Sanctum/Surveillance

I went to Amy Romano's presentation at the Lamaze Conference about "Optimizing Labor Progress: What the Research Does and Does Not Tell Us." She cited a recent book that proposed a theory of birth territory. In Birth Territory and Midwifery Guardianship, Kathleen Fahy, Maralyn Foureur, & Carolyn Hastie discuss "sanctum" and "surveillance rooms" for giving birth. An excerpt from the book (the language is sometimes a bit dry, but the ideas are very compelling):

“Birth territory” is comprised of a physical terrain of the birth space over which jurisdiction or power is claimed for the woman. The terrain denotes the physical, geographical and dynamic features of the individual birth space impacting on women and babies. Jurisdiction refers to power and how it is used in the birth space and beyond, including the way maternity services are organized and managed. Birth territories affect how women feel and respond as embodied beings; either they feel safe and loved or fearful and self-protective. The aim for the midwife is to skillfully create optimal environments within which women feel safe and where normal labor and birth physiology remain undisturbed.

In particular, birth territory refers to the features of the birth room, here termed the “terrain,” and the use of power within the room, here termed “jurisdiction.”


Terrain
“Terrain” is a major sub-concept of birth territory. It denotes the physical features and geographical area of the individual birth space, including the furniture and fittings that the woman and her attendants use for labor and birth. Two sub-concepts, “surveillance room” and “sanctum,” lie at opposite ends along this continuum called “terrain.”

Sanctum
“Sanctum” is defined as a homely environment designed to optimize the privacy, ease and comfort of the woman; there is easy access to a toilet, a deep bath and access to or a view of the outdoors. Provision of a door that can close and lock from the inside meets the woman’s need for privacy and safety. The more comfortable and familiar the environment is for the woman, the safer and more confident she will feel. And experience of “sanctum” protects and potentially enhances the woman’s embodied sense of self; this is reflected in optimal physiological function and emotional wellbeing.

Surveillance room
“Surveillance room” is the other sub-concept of “terrain.” It denotes a clinical environment designed to facilitate surveillance of the woman and to optimize the ease and comfort of the staff. This is relevant to the concept of “jurisdiction” (discussed below) and it is consistent with Foucault’s notion of disciplinary power. A “surveillance room” is a clinical-looking room where equipment the staff may need is on display and the bed dominates. It has a doorway but no closed door, or the door has a viewing window so the staff can see into the room (not so the woman can look out). The woman has no easy access to bath, toilet or the outdoors.

Proposition
The more a birth room deviates from a “sanctum,” the more likely it is that the woman will feel fear. This deviation from the “sanctum” will in turn reduce her sense of self—it will be reflected in inhibited physiological functioning, reduced emotional wellbeing and possibly emotional distress.

Jurisdiction
“Jurisdiction means having the power to do as one wants within the birth environment. “Power” is an energy which enables one to be able to do or obtain what one wants. Power is essential for living; without it we would not move at all. Power is ethically neutral; this is consistent with Foucault’s notion of power which he argued was productive; not necessarily oppressive. Power can be used to get others to submit to one’s own wishes. Health professionals who want women to submit to their authority (to be docile) normally use a subtle form of coercive power that Foucault called “disciplinary power.” The concept of jurisdiction is directly relevant to “midwifery guardianship” which is the topic of the next chapter in which the theory of birth territory continues to be developed.

To illustrate, here are photos of my own sanctum and a surveillance room in my local hospital.

Sanctum checklist: 

• homely, comfortable and familiar environment
• room designed to optimize privacy, ease and comfort
• easy access to a toilet (there's a small full bath, which you can see in the bottom photo)
  
• a deep bath
• access to or a view of the outdoors (I can look out the window or just walk downstairs and go outside)
• a door that can close and lock from the inside

Surveillance room checklist

• a clinical environment designed to facilitate surveillance of the woman 
• optimizes the ease and comfort of the staff
• equipment the staff may need is on display
• the bed dominates (note the bed's central location, framed by the linoleum inlay)
  
• It has a doorway but no closed door, or the door has a viewing window so the staff can see into the room (not so the woman can look out). You can't lock the door to the room, or the door to the bathroom, which has been the case with every hospital birth room I've been in.
  
• The woman has no easy access to bath, toilet or the outdoors (this hospital room has a bath and tub. The window looks out on a parking lot. There are some trees off in the distance, but I don't think we can argue this constitutes "access to the outdoors.")
  

I have some questions and requests:

• How can we create a sanctum within a clinical/institutional environment--for all those women who can't/don't wan't to give birth in an out-of-hospital setting?
• Do you have any photos that illustrate a sanctum or a surveillance room? If so, please email them to me (stand.deliver @ gmail.com) and I will repost the best ones.