• E-mail
• Print
• Comment
• Font Size
• Digg
• del.icio.us
• Discuss article

A Different Place to Birth: A Material Rhetoric Analysis of Baby Haven, a Free-Standing Birth Center

Posted on: Wednesday, 17 May 2006, 06:07 CDT

By Schuster, Mary Lay

Clients at a free-standing birth center resist the medical hegemonic construction of their pregnant bodies as risky entities through the spatial organization and material objects of the center. The center displays partisan messages about birth as a safe and private event. Therefore, when clients realize the physical and psychological consequences of structures and objects, they reconnect with their physical bodies, associate mental attitudes with physical sensations, and sustain a counterdiscourse about birth.

Keywords: material rhetoric, birth, privacy, safety, risk, bodies, agency, resistance.

In a small strip mall on the edge of a rural town in Middle America sits the state's only free-standing birth center, Baby Haven.1 Located next to an appliance store, Baby Haven is marked by a colorful awning and an exterior sign depicting a stork. The birth center features a large birthing suite, decorated in pink and mauve and lined with white Christmas lights. The suite contains a queen- size bed, a birthing tub and stool, a changing table, a rocker, and a buffet. Victorian dcor is prominent throughout Baby Haven, and the names of the 24 children born so far at the center are painted on the frame around the birthing suite door. Says Paula Gordon, whose second child was born at Baby Haven, going to the birth center "was like visiting a bed and breakfast. Some place that you look forward to going to to relax instead of dread."2

Baby Haven offers a smaller suite, used for birth once when two clients delivered on the same day, which provides a resting-place for family members and friends who attend births. The center also includes a children's play room; a kitchen, which often emits the smells of homemade soup or muffins; a bathroom equipped with a physician's scale and paper cups for urine samples; an exam and interview room furnished with books and a rocking chair as well as an exam table; and a reception area with comfortable couches and a coffee table. At the back of the center, in a large meeting room, Bradley childbirth education classes are offered, and a front office is rented to a wellness center run by two acupuncture therapists. Baby Haven opened on March 6, 2002, and is the vision of Naomi Stanton, a direct-entry midwife who still maintains a homebirth practice as well as runs the center.3 Stanton has attended over 450 births in her 22 years of practice and had thought about the birth center for 12 years before she decided finally there was a market for it. When the space occupied previously by a chiropractor opened up, she "rousted up people to bring trailers, and we moved everything. Because I had stuff in my basement I had bought years ago-the buffet, the glider rockers I had had for four years in boxes still. This is the stuff I had bought to get ready for this birth center, and we just went like gang-busters." The material objects that Stanton brought to the center define, in part, its essence.

The very existence of Baby Haven provides an opportunity to study what Barbara Dickson identifies as the purpose of material rhetoric, to examine "how multiple discourses and material practices collude and collide with one another to produce an object that momentarily destabilizes common understanding and makes available multiple readings" (298). The vast majority of people in the United States have their babies in the hospital, and most free-standing birth centers are run by nursemidwives and/or physicians.4 Baby Haven, therefore, is not only unusual but also particularly vulnerable in having to rely on more informal agreements with physicians for backup and with hospitals for transfers in problematic deliveries. Some medical practitioners actively discourage clients from using the birth center, and Baby Haven struggles to attract clients whose insurance may not cover births attended by direct-entry midwives. However, as this study will show, Baby Haven clients openly seek such alternative places to birth despite the barriers imposed by the medical and insurance industries because they believe that in a different space they will realize physical and psychological benefits for themselves and for their babies. Baby Haven clients, for example, perceive that these facilities enable birth without the anesthetic or pain-relieving drugs that so deaden the mother to impede her ability to deliver naturally and the infant to retard his or her initial adjustment to the world. The material rhetoric of Baby Haven then demonstrates that powerful systems of traditional medical authority can be displaced by resistance, at least on this local level and for these individuals. That resistance involves the creation of this unique space and the appreciation of the effects of that space on the body as well as the mind. This resistance reveals, to some extent, the ability of the creators and users of that space to develop an alternative partisan message about birth, which they then can articulate and disseminate outside the center. This study then clarifies and answers two central but related questions of material rhetoric-to what extent can people assume potency and agency to rewrite the cultural inscriptions that structure the body, and to what extent do the spaces they create and occupy make this change possible?

As Dickson puts it, material rhetoric, as a mode of interpretation,

seeks invention in the improvisations of the bodily writings; agency, in the ways these improvisations resist hegemonic structurings of the body and so change the relationships between these corporal bodies and the structures they inhabit; and persuasion, in the ways these changed relationships more fully satisfy the desires of the acting body. (298)

Baby Haven clients perceive that they can resist medical hegemonic construction of their pregnant bodies as risky entities best managed by medical experts who may intervene in the natural birth process, and they perceive that the spatial organization and material objects of the birth center enable that resistance. Baby Haven clients overwhelmingly testify that the birth center allows them to create their "ideal birth." They realize this ideal birth through particular bodily sensations, such as relaxation and alertness, and through accompanying psychological feelings, such as control, support, privacy, and accomplishment. This realization comes from a complex constellation of body, mind, and place.

The Challenges of Theorizing Material Rhetoric

To understand the consequences of the place called Baby Haven on the bodies and minds of clients seeking that ideal birth, we must theorize material rhetoric. Baby Haven clients' perceptions of the birth center and its features reveal resistance to hegemonic medical discourse about birth, reflect a sense of agency in controlling the physical experience of birth made possible in a particular place, and articulate alternative partisan messages about birth, what Nancy Fraser calls counterdiscourse. Theorizing material rhetoric to understand resistance, agency, and counterdiscourse in the case of Baby Haven involves describing the body as a cultural construct yet physical entity. Such theorizing also means accepting the materialization of the concepts of privacy and its relationship to a sense of control. Finally, theorizing material rhetoric includes identifying the relationship between resistance and what Foucault calls bio-power. All three moves demand acknowledging the rhetorical power of physical entities as well as the material construct of cultural concepts. But meeting such a demand provides us with a better understanding of the relationship of mind, body, and place.

Theorizing material rhetoric involves turning initially to media and materials other than language in order to consider what Jack Selzer calls, "the material conditions that sustain the production, circulation, and consumption of rhetorical power" (10). That theory includes notions that space, its arrangement, and the objects that occupy it have consequences and display partisanship, and that the body is "fashioned by literate practices" (Selzer 10). According to Dickson then, "material rhetoric is a mode of interpretation that takes as its object of study the significations of material things and corporal entities-objects that signify not through language but through their spatial organization, mobility, mass, utility, orality, and tactility" (297). Scholars such as Celeste Condit and Carole Blair find language studies alone limit our ability to perceive change, consequence, and partisanship. Language, according to Condit, focuses on generalizing relationships by naming them and on classifying objects in a way that makes those objects seem more permanent and material than they are (332). To Condit theorizing material rhetoric allows us to understand the nature of a social- material world, to understand rhetoric as a constructive act yet "in a relatively solid world" (333). Blair, in turn, finds that the language of symbolicity focuses on what a text means rather than what a text does regardless of the intentions of the rhetor (23). Instead, according to Blair, we must focus on the consequences on both the mind and the body of audience members: "Rhetoric's materiality constructscommunal space, prescribes pathways, and summons attention, acting on the whole person of the audience" (48). Understanding the nature of materiality in rhetoric is so challenging because it demands describing how our worlds might be socially constructed and yet relatively solid. In the case of Baby Haven, this challenge means teasing out how clients' perception of the experience they wish for and seemingly get in giving birth at the center is the consequence of the interaction of mind, body, and place.

An analysis of material rhetoric of a place and its consequences involves finding a way to describe actual spatial features and organization, and frequently to observe how people move through and are affected by a specific place. Most such analyses assume that rhetorical spaces reflect both cultural and material arrangements and thus are "a physical representation of relationships and ideas," as Roxanne Mountford proposes (42). Mountford extends Henri Lefebvre's theory of social space, for example, to argue that particular spaces can "move" people both by "suggesting symbolic associations" and by "causing us to form relationships with each other and the space through its structures" (49; see Lefebvre 73). Spaces, therefore, have "heuristic power over their inhabitants and spectators by forcing them to change both their behavior (walls cause us to turn right or left; skyscrapers draw the eye up) and, sometimes, their view of themselves" (Mountford 50). That behavior can reflect or challenge relationships and hierarchies. Lorraine Code calls such spaces "textured locations" where "acknowledgment is readily achieved, or where it is thwarted; where cognitive authority is readily granted, or denied or silenced" (x-xi; see also Johnson 22). Acknowledging the rhetorical dimensions of space is just a first step, however, in describing its consequences and partisanship. The researcher must then find a way to record and organize her descriptions of the space.

Blair provides a heuristic to describe the structuring of that space and to identify its effects on the whole person: "(1) What is the significance of the text's material existence? (2) What are the apparatuses and degrees of durability displayed by the text? (3) What are the text's modes or possibilities of reproduction or preservation? (4) What does the text do to (or with, or against) other texts? (5) How does the text act on people?" (30).5 Researchers who use Blair's questions to organize a study of material rhetoric may often be present to observe while people move through and are affected by the space. But in the case of Baby Haven, no researcher would be allowed to attend the birth of a client in order to observe how the space seemed to affect physical and psychological experiences realized during birth. In this study then, I was faced with the challenge of balancing my own scholarly observations of a particular space with participants' perceptions of their experiences in that space as shared during interviews with me. In terms of Baby Haven, my own photos and drawings of the structure of the birth center and the physical objects that occupy it became most meaningful after clients recalled how that structure and those objects seemed to affect their birth experience. Baby Haven clients' recalled perceptions, even though refreshed by visiting the space again for an interview, were most likely affected by time away from the experience. Undoubtedly my own observations of Baby Haven were both enhanced by clients' perceptions of the meaning of structures and objects during labor and delivery and challenged by the organization of these perceptions by clients into cultural relationships and hierarchies. These perceptions, moreover, were expressed in language, the symbolic system that Blair and Condit find lacking in revealing the nature of materiality in rhetoric. These limitations aside, there are some real advantages to an interview approach to understanding the materiality of rhetoric.

The first advantage rests in the very nature of the interview approach itself. The researcher can prepare her questions but often finds a pattern emerging in the interviews that takes her in an unexpected but important direction. In the case of Baby Haven, when the first few interviewees raised the issue of pain management and feelings of safety, I addressed these topics in each subsequent interview. The relationship of pain, perceived by the interviewees as a physical sensation, to safety, described by those interviewees as a psychological state, became a foundation to understanding the complex relationship of mind, body, and place at Baby Haven. Second, even if it were possible to observe a number of births taking place at Baby Haven, it would be intrusive to ask participants to describe physical sensation and psychological state during labor and delivery. It would be presumptive, on the other hand, to assume that the researcher's observations of what appeared to be relaxation or pain, for example, were accurate and shared by the person experiencing these sensations. Because I conducted my interviews in Baby Haven, however, I had the advantage of being able to walk with the interviewee back through the birth suite and other spaces so that she could calmly recall her experiences. In a sense, what she remembered, the objects she pointed out, were probably important during the birth because they remained in her memory. Finally, in the case of the alternative partisan message about birth, the counterdiscourse articulated by Baby Haven clients, it is important to discover whether that message is still considered valid by the interviewee after the birth experience. Baby Haven clients' very choice to birth at the center rather than in a medical facility reveals resistance to the hegemonic medical messages about birth. In an interview, I could discover how the counterdiscourse about birth might have been modified or refined as a result of the clients' recalled experiences in the center's spaces. In struggling to think about materiality as a rhetorical force, we may need to reconcile some dependence on symbolic language in order to capture the interconnections of mind, body, and place in such counterdiscourse if direct observation is not possible. Talking with those who had used Baby Haven's structure and objects enabled me to understand these interconnections in a very private space to which a researcher might not normally have access.

Baby Haven clients articulate their experiences in the birth center according to the ways their bodies felt to them during labor and delivery, a corporal version of the self that they both sense physically and organize mentally to resist the hegemonic medical version of the pregnant body and to reclaim their valuations and choices. To understand these articulations, we must theorize the body as cultural construct and yet acknowledge the body as physical entity. As this study will show, Baby Haven clients share perceptions of how the structures and objects of the birth center affected their bodies during labor and delivery and on how these bodily sensations affected them psychologically to create that ideal birth, one they suspect would have been impossible in another setting. They experience mind and body in relation rather than in division. They also react against the social construction of the pregnant body as one at risk, best monitored by a medical caregiver in a hospital setting. Finding ways to describe how the self both experiences the body and reflects or resists the cultural construction of that body is a challenge in theorizing material rhetoric. According to Susan Bordo and others, the mind/body division that has dominated Western thought for decades is more than a philosophical position but instead is a "practical metaphysics" that has been "deployed and socially embodied in medicine, law, literary and artistic representations," a metaphysics that has disadvantaged women by casting them into the role of caretaker of the body and by shaping the female body in negative terms (Bordo 13- 14; see also Crowley 360). Theorizing material rhetoric involves recognizing the body as a cultural form, a "focal point for power struggles" (Bordo 17). It is important, however, that such recognition resist what Anne Balsamo fears: "the easy dissolution and dematerialization of the body," the disappearance of the natural body (40; see also Douglas 65). Here Bordo and others use the term natural body in contrast to the cultural body; the natural body is the corporal or physical presence, one known through perceived physical sensations, leading to embodied knowledge, while the cultural body is constructed through messages and meanings imposed upon it and absorbed or resisted by the individual. Baby Haven clients' experiences with their natural or physical bodies reflect embodied knowledge of labor and delivery, knowledge stemming from experience in that relatively solid world as Condit calls it.6 The body then, according to Balsamo, is both a product, a cultural construction, and a process, a changing physical entity: "As a product, it is the material embodiment of ethnic, racial, and gender identities, as well as a staged performance of personal identity, of beauty, or health (among other things). As a process, it is a way of knowing and marking the world, as well as a way of knowing and marking a 'self'" (3; emphasis in original). Again, in studying the consequences of the structure and objects of Baby Haven on the laboring body, I relied on clients' articulations of their embodied knowledge of their natural bodies, articulations that are designed to resist the roles that the hegemonic medical community assigns to the pregnant body. As Bordo says in her study of bodily integrity in legal cases, the essence of the pregnant woman

is her biological, purely mechanical role in preserving the life of another. In her case, this \is the given value, against which her claims to subjectivity must be rigorously evaluated, and they will usually be found wanting insofar as they conflict with her life- support function. In the face of such conflict, her valuations, choices, consciousness are expendable. (79; emphasis in original)

The body then, as Elizabeth Grosz describes it, "is neither- while also being both-the private and the public, self or other, natural or cultural, psychical or social, instinctive or learned, genetically or environmentally determined" (23). In studies such as this one, the researcher must capture the perceptions of people who move through spaces in ways that articulate both the cultural roles assigned to these bodies and the ways in which the self experiences the natural body so as to reflect or resist those roles. As this study will show in the sections that follow, Baby Haven clients describe what they perceive as real bodily sensations such as pain that they attribute to psychological feelings such as the absence or presence of safety, and they organize these sensations and feelings to resist hegemonic medical construction of their bodies as out of control and at risk. They attribute their ability to do so, in part, to the structure and physical features of Baby Haven.

An analysis of the rhetorical power of the physical structure and features of Baby Haven also reveals that the center's clients materialize cultural concepts, in particular privacy as related to control, within their counterdiscourse about birth. Baby Haven clients attribute their ability to experience birth without medical intervention to how the structure and the physical features of the center afford them privacy. The Supreme Court, of course, has contributed to our cultural and material view of privacy in its cases involving the rights of citizens to make decisions about how to educate their children, to use contraceptives, and to undergo abortion, among others.7 In interpreting the due process rights granted under the Fourteenth Amendment, the Court has suggested that privacy is "an actual, material construct," as Christina Haas puts it (230). In Griswold v. Connecticut (1965), a case that struck down a law forbidding the selling of contraceptives to married couples, the Court recognized that various constitutional guarantees, established by the First, Third, Fourth, Fifth, and Ninth amendments, created "zones of privacy." Justice William Brennan, in Eisenstadt v. Baird (1972), extended the rights established in Griswold to unmarried persons and stated that the right to privacy means individuals could "be free from unwarranted governmental intrusion into matters so fundamentally affecting a person as the decision whether to bear or beget a child." Justices Blackmun, Brennan, Marshall, and Stevens, albeit in dissent in Bowers v. Hardwick (1986), asserted that privacy rights not only pertained to certain decisions but also must be recognized in "certain places without regard for the particular activities in which the individuals who occupy them are engaged."8 Baby Haven's director and her clients propose that a specific space, by its structure and objects, can create and guarantee privacy. These perceptions, in other words, materialize privacy. In the case of Baby Haven, that privacy offers a sense of control over mind, body, and place.

Finally, the materialization of these privacy desires and rights supports a form of resistance or counterdiscourse. In her study of the placement and cultural construction of a permanent injunction document posted in an abortion clinic, Haas relies on Nancy Fraser's reinterpretation of the theories of Hannah Arendt and Jrgen Habermas to identify "subaltern counterpublics" or "parallel arenas," places where people create "counterdiscourses" (Fraser, "Rethinking" 228). In those spaces, subaltern counterpublics can withdraw and regroup as well as prepare for agitation. Haas suggests, "The desire of an individual to be 'let alone' is strongly tied to the embodied, spatially oriented existence of that individual-an existence that, though indisputable, is extremely difficult to articulate," and this difficulty, particularly experienced by the Supreme Court, leads to the "increasing literalization of the spatial metaphor and the increasing materialization of privacy" (233). Baby Haven clients perceive that the center offers privacy and thus fulfills their desires to be let alone during birth in light of the alternative- medical management and possible intervention-and enables them to confirm and refine their counterdiscourse about birth.

Although only a few Baby Haven clients agitate in the public sphere for their partisan view of birth, all do offer a counterdiscourse or resistance to the medical discourse about birth in this private sphere. Rather than setting policy or arguing for the public good, goals of arguments expressed in the public sphere, Baby Haven clients offer anecdotal evidence to confirm that the birth center made possible their own ideal births, evidence appropriate in that private sphere.9 Such counterdiscourse enables them to resist the hegemonic messages about birth as a risky event, messages that come from family, friends, and at times medical caregivers and insurers who argue against a birth at Baby Haven. Michel Foucault held that conflict, in the form of such resistance, was necessary for the production of knowledge and its operation ("The Subject and Power" 211). As Hubert Dreyfus and Paul Rabinow say in their study of Foucault's theories of power, "It is through articulation of points of resistance that power spreads through the social field. But it is also, of course, through resistance that power is disrupted" (147; see also Rouse 147; McNay 6-7). We best understand power, such as that of the hegemonic medical community, by studying these points of resistance and the means used to create them. Foucault's suggestions about resistance, however, are somewhat underdeveloped, consistently gender blind, and seemingly contradictory. He seems to reject as a possibility that certain identifiable groups, genders, or organizations dominate and subjugate, and certain groups, genders, and organizations submit or resist; he certainly discourages the materialization of power as a property (Fraser, Unruly Practices 29). He also suggests both a subjugated subject, who is "the product of dominating mechanisms of disciplinary power," and an autonomous subject, one capable of resistance (Sawaki 161-62). But here perhaps this contradiction is helpful to exploring resistance in material rhetoric or less a contradiction than it seems-subjects may experience the cultural inscriptions on the body as well as the sensations of the natural body, sensations that lead to embodied knowledge of labor and pregnancy in the case of Baby Haven clients. Agency involves choice, and Baby Haven clients articulate their choices as they resist what they perceive is the elimination of choice by the hegemonic medical community. In reconciling these experiences, in accepting this contradiction as necessary complexity, unlike Foucault we can suggest that power can be perceived in both a culturally constructed and a solid world and that a disempowered subject may resist the discourse of the powerful by realizing those physical sensations of the body and psychological states of the mind.

Examining Baby Haven as a point of resistance is also appropriate because it is a distinct location attracting a particular group of clients. Modern power, proposes Fraser, "circulates throughout the entire social body down to even the tiniest and apparently most trivial extremities" (Unruly Practices 24). That reflection of power may come in the form of what Foucault called bio-power. Science imposes social controls on the individual body, creating a sort of species body, and through this bio-power citizens can be normalized and regulated. In extending Foucauldian theories of power, scholars identify experts who emerge to represent bio-power and claim authoritative knowledge about the body. These scholars find that as bio-power and authoritative knowledge grow, these experts assert a framework for how people should live, reproduce, and maintain health (see Foucault, Sexuality 140; Foucault, Clinic 35; Lay, Gurak, Gravon, and Myntti 4-5; Britt 221-23; Fraser, Unruly Practices 24). The power of authoritative knowledge is that it is basically what counts, not necessarily what is correct, and therefore participants in any situation use authoritative knowledge to make decisions and account for their actions (Jordan 58; Stair 3-4). Baby Haven clients declare their resistance to medical bio-power successful because of the material rhetoric possible within the birth center's walls.

To understand the complex constellation of mind, body, and place in the births at Baby Haven then, we need to theorize the body as a cultural construct yet physical entity, recognize the materialization of such concepts as privacy and control, and study the counterdiscourse of resistance as set against the discourse of medical bio-power. Material rhetoric then displays how rhetoric wields its power through the structures and organization of space. To analyze the specific discourses and material practices that collide in Baby Haven, we must first contrast the rhetorical bases of the medical and midwifery models of birth.

The Medical Model of Childbirth

Authoritative knowledge within the medical model of birth culturally constructs birth as a risky process, best monitored by hospital personnel who map a woman's progress through labor with high-tech equipment such as electronic fetal monitoring devices and intervene, if they think necessary, by such processes as Cesarean- section. On hand are drugs such as Pitocin to induce or speed up labor, epidurals to numb the pain of childbirth, and instruments to perform episiotomies or cuts in the perineal ti\ssue to make delivery of the baby's head easier. Within the medical model, women's bodies are often reduced to their reproductive parts, marked as chaotic and risky. Set against these divided bodies are the physician's analytical skills and training in diagnosis and treatment of disease, a category that includes many aspects of pregnancy (see, for example, Rooks 126; Balsamo 27-28).10 The mother's and the baby's interests might be seen in competition with each other, and the mother's body in a machine-like fashion must "progress" efficiently as marked by universal standards through the stages of labor and delivery (see, for example, Arney; Oakley; Martin; Davis-Floyd; Turkel). This medical model, of course, has always been influenced by the demands of consumers who expect a healthy baby, a safe birth, and pain management during labor and delivery (see, for example, Leavitt 48). The medical model of childbirth, however, perpetuates the separation of mind and body and encourages mothers to relinquish choice and control to achieve what is offered as a less painful and less risky birth.

Elizabeth Evans, for example, who had her first baby in a hospital and her second at Baby Haven, describes her first birth as overly managed, requiring one intervention after the other:11

Even though I thought I was going to have a natural birth . . . and thought I was up on my pain relief ideas and things, well, I went into labor . . . and was in labor all night long and couldn't sleep and was uncomfortable so went into the hospital and they said, "Oh, you are at a two [centimeters dilated]. Go home. Or if you want, we can let you in the hospital and give you a room, but then we are going to have to start Pitocin." And so it just went from there-Pitocin and then the epidural . . . they open up all the cabinets with the medical equipment, and they hook all the wires to you, and they won't let you get up. And, they, uh, they don't encourage you to do anything by yourself so you don't get the labor support. And they don't explain to you the risk of anything . . . . So I had a very managed first one. Everything they could do, they did. They tried the vacuum to pull him out and that didn't work. Well, you know I was just dumb; I didn't know what it should feel like. And then I had an epidural and didn't know how much I should feel, and they kept saying, "Oh, push." And I had no feeling whatsoever to push. And then once they finally got to the point they decided a C-section [Cesarean], afterwards then I started to, moved or turned or something, and [he] started to actually come down and then that's when I had that urge [to push]. And I had no idea. And by then it was too late . . . so I had a C-section.

To Evans, even entering the setting of the hospital meant relinquishing her sense of her own body to the instruments and processes of a medically managed birth. Because she lost her ability to read her body's signs, she was unable to participate in the decisions affecting her birth. She attributes this outcome in part to the physical structures and organization of the place in which she birthed.

Those who chose to birth at Baby Haven or to use its facilities to prepare for a homebirth articulate anecdotally a counterdiscourse to this medical model and loss of choice. They testify to the opposition they encounter from family members and friends because of the wide cultural acceptance of the medical model of birth. George Griffin, for example, comments on the reaction of his neighbors to his and wife Nancy's birth plan: "I mean that all of our neighbors, I am not even talking to a few of them, because they . . . told me that I was an idiot. In plain language that I am a damn fool. Now they are coming and wanting me to do that and this for them but ? hate to do that for you because I am too much of a fool' [laughter]." Nina and Allan Burns also encountered opposition to alternative therapies in general during their early prenatal visits with a physician before they came to Baby Haven. As Nina says,

I asked some questions about alternative therapies like chiropractic care and massage therapy, and they didn't know, and they didn't know how to answer my questions. I asked if it was safe, I asked too, you know, at what point should I stay away, and the nurse didn't know, and she said, "I will have someone get back to you." And then when they called me they said, "Just avoid all of it."

Hours after Nina had to have a Cesarean section for their first child, Nina and Allan talked with Naomi Stanton about having a vaginal birth for subsequent children. Stanton reassured them that it was possible. When a doctor came into Nina's room later, a physician she had never met, she asked his opinion. According to Nina, he said, "You know, it may or may not be my place to say this, but if you were my sister or my mother or my daughter, there's no way I would want you ever to birth with a midwife and so I hope you remember that."12 The medical model, as experienced by Alan and Nina Burns and other Baby Haven clients, articulates a kind of bio-power in dismissing other models altogether; to be healthy, clients are told, they must not engage in alternative therapies.

Another opposition to the counterdiscourse articulated by Baby Haven clients comes from the largest insurer in the area that the birth center serves. Blue Cross/Blue Shield (BC/BS), a plan owned and run by physicians, will not cover births at the center because Stanton is not a certified nurse-midwife working under the supervision of a physician and practicing primarily in a hospital. Although a Baby Haven birth costs less than half of what a comparable natural birth in the hospital costs, BC/BS also requires facilities to be certified before it will compensate clients; unfortunately, the state does not offer such certification for facilities as small as Baby Haven.13 Regardless of the hegemonic medical model of childbirth and the insurance industry that marks births at the center as uncertifiable, almost unidentifiable, Baby Haven clients come to the center because they perceive that the space and the midwifery model it reflects will enable them to resist a cultural construction of their bodies that leads to overly managed births in a hospital setting and a loss of choice. They perceive that they will experience birth at the center as whole persons, uniting mind and body, and that they can reconstruct their bodies in a way that recognizes their ability to read and control physical sensations.

The Midwifery Model of Childbirth

Baby Haven clients believe that the physical features of the center reflect the authoritative knowledge of the midwifery model of birth. This model defines birth as a low-tech natural process and most laboring women as well prepared to succeed if they are allowed to listen to their own bodies and articulate their own needs. Birth is considered an event within the context of a family who designs a birth plan that the midwife follows unless she identifies a specific risk that necessitates transfer to a physician or transport to a medical facility. Midwives call this philosophy the "whole woman" approach, offering clients emotional, psychological, and physical support and considering the mother and baby a unit: what is good for the mother will benefit the baby and vice versa. The midwife conducts prenatal exams, attends the delivery, and provides postnatal care to offer familiarity and consistency. Experiential knowledge of the midwife and embodied knowledge of the mother are more important than technical expertise. Although the midwife must follow some protocols, she is willing to let the mother's body move through labor according to individual needs articulated by the mother (see, for example, MANA Core Competencies 31; Turkel 54-57). Finally, as in the case of Baby Haven, fathers are involved partners and learn how to provide support through Bradley childbirth education classes.14

Ellen Sullivan, for example, who began prenatal care with a physician for a hospital birth before switching to Stanton and Baby Haven, describes the whole person approach of midwifery care as reflected in those prenatal visits:

I think another just really important part of midwifery care, especially here, is just the amount of time spent on prenatals . . . . You know, at the doctor, you get there, you go to the bathroom, they do a quick urine test, they get you weighed, they get your blood pressure, you go in, the doctor comes in, and says "any questions?" measures your belly and pretty much leaves . . . . My prenatals here [at Baby Haven] were always an hour, and we usually took that full hour. It was great . . . I just think of the lack of education I got through the doctor's office and the lack of real concern for me as a whole being . . . they never really asked me, "How are you eating?""How are you emotionally coping with this pregnancy?""How is your relationship with your husband?" those types of things that are really important components of pregnancy. Whereas Naomi asks all those things, and because of that relationship, you feel comfortable telling her those things, you know. And a lot of personal things. She asks about your sexuality. She asks about your body image and all those things that are really an important component of your life at any time, especially when you are pregnant.

Because of that whole woman approach, Baby Haven clients propose that the physical experience of giving birth without medical intervention can create a moment of empowerment for women and of emotional intimacy for a couple. As Elizabeth Evans said after giving birth in Baby Haven to her second child: "Well, it's amazing how you feel after giving birth, succeeding, doing it like you are supposed to do it, and then you are bouncing off the walls." This moment of empowerment begins with the physical experience and results in a psychological affirmation, all of which takeplace in the setting of the birth center, a physical setting that is interpreted as safe enough to share private information with the midwife and that articulates a counterdiscourse about birth.

The Material Structure and Organization of Baby Haven: Rhetorical Consequences for the Mind and Body

Baby Haven clients then attribute the quality of their birth experiences to the physical structure and organization of the center and the consequences on their minds and bodies. This structure and the objects within the center offer clients agency in resisting the hegemonic medical construction of the body by more satisfying the acting body, to use Dickson's terms. A great part of that satisfaction comes from birthing without anesthetic drugs, possible only, according to Baby Haven clients, if they can relax enough to manage pain. They perceive pain management then as within their bodily control if they can enter a certain psychological state, possible because of the presence of certain physical objects and the absence of others.

Stanton designed Baby Haven to support the midwifery model and the counterdiscourse it generates about the mind and the body:

the births that we do here are very low tech, and I cannot do anything more aggressive or invasive or supportive of the births here than I could in their own home. The only thing that they can visually see, and I don't know if they notice it, is that the oxygen is standing right there next to the changing table. And that's our resuscitation table if we need to get the baby over on a flat surface. But all the other stuff, I pull those drawers out; our set up tray for delivery and all that other stuff is in there. When they come in for birth, we usually pull out quite a bit of equipment. It's stuck inside of our homebirth bags, and we bring that stuff into the room too. But there're no monitors and any stuff blipping and beeping.15

Medical instruments are hidden in drawers; objects that could be used for intervention and emergency are presented as having other purposes or are marked as absent. Here Stanton expresses her intent in the design of Baby Haven, but it is also important to discover the consequences of this design on her clients' minds and bodies.

Paula Gordon confirms that the physical structure and organization of Baby Haven immediately mark it as different from the hospital:

The rooms don't echo like hospital rooms or hospital halls. Don't even have the smells, like that cold sterile, more like a warm home. Lots of times I come in here, and it even smells like food that they are cooking. You don't smell food cooking in a hospital; it's just nice. Yeah, and the lighting was low. That was really a big difference. It was very comfortable, you know, mood lighting, nice living room lighting.

Baby Haven clients perceive the effect of the low lighting, the quiet, and the smells from the kitchen on their minds and bodies. They attribute their ability to relax during labor to the center's homelike decor (reflected in its familiar rather than medical objects) and the sensations it provokes, and they propose that the ability of their bodies to relax within this structure helps them cope with pain.

Nicole Masters, for example, who had her first baby in the center and labored for only four and a half hours, attributes her positive birth experience to the space itself and her familiarity with it:

I think that the size of the place, it's not a very large building, so the size and the privacy . . . it was all just about the birth, my birth, my birth experience. Those two things made it seem more natural, more like a natural process, and I have done some reading about the culture of giving birth in this country here-how hospitals tend to treat it more like an illness. And, I didn't feel like that way at all. I felt like this is a very natural thing; this is supposed to be the way it was supposed to happen. And, I think that if I had been in a hospital setting, I would have been more stressed, and that maybe wouldn't have gone as quickly . . . In the hospital there would be more high tech equipment, like right there at your fingertips. And I think that would have made me nervous, knowing it was there should something go wrong, you know, kind of in anticipation of something going wrong.

For Masters, the small private space of Baby Haven reserved for her birth helped her focus on the physical aspects of birth, which she considers a natural process, but eliminated the mental distractions she perceived would characterize a hospital birth, which she considers a setting in which people are ill. She attributes her short labor to Baby Haven's material effect on her whole person.

Despite experiencing a very long labor in contrast to Nicole's, Ellen Sullivan also proposes that the material structures of Baby Haven affected her body's ability to relax and avoid medical intervention, intervention she speculates would have been inevitable elsewhere:

And, I think just that familiarity helped keep me relaxed, whereas honestly I am convinced that if I had been in the hospital I would have ended up with, if not medication and Pitocin, a C- section [Cesarean], just because it was a long labor. I was stalled for a long time and that [stalling] was in a relaxing and supportive environment.

Baby Haven clients then testify that the physical structure and organization of the center have a direct and positive effect on their bodies and their minds-the staged setting, designed to seem homelike and different from the hospital, seems instrumental in persuading clients that they could and did have a different birth experience.

The most important difference again, according to Baby Haven clients, was their ability to relax in order to manage pain without anesthetics. Avoiding the psychological sensation of fear makes the physical sensation of pain manageable, according to Stanton, and the most effective way to avoid fear is to birth in a place similar to home, where one feels safe and in control:

Well, I think that it [birthing in a setting that seems familiar] must have a very relaxing effect on the body because fear can take pain and really magnify it. And they have come here so much; they have taken all their prenatals here; the majority of them have taken Bradley classes here; they have spent hours in this facility before they ever come here to labor and birth. One of the things I notice is that when moms come back in, especially if it's been months since their births, they love to go sit in that room [the birth suite]. Even if they had a difficult birth, they want to go in there and sit in the rocking chair and just be in that room. And I think that's really cool. The first woman who gave birth here, she said, "I believe that there's an essence of each baby who comes onto the planet in this space; they leave a little bit of themselves behind."

Stanton's clients confirm that one of the consequences of the material rhetoric of Baby Haven-the physical structures that reflect the midwifery model of childbirth-is the ability to relax psychologically and so to manage pain physically.

In some cases, Baby Haven clients arrive at the center with this expectation and articulate it in a counterdiscourse to the construction of the pregnant body as subject to overwhelming pain that must be managed medically. Kate Mantel, for example, whose second child was born at Baby Haven, marks pain management through relaxation as an expectation of her ideal birth at Baby Haven:

I think that a big part of, just from what I have learned from Naomi especially, is that the more relaxed you are, the more easy it is going to be on your body, the less pain you are going to be in. I really felt that way. I felt much more relaxed here. It was just relaxing. It was a really good experience. And people look at me so strange when I say, "I loved giving birth here. You know, it was great." And they look at me and say, "How can it be great? It's the most painful thing you'll go through." And I say, "It really didn't seem that bad at the time."

For those who lose their resolve to have a drug-free birth, the very absence of drugs means that Baby Haven clients must rely on other options. After birth, that resolve seems to return or any lapse in resolve is revised, as in their counterdiscourse clients celebrate a drug-free birth.

Baby Haven clients then come to labor prepared to try breathing techniques, acupuncture, massage, aromatherapy, counter pressure, and so on. Elizabeth Evans, for example, lists the variety of techniques she counted on to manage her body's reaction during labor, even though she used few of them:

I remember I read . . . a lot of stuff about labor and pregnancy and delivery and all that stuff. And I packed this huge bag of stuff to bring. Naomi actually made fun of me, said that it was the most stuff that she had ever seen anyone bring. And then we didn't use any of it. I had aromatherapy stuff, and I had massage stuff, and I had some hard candy and a snack, you know. I had just, I had notes about how [my husband] was supposed to do acupressure for certain things and all this stuff. I had little aromatherapy massage oils that would say "lavender was for such and such" and "this one is for this other" and "push on this certain point on my [laughs here but doesn't complete her thought]." I had read everything and then we didn't use it . . . I had back labor and used counter pressure. I had him pushing on my back a lot. I remember hollering at [my husband] and saying, "Quit rubbing-just push!"

Evans, who could not have anticipated her back labor, found the appropriate option to manage it from her own resources, an act of agency in the midst of physical discomfort that she articulates in recalling her birth experience.

Four of the Baby Haven clients I interviewed noted that they were glad that drugs were not an option because drugs are not physically present at the center. Clare Merc\hant, for example, had her first baby at home and her second at Baby Haven:

I think that it's very easy if you have the option of some kind of pain management, drugs, to fall into the trap of "Oh, I cannot take any more. Give me something!" But when you know you don't have the option, you can make it through . . . And, I am not one to quickly turn to drugs, but I am sure that it would be easier for me to do it if they were there.

Baby Haven clients then use the material structure of Baby Haven to resist the normalization of birth as a condition managed by medical expertise. This assumption that medical expertise is necessary to ease pain through drugs and other interventions constitutes a form of bio-power. Clients assert a counterdiscourse instead that drug-free births are normal or natural. A drug-free birth again is cause for celebration for Baby Haven clients. Karen Star who had her first baby at the center sums up that feeling:

I was looking back at my birth pictures that they took here and thought "Wow, I did that." And I think that was actually an incredible experience. So as far as pain management, when the birth was all over, and, I went, "I did it. I really did it! And I didn't have any drugs, and it was great!" I was just thrilled . . . I think that it was [more] important than I realized consciously. And, I realized it more so afterwards that it was very important to me.

In fact, Star describes how important her counterdiscourse of a drugfree birth becomes after the physical experience of giving birth. Stanton intended for her clients to be able to relax psychologically enough to manage pain physically when she designed Baby Haven. The absence of pain-relieving drugs means that clients come to birth at the center prepared to depend on other options, a resolve that they sometimes lose in the midst of labor but return to when they articulated their counterdiscourse about birth during my interviews. Here intent seems to match consequence, an equation that Blair cautions might not always be exact, but one that in retrospect Baby Haven clients perceive as ultimately part of their successful resistance to medical construction of their bodies.

And so, for Baby Haven clients, the best pain management comes from confidence in their bodies, a psychological state that precedes the physical experience of birth, a relationship between the mind and body. George and Nancy Griffin, for example, own and operate a cattle ranch and decided to birth at home instead of going to Baby Haven in the middle of busy calving season. On a day when the temperature was "31 below and blustery and cold," according to George, and, in the midst of a chimney fire in their home, Nancy labored 30 hours without anesthetic.16 George attributes Nancy's ability to go through such a long labor, to avoid what might have meant inevitable transport to the hospital, to Nancy's ability to manage her own discomfort:

Yeah, it would be a nice world if we could get a shot and get it all done . . . . If I hadn't had the confidence in my wife like I did, I knew that she could do it [sic]. You know, they say, "They don't make women like they used to" . . . you hear the stories about the old gals who were forking hay on the hay pile and went in and had the baby and came back to finish the hay. But if I didn't have the faith in her that I did then maybe I wouldn't have attempted it, but I just, I cannot think of doing it another way.

Baby Haven clients then offer a counterdiscourse to the medical construction of their pregnant bodies as experiencing pain manageable only with drugs. Because the place in which they birth resembles the place over which they have most control, their own homes, they believe that their minds are not subject to the fear they would experience in the hospital and therefore their bodies are not subject to the pain. Their evidence comes from their own birth stories, recalled and perhaps revised during the interviews, but definitely linked to the physical structure and organization of Baby Haven.

Water Birth: Rewriting the Cultural Script about the Pregnant Body

While the structure of Baby Haven and the absence of anesthetic drugs help clients resist the medical model of birth that constructs the pregnant body as one at risk and so in need of control by medical caregivers, clients identify one material object as having the greatest effect on their laboring bodies-the birthing tub, a large Jacuzzi-like pool in the birth suite. If the absence of the psychological sensation of fear helps their bodies relax physically, Baby Haven clients mark the birthing tub as the place where they are most relaxed and the warm water as making that physical relaxation possible. Here again, Baby Haven clients improvise a way of birthing that enables them to achieve agency and so change the nature of their births in a satisfactory way, and they attribute the consequence of the ideal birth to one material object, confirming the rhetorical power of such objects. Some clients relinquish control to the warm water in the tub, but others use it as a tool in monitoring and controlling the stages of labor. To all, the tub represents an alternative environment that confirms successful resistance to the medical model of birth.

Seven of the clients I interviewed had water births at the center, and several others used it for laboring. It was a Baby Haven client, Clare Merchant, who identified the importance of this option for labor and birth before the center even opened:

And, the water birth, in my opinion, is the way to go. I had both of them [babies] in water. And, I am convinced that is the best thing .... When I first checked with her [Stanton] before [the first baby] was born, and we went through the prenatal stuff, I said, "1 would really like to do water births. Are you into this? What do you feel about it?" And, she said, "You know, I didn't do many of these before, but once I started doing them, I realized that it really helped the person delivering. It alleviated a lot of the pressure." ... I think that it would have been a lot harder to deliver if I hadn't been in the water, physically. The water, you know, exercising in water is easier to do. Also, it dissipates some of the heat that you are giving off. You are not sweating profusely. It's just a very calming thing too. And, having that as an option is just immense to me.

Clients propose then that the tub as material object has an identifiable effect on the body, the same effect that clients want to achieve in order to avoid anesthetic drugs for pain management. Nina Burns describes the relaxing effect the water had on her body during labor:

I spent most of my time in the birthing tub, which was a huge benefit to my labor. My body responds very well to water, and so the heat and the relaxation effect of being in the water just made everything a lot easier. The weightlessness, you know, being in the water. I had back labor, and it was very much a relief just to have that weight lifted off my [does not continue her thought]; it just relaxed my muscles and everything. And so, it was just very comforting to be in there, in the tub.

Susan Walker remarks on the support the water gave her body: "Warm water and the buoyancy. You didn't have to use your muscles to try to hold yourself. You just let the water hold you." These clients describe the ways that their bodies gave in to the physicality of the tub and the water.

Other Baby Haven clients argue that they assume control over their bodies more easily in the water, a belief that resists the normalization of the laboring body as best controlled by medical caregivers through external monitoring and that offers clients a sense of agency in orchestrating their birth experiences. Ellen Sullivan, for example, says that the water helped her avoid pushing too soon in her labor:

The tub was really my saving grace for a lot of reasons. One just for the pain, and it really helped relax me as much as I could possibly be relaxed. And, I had a really early urge to push with her, really early, far earlier than I could have begun pushing. And the water was the only thing that made that bearable. Any time I would get out, to fight that urge was infinitely more difficult, so that [the tub] really helped a lot with that.

Kate Mantel, who had her first child in the hospital and her second at Baby Haven, details the loss of that control she felt when she couldn't deliver in the water at the hospital:

I wanted to give birth in the tub with my daughter, my older one, and they wouldn't let me because I was in the hospital. There was, I guess, just safety issues or whatever. They wouldn't let me do it in the tub. In fact they had me get out to check how far along I was, and I didn't really get back in. It was going to be too big of a pain. But it was like all of a sudden my pain level jumped from way down there to way up here because I wasn't relaxed in the tub anymore. And that was really hard.

Finally, Faith Hoffman learned to resist any negative effects of the water on her body:

Well, it was a little tricky for me because I had a really, really long labor, and the tub wasn't necessarily my best friend during labor. I'd use it to stall out so I could get ten, fifteen minutes of shuteye. But I have to say when I started pushing, it was my best friend. I was like floating up on the water, and [her husband] was holding me, and I was floating, and I pushed [the baby] out.

The birthing tub then represents an alternative environment and tool; the tub and its warm water offer Baby Haven clients agency to resist the medical construction of their laboring bodies as unmanageable. According to these clients, the tub and the consequent physical sensations are both real and describable as they are cast into a counterdiscourse about the laboring body, a discourse that resists the medical model of birth.

In this counterdiscourse, Baby Haven clients also d\escribe the effect of a drug-free water birth on their babies. Not only is the baby's transition into the world easier in the water, clients propose, but also because the tub enhances the woman's ability to birth without drugs, the baby does not have to fight off the effects of drugs during the first few days of life. Here Baby Haven clients are constructing a story about another body, one that they cannot experience but which they assert provides evidence for their counterdiscourse. Baby Haven fathers, in particular, offer anecdotal evidence of their children's alertness. Joseph Byatt, for example, was so taken with his child's entrance into the world that he rethought the births of his other children:

I called my previous wife, and I apologized that we did not go through this with my original children. I think she, our child, totally reflects the natural birth. The alertness. When she was born, she was born with her eyes open. When she came up out of the water, her eyes were open, and she was like, "World, you had better be ready because here I come." And that's the way she has been, you know, ever since.

Steve Henderson also contrasts his son's birth and his wife's experience in the birthing tub at Baby Haven to the birth of his other children:

The difference in coming here is she [his wife] got to experience it. In the hospital either they give you some drugs, or there's a hundred people marching in and out, and there's no experiencing the good part of the birth. Here there wasn't the distraction from the positive part. Once the baby came, we were all happy, talking, laughing, and having a good time. And checking out the baby and enjoying the little noisy one. And you [addressing the baby] were awake and visiting us. He was awake the whole time.

Finally, Henry Walker offers anecdotal proof that his child had an advantage being born without drugs after wife Susan birthed in the water:

An hour after he was born, I laid him on my lap and tested him .. . and an hour after birth he actually had enough strength I stood him all the way up just by him holding each individual ringer. When we brought him home, I believe it was the next day, he inched himself across the bed like an inchworm would ... and I told my friends about this and they thought I was crazy. He wasn't even crawling. He would scrunch up his body from his hips and push his body forward ... and actually crawl across our bed in that manner.

By sharing stories about their infants' abilities, these Baby Haven fathers construct their infants' bodies and physical responses in a way that supports their counterdiscourse about birth.

Stanton recognizes how this counterdiscourse collides with the discourse of the laboring mother as one who might make foolish choices for her infant, a separation of the needs of the mother and infant common in the medical model of birth:

Everybody is drawn to that tub. They want to see it and get an idea. And some women want to sit down in it when it's empty to see how deep it is. Even just people off the street that might come in here and go, "Wow!" ... they go right over and look at the tub... "Women really do this?" and I say, "Yes, they do." And they have all the questions, "Does the baby drown?" all the stereotypical stuff that they have heard ... and we know, I knew, marketing-wise and what I had seen with women using water birth tubs in their home environments that that would be our selling point.

Water births in the area that Baby Haven serves are not an option at the hospital, although a few hospitals within the state allow women to labor in the tub until time of delivery. As Gayle Merchant states, "I have asked [at the hospital], 'Do you have water birth?' and they said, 'What?' It was like they didn't know what I was really talking about. It wasn't considered. You know, 'You can sit in the shower.' But that's not what I really want. I want to be engulfed in this water." Water birth is not an option in the hospital because medical practitioners fear infection, snapping of the umbilical cord, or neonatal aspiration of the water, even though studies find water birth quite safe.17 The positions that the caretaker and support team must take during a water birth are awkward and almost subservient to the laboring mother, a redistribution of the hierarchy common in the hospital. Stanton, for example, must get fully into the tub, and the support team sits in the tub or on its edge. The birthing tub and its warm water, however, as material objects have the rhetorical power to rewrite the cultural script that the laboring body must be managed within hospital structures where the woman lies prone and absolutely accessible to the medical caregiver. These material objects also figure prominently in the counterdiscourse about birth that constructs the infant as excelling because of its mother's ability to birth drug-free in a place that offers no anesthetic drugs.

Material Construction of Cultural Concepts: Privacy in Baby Haven

Baby Haven clients materialize cultural concepts, such as control, safety, and particularly privacy, as they testify to the ways in which bodies, minds, and place interact to resist the hegemonic medical construction of birth. Clients assert their right to be let alone, and they define privacy by the ways they control the birth center and its objects during birth. They describe the positive consequences of this materialized privacy as they offer anecdotes of how quickly and closely they bond with their babies or how easily they accept their pregnancies. Baby Haven clients attribute their ideal births to the birth center being a private place that provides the means for resistance, a phenomenon that illustrates the impulse to materialize a concept at the same time one constructs a place to support that concept.

Baby Haven clients note, for example, that they bond with their infants because infants are left with their parents for long periods before being taken to be weighed and cleaned. Clients may discharge themselves as soon as an hour after giving birth. While at Baby Haven, clie

Source: Women's Studies in Communication

More News in this Category