BIRTH

BIRTH . The mystery associated with birth forms a central motif in every religion. The motif may be appreciated in its irreducible physical form or may become a highly abstract symbol or ritual. Religiously, birth is not regarded as merely a physiological process, or even a ritualized physiological event, but is associated with the evolution and transcendence of spiritual powers or the soul. Transmuted through myth, ritual, and symbol, the concept of birth becomes a major cipher for understanding existence and expressing wonder at creation.

Most religions explore the motif of birth through these three areas of myth, ritual, and symbol. Mythic narratives about important births or mythic figures who give birth are found in most religious traditions, and these myths shed light on the theological and ethical importance of rituals surrounding birth and rebirth. The ritual concerning physical childbirth itself makes this physiological event a religious experience. A third important motif is symbolic rebirth. Many religions speak of the central transformations in the religious life as rebirth. Whether as a collective initiation or as a solitary conversion, members of most religions are expected to undergo a second birth, which sometimes closely duplicates the first, physiological birth. At other times it is intended to undo the inadequacies of the first birth, so that there is an opposition between physiological birth and spiritual or social rebirth. This kind of second birth can often involve great tension or even hostility between women and men. This second birth can be so abstract that the way in which it duplicates one's first birth is unclear.

Primal Religions

Statues of pregnant women dating from the Paleolithic period are important as indicators of the earliest attachment of religious significance to birth. Found in archaeological sites from Spain to Russia, these statues date from about 25,000 bce on. Since they are found in the remains of old settlements and dwellings, they are thus assumed to be part of domestic religion. Although the exact use and significance of these figures cannot be determined, it seems undeniable that they reflect and express concern with birth specifically and with feminine energy in general as central existential and religious symbols.

For the Neolithic period, the evidence for a religion centered on goddesses and for a matrifocal society in Old Europe between 6500 and 3500 bce is convincingly presented by Marija Gimbutas (1982). According to Gimbutas, the appropriate collective title for the goddesses is "the Goddess-Creatrix in her many aspects." Among the most important of these aspects is "the life-giving goddess, her legs widely parted" (p. 176). Reliefs of this goddess found in the temples of the Anatolian village of Çatal Hüyük (excavated and reported by James Mellaart) have become especially well known. Contemporary interpreters of this culture have suggested that one may contemplate the impact of entering a religious sanctuary and finding the large, central, elevated image of the Great Birth-Giver with widely parted legs. Such sanctuaries were common in Çatal Hüyük for at least a millennium. In addition, according to Gimbutas, the schematic diagram for this birth-giving goddess was widespread in Old Europe.

The religious significance of birth in primal religions can also be studied in the context of the present ethnographic data. Rituals surrounding first and second birth have been minutely described and analyzed for many societies. Small-scale societies provide reference points for many classic analyses of birth and rebirth ritual. The links between these rituals of birth and mythologies about birth have not been thoroughly studied, but many small-scale societies also possess a significant mythology concerning births.

Physiological birth is the occasion for rituals in almost all small-scale societies. The well-known pattern for transition rituals—withdrawal, seclusion, and return—is evident in the activities surrounding physiological childbirth. In this case there is an especially close connection between physiological requirements and ritual elaboration. Other transition rituals do not carry the same physiological necessity for withdrawal and seclusion, which strengthens the hypothesis that the experience of giving birth is the model upon which other transition rituals are based. This observation also intensifies the impression that the religious meaning of birth extends far beyond physiological childbirth, which is nevertheless one of the most powerful and pervasive root metaphors of religion.

The pattern of withdrawal, seclusion, and return can take many forms and can include other ritual details. The withdrawal may begin some time before the actual delivery, or it may begin only with the onset of labor, as among the !Kung of southern Africa. The seclusion may be short and solitary, an unusual pattern found among the !Kung and, among them, only for uncomplicated deliveries. Usually the woman giving birth is secluded with appropriate relatives and helpers. Though there are exceptions, as among the inhabitants of Tikopia and the Marquesas, one of the most reliable generalizations that can be made about childbirth seclusion in primal religions is the absence of men. Usually their absence is not merely an accident or a practical arrangement but rather a deeply felt religious requirement. However, the woman's husband may participate vicariously in childbirth through practicing couvade, a series of work and food taboos, physical symptoms, and seclusion. These practices are especially associated with South American Indians. While male absence from childbirth is a general requirement, exceptions are sometimes made in special circumstances such as a difficult delivery; then the shaman or the father may attempt to help the delivery.

After childbirth, the seclusion for the woman continues usually for at least a few days and frequently for a month or more. During this seclusion period, both mother and child receive special treatment and are subject to special restrictions. In most cases, during the entire period of the withdrawal, seclusion, and return, normal routines of eating, working, and human association are disrupted. Normal activities or associations may be restricted to protect either the mother and child or those with whom the mother comes in contact or both. On the other hand, the mother may also be indulged with special foods, a lighter workload, and the solicitous companionship of her friends and relatives. Generally, some ritual elaboration of physiological childbirth seems to be universal among the women of primal cultures.

Almost all of the observances of childbirth outlined above are found among the Aboriginal Australians. The ethnographic literature on these groups concentrates heavily on the second birth, or initiation, as the important birth. In fact, many analyses of Australian Aboriginal religion suggest that physiological birth is the low point in the life cycle relative to membership in the sacred or religious community, and that this situation begins to change only with a second or so-called real birth during initiation. For the birth-giver, however, childbirth is definitely a religious experience that also serves to advance her ritual status. She experiences and practices all the rituals associated with participation in a sacred ceremony and thus emulates models from the mythic Dreaming that sanction her experience and behavior.

For members of many primal religions, birth is believed to be something that must be reexperienced at least once, especially by men. Frequently, for this purpose, boys are forcibly removed from their familiar surroundings, isolated from women, subjected to painful ordeals and physical operations, and taught secret lore that only men may know (although, in fact, women often surreptitiously find out these secrets). When the boys are reintegrated into the society, they have become "men" through the agency of their male initiators.

Though there are exceptions, as among the Mende of West Africa, this process of a prolonged and tedious rebirth is more typically expected of males than of females. Some scholars analyze this male rebirth ritual as a symbolic gesture whereby boys enter the masculine realm and are freed of the feminine world in which they had previously lived. The second-birth ceremonies of Australian Aborigines may also be seen as experiences that serve as a transition from profane to sacred status. This analysis suggests that the second symbolic birth is the real birth, and that male initiation is needed to accomplish what women cannot do when they give birth. This analysis stresses the differences and tensions between the two modes of birth—that given by women and that given by men—and focuses often on male-female tension and hostility in the culture. However, other analyses emphasize the continuity between first and second births and see the second birth as a duplication rather than an undoing of the first birth. More significantly, the male initiators finally experience vicarious childbirth in a kind of delayed couvade as they duplicate the pattern of childbirth. This kind of analysis stresses the extent to which the ceremonies of male second birth are based on awe of, not scorn for, the women's accomplishment in giving birth.

Aboriginal Australian male ceremonies of second birth give clear evidence for the dual meaning of second birth as both a transformation of boys into men and as a birth-giving experience for men. During the ceremonies, boys are carried about by men in the same way that women carry babies. After the initiation operation, the boys are taught a new language, and the men engage in the same purificatory and healing practices as do women after childbirth like the mythic sisters of the Dreaming. The operation itself is symbolic of severing the umbilical cord. In other ceremonies, a trench, symbolizing a uterus, is dug on sacred ritual ground and boys are made to lie in it until the proper time for their emergence, which is indicated by the correct sequence in the dance dramas conducted by the men. In some ceremonies, men ritually wound themselves and correlate their blood with the blood that flows in childbirth.

Many primal religions focus on mythic births and birth-givers. No mythological system among primal religions is devoid of female personalities and activities that focus on birth and rebirth. Among the Aborigines of Australia, there are several well-known mythologies of birth-givers, who are also models for current ritual practices that both women and men engage in. Ronald M. Berndt has reported on two major myth cycles in Kunapipi (Melbourne, 1951) and Djanggawul (Melbourne, 1952). The Djanggawul epic concerns a brother and two sisters who travel together; the sisters are perpetually pregnant and constantly give birth, assisted by their brother. The other epic concerns two sisters, the Wawalag, one of whom is pregnant and gives birth. The sisters reveal their experiences to men through dreams that become the basis for the men's ritual drama that accompanies second birth. In some Aboriginal mythologies, the ritual process of second birth is itself identified with the great All-Mother or Birth-Giver.

Indian Religions

In the Indian religious context, especially in Indian folk religions, childbirth remains an occasion for religious observances. These rituals follow familiar patterns of withdrawal, seclusion, return, and disruption of normal daily routines. Usually both women and men take part in some birth observances, though the rituals are much more extensive for women. Indian childbirth practices are characterized by uniquely Hindu notions and practices of ritual purity and pollution and are colored by the highly patriarchal character of the Indian family.

The childbirth rituals of an Indian village have been described in a study by Doranne Jacobsen (1980). Though restrictions on food and activity during pregnancy are minimal, with the onset of labor the woman giving birth is separated from others. It is believed that during labor and for a short period immediately following childbirth, the woman and her baby are in a highly polluted and polluting state, similar to the state of people in the lowest untouchable classes. Anyone who contacts the mother and child contracts this pollution, so the two are carefully isolated. Only the midwife, who belongs to a very low class because of the polluting nature of her work, and one married female relative stay with the woman. This childbirth pollution extends to a lesser extent to all members of the husband's family. They also observe some of the restrictions incumbent upon one in a state of pollution and undergo purificatory practices.

The delivery is followed by a series of ceremonies gradually reintegrating the woman and child into the ongoing life of the village. On the evening of the birth girls and women gather in the courtyard of the house to sing. After three days, the level of pollution is lessened when the woman is given purifying baths; she then begins to have limited contact with her household. After ten days, in an important women's ceremony, the woman and her baby leave the house momentarily for the first time, and the mother blesses the family water pots and water supply. For the next month, the woman is still in a transitional state, participating in some of the family's activities, but not cooking or participating in worship services for the deities. Usually the pollution period ends about forty days after the birth, when the mother performs a ceremony at the village well at night, symbolically extending her fertility to the village water supply and completing her reintegration into the community.

This transition period in the woman's life is significant not only for her but for her entire family and community. Both male and female members of her husband's family, who often make the young wife's life very difficult, recognize the new mother's ritual status and must change their behavior appropriately. For the new mother herself, the forty-day seclusion is not so much a period of liability and deprivation as a period of healthful rest and indulgence. She receives special foods, attention, and a new, respected status in her husband's family, especially if she has just given birth to her first son. These rituals surrounding childbirth support and validate women's vital role in a society that often expresses ambivalence toward women and projects strong male dominance.

Second symbolic birth is important in some Indian castes and some religious groups. During the Vedic period (c. 1500–900 bce) and in those castes that are still heavily involved in rituals and privileges having Vedic antecedents, second birth is an important affair. During Vedic times it was important in its own right; in contemporary Hinduism it is more important because of the privileges associated with being eligible to undergo a second birth.

The upper levels of Hindu society call themselves "twice-born"; their second birth gives them privileges, status, and responsibilities unavailable to the rest of the population. The privileges include the right to study the Vedic sacred texts and to practice religious ceremonies derived from Vedic models. The visible symbol of this status is a cotton cord worn by men across the left shoulder and resting on the right hip. A boy's second birth occurs when he is invested with this sacred thread, receives a sacred verse from his mentor, and undertakes, for at least a few moments, the ascetic discipline of a religious student.

The ancient texts regarding this initiation ceremony regard it as a second birth conferred by the male preceptor. The preceptor transforms the boy into an embryo, conceiving him at the moment when he puts his hand on the boy's shoulder. The preceptor becomes the boy's mother and father and symbolically carries him in his belly for three nights; on the third day the boy is reborn as a member of the privileged twice-born group. After his initiation the twice-born man can perform further sacrifices, which also begin with an initiation involving return to embryonic status and rebirth. Some Indian cultic traditions that still rely heavily on initiation continue to employ these motifs. For example, some Buddhist initiations begin with a series of rites in which the neophyte, deliberately compared to an infant, is washed, dressed, decorated, taught to speak, given a name, and so on.

However, though the theme of second birth occurs in the Indian contexts, many of the great soteriological themes of the Indian tradition do not rely on metaphors of birth and rebirth. Neither Hindu yoga nor the Buddhist Eightfold Path are a process of second birth; neither Hindu brahman nor Buddhist nirvāṇa results from second birth. They destroy delusion and result in insight and understanding. Images of maturation and death, rather than images of birth and rebirth, more accurately describe this attainment of an otherworldly attitude.

In the Indian context both stories of mythic birth and images of great birth-givers are ambiguous. The two most familiar birth stories, that of the Buddha and that of Kṛṣṇa, are highly unusual. Rather than serving as paradigms of birth-giving, they tell of the extraordinary futures awaiting the infants Buddha and Kṛṣṇa. Goddesses are numerous and important, but they are never simple mother goddesses. Though the creative power of the goddesses is stressed, none of the great goddesses of Hindu mythology experiences a pregnancy and delivery with which a human female could identify, not even Pārvatī, the wife of Śiva and the mother of two of his children. But the veneration of symbols of male and female sexuality is widespread. Temple reliefs of goddesses, naked, hands on hips, knees turned outward to display their sex, recall the Creatrix of Çatal Hüyük. As Sakti, vital energy, she is the energy that fuels the entire phenomenal world. Moreover, without the touch of her energizing dancing feet even the greatest god, Śiva, is a mere sava or corpse.

Monotheistic Religions

In the ancient Near East, the concept of monotheism involved the suppression of the goddess as the legitimate symbol of divine creativity and resulted in her replacement by a solitary sovereign, an abstract and nonsexual, though male, creator. Many mythologies from the third millennium onward display an increasing attempt to present males as primordially creative, even as the first birth-givers. They become pregnant and give birth, despite their anatomical limitations. Even if they are not directly involved in birth-giving, they are depicted as performing creative acts. Perhaps the most dramatic account of this reversal occurs in the creation epic of ancient Mesopotamia (mid-second millennium bce). The older generation of gods are the primordial parents Apsu and Tiamat. After Apsu is killed by younger gods, Tiamat engages in battle against the younger gods. The battle is a confrontation between Marduk, a young male hero, and Tiamat, the Original Mother. He kills her and creates the cosmos out of her lifeless body. The gender identification of the two protagonists, though often ignored, is extremely significant. It is also found in one of the most important myths of Western culture, the creation of the female (Eve) out of the male (Adam).

Against this mythological background, physiological childbearing is not an especially important or religiously valued activity in monotheistic religions. The pains of childbirth are explained as punishment for Eve's curiosity and disobedience; the most noteworthy birth, Jesus' virgin birth, can no more be a model for ordinary women than can the births of the Buddha or Kṛṣṇa. Throughout the centuries, though women have been exhorted to bear children and even have been declared saved by their childbearing (1 Tm. 2:15), their childbearing has neither been given value by significant religious rituals nor been utilized as a significant symbol in the mythological system. In the Christian, Jewish, and Muslim traditions, childbirth has nevertheless been surrounded by folk rituals, taboos, and superstitions. Even in modern secular societies, the activities surrounding childbirth are highly ritualized, as has been pointed out by several anthropological analyses of modern Western cultures. These rituals are changing at present, as indicated by the growing popularity of home births, birthing centers, and so on, and by much more direct participation of fathers in the childbirth process than is found in most other societies.

In the context of these Western religious traditions, mothering as an activity has been a more significant religious symbol than birth itself, as is evidenced by the madonna-and-child imagery that is popular in Christian piety. Scholars are beginning to notice aspects of motherly energy in the symbolism of the divine. Yahveh of the Hebrew scriptures is also depicted as a mother eagle. The word for his mercy (raḥamim ) derives from the word meaning "womb" (reḥem ); some suggest that the phrase "merciful father" could be translated as "motherly father." The words for his spirit may be masculine or feminine, while the word for his wisdom is definitely feminine, as is shekhinah, the term for his presence on earth. In medieval times Christ was depicted as being motherly and feminine. Anselm, in his ontological proof of the existence of God, pictured Christ as a mother hen, an image that appears in the Bible (Mt. 23–37, Lk. 13–34).

Second birth has remained a central motif in monotheistic religions, especially in Christianity. Physiological birth by itself is insufficient to initiate a person into complete membership in the religious community, which is accomplished by the second and real birth. In Judaism and Islam the circumcision ritual does not stress, or even recognize, circumcision as rebirth. In Judaism it is simply "entry into the covenant," and is the first religiously significant event, but is not modeled on an earlier birth.

In Christianity, the necessity of second birth has been especially strong. The contrast between the "Old Adam" and the "New Man" is deeply built into the Christian symbol system. Transition from one birth to the other is a necessary individual experience, verified in baptism, or more recently, in the psychological experience of being "born again." Inasmuch as baptism is performed by a traditionally all-male clergy, the ritual resembles the second births performed by men in other religions. However, rebirth is not a duplication of physiological childbearing but instead emphasizes the need to die to the "old life." In Christianity, everyone, whether female or male, needs to be individually reborn. In this way the Christian understanding of true rebirth departs significantly from other traditions. However, this rebirth occurs through the ritual agency of a male clergy and is almost always understood as a rebirth into the graces of a male monotheistic deity. Perhaps in no other context is the need to be reborn so strongly felt yet so strongly removed from the arenas of feminine symbolism and replication of female activity.

See Also

Couvade; Initiation; Prehistoric Religions.

Bibliography

Literature about rituals of birth and rebirth as well as the mythology and symbolism of the Great Birth-Giver is scattered in many sources. Only rarely, or not at all, are such materials easily found in a few sources. Two classic discussions of transition rituals are Mircea Eliade's Rites and Symbols of Initiation: The Mysteries of Birth and Rebirth (New York, 1958) and Arnold van Gennep's The Rites of Passage (Chicago, 1960). More recent books that include significant comparative discussions of birth rituals include Martha Nemes Fried and Morton H. Fried's Transitions: Four Rituals in Eight Cultures (New York, 2001) and Sheila Kitzinger's Women as Mothers: How They See Themselves in Different Cultures (New York, 1978).

The Old European religion is discussed in Marija Gimbutas's The Goddesses and Gods of Old Europe, 6500–3500 B. C. (Berkeley, 1982) and in Anne Barstow's "The Prehistoric Goddess," in The Book of the Goddess: Past and Present, edited by Carl Olson (New York, 1983). The ceremonies of birth and rebirth among Aboriginal Australians are summarized in my essay "Menstruation and Childbirth as Ritual and Religious Experience among Native Australians," in Unspoken Worlds, edited by Nancy Auer Falk and me (San Francisco, 2001), where Doranne Jacobson's "Golden Handprints and Red-Painted Feet: Hindu Childbirth Rituals in Central India" can also be found. Rebirth ceremonies are described in David G. Mandelbaum's Society in India, 2 vols. (Berkeley, 1970), and Abbé Jean Antoine Dubois's Hindu Manners, Customs and Ceremonies, 3d ed. (1906; reprint, Oxford, 1968). The many qualities of Hindu goddesses and mythic birth-givers can be seen in N. N. Bhattacharyya's The Indian Mother Goddess, 2d ed. (Columbia, Mo., 1977), and in The Divine Consort, edited by John Stratton Hawley and Donna Marie Wulff (Berkeley, 1982).

Shifts in the core symbolism of the ancient Near East become apparent when the older worldview is first studied. Diane Wolkstein and Samuel Noah Kramer present a moving portrait in Inanna: Queen of Heaven and Earth (New York, 1983). The prebiblical shifts in symbolism are presented by Thorkild Jacobsen's The Treasures of Darkness (New Haven, 1976), and the struggle to enforce the biblical shift in symbolism is discussed by Raphael Patai's The Hebrew Goddess (New York, 1967). For symbolism of second birth in Christianity, see Marion J. Hatchett's Sanctifying Life, Time and Space (New York, 1976) and Joseph Martos's Doors to the Sacred (New York, 1982). Finally an older source containing much valuable information, including chapters on Palestine and the church, is E. O. James's The Cult of the Mother Goddess (New York, 1959).

Rita M. Gross (1987 and 2005)

Birth

Viviparous animals

How does birth begin?

Maternal progesterone

Oxytocin

Fetal endocrine control

Birth in humans

History of childbirth

Types of childbirth preparation

Types of anesthesia

Resources

Birth, or parturition, in mammals is the process in which a fully developed fetus is expelled from the mother’s uterus by the force of strong, rhythmic muscle contractions. The birth of live offspring is a reproductive feature shared by mammals, some fishes, and select invertebrates (such as scorpions), as well as some reptiles and amphibians. Animals who give birth to live offspring are called viviparous (“live birth”).

In contrast to viviparous animals, other animals produce eggs; these animals are called oviparous (“egg birth”). Some oviparous species, such as birds, retain their eggs inside their bodies for long periods of time; in these animals, the eggs are laid at an advanced stage of development. Other animals, such as frogs, give birth to less developed eggs, which undergo development outside the mother’s body.

Viviparous animals

In both viviparous and oviparous animals, fertilization of the mother’s egg with the father’s sperm takes place inside the mother’s body. One of the advantages to giving birth to live young is that the mother protects the fetus inside her body as it develops. The developing fetus derives nutrients from the mother’s body, and so is assured of receiving all the nourishment it needs to complete development.

The length of time between fertilization and birth in viviparous animals is the gestation period, which varies according to species. The gestation period of mice is 21 days, of rabbits is 30-36 days, and of dogs and cats is 60 days. The largest mammal, the baleen whale, has a gestation period of 12 months—only three months longer than the gestation period of humans. Elephants have one of the longest gestation periods of all animals, 22 months.

Some viviparous animals such as humans, horses, and cows, usually give birth to only one offspring at a time, although occasionally these animals produce twins or triplets. Other animals give birth to many offspring at a time. Usually, multiple offspring in a litter are each derived from a separate eggs, but the armadillo gives birth to four identical offspring that are derived from the same fertilized egg.

How does birth begin?

At the end of the gestation period, the mother’s uterus begins to contract rhythmically, a process called labor. The initiation of labor leading up to birth is the result of a number of hormones, notably oxytocin.

Maternal progesterone

Shortly after fertilization the hormone progesterone increases and is maintained at high levels in the

mother’s bloodstream. The high levels of progesterone prevent the uterus from contracting. The progesterone prepares the lining of the uterus (the endonestrium) for its supporting role in nurturing the developing fetus, and helps form the placenta. Maternal progesterone levels begin to drop during the last weeks of gestation, while the levels of estrogen begin to rise. When progesterone levels drop to very low levels and estrogen levels are high, the uterus begins to contract.

Oxytocin

Oxytocin is a hormone released from the pituitary gland in the brain, which stimulates uterine contractions and also controls the production of milk in the mammary glands of the breast (a process called lactation). Synthetic oxytocin is sometimes given to women in labor to induce labor.

The mechanism that prompts the secretion of oxytocin from the pituitary during labor is thought to be

initiated by the pressure of the fetus’s head against the cervix, the opening of the uterus. As the fetus’s head presses against the cervix, the uterus stretches, and relays a message along nerves to the pituitary, which responds by releasing oxytocin. The more the uterus stretches, the more oxytocin is released.

Fetal endocrine control

Fetal hormones are also thought to play a role in initiating labor. At the end of gestation, the fetal adrenal glands secrete steroid hormones called corticosteroids, which stimulate the production of hormonelike substances known as prostaglandins that contribute to the contraction of the uterus during labor.

Birth in humans

Labor culminating in birth in humans begins with the rhythmic contractions of the uterus, which dilate the cervix. This causes the fetus to move down the birth canal and be expelled together with the placenta, which had supplied the developing fetus with nutrients from the mother. Usually the entire birth process takes about 16 hours, but it can range anywhere from less than one hour to 48 hours.

The first stage: Dilation of the cervix

In order for the fetus to leave the uterus and to enter the birth canal, it must pass through the cervix, the opening of the uterus. The cervix is normally tightly closed, and sealed with a plug of mucus during gestation to protect the fetus from invading microorganisms. During the first stages of labor, the contractions of the uterus dilate the cervix, which widens to about 4 inches (10 cm), to accommodate the passage of the baby’s head.

In the last weeks of pregnancy, before labor begins, the uterus undergoes irregular contractions, which serve to exercise the muscles of the uterus and may even dilate the cervix; it’s not unusual for a woman to go into active labor with a cervix that is already dilated to 1 or 2 centimeters. During the last weeks of pregnancy, the cervix also thins out (or effaces), which makes dilation easier.

In preparation for birth, the fetus moves further down into the mother’s pelvis. When labor begins, the fetus is usually positioned with its head engaged with the top of the cervix. This engagement is called “lightening” or “dropping.” When labor begins, the contractions loosen the mucus plug in the cervix causing small capillaries in the cervix to break, and the mucus and blood are discharged from the vagina. This discharge is sometimes called “bloody show” and signals the onset of labor.

Another sign that may signal the beginning of labor is the rupturing of the amniotic sac. In the uterus the fetus is encased in a membrane and literally floats in amniotic fluid. When uterine contractions begin, this sac ruptures and the amniotic fluid can leak from the uterus. Not all women experience an abrupt rupturing of the amniotic sac; in some, the amniotic fluid gradually leaks out as labor progresses. Once the amniotic sac has ruptured, or the amniotic fluid begins to leak, labor usually progresses more rapidly. During the first stage of labor, the cervix dilates about 0.5-0.6 inches (1.2-1.5 cm) an hour. The uterine contractions are 5-30 minutes apart, and last for 15-40 seconds. The end of the first stage of labor is associated with the strongest uterine contractions. Contractions are two to five minutes apart, and last for 45-60 seconds. The cervix opens rapidly at this point. This period of labor, sometimes called transition, is usually the most difficult for the mother. The contractions are very strong and close together, and nausea and vomiting are common. After the cervix has dilated to its full width of 4 inches (10 cm), the contractions slow down somewhat to about three to five minutes apart. The fetus is then ready to be born, and the second stage of labor begins.

The second stage: Birth

During the second stage, lasting about one to two hours, the mother uses her abdominal muscles to push the fetus through and out of the birth canal.

The pushing is actually a reflex action, but if a woman can help the reflex by actively using her muscles, birth goes much faster. As the fetus moves

down the birth canal to the vaginal opening, the head begins to appear. The appearance of the head at the opening of the vagina is called crowning. After the head is delivered, first one shoulder is delivered, then the other. The rest of the body follows.

After the baby is born, the umbilical cord that has attached the fetus to the placenta is clamped. The clamping cuts off the circulation of the cord, which eventually stops pulsing due to the interruption of its blood supply. The baby now must breathe air through its own lungs.

The third stage: Delivery of the placenta

Before delivery, the placenta separates from the wall of the uterus. Since the placenta contains many blood vessels, its separation from the wall of the uterus causes bleeding. This bleeding, if not excessive, is normal. After the placenta separates from the uterine wall, it moves into the birth canal and is expelled from the vagina. The uterus continues to contract even after the placenta is delivered, and it is thought that these contractions serve to control bleeding.

History of childbirth

Until the twentieth century, childbirth was the province of women. A woman giving birth was attended by her female relatives and perhaps a woman in the community known for her midwifing skills. As the scientific revolution of the seventeenth century took place, concerned physicians noticed that childbirth was a dangerous, often fatal, process. Infections, injury, and even death were the result to both baby and mother when unskilled midwives attempted to manage

complications. Gradually, childbirth changed from an entirely female-centered activity to a medical process overseen by predominantly male physicians. By the early twentieth century, childbirth moved from the home to the hospital. By the mid-twentieth century, childbirth had become a completely medical process, attended by physicians and managed by medical equipment and procedures, such as fetal monitors, anesthesia, and surgical interventions.

Later in the twentieth century, some women became dissatisfied with this medical approach to birth. Many felt that the medical establishment had taken control of a natural biological process. Women wanted more control over labor and birth and new ways of giving birth that sought to reduce or eliminate the medical interventions became popular. With the increasing concern about the effect of anesthesia on the fetus, many women refused artificial means of controlling pain, and instead relied on breathing and relaxation techniques. Fathers, once banished from labor and delivery rooms, were now welcomed as partners in the birth process.

Today, women have many options for labor and birth. Some women deliver in a hospital with doctors and nurses close by to supervise the birth process. Others choose a nurse-midwife, a person who has been trained to deliver babies but who is not a doctor. Still others choose home birth, attended either by a doctor or midwife, or sometimes both. Whichever option a woman chooses, it is important to get good medical care throughout pregnancy. Periodic prenatal checkups are one of the best ways to avoid birth complications.

KEY TERMS

Amniotic fluid— The fluid in which the fetus lives in the uterus.

Amniotic sac— The sac that contains amniotic fluid.

Gestation— The period of carrying developing offspring in the uterus after conception; pregnancy.

Labor— Strong, rhythmic uterine contractions leading to birth.

Placenta— The organ that develops during gestation through which a fetus receives nourishment from the mother.

Prostaglandins— A substance released by uterine cells that cause uterine contractions.

Umbilical cord— The cord that attaches the fetus to the placenta.

Types of childbirth preparation

Many childbirth experts believe that the more a mother knows about the birth process, the less fear and apprehension she will feel. Many childbirth preparation methods prepare both mother and father for the birth experience and teach relaxation and breathing techniques. The Read method, for instance (named after its founder, British physician Grantley Dick-Read), is based on the notion that fear leads to pain. The Read method includes childbirth education, exercises to improve muscle tone, and relaxation techniques. The Lamaze method (named for Dr. Ferdinand Lamaze) takes a psychological approach to managing labor. The Lamaze method teaches women to relax and breathe in response to pain, the theory being that this substitution of favorable activity for negative sensations reduces pain. The Bradley method focuses on deep relaxation and slow, deep breathing, and ascribes an important role to the father.

Types of anesthesia

Two types of anesthesia are commonly used during labor and birth. In general anesthesia, the mother is given drugs that put her to sleep, but this type of anesthesia is rarely used today, since the drugs can depress the fetal heartbeat. In regional anesthesia, drugs are injected to deaden sensation around the spinal nerves that carry sensations from the pelvic region. Controversy about whether these drugs affect the fetus is ongoing, although some kinds of regional anesthesia affect the fetus less than others.

See also Embryo and embryonic development;Reproductive system; Sexual reproduction; Viviparity.

Resources

BOOKS

Bean, Constance A. Methods of Childbirth. Second edition. Garden City, New York: Doubleday, 1990.

Karmel, Marjorie. Thank You, Dr. Lamaze. New York: Harper and Row, 1993.

Knobil, Ernst and Neill, Jimmy D., eds. The Physiology of Reproduction. 2nd ed. New York: Raven Press, 1994.

Korte, Diana. The VBAC Companion: The Expectant Mother’s Guide to Vaginal Birth after Cesarean. Cambridge, MA: Harvard Common Press, 1999.

Mitford, Jessica. The American Way of Birth. New York: Dutton, 1992.

Moore, Michele, and Caroline De Costa. Cesarean Section: Understanding and Celebrating Your Baby’s Birth. Baltimore, MD: Johns Hopkins Medical Press, 2003.

PERIODICALS

“Deciding to Be Born.” Discover 13 (10 May 1992).

Fischman, Joshua. “Putting a New Spin on the Birth of Human Birth.” Science 264 (20 May 1994): 1082.

Ventura, S.J. “Births: Final Data for 1999.” Service Today 49, no. (2001): 1-100.

OTHER

Babycenter, LLC. “Labor and Delivery” <http://www.babycenter.com/childbirth> (accessed November 2, 2006).

March of Dimes. Pregnancy and Newborn Health and Education Center “Giving Birth” <http://www.marchofdimes.com/pnhec/240_1034.asp> (accessed November 2, 2006).

Kathleen Scogna

BIRTH

Throughout the animal kingdom, birth is universally recognized as a miracle of renewal where, once again, a life begins. While humans are better than ever at saving the lives of even the smallest newborn, the whole process of birth is one of amazing change and brings finality to nine months of preparation.

Labor

Labor is the beginning of the active birth process. Many expectant mothers ask themselves the important question "Is this it?" more than once in the late weeks of pregnancy. Sometimes they feel a slight contraction and then nothing more. Such contractions, known as Braxton-Hicks contractions, are relatively painless and begin as early as the sixth month and may continue throughout the pregnancy. Real labor contractions cause more discomfort, occur with greater regularity, and are intensified by walking.

Other signs may or may not indicate that labor is beginning, such as an ache in the small of the back, abdominal cramps, diarrhea, indigestion, "show" (a small amount of blood-tinged mucus emerging from the vagina), and the "water breaking" (a discharge of fluid from the vagina). The discharge of fluid, which is caused by the rupture of membranes, can occur some time before actual labor begins. The only certain signs of labor are the appearance of the show and the onset of regular, rhythmic contractions that increase in frequency and strength. When the fluid from the amniotic sac is discharged, the first line of defense against infection is broken. Often, if labor does not begin after the water breaks, the physician may induce labor.

Stages of Labor

Labor progresses through three stages: dilation, or "the opening," expulsion, and placental. The first stage, dilation, can last anywhere from two hours to sixteen hours or more. At first, each contraction is thirty to forty-five seconds in duration and occurs about every fifteen to twenty minutes. The contractions are involuntary and the woman cannot start them or stop them at will or make them come faster or slower. Their function is to dilate the cervix until it is wide enough to let the baby through—usually about four inches (ten centimeters). In the course of the first stage of labor the contractions increase in frequency until they are only a minute or two apart. Each contraction itself also becomes longer and, toward the end of the first stage, may last ninety seconds.

At the end of the first stage there may be a series of very intense contractions; during this time the cervix has been stretched around the baby's head. The woman may feel ready to give up, but this phase, known as transition, is soon over. It rarely lasts more than half an hour and is often much shorter. In expulsion, the second stage of labor, the involuntary contractions continue to be long in duration and closely spaced, but now the woman has a strong urge to bear down with her abdominal muscles. At each new contraction she pushes down with all her strength as the baby's scalp comes into view, only to disappear again when the contraction ends. This is known as crowning. With each contraction more and more of the baby's head can be seen. At this point in labor, some obstetricians may perform an episiotomy (making a small slit in the skin outside the vagina toward the anus) to prevent this tissue from tearing. When the baby's head comes out as far as its widest diameter, it stays out, and in a short time it is free. The head may be molded (elongated in shape as a result of its passage through the cervix), but the soft skull bones that have been squeezed together soon recover their normal shape.

Some babies will give their first cry at this point. With the next contractions the shoulders emerge, and the rest of the body slips out easily. The feelings of both parents at this time are almost impossible to put into words: elation, exhaustion, and great feelings of tenderness and caring.

It was once the practice for the doctor to hold the baby up by the feet immediately following delivery to allow fluid and mucus to escape from the baby's mouth and nose, so that the infant could start breathing, usually with a gasp and a cry. Today it is more usual to aspirate the mucus from the baby's mouth and nose by suction as soon as the head is delivered. This gives the baby a slight head start on independent breathing.

As soon as delivery is complete, the umbilical cord is clamped and cut. The baby is then wrapped in a receiving blanket, and someone performs a variety of procedures that vary from hospital to hospital. Typically, drops of silver nitrate are placed in the baby's eyes to prevent infection, both mother and baby are given plastic identification bracelets, and fingerprints of the mother and sometimes footprints of the baby are taken.

At this time the neonate's general state of health is evaluated using the APGAR scoring system. At one, five, and ten minutes after birth the baby is given a score of 0, 1, or 2 on Activity (muscle), Pulse (or heart rate), Grimace (or reflex action), Appearance (color), and Respiration (breathing). This test provides very general information on whether the baby's life-sustaining functions appear normal and what kinds of potentially dangerous problems may be present. The majority of children score between 5 and 10, and 90 percent have a score of 7 or better; there is no reason for concern unless the score is below 5.

During the third or placental stage, the afterbirth (the placenta and cord) is expelled from the uterus. Labor is now completed.

The length of the entire process varies greatly, as does the actual experience of labor. Fifteen hours is an average figure for the duration of birth from the first contraction to the expulsion of the afterbirth for a first birth. But this average covers a spectrum of labor as long as twenty-four hours and as short as three hours or less. Labor is usually longer for first babies than for later ones, and longer for boys than girls. Two reasons for a longer first labor might be the easier adaptation of the woman's body to the process and the reduced amount of anxiety present in subsequent births.

"Gentle Birth" Techniques

One way that the process of labor can be made easier for the expectant mother is the use of certain techniques often referred to as gentle births, such as the Lamaze and Dick-Read methods of childbirth. Both of these became very popular in the early 1970s. Grantly Dick-Read believed that pain during childbirth is not inevitable but is the result of fear passed on from mother to daughter over the generations. Dick-Read stressed that by educating the woman about the birth experience, the fear of the unknown can be removed. In its place a more positive view about delivery can be substituted. In 1967 a French obstetrician, Fernand Lamaze, developed a method for childbirth he called "childbirth without pain." This popular technique usually begins in the third trimester of pregnancy when the woman practices breathing and other exercises with her "coach" (usually the father). These exercises are used during labor to help a woman control her anxiety and be able to relax and push at the appropriate time. By practicing the exercises in advance, the command or suggestion of the coach is quick in coming and easy to maintain at the time of childbirth.

There are a substantial number of studies showing that prepared childbirth enhances feelings of self-esteem, increases the husband's degree of participation, and even strengthens the marital relationship. Whereas in the 1970s fathers were still marginally included in the birth of their children, it is almost the exception in the early twenty-first century when they are not.

What are the baby's first impressions of the world he or she is being thrust into? One French obstetrician, Frederick Leboyer, believes that the very act of being born can be a terrifying experience. In Leboyer's view, the violence of modern delivery techniques contributes a good deal to this "hell and white hot" experience.

The Leboyer technique involves a number of radical changes in the delivery procedure. As soon as the infant begins to emerge, the physicians and nurses attending the birth lower their voices, and the lights in the delivery room are turned down. Everyone handles the baby with the greatest possible tenderness. Immediately after delivery the baby is placed on the mother's abdomen, where the baby can start breathing before the umbilical cord is cut. After a few minutes the obstetrician places the baby in a lukewarm bath, an environment very much like the amniotic fluid. In this way the difference between the fetal environment and the world is minimized.

Is Leboyer's method better? Safe? Of the few studies that have been done, the results seem to indicate that babies delivered this way are similar to others delivered in a more conventional fashion. Whether or not there are any long-lasting effects will have to be judged after sufficient information is available about these "gentle birth" babies as they grow.

Alternate Birth Centers

Hospitals operate as bustling, crisis-oriented places. Such institutions are for sick people, and pregnancy is not considered an illness by supporters of a new kind of environment for giving birth—the alternate birth center. Alternate birth centers were developed because many parents objected to what they felt to be the impersonal, needlessly technological, and increasingly expensive childbirth procedures available in the conventional hospital setting. As a growing number of women chose to give birth at home, the risks involved became a concern. Alternate birth centers, then, are a response to both the dissatisfaction with hospitals and the hazards of home births.

These centers were all but unheard of in 1969. Within a few decades, at least 1,000 had been established, and the trend continued into the early twentyfirst century. In 1978 the medical establishment officially endorsed many elements of this alternate care, recommending that it be included in conventional maternity services. Out-of-hospital facilities for the management of low-risk deliveries were also established.

Alternate birth centers provide a relaxed, homelike atmosphere for the pregnant woman, her family, and the newborn. The most dramatic aspect of an alternate birth center compared with a conventional hospital is the room where the deliveries take place. Unlike the operating-room atmosphere to which laboring women are generally sent at the most uncomfortable, critical moment, the birthing room—the location of the woman's predelivery hours—is a cheerfully decorated suite resembling a bedroom. Women in labor move about freely. They rest as they choose and may be accompanied by their husbands, families, and friends. An attending nurse, midwife, or doctor delivers the baby into this low-key, family-oriented environment. It is dimly lit, quiet, and peaceful.

The new mothers, and those with them, report a sense of control and contentment in contrast to the anxiety and isolation experienced by many in the traditional delivery room. Many of these centers also encourage the participation of other siblings in various stages of the pregnancy and birth.

Following the birth, the new family remains in the birthing room, in close physical contact. The newborn is placed on the mother's bare skin (which can act almost like a "natural incubator") and has the first opportunity to suckle and enjoy eye contact. A soothing warm bath may be administered. In these first hours, bonding between the parents and child has a unique quality. In some birthing rooms, siblings may also share these special experiences. The entire family leaves the alternate birth center together, usually earlier than from the traditional setting.

For safety, birthing-room facilities keep a significant amount of emergency equipment hidden within the suite itself and deliver only low-risk births. Nonetheless, of these births, approximately 10 percent develop problems best handled in a more conventional setting. When located in a hospital, birthing rooms are usually adjacent to traditional delivery and operating rooms.

Midwives

At one time the use of a midwife conjured up visions of birth-attending barbarians in a dimly lit, unsanitary room. Today, nothing could be further from the truth. Midwifery as a profession has the status it deserves as an integral and indispensable component of prenatal care and childbirth. Popular in Europe for many years, it is becoming more so in the United States.

Midwives are increasingly associated with physicians, where they can handle the majority of the prenatal care that needs to be done and up to 90 percent of the actual births. The remaining births that are of high risk are usually under the physician's care.

A woman might choose to have a child delivered by a midwife for several reasons. One of the most important is that the traditional medical community continues to treat pregnancy as an illness and the pregnant woman as a sick person. This kind of thinking is slowly being rejected, in part as the result of a U.S. Supreme Court action ruling that pregnancy is a disability and not a disease. There are several other reasons why midwives are becoming more popular:

• New changes in the law allow the licensing of midwives.
• There is, as a result of the women's movement, a sharp increase in the demand for women practitioners to assist in deliveries.
• Midwives are better trained today than ever and often go through intensive university-based classes in physiology and obstetrics.
• The role of technology in childbirth has been questioned in that it tends to be dehumanizing. Midwives are less likely to resort to such techniques, which in some cases may present more dangers to the woman and the infant than not.
• The federal government endorses the use of midwives and encourages institutions to employ them.

Perhaps the best combination is a midwife working directly with a physician so there is adequate technical backup if necessary.

Complications

Most "complications" can usually be dealt with successfully by the obstetrician and the hospital staff. The baby may, for example, come out bottom first in what is called a breech presentation. Sometimes one foot is first to appear, and sometimes the umbilical cord comes out alongside the head. The doctor must manage these variations and often actually turn the baby before birth with great skill to avoid any further complications.

Babies, for the most part, deliver themselves. It is when complications develop that the training and expertise of the health-care provider are needed. The fetal heartbeat is monitored during labor, and when there is cause for concern, a cesarean delivery may need to be performed.

A cesarean birth is one in which the baby is delivered through a surgical incision made into the woman's abdomen and uterus. Although it is generally considered a safe operation for both mother and baby, it is still major surgery. Babies delivered by cesarean do not have molded heads and look better in general than babies born vaginally. A cesarean delivery might be performed for reasons such as difficult and perhaps dangerous labor, fetal distress, breech presentation, and previous cesareans. These reasons explain some 50 percent of all cesareans being performed. As a rule, a cesarean delivery is planned ahead of time and performed before labor has a chance to begin. Today it can be performed even after the uterine contractions have started if the child cannot be delivered otherwise.

Another means of helping nature during birth is through a tonglike instrument, known as forceps. These concave, elongated tools are inserted as two separate units into the vagina. Each is placed on the baby's head. When the handles are joined, the baby be rotated and pulled.

A forceps delivery may be required if the mother's contractions slow down or stop. Today, hormones are usually given to make the contractions continue. But danger signs from either fetus or expectant mother could call for delivery with forceps.

The use of forceps either in the first stage of delivery or early second stage can cause brain damage to the child. At these stages it is important to place the forceps accurately on the child's head. It is also necessary to use considerable force to pull the baby's head out. This is called high forceps delivery and is almost never used today because of the danger involved. Low forceps delivery, that is, the use of forceps in the actual delivery stage, is rarely damaging to the child and is still commonly used in many hospitals.

See also:CESAREAN DELIVERY; PREGNANCY; PRENATAL DEVELOPMENT

Bibliography

Goer, Henci. The Thinking Woman's Guide to a Better Birth. New York: Berkley, 1999.

Leiter, Gila, and Rachel Kranz. Everything You Need to Know to Have a Healthy Twin Pregnancy. New York: Dell, 2000.

Mahler, Margaret S., Fred Pine, and Anni Bergman. The Psychological Birth of the Human Infant: Symbiosis and Individuation. New York: Basic Books, 2000.

Simkin, Penny. The Birth Partner Cambridge, MA: Harvard Common Press, 2001.

Stoppard, Miriam. Conception, Pregnancy, and Birth. New York: Dorling Kindersley, 2000.

Neil J.Salkind

Birth

For most of human history, birth was exclusively the work of women who labored to push their babies from the private inner world of their wombs into the larger world of society and culture. Yet in the early twenty-first century, increasing numbers of babies are pulled from the vaginal canal with forceps or vacuum extractors, or are cut from their mothers' wombs via cesarean section. The medical definition of birth is the emergence of a baby from a womb—a definition that ignores women's involvement and agency.

BIRTH AND HUMAN EVOLUTION

Higher primates walk on all fours and have pelvises wide enough to allow the direct descent of the fetal head, making for easy labors and uncomplicated births. When humans began to walk upright, the pelvis narrowed, so that the human baby has to rotate as it descends through the birth canal. Non-human primate babies can climb onto their mothers' backs and cling immediately after birth. But the larger brains of human infants make it necessary for them to be born earlier in the developmental cycle, ensuring that human babies are relatively helpless at birth and require immediate nurturing. These factors encouraged the evolution of birth as a highly social process; women give birth alone and unaided in very few societies.

Evolutionary scientists postulate that midwifery evolved along with human birth. The presence of other women at a birth would have enhanced the success of the birth process, as these women acquired skills such as turning the baby in utero to ensure the optimal position for birth, assisting rotation of the head and shoulders at birth, massaging the mother's uterus and administering herbs to stop postpartum bleeding, and facilitating breastfeeding. For these reasons, more mothers and babies survived in societies that developed midwifery traditions early on, giving them a distinct evolutionary advantage.

BIRTH, CULTURE, AND WOMEN'S STATUS

Although childbirth is a universal fact of human physiology, the social nature of birth and its importance for survival ensure that this biological and intensely personal process carries heavy cultural overlay, resulting in wide variation in childbirth practices: Where, how, with whom, and even when a woman gives birth are increasingly culturally determined. In 1908 French ethnographer Arnold van Gennep (1873–1957) noted that cultures ritualize important life transitions—of which birth is a prime example. Birth practices reflect and reveal the core values and beliefs of the culture, telling the observer a great deal about the way that culture views the world and the place of women in it. Many religions, including Judiaism and Zoroastrianism, regard birth as polluting and require ablution and isolation for purification afterward.

Where women's status is high, a rich set of nurturant traditions tends to develop around birth; where it is low, the opposite may occur. For example, in the highly patriarchal Islamic society of Bangladesh in which the status of women is low, childbirth (like menstruation) has traditionally been regarded as highly polluting. Before modernization, women gave birth on dirty linens, attended only by female relatives or traditional midwives who were themselves regarded as polluting. In contrast, in the matrilineal societies of Polynesia where the status of women is high, pregnant women are pampered and nurtured. Skilled midwives administer frequent full-body massages during pregnancy and have a rich repertoire of techniques for assisting women during labor and birth.

THE EFFECTS OF PLACE OF BIRTH

Anthropologist Brigitte Jordan's comparative study of birthing systems in the Netherlands, Sweden, the United States, and Mexico's Yucatan, originally published in 1978, was the first to comprehensively document the wide cultural variations in birth. Her biocultural approach utilized the definition of birth, the place of birth, birth attendants, artifacts utilized to facilitate or control birth, and differences in knowledge systems about birth as foci for cross-cultural comparison.

Among these factors, place of birth has emerged as most salient for how birth happens. In home settings across cultures, from huts to houses, childbirth occurs according to the natural rhythms of labor and women's social routines. In early labor, women move about at will, stopping their activities during the 45 seconds or so per contraction, and then continuing their activities (which may include doing chores, chatting, walking, eating, singing, and dancing). Such activities subside as the women begin to concentrate more on the work of birthing, often aided in this labor by massage and emotional support from their labor companions, who are usually midwives. Many cultures have set patterns about who should be present at the birth (sometimes the father, sometimes only women, sometimes the whole family and/or friends), how labor support should be provided, what rituals should be performed to invoke the help of ancestors or spirits, and what herbs and hand maneuvers may be helpful to assist a birth or stop a postpartum hemorrhage. When birth is imminent, women at home usually take upright positions, squatting, sitting, standing, or balancing on hands and knees, often pulling on a rope or pole or on the necks or arms of their companions, and work hard to give birth. Postpartum practices vary widely: Some cultures encourage early breastfeeding, some define colustrum as harmful and feed the baby other fluids until breastmilk comes in (a practice now known to be medically dangerous—many babies die from imbibing contaminated water). Steam and herbal baths and periods of postpartum confinement are often culturally prescribed, varying in length from a few to forty days.

Where freestanding birth centers exist staffed by professional midwives, the experience of birth is resonant with the experience of birthing at home—a free flow. There are no absolute rules for how long birth should take. As long as the mother's vital signs are good and the baby's heartbeat is relatively stable, trained attendants allow the birth process to proceed at its own pace, keeping their focus on the needs of the mother, encouraging her to eat and drink at will, and to move about freely, adopting positions of her choice.

Birth in the hospital is an entirely different experience. The biomedical model dominant in hospitals demands that birth follow a certain pattern, including cervical dilation of 1 centimeter per hour—an arbitrary rule unsupported by science but consistent with industrial patterns of production. Ensuring the mechanical consistency of labor requires frequent manual checking of cervical dilation, which, if determined to be proceeding too slowly, will be augmented by breaking the amniotic sac and intravenous administration of the synthetic hormone pitocin (syntocinon) to speed labor. Women are often not allowed to eat or drink, and thus are routinely hydrated through intravenous lines, which also facilitate the administration of pitocin and other drugs. Electronic fetal monitoring to record the strength of the mother's contractions and the baby's heartbeat is pervasive in hospitals in developed countries, in spite of the fact that its routine use does not improve birth outcomes but does significantly raise cesarean rates because hospital personnel often misinterpret the monitor tracings, seeing an impending crisis where there is none. (Intermittent auscultation by a nurse, doctor, or midwife has been proven to be far more effective in identifying emerging problems.) Episiotomies to widen the vaginal outlet at the moment of birth are also common, although scientifically demonstrated to be unnecessary in 90 percent of births. Such routine obstetric procedures have been interpreted by cultural anthropologist Robbie Davis-Floyd as rituals that symbolically enact and display the core values of the technocracy, which supervalues progress through the development and application of increasingly advanced technologies to every aspect of human life, including reproduction.

IMPACT OF THE BIOMEDICAL MODEL ON BIRTH IN DEVELOPING COUNTRIES

The growing worldwide supervaluation of high technologies has induced many developing countries to suppress viable indigenous birthing systems and import the biomedical model from developed nations even when it is ill suited to the local situation. Hospitals built in the Third World may lack basic supplies such as bandages, clean sheets, and fresh needles yet be stocked with high-tech equipment. Hospital staff often has little understanding of or respect for local birth traditions and values, with the result that local women often avoid such hospitals. From northern India to Papua New Guinea to Mexico, indigenous women voice concerns about biomedical hospitals and clinics in both rural and urban areas: "They expose you;" "they shave you;" "they cut you;" "they leave you alone and ignore you, but won't let your family come in;" "they give you nothing to eat or drink;" and "they yell at you and sometimes slap you if you do not do what they say." Ironically none of the rules and procedures these women find so alarming are essential to good obstetric care; rather they reflect the importation of the culturally insensitive technocratic approach.

The transglobal imposition of this model on childbirth, sold to goverments as modern health care and to women as managing risk and increasing safety in birth, has resulted in an explosion of technological interventions in birth unprecedented in human history, including numbers of cesarean sections. Despite the World Health Organization's (WHO) demonstration that cesarean rates should never be above 15 percent, cesarean rates for Taiwan, China, and Puerto Rico are well above 40 percent; for Mexico, Chile, and Brazil are at around 40 percent; for the United States are 30.2 percent, and for Canada and the United Kingdom are 22 percent. Physician convenience and economic gain, combined with deeply ingrained medical beliefs that birth is a pathological process that works best when technologically controlled, are other factors in the recent rise in the number of cesareans performed. The WHO standard is met in the Netherlands, with a cesarean rate of 12 percent, and is reinforced by the excellence of birth outcomes in that country. This success is entirely cultural: The definition of birth as a normal physiological process in the Netherlands, in combination with Dutch cultural values on family, midwifery care, and careful attention to scientific evidence, have led to minimal interventions in hospital birth and the high home birth rate (30%) in that country. In contrast, in most of the developed world, home birth rates hover around 1 percent, despite the demonstrated efficacy and safety of a planned, midwife-attended home birth.

CONTESTING BIOMEDICAL HEGEMONY

The massive disparity between the scientific evidence in favor of less intervention in birth and the increasing interventions in actual practice reflect widespread acceptance of the technocratic model of medicine—a model developed by white male physicians—as the model on which to base developing health care systems. The hegemony of this approach is ensured by the political and economic benefits to physicians and technocrats from the imposition of the model, the forces of globalization and their concurrent trends toward increasing technologization, and women's concomitant faith in the model as the safest practice.

Nevertheless this hegemony is heavily contested. In addition to the thousands of local birthing systems, two other paradigms for contemporary childbirth exist throughout the world: The humanistic and holistic models. The highly patriarchal technocratic model of biomedicine metaphorizes women's birthing bodies as dysfunctional machines and encourages aggressive intervention in the mechanistic process of birth. The reform effort located in the humanistic model stresses that the birthing body is an organism influenced by stress and emotion and calls for relationship-centered care; respect for women's needs and desires; and a physiological, evidence-based approach to birth. The more radical holistic model defines the body as an energy system, stresses spiritual and intuitive approaches to birth, and places high value on the feminine. In dozens of countries, humanistic and holistic practitioners and consumer members of growing birth activist movements are utilizing scientific evidence and anthropological research to challenge the technocratic model of birth. They seek to combine the best of indigenous and professional knowledge systems to create healthier, safer, and more cost-effective systems of birth care.

Yet, from a crosscultural point of view, the focus on care of the individual limits all three paradigms. For example mortality resulting from birth is widely recognized as a massive global problem; more than 529,000 women die annually from complications of pregnancy and birth (including unsafe abortion). Biomedicine identifies conditions such as hemorrhage and toxemia as major causes of maternal death, and advises investment in doctors, hospitals, and rural clinics to provide prenatal care to prevent toxemia, and active intervention immediately after birth (i.e., administration of pitocin, cord traction for rapid removal of the placenta) to prevent hemorrhage. This biomedical approach makes it appear that problems inhere in individuals and should be treated on an individual basis, patient by patient, hospital by hospital. In contrast social science research in countries with the highest maternal mortality rates highlights the general poor health of women, who in many patriarchal societies suffer from overwork, exhaustion, anemia, malnutrition, and a variety of diseases resulting from polluted water, showing that the most important interventions required for improving women's health and for increasing safety in birth are clean water, adequate nutrition, and improved educational and economic opportunities for women.

BACK TO THE FUTURE: SCIENCE AND MIDWIFERY CARE

In the United States, obstetricians solidified their control over birth during the first half of the twentieth century and nearly eliminated midwifery by the 1950s. Since then the demands of many women for natural childbirth, coupled with scientific research into the dangers of interventionist hospital birth and the benefits of planned, midwife-attended births at home or in freestanding birth centers have generated a midwifery renaissance. Indeed in the four countries in which infant perinatal mortality statistics are the lowest in the world—Japan, the Netherlands, Sweden, and Denmark—more than 70 percent of births are attended by midwives who serve as the woman's primary caregiver throughout pregnancy, birth, and the postpartum period.

see also Anthropology; Fatherhood; Motherhood.

BIBLIOGRAPHY

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

Davis-Floyd, Robbie E., and Carolyn Sargent, eds. 1997. Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives. Berkeley: University of California Press.

DeVries, Raymond; Edwin van Teijlingen; Sirpa Wrede; and Cecilia Benoit, eds. 2001. Birth by Design: Pregnancy, Maternity Care and Midwifery in North America and Europe. New York: Routledge.

Jordan, Brigitte (1993). Birth in Four Cultures: A Cross-Cultural Investigation of Childbirth in Yucatan, Holland, Sweden and the United States. 4th edition. Prospect Heights, IL: Waveland Press.

Kalpana, Ram, and Margaret Jolly, eds. 1998. Maternities and Modernities: Colonial and Post-Colonial Experiences in Asia and the Pacific. Cambridge, UK: Cambridge University Press.

Lukere, Vicki, and Margaret Jolly, eds. 2002. Birthing in the Pacific: Beyond Tradition and Modernity? Honolulu: University of Hawaii Press.

Murphy-Lawless, Jo. 1998. Reading Birth and Death: A History of Obstetric Thinking. Bloomington: Indiana University Press.

Van Hollen, Cecilia. 2003. Birth on the Threshold: Childbirth and Modernity in South India. Berkeley: University of California Press.

                                            Robbie Davis-Floyd

Birth

Birth, or parturition, in mammals is the process in which a fully developed fetus is expelled from the mother's uterus by the force of strong, rhythmic muscle contractions. The birth of live offspring is a reproductive feature shared by mammals, some fishes, and selected

invertebrates (such as scorpions), as well as some reptiles and amphibians . Animals who give birth to live offspring are called viviparous (meaning "live birth").

In contrast to viviparous animals, other animals give birth to eggs; these animals are called oviparous (meaning "egg birth"). Some oviparous species , such as birds , retain their eggs inside their bodies for long periods of time ; in these animals, the eggs are laid at an advanced stage of development. Other animals, such as frogs , give birth to less developed eggs, which undergo development outside the mother's body.

Viviparous animals

In both viviparous animals and oviparous animals, fertilization of the mother's egg with the father's sperm takes place inside the mother's body. One of the advantages to giving birth to live young is that the mother protects the fetus inside her body as it develops. The developing fetus derives nutrients from the mother's body, and so is assured of receiving all the nourishment it needs to complete development.

The length of time between fertilization and birth in viviparous animals is called the gestation period. The length of the gestation period varies according to species. The gestation period of mice is 21 days, of rabbits is 30-36 days, and of dogs and cats is 60 days. The largest mammal, the baleen whale, has a gestation period of 12 months—only three months longer than the gestation period of humans. Elephants have one of the longest gestation periods of all animals, 22 months.

Some viviparous animals such as humans, horses , and cows, give birth to only one offspring at a time, although occasionally these animals produce twins or triplets. Other animals give birth to many offspring at a time. Usually, the multiple offspring in a litter are each derived from a separate egg, but the armadillo gives birth to four identical offspring that are derived from the same fertilized egg.

How does birth begin?

At the end of the gestation period, the mother's uterus begins to contract rhythmically, a process called labor. The initiation of labor leading up to birth is the result of a number of hormones , notably oxytocin.

Maternal progesterone

Shortly after fertilization the hormone progesterone increases and is maintained at high levels in the mother's bloodstream. The high levels of progesterone prevent the uterus from contracting. The progesterone prepares the

lining of the uterus (the endonestrium) for its supporting role in nurturing the developing fetus, and helps form the placenta. Maternal progesterone levels begin to drop during the last weeks of gestation, while the levels of estrogen begin to rise. When progesterone levels drop to very low levels and estrogen levels are high, the uterus begins to contract.

Oxytocin

Oxytocin is a hormone released from the pituitary gland in the brain , which stimulates uterine contractions and also controls the production of milk in the mammary glands of the breast (a process called lactation). Synthetic oxytocin is sometimes given to women in labor to induce labor.

The mechanism that prompts the secretion of oxytocin from the pituitary during labor is thought to be initiated by the pressure of the fetus's head against the cervix, the opening of the uterus. As the fetus's head presses against the cervix, the uterus stretches, and relays a message along nerves to the pituitary, which responds by releasing oxytocin. The more the uterus stretches, the more oxytocin is released.

Fetal endocrine control

Fetal hormones are also thought to play a role in initiating labor. At the end of gestation, the fetal adrenal glands secrete steroid hormones called cortico steroids, which cause the hormone-like substances known as prostaglandins. Prostaglandins contribute to the contraction of the uterus during labor.

Birth in humans

Labor culminating in birth in humans begins with the rhythmic contractions of the uterus, which dilate the cervix. This causes the fetus to move down the birth canal and be expelled together with the placenta, which had supplied the developing fetus with nutrients from the mother. Ususually, the entire birth process takes about 16 hours, but it can range anywhere from less than one hour to 48 hours.

The first stage: dilation of the cervix

In order for the fetus to leave the uterus and to enter the birth canal, it must pass through the cervix, the opening of the uterus. The cervix is normally tightly closed, and is sealed with a plug of mucus during gestation to protect the fetus from invading microorganisms . During the first stages of labor, the contractions of the uterus dilate the cervix, which widens to about 4 in (10 cm), to accommodate the passage of the fetal head.

In the last weeks of pregnancy, before labor begins, the uterus undergoes irregular contractions, which serve to exercise the muscles of the uterus and may even dilate the cervix; it's not unusual for a woman to go into active labor with a cervix that is already dilated to 1 or 2 cm. During the last weeks of pregnancy, the cervix also thins out (or effaces), which makes dilation easier.

In preparation for birth, the fetus moves further down into the mother's pelvis. When labor begins, the fetus is usually positioned with its head engaged with the top of the cervix. This engagement is called "lightening" or "dropping." When labor begins, the contractions loosen the mucus plug in the cervix causing small capillaries in the cervix to break, and the mucus and blood are discharged from the vagina. This discharge is sometimes called "bloody show" and signals the onset of labor.

Another sign that may signal the beginning of labor is the rupturing of the amniotic sac. In the uterus the fetus is encased in a membrane (the amniotic sac) and literally floats in amniotic fluid. When uterine contractions begin, this sac ruptures and the amniotic fluid can leak from the uterus. Not all women experience an abrupt rupturing of the amniotic sac; in some, the amniotic fluid gradually leaks out as labor progresses. Once the amniotic sac has ruptured, or the amniotic fluid begins to leak, labor usually progresses more rapidly. During the first stage of labor, the cervix dilates about 0.5-0.6 in (1.2-1.5 cm) an hour. The uterine contractions are 5-30 minutes apart, and last for 15-40 seconds. The end of the first stage of labor is associated with the strongest uterine contractions. Contractions are two to five minutes apart, and last for 45-60 seconds. The cervix opens rapidly at this point. This period of labor, sometimes called transition, is usually the most difficult for the mother. The contractions are very strong and close together, and nausea and vomiting are common. After the cervix has dilated to its full width of 4 in (10 cm), the contractions slow down somewhat to about three to five minutes apart. The fetus is then ready to be born, and the second stage of labor begins.

The second stage: birth

During the second stage, lasting about one to two hours, the mother uses her abdominal muscles to push the fetus through and out of the birth canal.

The pushing is actually a reflex action, but if a woman can help the reflex by actively using her muscles, birth goes much faster. As the fetus moves down the birth canal to the vaginal opening, the head begins to appear. The appearance of the head at the opening of the vagina is called crowning. After the head is delivered, first one shoulder is delivered, then the other. The rest of the body follows.

After the baby is born, the umbilical cord that has attached the fetus to the placenta is clamped. The clamping cuts off the circulation of the cord, which eventually stops pulsing due to the interruption of its blood supply. The baby now must breathe air through its own lungs.

The third stage: delivery of the placenta

Before delivery, the placenta separates from the wall of the uterus. Since the placenta contains many blood vessels, its separation from the wall of the uterus causes bleeding. This bleeding, if not excessive, is normal. After the placenta separates from the uterine wall, it moves into the birth canal and is expelled from the vagina. The uterus continues to contract even after the placenta is delivered, and it is thought that these contractions serve to control bleeding.

History of childbirth

Until the twentieth century, childbirth was the province of women. A woman giving birth was attended by her female relatives and perhaps a woman in the community known for her midwifing skills. As the scientific revolution of the seventeenth century took place, concerned physicians noticed that childbirth was sometimes a dangerous, often fatal, process. Infections, injury to the baby and mother, and death occurred when unskilled midwives attempted to manage complications. Gradually, childbirth changed from an entirely female-centered activity to a medical process overseen by predominately male physicians. By the early twentieth century, childbirth moved from the home to the hospital. By the mid- twentieth century, childbirth had become a completely medical process, attended by physicians and managed by medical equipment and procedures, such as fetal monitors, anesthesia , and surgical interventions.

Later in the twentieth century, some women became dissatisfied with this medical approach to birth. Many felt that the medical establishment had taken control of a natural biological process. Women wanted more control over labor and birth and new ways of giving birth that sought to reduce or eliminate the medical interventions became popular. With the increasing concern about the effect of anesthesia on the fetus, many women refused artificial means of controlling pain , and instead relied on breathing and relaxation techniques. Fathers, once banished from labor and delivery rooms, were now welcomed as partners in the birth process.

Today, women have many options for labor and birth. Some women deliver in a hospital with doctors and nurses close by to supervise the birth process. Others choose a nurse-midwife, a person who has been trained to deliver babies but who is not a doctor. Still others choose home birth, attended either by a doctor or midwife, or sometimes both. Whatever option a woman chooses, it is important to get good medical care throughout pregnancy. Periodic prenatal checkups are one of the best ways to avoid birth complications.

Types of childbirth preparation

Many childbirth experts believe that the more a mother knows about the birth process, the less fear and apprehension she will feel giving birth. Many childbirth preparation methods prepare both mother and father for the birth experience and teach relaxation and breathing techniques. The Read method, for instance (named after its founder, British physician Grantley Dick-Read), is based on the notion that fear leads to pain. The Read method includes childbirth education, exercises to improve muscle tone, and relaxation techniques. The Lamaze method (named for Dr. Ferdinand Lamaze) takes a psychological approach to managing labor. The Lamaze method teaches women to relax and breathe in response to pain, the theory being that this substitution of favorable activity for negative sensations reduces pain. The Bradley method focuses on deep relaxation and slow, deep breathing, and ascribes an important role to the father.

Types of anesthesia

Two types of anesthesia are commonly used during labor and birth. In general anesthesia, the mother is given drugs that put her to sleep , but this type of anesthesia is rarely used today, since the drugs can depress the fetal heart beat. In regional anesthesia, drugs are injected to deaden sensation around the spinal nerves that carry sensations from the pelvic region. Controversy about whether these drugs affect the fetus is ongoing, although some kinds of regional anesthesia affect the fetus less than others.

See also Embryo and embryonic development; Reproductive system; Sexual reproduction; Viviparity.

Resources

books

Bean, Constance A. Methods of Childbirth. 2nd ed. Garden City, NY: Doubleday, 1990.

Karmel, Marjorie. Thank You, Dr. Lamaze. New York: Harper and Row, 1993.

Knobil, Ernst, and Jimmy D. Neill, eds. The Physiology of Reproduction. 2nd ed. New York: Raven Press, 1994.

Korte, Diana. The VBAC Companion: The Expectant Mother'sGuide to Vaginal Birth After Cesarean. Cambridge, MA: Harvard Common Press, 1999.

Mitford, Jessica. The American Way of Birth. New York: Dutton, 1992.

Moore, Michele, and Caroline De Costa. Cesarean Section:Understanding and Celebrating Your Baby's Birth. Baltimore, MD: Johns Hopkins Medical Press, 2003.

periodicals

"Deciding to Be Born." Discover 13 (May 10, 1992).

Fischman, Joshua. "Putting a New Spin on the Birth of Human Birth." Science 264 (20 May 1994): 1082.

Ventura, S.J. "Births: Final Data for 1999." Service Today 49, no. (2001): 1-100.

Kathleen Scogna

KEY TERMS

Amniotic fluid

—The fluid in which the fetus "floats" in the uterus.

Amniotic sac

—The sac that contains the amniotic fluid.

Gestation

—The period of carrying developing offspring in the uterus after conception; pregnancy.

Labor

—The strong, rhythmic contractions of the uterus leading to birth.

Placenta

—The organ that develops during gestation through which a fetus receives nourishment from the mother.

Prostaglandins

—A substance released by uterine cells that cause contraction of the uterus.

Umbilical cord

—The cord that attaches the fetus to the placenta.