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Description
Abstract: Despite ongoing challenges, the medical approach to maternal care that achieved preeminence in the early 1920s has prevailed. Increasing evidence that fictionalized accounts of important social issues can influence the ways people make sense of and make choices with regard to their health may suggest popular media representations of pregnancy and childbirth facilitate the cultural indulgence of the medical model and contestation of the midwifery model. In this analysis, l focus on three prime-time television series: Dharma & Greg, The Gilmore Girls and Girlfriends, each of which featured a storyline in which one of the characters has chosen a midwife for her primary attendant in an uncomplicated pregnancy/childbirth. I argue that these representations craft coherent narratives of midwife attended births that stand in sharp contract to the midwifery model and invoke and support rationales of the medical model. In sum, these representations undermine the midwife-attended birth as an irrational choice, depict the midwife as a controlling bitch, and ultimately affirm the need for the dominant medical model.
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Regardless of an individual woman's situation, the experiences of pregnancy and childbirth engender expectations, desires and concerns; thus, women seek advice, guidance and care from others with experience and knowledge of the contingencies of these processes. Today, two different models guide maternal care: the medical model which presumes pregnancy and childbirth to be inherently pathological and thus dangerous and the midwifery model which views pregnancy and birth as normal and healthy events. The ideological contrast between these two approaches has significant implications for associated practices and, notably, for maternal and infant outcomes (Robbie Davis-Floyd, 1992; Engel, 1977; Rooks, 1997; Rothman, 1989; Simonds, 2002). (1) Briefly, the midwifery model provides appropriate intensive personalized care for women experiencing uncomplicated pregnancies (2) and the medical model usefully addresses physiological complications as they arise throughout the pregnancy and birth.
In spite of ongoing challenges, the medical approach that achieved preeminence in the early 1920s has prevailed. Yet, the cultural privilege afforded to western medical practitioners, at least with regard to pregnancy and childbirth, is not a function of evidence-based reasoning that it results in better maternal and infant outcomes; indeed, there is no dearth of evidence that this is not the case (Chalmers, Enkin, & Keirse, 1989; Rooks, 1997). Rather, the cultural hegemony of the medical model is in large part due to sociopolitical forces that position the medical establishment to maintain control over health related matters (Zola, 1972). Henci Goer (1995) explains, "the virulence and hysteria with which midwifery has been attacked by doctors is a give-away that the driving force is not a rational assessment of the facts, but the threat to beliefs, power, and income" (p. 299). Paula A. Treichler (1990) points out that "A commonsense deduction from current statistics suggests neither tension nor contradiction, but consensus," given the preponderance of physician attended hospital births. She goes on to note "the feminist interpretation is different. Childbirth takes place in hospitals because there are few alternatives: yes, obstetrics has been successful--not in creating safe childbirth but in creating a monopoly" (p. 114). Others support Treichler's (1990) main premise that this monopoly is the inevitable outcome of the medical establishment's ability to accrue professional authority, material resources and, in particular, "linguistic capital" or "the power to establish and enforce a particular definition of childbirth" (p. 116). In short, the medical monopoly constitutes and is constituted by an ideological hegemony (Condit, 1994; Hall, 1997).
While some of the cultural indulgence of the medical model and contestation of the midwifery model has taken place in political debates (Miller, 1999), fictionalized accounts of pregnancy and childbirth in popular media have bolstered medically oriented ideologies with persistent images of the "normal" physician-attended hospital birth. Judith Rooks (1997) suggests that the experience of birth as "peaceful, obviously deeply satisfying, yet completely natural" and the suggestion that "women can and do go through it in ways that are positive, strong, and joyful ... has been lost, replaced by the usual television and movie depiction of childbirth as a clamorous emergency in which someone other than the mother, usually a physician, comes through as a hero" (p. 462). Notably, Rooks does not seem to be referring to depictions of the intentional use of a midwife as the primary attendant in uncomplicated pregnancy and childbirth. The omission is both telling and not surprising; there are few popular media representations of the latter and those available are highly problematic.
Few fictionalized prime-time episodes feature a storyline wherein one of the characters has chosen a midwife for her primary attendant in an attempt to demedicalize the pregnancy/birth and a birth that does not result in a visit to the emergency room. Not only are such representations a significant means of reflecting, maintaining and perpetuating common health-related ideological beliefs and values (Atkin & Wallack, 1990; Conrad & Kern, 1990; Foucault, 1994; Lupton, 1992; Parrott & Condit, 1996; Seale, 2004a, 2004b; Signorielli, 1998; Turow, 1989), given the contrasting ideologies that distinguish the midwifery model from the medical model, it might be expected that these storylines would represent childbirth narratives that challenge those that are more commonplace (i.e., representative of the medical model). Here I examine three fictionalized accounts that seemingly depict an alternative, and argue that even these narratives promote ideological inflections that recuperate the medical model and subvert the midwifery model of maternal care. (3)
I use qualitative textual analysis following guidelines set forth by Sonja K. Foss (2004) in her discussion of generative rhetorical criticism to identify and assess the latent content of prime-time fictionalized accounts of midwife-attended births. My goal is to identify relevant themes as reflected and constituted by popular media representations and to discuss their sociopolitical implications. In the following sections, I describe why/how these shows were chosen for analysis, use qualitative textual analysis to thematize the common narrative elements of three prime-time TV shows, and discuss sociopolitical implications of these representations for understandings of the midwifery model of maternal care.
Prime Time Midwife Stories
For analysis, I focus on episodes from Dharma & Greg, The Gilmore Girls and Girlfriends. First, here are basic plotline summaries and an explanation of why/how these shows were chosen for this study.
Plot Summaries
Gilmore Girls: "The Festival Of Living Art" First Aired November 2003
The show is about single young mother Lorelai and her teenage daughter Rory. Effervescent and droll Sookie is Lorelai's best friend and business partner. Sookie gives birth to her first child in this episode. Additional characters: Jackson--Sookie's husband; Beau--Jackson's visiting brother; Bruce--midwife
Dharma & Greg: "Midwife Crisis" First Aired November, 2000
The show is about the relationship between Dharma, the free-styling yoga-teaching daughter of bohemian parents Abby and Larry Fincklestein and her husband Greg, the attorney son of ultraconservative upper crust parents Kitty and Edward Montgomery. Abby's late in life pregnancy culminates in this birth episode. Additional characters: Chloe Spencer Chung - midwife.
Girlfriends: "And Baby Makes Four" First Aired November, 2003
The show is about the friendship of four African American women, Joan, Maya, Lynn, and Toni (who is shown shopping for a baby gift in this episode) and their male buddy William. In a previous episode, William's sister Linda has asked him to be a sperm donor for her lesbian partner Kira. In subsequent episodes, the pregnancy is mentioned sporadically and we don't meet Linda and Kira until they attend the baby shower William has asked Joan to host for the couple. Additional characters: Marsha--midwife.
Selection of Episodes
To select episodes for analysis, I searched for fictionalized accounts of midwifery or those which might "reach viewers who would otherwise not expose themselves to such information and do not fully realize that these messages may impact upon them" (Signorielli, 1993, p. x). Thus, reality shows such as A Baby Story were not included. Few such episodes exist. Episodes were primarily identified through my personal viewing. Having a... |
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