Birth, death, and media: My Downton Abbey eclampsia blog post.

My husband and I recently discovered Downton Abbey (he's actually way more into it than I am, which I find endlessly endearing), and we got to the eclampsia episode last night. I feel a little silly, because I'm not someone who dissects TV shows in blog posts, but here we are. I talk to a lot of women about their fears around birth, and I'm sensitive to how childbirth is portrayed in the media and generally critical of negative portrayals of birth. A few observations:

  1. The "bad" doctor praised her birth as natural and normal, and praised her body as able to birth.
  2. He was wrong; she was not experiencing a healthy labor, and the proper course of action was for her to immediately go to the hospital and have a cesarean, as the "good" doctor insisted.
  3. As the "bad" doctor had greater prestige, the family followed his decision and as a result Sybil died.

I don't think I've ever heard a doctor in the media describe a birth as healthy or normal. In what anthropologist Robbie Davis-Floyd refers to as our "technocratic" society's model of birth, childbirth is envisioned as unpredictable, uncontrollable, and pathologized, and the female body is a broken machine in need of management. In this model, "the interests of science, technology, patriarchy, and institutions and held superior to--and are often imposed on--those of nature, individuals, families, and most especially (because of their devaluation under the technocratic model) women." So, to hear a doctor describe Sybil's labor this way was refreshing, because it suggests an alternative to the hegemonic medical model that so many of us struggle against. Such a statement created an opening, an entry point into seeing birth from a different perspective. That is, the perspective that birth is in fact a normal physiological process.

However, the "bad" doctor was wrong. Sybil was displaying clear symptoms of preeclampsia, the most obvious to me being swelling of her ankles and severe headache, which her "good" family doctor picked up on and became alarmed by. He urged the family to rush her to the hospital for surgery, which we understood by the end of the episode as something that might have saved her life.

Two thoughts on this. First, because we no longer live in communities where childbirth is a direct part of our lives, the media is unfortunately the place where most women first learn about birth. It also shapes the expectations most women will have for their own births (this is one of the things we work on with HypnoBirthing). So it's sad to see a rare example of a doctor praising a woman's inherent ability to birth, and being blind to the truth of her situation. This actually negated the work that the praise could have done in the minds of viewers, had her birth been normal, and reified the idea of birth as pathological.

The "bad" doctor came off as irresponsible, foolish, and ignorant. There are people who make these assumptions about midwives. In fact, this was one of the tropes used by the expanding medical establishment during the same era as Downton Abbey to turn women away from midwifery care and into the hospital, which was far more brutal and dangerous a place to give birth at the time. Midwives were portrayed as uneducated, foolhardy, irresponsible, backwards, low-class, criminal, and that they were immigrants, "The Other." This perspective, when and where it persists, is uninformed and ignores midwives' extensive direct experience and evidence-based training, including their keen perception of what is normal and not normal and what necessitates medical intervention. Praising women's ability to birth in safety is not the same thing as assuming that all birth is always safe. I think about these issues more and more as I begin my studies in midwifery.

The second thought is that the doctor with the most prestige ignored her symptoms. What I'm underscoring here is that prestige does not make a good practitioner. It also works the other way; a good doctor (or midwife) is a person who, when there is no indication of distress, is patient. When we give authority to someone simply because they have prestige, as many women and couples do when they hire "the best doctor in town," they may not understand that most doctors want to "do something," to intervene and manage birth. This may result in a healthy baby (though not always), but it may also leave women feel bewildered, upset, out of control of their own body, that their body is lacking or that they're a failure. A growing body of evidence suggests that there are many short and long term benefits of mothers' emotional, spiritual, and physical well being during pregnancy and birth. Whether a care provider incorporates this information meaningfully into their practice makes a huge difference on women, their partners, and their babies' experience of birth. (Incidentally, I just finished reading Naomi Wolf's Misconceptions, which goes into this in depressing detail).

In Sybil's case, and in the case of women today with symptoms of preeclampsia, it's critical that there are medically appropriate means to save their lives and care providers with the training to recognize its early warning signs. I think it's great that organizations like Pathfinder have used the episode to raise awareness of preeclampsia and of their own work with maternal health worldwide, because it is outrageous that women die from preventable diseases due to lack of basic medical care.

As for the many more women with normal pregnancies and normal labors, it would be great to see those on television, and to hear their bodies praised as doing the good, hard work they're made to do.

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