Shared Power: The Essence of Humanized Childbirth

ABSTRACT: This paper discusses the implications of a research project that was reported elsewhere. Here the issue of empowerment and disempowerment of women during hospital births is discussed. The author takes the view that birthing technology can be used to both ends, but is usually used in disempowering ways. Power, as discussed by Boulding (1989), can be defined in terms of the achievement of individual desires but may also be used to describe the ability to achieve common ends for families, groups and organizations of all kinds. Much discussion has taken place during the past 25 years about how birth facilities can better respond to family members by humanizing maternity services (McKay, 1982, McKay and Phillips, 1984). The issue of power, however, is seldom identified in the professional literature as being pivotal in achieving the goal of humanized maternity services. Both the birth setting and its participants powerfully influence the process of childbirth, shaping the roles and amount of control held by laboring women, those who support her, and her caregivers. The outcome can be an environment of support, enabling the woman to experience her power and control or, at the opposite end of the spectrum, managed birth where the principal actors are the caregivers, their procedures and technology. In the latter situation, dehumanizationthe feeling that one is isolated from others and is regarded as a thing rather than as a person (Leventhal, 1975)-inevitably results. The challenge, therefore, is to combine the advantages of technology (and reduce its risks) with time-tested "hands on" approaches to care. These latter approaches are seldom "science tested" so that less value is usually placed upon human-to-human interactions. The result is that birth, for many, has become biologically safe yet psychologically a dehumanized, unsatisfying and disempowering experience, the results of which may affect women for years (Humenick, 1981). This paper argues that if humanization of the birth process is to be achieved, the birth environment must encompass far more than an attractive physical appearance. The assertion commonly made about LDRP's (labor, birth, and postpartum recovery rooms) is that they provide humanistic childbirth-which ignores the truth that people, not rooms, create humanistic care; environmental comfort and beauty hold no guarantees that procedures and technology, when needed, will be used in a human way or that power will be shared among participants. A community of strangers. Bergum (1989) observed that "we take the technological approach, with its community of strangers, for granted. Even the new birthing rooms . are equipped with all the latest technological machines-the fetal monitor, intravenous supplies, suction apparatus, the respirator, scales, test tubes, the incubator-however well they may be hidden behind the colorful curtains, flowery wallpaper, and collapsible oak bed (p. 147). " The imperative of technology, of "high tech," continues to dominate caregivers' attention, even in birth rooms, so they may be "out of touch" with laboring women's needs and strangers to her. A postpartum mother interviewed by the author1 recalled her baby's imminent birth in a LDRP: "She [nurse] was the only one there at the time, but then when the doctor came in and those two other people came in . I really wasn't sure who they were and what they were doing there . that was a distraction. I'm sure they were from the nursery . to look after the baby once it comes. They didn't have anything to do with me. They're weren't my nurse and . every time a nurse would come in you weren't sure if it was a baby nurse or my nurse. " Another woman who had been moved to the delivery room for the birth of her first baby shared the following: I was kinda concerned that he [the baby] was coming into this world with all the people and the noise that was in the delivery room. …