Wednesday, September 17, 2008

Visual representations of childbirth

How we visually represent the birth process is not just a minor detail, but a reflection of fundamental beliefs about the nature of birth and women's bodies. In other words, visual depictions of women giving birth are politically charged texts, not just neutral representations of reality.

Take, for example, the almost universal lithotomy (or in layman's terms, stranded beetle or beached whale) position in illustrations of the birth process. This position is certainly not culturally consistent or physiologically appropriate in most cases. It emerged out of a particular set of historical circumstances and has become solidified in Western obstetric practice, despite it being one of the worst positions, mechanically, for the birthing mother. Not to mention more painful for most women! It is, however, more convenient for the birth attendant.

For example, these two 3-D videos of birth, showing the baby in relation to the mother's skeletal structure. They are beautiful illustrations, but of course they show the mother supine.

3D Medical Animation of Normal Vaginal Birth

Normal Birth Animation

My suggestion: tilt your head or your computer screen 90 degrees to view an upright birth (supported squat, birth stool, or sitting on a toilet) and 180 degrees to see birth on hands & knees. A simple but effective technology! If you are a doula, midwife, childbirth educator, or one of those wonderful progressive physicians, you can subvert the message of your existing supine illustrations by simply rotating them around, emphasizing to your clients the importance of giving birth in upright, physiological positions that work with gravity and the maternal pelvis. And, of course, stress that the woman should always have freedom of movement and position changes during labor and birth.

You might also have noticed that both of these animations show just the torso or the pelvis, rather than the entire woman giving birth. This is another artifact of a certain cultural view of birth and of women's role in the birth process. For a more lengthy discussion on this topic, please read Bearing Meaning: The Language of Birth. In particular, chapters 6-8 and 10-11 analyze the changing meanings and representations of birth in both Williams Obstetrics and Our Bodies, Ourselves.

One of the most remarkable departures from the disembodied-supine-torso representation of birth is this series of illustrations from Birth International, an Australian childbirth education and midwifery products company. They designed a series of six charts showing the birth process, designed to enable "women to develop confidence in being able to give birth." The illustrations show "a woman truly giving birth to her child, rather than being delivered of a baby." The charts' purpose is to teach women that they have the ability to birth their babies without assistance. The text comments: "If you want to show women how they can 'do it themselves,' then you need these pictures to reinforce your message."

Note that the charts show the whole woman in relation to the physiological process. The woman is upright and mobile, and because she is close to the ground, needs no one to "catch" the baby for her.

Now, I do take issue with some of the wording in the advertisement--that they are
"the only charts in the world that show birth in its truly natural state"--because the term natural is highly charged with multiple layers of meaning, some that are oppressive to women, some that essentialize female nature, and some that emphasize biological determinism. However, I find Birth International's political project admirable. These charts call into question the "natural" position of lying on one's back, integrate the woman giving birth back into the baby's descent and emergence, and encourage confidence and power in the birthing woman.


  1. As always, such pertinant and beautiful information.
    Thank you!
    Oh and CONGRATS on the recent, exciting news. I cannot wait to follow your pregnancy and birth journey...

  2. Thanks for the pictures. I realized that people think of birth in the supine position as "normal" when I got into a discussion about posterior. I said that posterior meant the baby's face was facing forward- its neck and spine against your spine. They kept saying posterior was when the baby was facing "up." I could not for the life of me figure out what "up" meant until I realized they've only seen birth with the woman on their back. After realizing this, I explained that I gave birth on my knees, so "up" didn't mean anything to me- hence the confusion!

    But great pics!

  3. You can also give birth on your hands and knees while you have an epidural. Problem is most Doc's wont agree with me. Most women are more comfortable in the up right hands and knees position. But most women also want an epidural which is fine. I would love to see more woman be able to birth upright with an epidural but changing folks minds is tough.

  4. Oh I'd love to get these charts! The charts I have show the physiological process of birth, but with the woman lying on her back, and the attendant "supporting" the head.

    not that it's bad. but it is so typical of what a woman would expect. i'd like to change that line of thought.

    in the last chart i would have so loved to see her holding the baby.

  5. Awesome pictures. I wish I'd had these to show my boys before Rachel's birth. Oh well. They saw the real thing anyway.

  6. Those are awesome pictures, thanks for sharing. And the analysis is spot on.

  7. "But most women also want an epidural which is fine."
    I don't believe most women want an epidural. Most women just don't get the kind of support they need to labour without one. And most women are induced, which leads to a much more painful labour that most women can't cope with without drugs.

    If most women were left to go into labour when their babies and their bodies were ready, and if most women were given one-to-one support from a trusted caregiver with whom they had built up a relationship over time, most women would not want an epidural. So it's not "fine" that most women want an epidural, it's a sign that most women are not supported and cared for by the current system - and that's anything BUT fine.


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