Title: Birth as a Rite of Passage: The Cultural Context
1Birth as a Rite of Passage The Cultural
Context
- Robbie Davis-Floyd PhD
- Medical anthropologist
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3A brief look at the history of Western
technological evolution
4From down
5To ever and ever more up
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7The primary myth of human evolutionThe
technologies of man the hunter and killer
8Man as up, woman as down In her proper place
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10Who really brought dinner home? Woman the
gatherer 80 of the daily fare
11The primary technologies of human evolution
Carrying and sharing at a home base
12Nevertheless, the myth continues
13The myth of technological transcendence
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19The 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
20The post-industrial technocracy a society
organized around an ideology of progress through
the development of high technologies and the
global flow of information
21What is a paradigm?
- A paradigm, most simply, is both a model of and a
template for reality. Complementary terms include
belief system, and worldview.
22- 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.
23Three primary paradigms of health care in the
post-industrial technocracy
- The technocratic model
- The humanistic model
- The holistic model
24The Technocratic Model
- Mind-body separation
- The body as machine
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27The technocratic model of birthThe female body
as a defective machine The hospital as factory
The baby as product Technology as transcendent
28Hospital-factory in Argentina
29The myth of technological transcendence in birth
30The technocratic model as representative of the
core values of the technocracy
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32The Technocratic Model of Medicine
- The patient as object
- Alienation of practitioner from patient
33The technocratic model
- Diagnosis and treatment from outside in
- Supervaluation of high technologies
34The technocratic model
- Aggressive intervention with emphasis on
short-term results
35The technocratic model
- Authority and responsibility inherent in
practitioner, not patient
36The technocratic model
- Standardization of treatment
37The 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
38- A RITUAL is a patterned, repetitive, and symbolic
enactment of a cultural belief or value
39Characteristics of ritual
- Symbolism
- Rituals work through symbols. A symbol is an
object, idea, or action loaded with cultural
meaning
40Characteristics of ritual
- Rhythm, repetition, and redundancy
- Rituals send the same messages over and over,
in many different symbolic forms
41Characteristics 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
42Order and hierarchy matter, andAuthoritative
knowledge resides in the physician, and not in
the womans body
43Characteristics 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.
44Through 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.
45Functions of ritual
- Augmenting group cohesion through teaching a
system of shared group beliefs (that includes a
special in-group language, artifacts, and spaces)
46Functions of ritual
- Generating emotion and thus belief
- Enhancing courage in the face of danger
- Bringing order to chaosa sense of control.
47Precise 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.
48- The more peoples emotions can be engaged through
ritual, the more they can be prevented from
questioning its messages or examining alternative
views
49Rituals and symbols Position
50Rituals and primary symbols of the technocratic
model Time
51Rituals and primary symbols of the technocratic
model
IV
52Rituals and their primary symbols of the
technocratic model EFM
53Rituals and symbols Separation of mother and
baby
54Separation of father from family
55- A hegemonic system
- Biomedecine
- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
- Alternatives
56The Humanistic (Bio-Psycho-Social) Model of
Medicine
- Mind-body connection
- The body as organism
57The Humanistic Model
- The patient as relational subject
- Connection and caring between patient and
practitioner
58The humanistic model is based on scientific
evidence
59The humanistic model
- Diagnosis and healing from the outside in and
from the inside out - LISTENING
- TO WOMEN
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61The epidural A humanistic intervention?
62Water A humanistic intervention
63The doula a humanistic intervention
64The humanistic model
- Information, decision-making, and responsibility
shared between patient and practitioner
65Superficial humanism
- Institutional priorities counter-balanced with
individual needs
66The problem with counter-balancing
67Deep humanism
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69The essence of humanism A flower growing amidst
the machines
70The holistic model of medicine
- Unity of body, mind, spirit
- The body as an energy system interlinked with
other energy systems
71The holistic model of medicine
- Healing the whole person in whole life context
- Essential unity of practitioner and client
72The holistic model
- Science and technology at the service of the
individual
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78An entirely holistic use of the fetal monitor,
based on scientific evidence!
79The holistic model of medicine
- Diagnosis and healing from the inside out
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86The holistic model
- Authority and responsibility inherent in each
individual - Individualization
- (not standardization) of care
- normalizing uniqueness
87Obstetricians standardize pathology.
- Midwives normalize uniqueness.
88A humanistic/holistic birth in the hospital
Fernanda
Nurse-midwife - Zeza Doula - Cristina Obstetricia
n - Ricardo
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95A humanistic/holistic obstetrician in
BrazilRicardo Jones
96Study groups
Group 1 473 births Group 2 1027 births
Total 1500 births
97Episiotomy rate
72.5
24.7
98Forceps
21.7
6.9
99 Fetal distress rate
4.4
1.2
100The most important determinant of the outcome of
a birth is
- THE IDEOLOGY OF THE PRACTITIONER
101The ultimate holistic vision
102Where 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
103International Congress on the Humanization of
Childbirth Fortaleza, Brazil, 2000
104The 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
105- The Medical Spectrum
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------------------ - 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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107Today 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!
109--and certainly, that will be a cause for
celebration!
110THANK YOU!!
- Please visit me at www.davis-floyd.com