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Title: Birth as a Rite of Passage: The Cultural Context


1
Birth as a Rite of Passage The Cultural
Context
  • Robbie Davis-Floyd PhD
  • Medical anthropologist

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A brief look at the history of Western
technological evolution
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From down
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To ever and ever more up
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The primary myth of human evolutionThe
technologies of man the hunter and killer
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Man as up, woman as down In her proper place
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Who really brought dinner home? Woman the
gatherer 80 of the daily fare
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The primary technologies of human evolution
Carrying and sharing at a home base
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Nevertheless, the myth continues
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The myth of technological transcendence
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The technocratic imperative
  • If the technology exists, we must use it.
  • Using existing technologies constitutes the best
    care
  • Not using them constitutes inferior and more
    ignorant care

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The post-industrial technocracy a society
organized around an ideology of progress through
the development of high technologies and the
global flow of information
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What is a paradigm?
  • A paradigm, most simply, is both a model of and a
    template for reality. Complementary terms include
    belief system, and worldview.

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  • Just as a fish cannot step outside of the water
    it swims in, so an individual operating within a
    paradigm is subject to the illusion that the
    paradigm represents the whole of reality. But no
    paradigm does.
  • All models of reality, no matter how complex, are
    bound to leave out some aspects of the reality
    they are attempting to model.

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Three primary paradigms of health care in the
post-industrial technocracy
  • The technocratic model
  • The humanistic model
  • The holistic model

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The Technocratic Model
  • Mind-body separation
  • The body as machine

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The technocratic model of birthThe female body
as a defective machine The hospital as factory
The baby as product Technology as transcendent
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Hospital-factory in Argentina
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The myth of technological transcendence in birth
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The technocratic model as representative of the
core values of the technocracy
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The Technocratic Model of Medicine
  • The patient as object
  • Alienation of practitioner from patient

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The technocratic model
  • Diagnosis and treatment from outside in
  • Supervaluation of high technologies

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The technocratic model
  • Aggressive intervention with emphasis on
    short-term results

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The technocratic model
  • Authority and responsibility inherent in
    practitioner, not patient

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The technocratic model
  • Standardization of treatment

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The technocratic model is
  • Based in traditional medicine, and in the
    transmission of information from teacher to
    student
  • Reinforced through rituals that seem to prove
    this model, and that habituate practitioners to
    the performance of these rituals

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  • A RITUAL is a patterned, repetitive, and symbolic
    enactment of a cultural belief or value

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Characteristics of ritual
  • Symbolism
  • Rituals work through symbols. A symbol is an
    object, idea, or action loaded with cultural
    meaning

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Characteristics of ritual
  • Rhythm, repetition, and redundancy
  • Rituals send the same messages over and over,
    in many different symbolic forms

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Characteristics of ritual
  • Framing, order, and formality
  • Rituals send are framed, set apart from ordinary
    life.
  • Behavior is formalized, order is important,
    things must be in their places

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Order and hierarchy matter, andAuthoritative
knowledge resides in the physician, and not in
the womans body
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Characteristics of ritual
Inviolability and inevitability Its set
apartness and formality enable ritual to
establish an atmosphere that feels inviolate and
an order that feels inevitable.
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Through neural entrainment to its repetition and
precise order, ritual creates habituation
  • Benefits of Habituation
  • You dont have to think.
  • Disadvantages
  • Change becomes difficult or impossible.

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Functions of ritual
  • Augmenting group cohesion through teaching a
    system of shared group beliefs (that includes a
    special in-group language, artifacts, and spaces)

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Functions of ritual
  • Generating emotion and thus belief
  • Enhancing courage in the face of danger
  • Bringing order to chaosa sense of control.

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Precise performance of ritual gives humans the
feeling that they are locked onto a set of cosmic
gears which, once set in motion, will inevitably
crank them through danger to safety.
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  • The more peoples emotions can be engaged through
    ritual, the more they can be prevented from
    questioning its messages or examining alternative
    views

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Rituals and symbols Position
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Rituals and primary symbols of the technocratic
model Time
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Rituals and primary symbols of the technocratic
model
IV
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Rituals and their primary symbols of the
technocratic model EFM
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Rituals and symbols Separation of mother and
baby
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Separation of father from family
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  • A hegemonic system
  • Biomedecine
  • _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
  • Alternatives

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The Humanistic (Bio-Psycho-Social) Model of
Medicine
  • Mind-body connection
  • The body as organism

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The Humanistic Model
  • The patient as relational subject
  • Connection and caring between patient and
    practitioner

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The humanistic model is based on scientific
evidence
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The humanistic model
  • Diagnosis and healing from the outside in and
    from the inside out
  • LISTENING
  • TO WOMEN

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The epidural A humanistic intervention?
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Water A humanistic intervention
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The doula a humanistic intervention
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The humanistic model
  • Information, decision-making, and responsibility
    shared between patient and practitioner

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Superficial humanism
  • Institutional priorities counter-balanced with
    individual needs

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The problem with counter-balancing
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Deep humanism
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The essence of humanism A flower growing amidst
the machines
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The holistic model of medicine
  • Unity of body, mind, spirit
  • The body as an energy system interlinked with
    other energy systems

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The holistic model of medicine
  • Healing the whole person in whole life context
  • Essential unity of practitioner and client

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The holistic model
  • Science and technology at the service of the
    individual

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An entirely holistic use of the fetal monitor,
based on scientific evidence!
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The holistic model of medicine
  • Diagnosis and healing from the inside out

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The holistic model
  • Authority and responsibility inherent in each
    individual
  • Individualization
  • (not standardization) of care
  • normalizing uniqueness

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Obstetricians standardize pathology.
  • Midwives normalize uniqueness.

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A humanistic/holistic birth in the hospital
Fernanda
Nurse-midwife - Zeza Doula - Cristina Obstetricia
n - Ricardo
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A humanistic/holistic obstetrician in
BrazilRicardo Jones
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Study groups
Group 1 473 births Group 2 1027 births
Total 1500 births
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Episiotomy rate
72.5
24.7
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Forceps
21.7
6.9
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Fetal distress rate
4.4
1.2
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The most important determinant of the outcome of
a birth is
  • THE IDEOLOGY OF THE PRACTITIONER

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The ultimate holistic vision
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Where is the technocratic model taking us?
Cesarean rates around the world
  • Taiwan 50
  • Puerto Rico 48
  • China 47
  • Chile 43
  • Argentina 40
  • Brasil 40
  • México 40
  • United States 27
  • United Kingdom 22
  • Canada 22
  • Netherlands 12

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International Congress on the Humanization of
Childbirth Fortaleza, Brazil, 2000
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The challenge for contemporary birth
practitioners is to realize the promises of
science and technology, while removing their
threat to normal birth
  • and to create new rituals that enact a more
    fluid and holistic ideology of birth

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  • The Medical Spectrum
  • --------------------------------------------------
    ------------------
  • Technocratic model gtgtltlt Humanistic model gtgtltlt
    Holistic model
  • Author Ken Wilbur notes that if a paradigm really
    is the next evolutionary step, it should both
    include the best of,
  • and transcend the limitations of,
  • the paradigm that preceded it.

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Today we have the great advantage that we can
realize this spiral, combining the best of
technocratic medicine, a humanistic philosophy,
holistic modalities, and the knowledge systems of
ancient and indigenous cultures
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  • to transcend the limitations of paradigms,
    creating new rituals that enact the most
    comprehensive and effective knowledge system
    about birth that the world has ever known!

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--and certainly, that will be a cause for
celebration!
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THANK YOU!!
  • Please visit me at www.davis-floyd.com
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