and political chaos.

Perhaps the most sobering aspect of this scenario of boom and bust is that the very people who were supposed to benefit from the program end up being worse off than before. Either the government does a 180-degree about turn (while appealing to the International Monetary Fund and the World Bank for assistance), or it is removed from office. The likely result is an abandonment of the noble intentions that originally prevailed, and a return to authoritarianism–as has been the case in many Latin American countries. Right-wing armies often stage coups under such conditions, claiming a need to restore law and order.

The Flight of the Flamigoes

Flamingoes characteristically take off slowly, fly high, and fly together. In this scenario, a decisive political settlement, followed by good government, creates conditions in which an initially slow but sustainable economic and social take-off becomes possible. The key to the government’s success is its ability to combine strategies that lead to significant improvements in social delivery with policies that create confidence in the economy. Access to world markets and relative regional stability facilitate the flamingoes, but South Africa does not receive massive overseas investments or aid on the scale of a Marshall Plan.

The government adopts sound social and economic policies and observes macro-economic constraints. It succeeds in curbing corruption in government and raises efficiency levels. It makes well-targeted social investments which lead to a decrease in violence and give people confidence that many of their social needs will be met in the longer term. Once business is convinced that policies will remain consistent in the years ahead, investment grows and employment increases. Initially this growth is slow, because confidence does not return overnight, but over the years higher rates of growth are attained, and an average rate of growth of close to five percent is realized over the period.

The overall income of the upper income groups grows between one and three percent a year, and that of the poorer classes by an average of six to nine percent a year, mainly because of the increase in formal sector employment. From the outset processes are developed which facilitate broad participation, creating the conditions under which it becomes possible to find a sound balance between social reconstruction and sustained economic growth. In spite of conflict between different groups and classes, there is substantial agreement on broad objectives.

Some team members believed that Flight of the Flamingoes could prove to be so appealing that South Africans might choose not to deviate from it, so a set of “Necessary Conditions for Takeoff” were developed. In the political realm, these included: a culture of justice, a break from authoritarianism, a bill of rights, proportional representation, and effective citizen participation. In the economic realm, they included: a market-oriented (not free-market) economy, monetary and fiscal discipline, increasing foreign exchange earnings by growth in exports and in tourism. Necessary social conditions included: more effective delivery systems for increasingly effective service provision, economic growth and, given the history of apartheid, some degree of redistribution, the curbing of violence, better education and training, improved nutrition and public health. The empowerment of women was seen as a prerequisite for dealing with social problems such as rapid population growth, educational reconstruction, and the spread of AIDS.

In addition, the scenario team stressed five general points to the South African public about “Flight of the Flamingoes”: (1) The scenario is not a blueprint. While team members generally agreed on the broad conditions required for success, they differed substantially on the details. (2) It would be utopian to expect all of the necessary conditions to be fully met. Rather, the team believed that the outcome would depend on the degree of progress toward meeting the conditions. (3) The future is not predetermined. It can be shaped by the decisions and actions of the major players. (4) Various groups, such as the right wing, alienated youth, a corrupt bureaucracy, trade unions, and disinvesting businessmen, each have the power to prevent the flock from becoming airborne. (5) Once airborne, even flamingoes don’t always have a smooth flight.

Excerpted from “The Mont Fleur Scenarios,” The Weekly Mail/The Guardian Weekly, South Africa, 1992.3

It’s eye-opening. It allows you to have a very complex story which you can then talk about at a meta-level. See, for example, whenever we talk about health care reform in the U.S., we always get just totally embroiled in all kinds of arcane discussions–we don’t even know if we’re using the same terminology. If we’re talking about “managed care,” what does that mean to you, what does that mean to me? We have no way to talk about it except to reinvent the wheel every time we talk, or to have a very low-level discussion, very general.

What stories allow you to do is have a whole, completely fleshed-out story with a level of imagery, like “Flight of the Flamingoes,” that encapsulates something about the story that allows you to refer to a much more adumbrated whole, so that you can talk at this level, comparing stories, without getting mired down in the details. But the details are there–which is what Shell calls “rich stories.” So they have to be rich, much detail, many things all fitting together. We ran the numbers, I don’t know how many times, to get it to work out, because you have to tweak this number and then run it through the computer and something else wouldn’t work out if you didn’t have right numbers–these scenarios are very very completely worked out.

Davis-Floyd: You went over there to be the Editor, to bring all this information together. What kind of facilities did they provide you with?

Flowers: A regular office. I was in there alone for 10-12 hours every day. I mean, it was a real press. The last editor had had to get a private office so no one could come lobby him. I mean, he had to get a secret office. It was a very pressurized situation.

Davis-Floyd: Why did people lobby the last editor?

Flowers: Oh, I got lobbied–all over. Because the way you tell the story influences the way people think about the future. So if you say coal will not do so well because it pollutes, the coal people all over the world will get upset. So every sentence I wrote was faxed around the world to these different interested parties, you know.

Davis-Floyd: And did you get grief, if you said something like that, like “coal will not do so well”?

Flowers: Yes. Now, when I say “I,” it’s the team writing these stories, and figuring out what they would be. When I put them together, I had to make them congruent, and sometimes shape them more than others, but when it came to specific things like coal, or chemicals, where every sentence was run by the people in the field, then one of the technical guys would kind of spearhead what the story would say, and then I would write it.

Davis-Floyd: And what it said was based on the numbers, on all these projections that they were making?

Flowers: Well, you start with the story, and then you feed in a number and see how it turns out. If it doesn’t turn out the way you have been claiming, you have to change the story slightly. So it’s always a dialogue with the numbers.

Davis-Floyd: Because what I don’t understand is, if you’re not doing straight-line projections from numbers, then how can they be so influential in the story?

Flowers: Because they’re compelling. Numbers are compelling, psychologically compelling.

Davis-Floyd: But, what, how–

Flowers: Oh you have to start with real numbers now, because it’s 1992, not 2020. So you can’t just make up a story like, Suppose that gasoline were so much a gallon–no. You start here. And then you have certain things happen that change the price, if you’re talking about gasoline. I mean, we had political stories and religious–you have this happen there, and this has this effect. And you have this happen there, and then this happens.

Davis-Floyd: Like for example, you say maybe there’s a war in the Middle East, or Bosnia erupts into a larger regional conflict–something like that?

Flowers: Yeah, although we tried to keep that to a minimum. We tried not to “cheat” by having a big event that would change it in the direction we wanted it to change. We tried to be as subtle as possible. So if you made a small decision here, you could see the large consequences down the line. So we didn’t, we had maybe one big political thing. We flirted with a war over water around Turkey. And we had a few little blowups here and there, but we didn’t have a major thing, because that’s kind of cheating. I mean, there’s a whole sort of culture of telling scenarios, which is to be as conservative as possible, in order to see consequences of actions that in fact you’re taking now.

Davis-Floyd: So what kind of big political thing did you pick–a war, a revolution?

Flowers: Um-no, not a war or revolution. It had to do with a cabal among suppliers, energy suppliers, in a certain political context to do with the royal family of Saudi Arabia, which we then had to cut out because of its political implications, because of the oil fields. So we toned that down and made it another kind of story that didn’t involve political upheaval, but just an oil thing.

Davis-Floyd: Did part of your storytelling involve projecting what would happen in Eastern Europe?

Flowers: In one story, Eastern Europe becomes Balkanized. In another story, it sort of, you could say its on the road to being a kind of part of the EC, through a long, complex series of things I can’t really go into. But, yeah. So in one, it’s drawn more into the border areas of the European community, and in another, it’s like you can see in Yugoslavia.

Davis-Floyd: Did your stories project that the EC would work, would become a viable economic unit?

Flowers: Totally different, totally different stories–two very different stories about that.

Davis-Floyd: One story that it does work, the other that it falls apart?

Flowers: No, it works in two different ways, that have different economic and social consequences.

Davis-Floyd: Did your scenarios predict, for example, that Japan and Asia would take on greater and greater roles, or that there would be some sort of a balancing between their increasing economic power and the economic clout of the West?

Flowers: I think in both stories, China particularly takes on more of a role, in different ways–very different ways.

Davis-Floyd: But in both stories, China moves ahead?

Flowers: Umhmm, umhmm. [looks at me like "don't ask any more."]

Davis-Floyd: Did you have fun while you were doing this?

Flowers: Fun–it was exciting to be on such a steep learning curve, so I think I was having fun! but–[laughs]

Davis-Floyd: Was there a lot of deadline pressure?

Flowers: Yes, every day.

Davis-Floyd: How long was this process?

Flowers: Four months.

Davis-Floyd: And why was there so much pressure every day?

Flowers: Well, you had to keep rewriting the thing, and, in terms of printing deadlines, there was a due date on which these things had to be disseminated world wide, and I had to have these two volumes and a video done, and produced, by that time. You know, the colors right, and the paper right, and all this kind of stuff. And various things happened, along the way–you know, you always get differences of opinion. People would go on vacation and they would be strong people, and while they were gone the story would change, slightly, and they would come back and be upset and lobby to have it changed back, so we were always fighting over the story. And then we drew many more illustrations than we could use, and people would insist on their favorites. They were always changing the numbers, running the numbers again, which would change the illustrations, and change the story. So it was, you know, a kind of battleground, pretty bloody, actually, from time to time.

Davis-Floyd: Did you get emotionally wounded in the process?

Flowers: No, I couldn’t, because early on I realized that there was a testing process going on. In fact they told me at the very end, at the going away party, that they tried to break me at the beginning. So I knew that part of the whole ordeal was to be as unflappable as I could be, and still get the job done, and still be passionate enough to write good prose.

Davis-Floyd: Why did they try to break you at the beginning?

Flowers: Well, I think there were a number of reasons. One was just to see who I was, because–see, they had been working together for three years, and these things were important to them, and to their careers. And they were a little suspicious at the story the head guy, who was an American, was telling, and they knew that when the crunch time came–there is always a crunch time in these sorts of projects–I’d have to be able to hold up. So I can see why they did it.

Davis-Floyd: So they had been working for three years gathering all this data, then you show up, and did they immediately start feeding you the data?

Flowers: Yes.They gave me piles of stuff, piles. And then I heard each of them tell the story as they saw it, and they were utterly different.

Davis-Floyd: Sitting around a big table for a day or two?

Flowers: No, I went individually to their offices. Eventually we would start meeting together, but there were different factions with different stories so it was quite a political process, learning who had power.

Davis-Floyd: Did you ever go off for a retreat?

Flowers: Yes, we all went off for a retreat, to tell the story completely, so that we’d all hear it, and especially so I’d hear it, and get it down. But different people told different parts of it, and other people kept quiet when they violently disagreed, and waited till they had a strategic moment to violently disagree.

Davis-Floyd: Were you taking notes during these sessions?

Flowers: Oh, yes, madly.

Davis-Floyd: No time for tape-recording because you couldn’t transcribe the tapes?

Flowers: No, I didn’t have time!

Davis-Floyd: High stress, high intensity, exciting–

Flowers: Yes, it really was.

Davis-Floyd: Were you in any danger of getting addicted to adrenaline during this process?

Flowers: No, because it was very wearing, too, and I generally like a little bit more leisure, I think. Although the people were so intelligent,I did get addicted to being around them, because they were so much fun–very high energy and bright.

Davis-Floyd: It is addicting to be around intensely intelligent people–you’re always stimulated.

Flowers: Um-hmm. They complained about everything, from the serial comma to the Cavafy quote I put at the beginning, “There are no more barbarians”–you know, what do we do now that there are no more barbarians? And one of the guys who was in charge of the Iceberg Data Base–a top secret data base with all kinds of statistics about oil and everything else–complained because I hadn’t kept it in the original Greek! So when I was about to leave, he gave me this beautiful thing with a fractal image that he had run off on his computer, and the original Greek of the bits that I had quoted from the Cavafy poem, and I took it outside and was walking down the hall looking at it, because I had just opened it up from my mailbox, and the first person who came down the hall, who was someone who had been in some kind of new heavy motor oil, looked at it and started translating it. You know, looked over my shoulder!

That’s just kind of an example of the kind of wit and fun and good education that was so much a part of the people at Shell. They had all lived all over the world, because Shell moves its people every three years to a different country. So they had lived everywhere, and the tales were just wild.

Davis-Floyd: How did the team feel about the scenarios once they were finished?

Flowers: Well, they were a bit dubious, all the way through. They were dubious about the story we were telling. They were dubious about my being brought in. They were just dubious. But since Shell began disseminating the scenarios, the feedback they’ve gotten, if I can believe what’s being reported to me, is that they are the best set that’s ever been done there. They’ve had quite a response, and a lot of extra governmental agencies wanting to have scenario presentations. So I feel good about them.

Davis-Floyd: I get a fairly clear picture of what has happened to these scenarios so far–they are out there in the world being very active. And they’re used in seminars all over the place and people react to them, and are using them within Shell–just within Shell?

Flowers: Yes, the corporate managers within Shell go through these workshops, that are honed down very tightly, where the scenarios are presented, and then a bunch of events are put up–in fact, Shell has kind of patented the process of these workshops–some events are put up, and they are put up in terms of time and area–

Davis-Floyd: You mean real events, events that have happened?

Flowers: That have happened and that could happen, according to the scenarios. So you begin to see events now that have happened that could happen in the future that are consonant with the story. Then you begin to see patterns that emerge, and actions that you would take into that kind of future. So there are even more details that participants themselves come up with.

Davis-Floyd: So this process then would make you hyper-conscious about–

Flowers: Weak signals–weak signals. That’s their terminology, meaning that you get faint signals of something about an emerging trend, and you learn to be conscious of those, because this process they teach in the seminars through the scenarios attunes you to these weak signals from the environment.

Davis-Floyd: So this is a process of attunement and the idea is that as you become more and more hyper-conscious about how different events can lead to alternative futures, you begin to be able to read the future as a text, almost as emergent before it’s quite there–

Flowers: That’s right.

Davis-Floyd: So then you can make your business decisions based on those probabilities that you’re seeing emerging–

Flowers: Then it gets even more mysterious, because then you begin to see that the future is what you use to create the present, and that the present that you then create will create the future that you want. I mean, it’s chicken-egg. It gets very curious. So you see into a future, you see this way and you see that way, and then you use this future that you’d rather have to create the present.

Davis-Floyd: So it becomes a very strong cognitive feedback loop.

Flowers: Yes. Even though they don’t even exist–those futures. It’s really fascinating, really fascinating talking about them. And over the period of four months I could see these stories, mere stories, begin to take on life, vitality, depth, in the group, working with the group. So by the end, it’s not so much that we were believing them, because they had such power and palpability–maybe, maybe we were. I’m not sure. They took on a life of their own, these stories.

Davis-Floyd: I’ll bet. What values were stressed in these stories, these self-consciously created myths?

Flowers: In one, the value of individual/group ethnic diversity–”doing it my way.” And in the other, the environmental values of cooperation and a long-term good future for everyone, because we’re all in this together. That’s oversimplifying it a bit, but it would be fair to say that. The first scenario stressed nationalism, bettering your own group, acting in your own self-interest. The other one had acting in your self-interest, but your self-interest was more enlightened, or broader, and included other people than yourself. So there was much freer access on all sorts of levels–many more horizontal linkages, much more cooperative interaction.

Davis-Floyd: While the other, “the bad story,” is more vertical, more about one group dominates, that sort of thing?

Flowers: Um-hmm.

Davis-Floyd: Was there general agreement among the team over what values would be emergent in each story? When people fought over things, were values one of the things they fought over?

Flowers: Yes, they fought over having any values in there whatsoever besides economic self-interest.

Davis-Floyd: Oh really? Why?

Flowers: Because they’re all economists. See, the only way to tell a believable story is to tell it in economic terms. That’s why I went over there–to learn how to tell a story in economic terms. So, this is what I’m saying emerges from the stories, but that’s not the language of the stories. The language is very hard-nosed, about this kind of thing happening with that linkage in order to predict this result. But that in fact is what drives a different decision about what you do.

Davis-Floyd: Right. So the value is implicit in your discussion of the linkages, for example, in the good story, or implicit in your projections of what happens with ethnic strife in one’s own self-interest in the bad story.

Flowers: Yes, it’s implicit. Now, I did manage to put in some things, sort of “over their dead bodies.” I did talk about fear, in the negative story, and I did talk about a kind of acceptance of change, in the positive story. I did use those psychological terms, you know–in spite of the pain of change, accepting it, and working within it, instead of resisting it. I talked in psychological terms to get the stories going in different directions, as if there’s a dividing point–you can either accept these changes, or resist them, and then go back into old ways of doing things. I mean, that’s oversimplifying, but it’s the best I can do without revealing too much.

Davis-Floyd: Did these economists have any sense of the psychology that goes into making up a human being who will accept change or who will resist change?

Flowers: They did in terms of nationalism–fear, and nationalism. That was very strong. And the underlying assumption about people of the economic myth is that we’re all motivated by selfish self-interest.

Davis-Floyd: Do you think that’s true? Do you think the economic myth is correct when it says that self-interest is the motivating factor?

Flowers: It is if we’re in that myth! I don’t think it’s necessarily correct–we have the capacity to be motivated by different things, and have in the past. But we are in the economic myth, and so for the most part we are very much influenced by that set of motivations. So if I’m interested in changing the world, I’ll work through business, and I’ll work through the notion of self-interest. In other words, I wouldn’t go out and say “Here’s the right thing to do,” I would go out and say “Here’s the thing to do for your long-term enlightened self-interest.”

One of the quotes in the scenarios was by Kaku, who’s head of Cannon, in Japan, which is a vastly successful company. And he says that the only institution whose self-interest coincides with global self-interest is a multi-national corporation. Many corporations are beginning to become conscious of this. This past weekend I was in Boston at a global citizenship conference that was about the interface of education and global business. In the same way that the church influenced education, and then democracy influenced education, and then the state, now it’s corporations that are coming in with new ideas about education–all over the country, all over the world, actually. They’re becoming very conscious of what they do to influence schools to produce the kind of people they need…because of their enlightened self-interest, and, as they see it, the interests of the world.

Davis-Floyd: When you talked about Shell as a largely decentralized corporation, I suddenly realized how powerful the stories must be at the ends of the– You know how if you diagram a corporation you go out to the individual units out there in the field where the action is, where it’s most profoundly and immediately happening? If those individuals are the ones that are perceiving trends because of the stories, because of what they’ve been taught in the seminars, and then acting immediately, what you have overall is a corporate structure that really looks very much like an octopus with a brain in each arm–

Flowers: –yes–

Davis-Floyd: –instead of a bunch of boxes, like IBM used to look–

Flowers: Yes, Shell is very fluid, very decentralized–so they can make quick responses on the ground, like one arm of the octopus reacting to a change. I think that’s one reason for their success, and their longevity.

Davis-Floyd: And of course that is very much in keeping with the vision of this Director of Scenarios that you talked about–his vision for individual choice.

Flowers: That’s right!

Davis-Floyd: This is very impressive, really. It’s not your usual business story. Do you see other companies doing this sort of thing very much? Is Shell really the leader out there? Are there other companies flocking to follow suit?

Flowers: There are some who do scenarios–I don’t know that they commit as much as Shell commits. I don’t see any doing that. I think Shell, because it’s been around so long, is able to make decisions in a different way. And because it’s so international. They’ve got so many people all over the world, of different nationalities, so you can’t be so boxed into the story of values that, say, the English represent–at any given time in their executive lunchroom where I ate, you could hear all these different languages going on.

Davis-Floyd: So they don’t identify themselves with particular countries, not even England and The Netherlands?

Flowers: Not really. They really think of themselves as a global corporation. That’s their consciousness–it’s a global consciousness. And then the reaction to these stories filters back up gradually into the back end of the planning department, so you get the responses to the stories too, gradually.

Davis-Floyd: What does the planning department do with these responses?

Flowers: They take them in for the next round of stories.

Davis-Floyd: Why do you think this project matters, in the end? What differences will it make in the course of corporate, human, or planetary history?

Flowers: Goodness, who can tell? I’m not into forecasting! [laughter] But I can tell a story.

Davis-Floyd: Tell me your story about the importance of these stories.

Flowers: Well, for me, they’re important in a whole lot of different ways. One way had to do with the whole South Africa thing. I observed what a difference the South African scenarios made. I heard preachers in their sermons referring to these scenarios, and ladies in the boondocks calling in on radio talk shows saying, “I’m afraid we’re going in the direction of Ostrich scenario.” It was important to see how a language of story could appeal so much, and become a language that all levels of society could enter into for the sake of democratic discussion.

And there are a lot of people now, like Global Business Network, who are doing scenarios. Almost all of them have come from Shell. They spin off and do their own sorts of things. And you’ll see these little things–there was a little book published last year called The Art of the Long View–it’s all about Shell. This stuff is sort of disseminating now. I saw the scenarios for the California System of Higher Education–four different stories of a possible future. They were done by ex-Shell people. So there are all these little pockets of this stuff that’s specifically from Shell.

For me personally–I learned a tremendous amount about working in an economic language, about the power of story, even when it’s so narrowly defined that you have to use numbers to tell it. It taught me a lot. So what difference will one individual’s learning make for the future?–or many individuals? I don’t know. But I do know that we’re starting to talk about changing the story of America, and the story of the American dream. If we can go from belief, from holding ideas as beliefs to holding them as stories, then there’s a possibility for change at a very profound level. And not the change that comes from somebody from above saying “you will do this” in a certain way, because there is more power in disseminating stories than a five-year plan. No central government can be wise enough to give a plan. That’s my belief. I’m enough in the economic myth to believe that the invisible hand is wiser than any particular hand anywhere.

So then the question is, How do we become a community? How do we operate in terms of the large self-interest? Because the economic myth does not allow you to do that. It’s wrong to think that the invisible hand is a benevolent hand. It’s very effective, it’s very powerful, but it’s not necessarily benevolent, especially for the powerless. So in this instance I think that stories that have values implicit within them, that are compelling, that become common, are very powerful. They’re not directive, they’re suggestive.

Davis-Floyd: So, if you wanted to use scenarios to transform health care in the U.S., for example, how would you go about it?

Flowers: I would work out three very different scenarios for health care, and then float them around the country, not as plans to be adopted, but as stories–and see how people respond. You know: If you adopt the Canadian system by the year 2000, it’ll look like this. But good and bad. A scenario has to be perceived as a real story, and not just propaganda: if you adopt managed competition, what happens here and what happens there? and you tell that story. And you disseminate these stories, and then people can talk about the stories, and not have to stand on positions politically about something. Then you can have a real discussion, and not an argument.

Davis-Floyd: So then when it’s time to vote on legislation to create policy, they’ll have more consciousness about the implications of the vote, rather than getting narrowly trapped into protecting the AMA, or whatever, they’ll see it a more systemic way, even.

Flowers: Yes, and that allows you to build a coherent policy. As it is now, we’re going to have a little bit of this and that, depending on which pressure group is strongest, and when you get a hodgepodge, it can tend not to work, because it’s not coherent.

Davis-Floyd: Yes, stories are coherent–they have a beginning, a middle, and an end, things lead to other things, and you can see relation and causation.

Flowers: Exactly, that’s their power, is the coherence. Not coerciveness, but coherence. It’s related, I think, to Wittgenstein saying ethics and esthetics are one and the same, and I think he was talking about ethics, which is an esthetics, which has to do with order, and the principle of harmony. Stories have coherence and harmony, and that can actually make things happen in the world, in a way that laws cannot, when you have different ethnic groups, and different value systems. So that’s how I would have done it, very different from the way they’re doing it.

Davis-Floyd: I understand.

Flowers: And then, when you talk with someone who is saying, “By God, we need to have X as our health care system,” someone, even a person on the street, can say, “Well, you know, that’s really a part of “Flight of the Flamingoes,” that’s really a part of that other story–you know, what does that belong to? Because it’s always a fight among “goods.” So if someone says, “We need to have kidney dialysis in every primary school for the people on the block”–who’s gonna say no? That’s a wonderful idea–it’s just that it doesn’t fit the story of “preventive health care,” for example. It’s not that it’s good or bad, it just doesn’t fit. So then you’re judging on what fits, and not what’s good, because there are too many goods. Too many “goods,” that’s the problem with the economic myth.

Davis-Floyd: So, for example, a kidney dialysis machine on every block wouldn’t fit the story of a decentralized, less technological, health care system based on preventive medicine.

Flowers: Right. It wouldn’t fit that health care policy. Massive bone marrow transplants in the last year of life of someone dying of leukemia, or some kind of cancer, fits “managed competition,” but it doesn’t fit the preventive story. It doesn’t fit–you don’t have to say it’s good or bad. Your grandfather’s dying–who’s gonna say those transplant are bad? You don’t have to argue it on moral grounds, which is what we’re continually doing in America. When we argue on moral grounds, we have to make someone wrong. And that’s a losing proposition. If you argue on the grounds of fit, then you don’t have to be wrong. I think that’s why a story has much more power in a diverse society. In a homogenous society, you have the luxury of having beliefs, because everyone believes the same way, and you have a value system and you can make decisions based on values. In a diverse society, you do not have the luxury of operating on belief, I don’t think, but on coherence.

Davis-Floyd: So of course that’s why stories become so important–because they’re only stories. But as stories, not only are they coherent, but they focus attention on certain issues without demanding belief–

Flowers: Right!

Davis-Floyd: –so you can see implications and you’re free from all those moral restrictions that make people so livid and rabid and unable to think any more.

Flowers: Yes, that’s right. It really has to do with the strength we have as a nation, of trying to find the “right.” Because we’re trying to find out who’s right, and there are multiple rights, we’re in a kind of gridlock. Whereas if we have coherent stories, we could get out of some of those areas of gridlock without having to make someone wrong. Because when someone is made wrong (and they’re not–in most cases, they have a point), they can cry “injustice, injustice!”–and make a law, and so we have all these ad-hoc mutually contradictory bureaucratic things going on that do not allow us to move forward.

Davis-Floyd: There’s a little schema that I find useful for discussing cognitive styles. Stage One is either/or, black-or-white, fundamentalist thinking, and Stage Four is highly relational, non-judgmental, comparative thinking, in which the world is replete with options and there is no one reality. Stories are a Stage Four phenomenon, really, when you understand them as stories. In Stage One, everybody tells the same story and believes it. But in Stage Four, fluid thinking, it’s all just stories. Stage Four is more adaptive in conditions of rapid change, so it’s a good thing we’re becoming a Stage Four society. The problem of course is that this Stage Four society is full of Stage One people, and Stage One groups. The dynamic that I see is the one between fluidity and fixity–this constant tension between looking at reality as a set of stories, and looking at it as Truth. What’s good for the country is the fluidity of the stories, but it’s so hard for individuals who deeply believe a story to step outside of it and allow it to be fluid.

Flowers: That’s right. Which is why I’ve given my life not to preaching any particular story–I don’t have any particular thing I’m selling by way of content–but to changing the way we hold stories, as a kind of first step. That to me is a form of literary criticism, and so back to my discipline–it’s a way I define myself in relation to my discipline, which nobody else in my discipline gets! I mean, this is truly a “discipline of one,” in this case. But if someone says, What does all this have to do with you being an English professor? it has completely to do with it, through a redefinition of what a literary critic can do if a literary critic is interested in society as well as in criticizing stories.

Davis-Floyd: So your role is one of a culture critic, someone who is able to help people become conscious of the stories that they’re telling about themselves and about the world.

Flowers: Yes, a culture critic from the perspective of literature, fiction–so it would be closer to a movie reviewer than a sociologist, or pollster. It has different rules to it, which we don’t recognize, so it would be very hard for me to have any authority speaking, because the rules of culture critics rest on some kind of evidence that isn’t fictional–statistics. We do go with statistics, even though we all know what they may or may not represent.

Davis-Floyd: Movie reviewers, for example, know that the movie could’ve ended any way that the script writer and the director chose for it to end. So they are completely free to criticize, because there was complete freedom on the part of those creating the movie to make it go any which way. But what you know is that culture-wide, we may actually have the same choices, not quite so freely as in a movie, cause we are dealing with large forces, but it’s back to the vision of the Director of Scenarios–there is this powerful role of individual choice. So if we’re free to see it as stories, and to see the directions the stories will move us in, we’re much freer to make those choices, to come consciously as a culture to where we want to end up.

Flowers: Yes.

Davis-Floyd: Do you think that we can do that?

Flowers: Well, the South African thing was very hopeful. I didn’t go to South Africa to do the workshop–I just helped plan it. But when the head guy came back, and was talking about it, it was clear that you could do that, you could tell scenarios in such a way that I wouldn’t have to stand on position and argue with you, but could actually yield my position in the interests of the story. I couldn’t yield my position per se because then I would be a betrayer. But I could work for a story that in effect made me yield in terms of the timing. Like if I’m saying “End apartheid now,” I have a very strong moral position, and I can rally the troops behind me. It doesn’t matter if ending apartheid tomorrow creates total chaos and in the end, a fascist government, or whatever. But if I’ve worked it out, and I see that “End apartheid now” might be “The Flight of Icarus” and that doing this interim thing, and finally having elections in April, is “Flight of the Flamingos,” then I can be in coherence with a story in a way that I couldn’t, otherwise, without betraying my position.

Davis-Floyd: How did you get interested in myth in the first place?

Flowers: There are a lot of ways to tell this story, but if you were going to be psychoanalytical about it, I would say that my parents were very different in how they saw the world. I observed my father making one story about the same event and my mother making another, and that it was her story that would cause her grief or discomfort, and that my father’s story actually created smooth sailing for him. I realized that the difference lay not in what was happening to them, but in something very different in the way that they were thinking about it. And that taught me to be on the alert for the stories people were telling to interpret their experiences.

Davis-Floyd: Were you ever able to actually articulate for yourself what the story was that your father was telling about the world, and the story that your mother was telling?

Flowers: No, I was only able to see it in specific instances. I found myself sometimes trying to tell my father’s story to my mother so she wouldn’t be upset, telling her, “I think he thinks this” or “he sees it this way.” I just knew that I could change the reality of what happened by changing the story, and that she could.

Davis-Floyd: So then, how did you explore that academically?

Flowers: Well, there’s not really a field called “changing your story” [laughs], except for psychoanalysis to some extent, but they’re caught up in their own story! So I did read whatever I could about psychoanalysis–more psychoanalysis than psychology, because I wasn’t so interested in scientific experiments that count the numbers–how many heads do this, you know, because they’re in the economic myth, too, about statistics. We all are. We’re statistic-crazy because we believe them.

But, I was interested in psychoanalysis because it’s the theory of story as it relates to the human being. So I read Freud and Jung and Adler, whatever I could get my hands on. It was fascinating to me. It made me look at life differently. But I also felt that their stories were somewhat limiting, that they were caught in a founder story, as many religious groups are–in this case it’s a Freudian story–and that the founder story had certain limitations, particularly if you were a woman, and also spiritual limitations. There was not very much room in the myths of psychoanalysis for transcendence or for other experiences that didn’t fit that story. So then I began looking around for other ways of telling the story. It seemed as if no one had the whole story in the way that I liked it. I write fiction, too, and poetry, so I thought well, what would life look like if I do a different story?

Davis-Floyd: Is that why you picked English as your major rather than Psychology, for example?

Flowers: Yes, although it would be hard to say I could have articulated that back then. I was very interested in the stories people told about reality. For my PhD, I went to the University of London and worked with the British Museum on Browning’s influence on contemporary or modern poetry. And I came to realize that to tell a story of influence is to make up lots of stuff. So I was continually having to tell the story in a more muted way because you couldn’t say–um–there are certain stories The Academy is allowed to tell, and others stories that it isn’t. And part of graduate education is teaching students what stories are permissible in the discipline. And so what I learned in London was what stories were permissible, how to tell a story in the discipline of English. But what I found constricting was that “how to tell a story in the discipline of English” did not include how to tell a story that made any difference to what was going on in the world around me, except as it made a difference in individual lives.

But the great cultural stories, which to my mind were the stories of business as it was happening, were not told in literary ways, and it struck me that if I wanted to study the stories that were influencing us now, they were not the stories from religion. Most literature arises from the heroic tradition or the religious tradition–a little bit of it from the democratic tradition, not too much–enough so that it’s about salvation in some form or another, even if it’s not explicitly Christian or theological. So, if you were interested in what was going on in the world, the stories going on in the world, you had to do something else. That’s how I got interested in myth theory, if you want to put it that way–learning about and reading about myth, because that seemed to back up and have a more architectural approach that would allow me to look at larger stories.

Davis-Floyd: Who are the storytellers in the business world?

Flowers: Well, there is this myth that–it’s the myth, it’s not that they’re telling individual stories. There is a myth which you can see in advertising that has to do with the things myths always have to do with–salvation, beauty, power, truth, love–and it has to do with more and better things, and the right way of doing things with things. And so the myth-tellers are the marketing people, you could say. Advertisement tells this story, this myth in which people are embedded. But the measurement of the success of the story is not the applause at the end of the performance or how many people join up with your religion, it has to do with the bottom line. And you can tell a story about your own product which is embedded in the larger story of the culture, and you can tell immediately how effective a storyteller you are by the bottom line.

Davis-Floyd: What happens if people don’t like your story? They don’t buy the product?

Flowers: That’s right. Sometimes they buy the product because they like your story. I think it’s very interesting now to see the battle in Europe, or even here, between Haagen Daas and Ben and Jerry’s. I mean, basically they both make ice cream. But the Ben and Jerry’s story is “We are ecologically sound–we’re really selling the environment.” And Haagen Daas typically has been selling pleasure. Now it’s a toss-up as to whether we’re buying the story of pleasure or the environment. I mean, both of them have to do with purchases of certain milk products, but, you know, it’s how the marketing story goes. And Haagen Daas is very consciously trying to change its story because the ’80s are over and that self-indulgent pleasure is a little on the wane. See, both of those little submyths are part of a larger myth–

Davis-Floyd: –which is?

Flowers: The myth of the power of things–the right thing, the best thing, or more things. See, we’re not arguing over whether we should buy ice cream at all–or make it–

Davis-Floyd: Yes, it’s fundamentally taken for granted–

Flowers: –that we’re going to buy something.

Davis-Floyd: Yes! When did you first become aware of the role of myths in business? When did you first start looking at how business stories were stories that weren’t told? I mean, most people don’t think of businesses as having stories, much less telling them, or of myth as having any role in business. When did you first start to figure that out, and why?

Flowers: I grew up without a TV. Most of my friends in high school did have TV. And I was aware that they saw the world a certain way that had to do with things I wasn’t seeing. It wasn’t just that they knew things I didn’t know, but that they assumed things about–the power of lipstick, or something, that I didn’t. Even though I wore lipstick and liked it, it wasn’t numinous for me. But it was for them. And it made me very curious. And then I got very interested in ads, in just how ads were constructed. They were by far the most brilliantly produced things on television. Much more thought went into the language of advertising–and I’m interested in language, as a poet–than the language of the scripts, of the shows around the advertising. I became aware that the real story was being told there, in the ads. Some of the ads are brilliant. There are a lot of implicit stories in the ads. And they have to do with happiness, well, with all the things stories have always had to do with, with the “good news.”

Davis-Floyd: It’s amazing what a profound story you can tell through a series of images that take maybe 30-40 seconds to watch. If you were to write that out, it would take maybe 30-40 pages.

Flowers: Oh, yes, because imagery–it’s the “picture worth 10,000 words” type thing. Part of the power of the economic myth is that it’s told in numbers, which is a world-wide language, and in imagery, which is also world-wide. We don’t need to be impeded by language barriers. We’re building a Tower of Babel.

Davis-Floyd: The economic myth is creating a truly transcendent medium of expression.

Flowers: Yes, you can show all over the world, even in poor countries, a satisfied person, even with a different ethnic face, getting into a Mercedes with a grin on his face and with his arm around a blonde or something and right there is a whole message about life that’s similar to the Gospel being spread. It’s the good news, and we want it!

Davis-Floyd: Pick some other companies that you’ve thought about and tell me their stories.

Flowers: There’s a whole corporate literature which I’m not that familiar with, where they talk about “corporate culture” and “founding stories,” like the “IBM Founding Story” and the “Xerox Founding Story,” and certainly the “Sam Walton Founding Story.” McDonald’s has a strong Founding Story. So, there are myths within individual corporations that tell their story. And then there are myths of management that help keep things together, which often have to do with what the mission of the company is, so that they’re selling not products but they’re selling hope or they’re selling truth or they’re selling justice–these larger things. So there’s that aspect of storytelling in companies.

Now Shell was a different thing because Shell is actually thinking about the future apart from its company, although the company is embedded in it. The job at Shell didn’t have to do with talking about the future at Shell, but the future of the world. The way they used “story” was very self-consciously, not just as a marketing thing, but looking at the world in terms of story.

Second Interview, Spring of 1995

Davis-Floyd: Betty Sue, I’ve been eager to tell you that since our earlier conversation, whenever I run into anyone from South Africa, I always make a point of asking them about the scenarios, and they all know the stories. They tell me all four stories, and say that clearly “Flight of the Flamingoes” was preferable, and that everybody in the country knew the stories, and that those stories made it possible for people to understand that this decision leads to “Flight of the Flamingoes,” and this one leads to “Ostrich,” and this one to “Icarus”–so it became not about your group wins versus mine, it became, “This works–this works!” So that kind of storied thinking helps me to understand what you mean about creating scenarios for health care, rather than arguing over legislation.

Flowers: Yes. The practice will change as a consequence of the story changing, rather than the government trying to direct the practice.

Davis-Floyd: How have the scenarios you wrote been received?

Flowers: Very well! They’ve been presented–I should give you the list, because I don’t remember it all off the top of my head. They’ve been presented to the G7, and the UN, and the European community, and the French government here and there, and to different nations around the world, and the World Bank–just a lot of different places. And, I have seen evidence of their leaking out in various journal articles–in Foreign Affairs, for one, and in a speech I heard given by someone from Washington, who in fact had been in on the Shell briefings, as I discovered when I talked with the speaker afterwards. So the story is getting disseminated, in various forms. And for the very first time, they are using the same story–just tweaking it a bit, for the next round, and then adding two dimensions on to it–the human dimension, and technology. So I’m going back this summer, to tweak. But it will be the same basic story, because the story I wrote has lasted.

Davis-Floyd: Both of the ones you wrote?

Flowers: Yes.

Davis-Floyd: Why did they decide to keep the same stories?

Flowers: Because they are still alive. See, when a story has power, when it still explains things that you feel are coming to you from the future, then it’s still useful to tell it. When a story loses power, it doesn’t get told any more. So they still want to tell these stories. And they do it in a story-telling fashion–it’s not like they become any more or less true.

Davis-Floyd: And what kinds of changes does Shell want to make in them?

Flowers: I won’t know exactly till I get there–but they want to add two dimensions, extra bits to them, one on humans–the new relationship of people to their work.. And then another dimension–technology. We dealt with technology, but they want to do a whole big thing on it. And those are two areas I’m very interested in, so I’m really eager to go back.

Davis-Floyd: Tell me more about this new relationship between people and their work.

Flowers: Last time I argued strongly for a section on the human being, which I said would be true for either scenario–that workers were going to demand more holistic attention, that they weren’t going to be machines any more, that they would look at their jobs as their lives, in a way, and would be more attracted to what gave them a larger sense of themselves. It’s a little more complicated than that. And we had this story, and it was a huge story, and we kept trimming it back, because people didn’t think it was very important, and finally it was thrown out altogether. And I made a big argument, and won over the head guy, to keep it in, and we just insisted on it because it is true to both stories, which hadn’t happened before.

Davis-Floyd: And why did some people want to throw that out?

Flowers: Well, it didn’t seem to be as important at the time, as all the economic and military things that were going on in the scenarios. I would say it’s still pretty controversial–people will say no, people just work for the money.

Davis-Floyd: Tell me what difference it makes to encode something like that into the scenarios themselves. In other words, you were saying this is so important that it should be in the story, and they’re saying well it may be true but it’s not important enough to be in the story. What difference does it make to have it in or out of the story?

Flowers: It raises the issue, it raises the question to talk about. The stories are starting places for discussion, really. What they do is throw light on things that managers can look at. If the light isn’t thrown on that dimension, then it will not stand out as a subject for discussion. I wanted to see it in the conversation, I wanted it to be talked about.

Davis-Floyd: I’ve been trying to ask people in the business world if they have heard about the Shell scenarios, but so far I have not encountered anyone who has heard more than a tiny bit about them. Last night, I did overhear a conversation between two businessmen at a restaurant, which sounded very intense and very global, so I interrupted them to ask if they had heard of the Shell scenarios, or of scenarios in general. They hadn’t, but they asked me what scenarios are. When I explained, they immediately started talking to me about chaos theory, fuzzy sets, and neural network theory.

Flowers: Those are the buzz words now! and they are all part of the scenario process.

Davis-Floyd: What have you learned about the scenario-writing process, or about scenarios in general, since you left England?

Flowers: Wow! Well, I’ve learned, for one thing, about how easily companies can believe their own scenarios, which started off as fiction but up as “fact”–I guess because of the natural human desire to make something that’s real–so that by the time you finish with the scenario, it is carried around as a prediction, rather than a fiction. Very few companies have the courage that Shell has to claim something as a fiction.

Davis-Floyd: So what makes Shell unique in that regard?

Flowers: Well, there were some unique people involved with its founding, as is often the case–when you find something that’s really different from the run of the mill, there’s a human being behind it, in its history. And in this case, there was an amazing human being, Pierre Wack, who was a kind of wild man whom could be found in his Shell office, in the most sterile building in London, sitting on his floor amidst a haze of puja sticks, meditating, to come up with his stories about the future of oil and gas–those are the stories told about him. He would go off on sabbatical, to India, or wherever–just disappear for a month at a time, and come back with his head full of ideas. And Shell supported that happening in their midst.

Davis-Floyd: Why?

Flowers: For some reason, and I don’t know why, they had the instinct that it’s good not to get encrusted in one way of thinking about things. And maybe that comes from their multi-cultural background. You know, it’s a very old company, begun over a hundred years ago by a dual team, Dutch and British, so the fact that there are two founders, that from near the beginning, two different cultures have run this company, as they moved their headquarters from The Hague to London every other week–that does something. If you are in constant flux, you are reminded again and again that nothing can be depended on to stay. That’s a kind of wisdom that we all know intellectually, but very few of us know day-by-day.

Davis-Floyd: Do you have any concrete information on what differences the stories you wrote for Shell have made in the world to date?

Flowers: No, no way, they’re too big. There’s no way anyone could know that. Which is another interesting thing about Shell, because you could make a case that these have absolutely no influence at all, because there is no way to show it, and yet they continue doing it.

Davis-Floyd: Well, looking at Art of the Long View and “Gentle Art of Reperceiving,” you can clearly see how the scenarios helped Shell position itself for the oil price crash in the ’80s. And the end of the Cold War–one of Shell’s scenarios predicted that, so they saw it coming a long way off. But those were dramatic shifts. And in the last two years, there hasn’t been anything that concrete and dramatic, with that kind of global effect, so the impact of your stories would be harder to assess, right? because the shifts have been more subtle.

Flowers: Yes.

Davis-Floyd: So what are the major things to look for? What could happen, in the scenarios you are going to write this summer, that would be huge and dramatic?

Flowers: Probably it would happen on the financial level, the movement of money around the world. Anybody with a huge amount of overhead and a lot of money being moved would have to know both fictions, because different things will happen about money in each. If there were to be some kind of global financial crisis–which might be coming–unless you knew Shell’s books, you wouldn’t know what they had done to prepare. I don’t know whether it would be obvious, even if they were making tremendous changes. The other place they could be making changes is in the way they run themselves internally. And I won’t know that until I get there. And even then I may not know, because that’s really subtle.

Davis-Floyd: So let’s scenario a bit right now. Suppose there is a wordwide financial crisis, set off by some trader in Japan, with a snowball effect, in Scenario I. And in Scenario II, everything just kind of keeps rocking along. What could a company like Shell do about it, if they wanted to prepare for Scenario I?

Flowers: Going back to the real scenarios, a lot of which had to do with communications technology–they would be very wired. They would know, in advance all kinds of things that were happening, would be tuned it, in touch, to make very quick decisions and increase their speed of implementation.

Davis-Floyd: You mean, to move money here or there, put it in this bank or buy that factory–

Flowers: So, if you see these two scenarios, what you might do is say, you know what? we need more computer connections. We need to be more closely connected to the Bank of Tokyo–we need to work out a special deal with them, so there is some kind of trigger mechanism whenever any large shift occurs, so we’ll know if the Japanese do X, Y, or Z with the yen, and then we’ll immediately need to flag the bottom line investment in Singapore. A company could increase its options that way–but of course, I’m just making this up.

Davis-Floyd: For me, this is part of the process of learning to think in terms of scenarios.

Flowers: You wouldn’t start by putting it all in gold, because that would be to treat the scenario as true.

Davis-Floyd: And you’re hoping that Scenario II will happen, but because I exists, in which there is a crash, you’ve got to ask yourself how could we respond most effectively in the face of a crash, so then you go, oh gee, we don’t have enough communications links–

Flowers: Right– and we need more flagging mechanisms than we have in place–we should think this through.

Davis-Floyd: So you want to be prepared for Scenario I while you’re hoping–and trying to create–Scenario II. But in any case, you are ready, whichever way it goes.

Flowers: Yes.

Davis-Floyd: What might be another major event, besides a worldwide price crash, that would affect your scenarios?

Flowers: Umm…well, if there really were a major technological breakthrough in energy.

Davis-Floyd: Like someone coming up with a really cheap and viable alternative energy source that would eventually replace oil altogether–

Flowers: Right. It would have a dramatic impact–dramatic. So if you have a scenario that says that in ten years’ time it will be economically viable, then what you do is put some of your money in those technologies, maybe establish your own research arm–

Davis-Floyd: so that if there is a sudden shift from oil to some other technology, you’ll be part of that shift.

Flowers: But see, what’s important about a story instead of a prediction, is that, if I just predict that by 2025 windmills are going to provide the heating and not gas or coal, that won’t be enough. Because the thing about a story is that it tells you how we got from here to there, and what if getting from here to there meant passing through Russian gas? (Russia has a whole bunch of gas.) So then the flexible response is not “Let’s start building windmills,” but “Ah, now let’s get heavy into Russian gas and quick out in three years time”–or whatever.

So, the point of a story is that it tells you how you get from A to B, because in the interim you might make very different decisions, even if the outcome is the same. And if you don’t get the middle right, by the time windmills are the hot thing, you might be too broke to invest in them! In the scenarios we write at Shell, almost no one disagrees with how we get to the end, if we do our job right. They may disagree about the end itself, but almost no one disagrees with how we get there–and that’s what has the influence. And that’s why it’s not a prediction. It’s the story, not the end.

Notes

1. Since these interviews were conducted, a third major publication has come out that also details this process–Joseph Jaworski’s Synchronicity: The Inner Path of Leadership (1996). See pp. 154-171 for the full text of the two 1992 scenarios, which are entitled “Barricades” and “New Frontiers.”

2. The title has since been changed. See footnote 1.

3. It should be obvious from a quick read-through that none of these scenarios focuses on the divisive issues of black-white antagonism. Rather, they keep their sights on the long term economic prosperity of the nation as a whole. The word apartheid, for example, is only mentioned once. This was intentional, and is one of the great benefits of the scenario process: scenarios shift the focus from specifically opposed political positions to a broader look at what will work–or fail– in the long run.

The creation of these scenarios was sparked in mid-1991 by a request to economist Pieter le Roux to organize a conference on South Africa’s economic future. Feeling the time was right for a different approach, Le Roux put together a multi-disciplinary team of 22 people—-four women and fourteen men–to work on possible scenarios for South Africa. Team members met for the first time at Mont Fleur near Stellenbasch in September 1991. Adam Kahane of Shell International in London, a recognized expert in scenario planning, acted as facilitator.

The team members included: Dorothy Boesak, Administrative Coordinator, Rob Davies, Co-Director of the Center for South African Studies at the University of the Western Cape; Howard Gabriels, Project Officer at Friedrich Ebert Stiffung; Koosum Kalyan, Manager of the Social Political, Communications, and Media Department of Shell International in Cape Town; Michiel Le Roux, Managing Director of Distillers Company in Stellenbosch; Pieter Le Roux, Director of the Institute for Social Development, University of the Western Cape; Johann Liebenberg, Senior General Manager: External Relations, of the Chamber of Mines; Saki Macozoma, Member of the National Executive Committee of the ANC, Head of the ANC’s Media Liason Unit of the Department of Education and Publicity; Tito Mboweni, economist in the ANC’s Dept. of Economic Planning; Gary Magmola, Ex-Director of FABCOS and Chairman of the Inter-Africa Group; Mosebyane Malatsi, PAC economist and Senior Policy Analyst, Development Bank of Southern Africa; Thobeka Cikizwa Mangwana, teacher of social planning at the UWC Institute for Social Development; Trevor Manuel, ANC Executive Committee Member and Head of the ANC’s Department of Economic Planning; Vincent Thabane Maphai, Head of the Department of Political Studies, University of the Western Cape; Philip Mohr, Head of the Economics Dept, University of South Africa; Nicky Morgan, Dean of the Faculty of Economic and Management Sciences at the University of the Western Cape; Patrick Ncube, Senior Research Fellow in economics, University of Cape Town; Gugile Nkwinti, ANC National Executive Committee member, ANC Regional Secretary, Eastern Cape Region, Director of the Eastern Cape Development and Funding Forum. Brian O’Connell, Director of the Peninsula Technikon School of Education in Cape Town; Mahlomola Skosana, First Assistant Secretary General of NACTU; Vivienne Taylor, Director of the South African Development Education Programme at the University of the Western Cape; Sue van der Merwe, Member of the Black Sash National Executive Committee; Christo Weise, Executive Chairman of Pepkor, Member of the President’s Economic Advisory Council; Winfried Veit, Director of the South African office of the Friedrick-Ebbert-Stiffung in Cape Town, a company which provided the funding for the development of the Mont Fleur Scenarios, with technical support provided by Shell South Africa.

A video, “The Flight of the Flamingoes,” describing the four scenarios and the process by which they were created can be obtained by writing to “The Mont Fleur Scenarios,” The Institute for Social Development, University of the Western Cape, Private Bag X17, 7535 Bellville, South Africa, or by sending a fax to 021-959-3242.

4. The cover page says GLOBAL SCENARIOS 1992-2020 at the top, and confidential at the bottom. According to the next page:

the cover illustration, a series of fern-like spirals heading off into the distance, is a detail of the Mandelbrot set, named after its discoverer and the father of fractal geometry, Benoit Mandelbrot. Fractal geometry provides a common language to characterize certain complex systems studied in chaos theory. Chaos theory is now being applied in fields as diverse as physics, weather forecasting, economics, cardiology, and traffic planning as a way of dealing with data that cannot be used to predict the long-term future–not because we don’t have computers big enough to do the job, but because after a time, small variations in initial conditions (like rounding of decimal places when we calculate with irrational numbers like pi) result in sudden and significant transformations.

References

Flowers, Betty S., Extending the Shade. Austin, Texas: Plain View Press, 1990.

Flowers, Betty S., ed. Joseph Campbell and The Power of Myth: Bill Moyers and Joseph Campbell in Conversation.New York: Doubleday, 1988.

Flowers, Betty S. ed., Moyers: A World of Ideas.New York: Doubleday, 1989.

Jaworski, Joseph, Synchronicity: The Inner Path of Leadership. Betty Sue Flowers, ed.San Francisco: Barrett-Koehler Publishers, 1996.

Moyers, Bill. Healing and the Mind, edited by Betty S. Flowers.New York: Doubleday, 1993.

Schwartz, Peter. The Art of the Long View.New York: Doubleday, 1991.

Wack, Pierre. “The Gentle Art of Reperceiving.” Harvard Business Review Vol. ?, 19??. Reprinted as “‘Strategic Planning in Shell’ Series No. 1, Shell International Petroleum Company Limited, Group Planning, PL86R21, March 1986.