© 2019 Natalia Shalygina
2019 — №1 (17)
Keywords: obstetrics, boundaries of the body, childbirth anthropology, motherhood, traditions, customs, rites of passage, prohibitions, psychotherapy during childbirth
Abstract: The article reviews the most important concepts of humanization of childbirth in the modern world generally and, particularly, in Russia. The cause for accentuating the Russian experience as a separate problem is obvious strengthening in the last years of “childbirth narrative” in the information space of the Russian Internet, where young Russians express discontent with the existing practice of obstetric care in maternity hospitals. However, their active evaluation of obstetric processes is characterized by a high uncertainty of values and principles. On the one hand, young women discuss the problem of the medicalization of childbirth; on the other hand, among Russian bloggers, the notion of childbirth humanization is gaining a better understanding. This notion takes into consideration women’s convictions and feelings, their dignity and independent decisions on obstetric care.
Natalya Valentinovna Shalygina is Cand. Sc. and Senior Research Fellow at the Ethnogender Studies Sector of the Institute of Ethnology and Anthropology, Russian Academy of Sciences (Moscow).
The experiences of Russian women during childbirth, taking place in maternity hospitals and under the supervision of doctors, over the past few years have become one of the most discussed topics in the Russian-speaking Internet communities. Many websites, such as Topmama.ru, Babyblog.ru, Deti.mail.ru, Stranamam.ru, U-mama.ru, Babyplan.ru, Forum.littleone.ru, Sibmama.ru, Mama.ru, Kidsreview.ru, Materinstvo.ru, Novmama.ru, are involved in online discussions of Russian obstetric practices. Moreover, women not only discuss obstetric care practices in Russian maternity hospitals but also actively create their own online communities, promote the most relevant topics using viral marketing, expand their discussion topics, and attract more and more like-minded people.
The obvious increase in the interest of Russians in obstetrics problems contrasts sharply with the Soviet period, when these problems were completely hushed up by public opinion and were discussed on a private level only. The reasons why the previously “nonpublic” topic has become the subject of wide and comprehensive discussion, at first glance, lie on the surface: globalization of information flows, unlimited opportunities for the exchange of views on social networks, the advantages of an open society that allows one to gain personal experience with medical services in others countries, etc. However, the collective reflections of young women on the Runet about the problems of obstetric care have their hidden reasons associated with the transformation of the mentality of Russians themselves in the modern world.
Correlation of the “spiritual” and “bodily” in obstetric practice
An anthropological study of corporeality in the structure of social space was conducted by the British anthropologist Mary Douglas (Douglas 1966), British sociologist and anthropologist Brian Turner (Brian 1994: 137–167), as well as by the Americans Albert Kreber and Thomas Parsons (Kroeber and Parsons 1958: 582–583), who contemplated the human body in general philosophical terms originating in the antiquity, when the body was understood as an integral part of the world, and nature as a whole. The conceptual developments of the “phenomenal body” of the French philosopher Maurice Merlot-Ponti echoing these ideas also reveal the unproductive rationalist tradition of contrasting the “spiritual” and “corporal”, which was formed at the dawn of Christianity (Merlot-Ponti 1999). The concept of separation ofthe “spiritual” and “corporal” was also in demand in the Soviet state ideology, which led to the neglect of many human needs at an everyday level, not excluding the practice of obstetric care in maternity hospitals
However, feminist theorists perceive the thesis of the separation of the “spiritual” and “bodily” as the doom for female nature, allegedly forever limited by the biological boundaries of the body and unable to reach the absolute heights of the human mind, as men can (Kupferman 1981). The American researcher Andrianna Rich suggested, for example, that childbirth and motherhood should be considered merely a part of a woman’s life. A woman’s body and its capabilities are a sociocultural phenomenon that, in Rich’s concept, should belong only to herself, and, therefore, only she can control it (Rich 1977: 21). Representatives of those areas of feminism that are convinced of the inherent value of female nature as a whole, view the female body in a slightly different way. In their opinion, the “female voice” in society should not be perceived as a distortion of the male voice, but, on the contrary, it should have its own sound, its own projection in any culture. Therefore, pregnancy, childbirth and motherhood should be perceived by society not so much as an alternative to male experience, with the latter viewed as the more important one, but as an independent value system equivalent to it (Raddick 1983: 87).
Understanding the problems of the female body and childbearing as the object of “anthropology of birth” is connected with the name of the American researcher of German descent Brigitte Jordan, who also had significant experience in obstetric practice. In her famous book Birth in Four Cultures: A Cross-Cultural Investigation of Childbirth in Yucatan, the Netherlands, Sweden, and the USA (1978), Jordan argues that childbirth in any country is an “internally consistent” phenomenon that depends entirely on the dominant cultural model. Thus, Jordan writes, in the United States childbirth is perceived as a purely medical procedure; in Yucatan, as a stressful part of family life, in Holland as a natural process, in Sweden as a woman’s personal success (Jordan 1993: 48). Jordan called the intervention of any biomedical mechanism in the culture of childbirth in other countries (especially Third World countries) a form of imperialism (Jordan 1993: 186) and “biomedical colonization” (Jordan 1993: 215). Defending the diversity of culturally determined practices of obstetric care, Jordan opposed a single, “cosmopolitan model of childbirth,” which is based solely on medical technology and eliminates the culturally conditioned specifics.
Pros and Cons of Childbirth Medicalization
The debate on the problem of a unified childbirth model, based on the medicalization of the process, became relevant by the mid-1970s. During these years, many countries in both South and North America actually abandoned vaginal delivery and almost completely switched to caesarean section. For example, Brazil at that time faced a real epidemic of caesarean sections, with the rates of 40 % in public health facilities and 84 % in the private ones (Belizán 1999: 1397–1400). This delivery model, where “the machine replaces the human universe,” was called “technocratic” by the American researcher Robbie Davis-Floyd (Davis-Floyd 1994: 44). It is the technocratic model of childbirth, according to Davis-Floyd, that prevailed in the USA, where dominant was the notion of childbirth as a pathological process requiring intensive monitoring by a doctor. That was why, obviously, medical procedures such as electronic fetal monitoring (EFM), epidural anesthesia, amniotomy, artificial birth, episiotomy, and caesarean section were becoming more common in the United States (Leeman 2003: 1115–1120). R. Davis-Floyd believed that the prevalence of the obstetric culture created by the scientific revolution over the nature of man inevitably began to reproduce the patriarchal relations of the sexes, making female bodies weak and dependent on technologies invented by men (Davis-Floyd 1994: 152). At the same time, the technocratic model of childbirth itself can have several varieties, depending on the complexity of social stratification in a given society. White middle-class Americans, for example, prefer the maximum use of modern medical technology in the process of childbirth, completely ignoring its ritual component. Thus, U. S. women, Davis-Floyd believes, are striving to become a full-fledged part of the technocratic American society as a whole.
A similar picture, according to many North American researchers, is characteristic of Canada. Professor W. Chalmers and her colleagues from the University of British Columbia (Vancouver, Canada) conducted a survey of Canadian women at the end of the 2000s based on a randomized sample of 8542 women living at the time of the survey in various provinces of Canada and having children aged 9 to 14 months. The survey was conducted using telephone interviews, and took an average of 45 minutes. The purpose of the survey was to study the perception by women of their pregnancy, childbirth and the first postpartum months. According to the members of the research group, the national indicators of perinatal health obtained by the Public Health Agency of Canada (PHAC) do not reflect the actual situation in this area and do not take into account the real assessment by Canadian women of the quality of medical management during their pregnancy and childbirth. According to a survey by Chalmers and her colleagues, almost 80 % of Canadian women consider the medical treatment of childbirth (and, in particular, the methods of pain relief) to be a very useful and necessary experience (Chalmers 2008: 217–228).
However, many Canadian specialists in the field of reproduction hold a different point of view, criticizing the technocratic obstetrics model. Excessive medicalization, according to this group of researchers, deprives a woman of a full-fledged sense of new motherhood and, on the other hand, contributes to her loss of control over her body (Hausman 2005: 23–38). The main goal of the alternative model of obstetric care, defined as “humanized,” is to make the experience of childbearing emotionally meaningful and generally positive, both for the woman and her family as a whole. Achieving this goal is ensured by giving the woman the right to choose the form of birth support (natural, home, medical, etc.), the right to make decisions during the delivery, the right to be treated with respect by obstetric staff, etc. (Wagner 2001: 25–37). Even experiencing pain is recognized as a woman’s choice.
Ethnocultural strategies of humanizing the birth (Japanese experience)
An important component of the humanized model of obstetric care is the orientation toward the sociocultural factors associated with childbirth. So, from the point of view of the followers of this childbirth model, what matters are the woman’s religion, the traditions of the ethnos to which she belongs, her family’s moral values, her social status, etc. Specialists from the Department of Family Medicine at McGill University of Canada (Montreal) argue that a gender-oriented approach to increasing women’s rights in the “male world” practically does not take into account the cultural background of women in labor, their experience of socialization and value orientations (Dillaway 2006: 16–41). This point of view is shared by Dr. Michael Klein, Emeritus Professor of Medicine at the University of British Columbia. In 2016, studying safety of obstetrics in rural areas, Klein came to the conclusion that pregnant women are guided mainly by the values dominating in their culture; therefore, to provide full assistance to women in labor, it is necessary to know and take into account specific historical and cultural conditions ( Klein 2016: 245–250).
Here I should add that Canadian scholars who advocate the principles of humanistic childbirth are conducting similar studies in other countries, e. g., in Japan, where deep-rooted historical and cultural traditions play a much more important role in the society, compared with the countries of North America. Members of the research team at the Department of Social and Preventive Medicine at the University of Montreal, for example, are convinced that the humanization of childbirth is a form of extension of women’s right to make their own choices, as it takes into account their values and feelings, and preserves the dignity and independence of women in childbirth (Behruzi 2010: 25).
In 2010, a group of scientists from this university conducted a fundamental study of some outcomes of the policy to reduce the childbirth medicalization initiated by the Japanese government in early 2000. The study was conducted in 9 maternity centers of the country (Tokyo, Okayama, Atsugi, Kamakura, Chiba and Kanagawa prefectures) and was based on methods such as observation, informal and semi-structured interviews, as well as qualitative content analysis. The data obtained allowed us to conclude that, as a result of the state policy of reduction of excessive childbirth medicalization, most Japanese women prefer to avoid medical intervention during childbirth and, in case of normal pregnancy, refuse epidural anesthesia (Behruzi 2010: 25). Japanese obstetricians themselves have a rather limited involvement in cases of uncomplicated childbirths, as they consider birth a physiological rather than a potentially pathological event (Fiedler 1996: 195–212). It is important to mention that in 2009, perinatal outcomes in Japan were considered the best in the world, with infant mortality rate 2.7 per 1000 newborns. And this state of affairs, as it turned out in the course of the study, was achieved precisely by reducing the medicalization of childbirth, which had been actively carried out in the country over several years. A decade earlier, in the late 1990s, the Caesarean section in Japan was performed in 21 % of all births, this rate being comparable to contemporary North American rates (30 % in the United States and 27 % in Canada) (Leone 2008: 1236–1246). However, at the time of the study, none of the 9 maternity centers in Japan used, for example, intravenous infusion during normal pregnancy or routine episiotomy. All these procedures were used only by strict medical prescriptions and only for pregnancy pathologies.
It is important to emphasize that Canadian researchers, studying the Japanese experience in obstetrics, identified several groups of barriers that had previously prevented a decrease in medicalization of childbirth in that country. These barriers included, first and foremost, the institutionalized regulations for birth process in the country, as well as unforeseen circumstances, and situational factors (Reeves 2008). In addition, so-called facilitators have been identified that remove these barriers: prevention of unnecessary medical intervention, natural pain relief methods, women’s consent to this or that type of support in delivery, as well as long periods of postpartum rehabilitation.
Russian strategies for childbirth humanization (method of I. Z. Velvovsky)
Comparing the Japanese experience of a successful childbirth optimization policy with the existing obstetric practices in Russia, it should be recognized that the latter are actually devoid of any intelligible development strategy. It is notable that, as in Japan, the first full-fledged field study of the reproductive status of Russians was carried out around the same years, and also by foreign experts. The American anthropologist Michelle Rivkin-Fish, who, in the 1990s, studied women’s reproductive health in Russia, came to the conclusion that the Russian model of obstetric care is characterized mainly by excessive bureaucratization of the responsibility of Russian doctors: “In Russia, doctors do not have the degree of expert power and autonomy that in other societies allows them to impose their vision and control its implementation. The reason for this is a lack of resources and dependence on the state” (Rivkin-Fish 2005: 20–26).
It must be admitted that a certain inflexible institutional birth management policy does exist in Russia. Moreover, it has persisted for decades without any tangible changes. In 1949, the Soviet psychiatrist I. Z. Velvovsky was the first to develop a well-founded practical guide for physicians on the “Psychoprophylactic Method for Pain Relief of Childbirth” (Velvovsky 1963: 308). For the first time ever, it was proposed not to stifle the pain of women in childbirth, nor to fight it, but to eliminate the causes of pain. The focus was on exercises that bring about muscle relaxation. To some extent, this method turned out to be akin to the traditional anesthetic practices in archaic cultures, where the natural resources of the female body were utilized. The Velvovsky method, called the system of psychoprophylactic anesthesia of childbirth (С.П.О.Р. in Russian), provided for a whole range of measures and techniques aimed at preventing violations of the physiological course of pregnancy, maximizing the elimination of false anxieties, fears and negative emotions associated with childbirth, and also familiarization of women in labor with the basic physiological laws of the birth act and techniques that contribute to active behavior in childbirth.
But the most important thing was that the system of psychoprophylactic analgesia was supposed to encourage the restructuring of traditional views and ideas about the inevitability of suffering in childbirth. Velvovsky, in fact, suggested introducing a psychoprophylactic practice in maternity hospitals and antenatal clinics by training obstetrician-gynecologists and paramedical staff, as well as by raising the level of medical ethics in general. Careless statements by the medical staff, the scientist concluded, may cause psychopathological reactions in pregnant women, even lead to an abortion, given the fact that the period of early motherhood is phylogenetically characterized by increased vulnerability, sensitivity and suggestibility of women.
However, the recommendations of Velvovsky, who proposed the training of staff of obstetric institutions in the spirit of “sterility of words and behavior,” apparently did not fit into the Soviet traditions of that time. The statistics of the USSR reflected only such quantitative priorities of obstetric practice, as, for example, an increase in the number of beds in maternity hospitals, an increase in the number of medical personnel, the number of antenatal clinics, etc. (Women and children in the USSR 1969: 67–169). The most important psychoprophylactic indicators for the future life of mother and child were practically not taken into account. Monitoring of the psychological state of women in labor was in those years simply not in demand by Soviet obstetric practitioners.
Today, the method of psychoprophylaxis of birth pain has a well-deserved scientific recognition and is widely used in Russian obstetric practices. Neurophysiologists believe that childbirth is a natural physiological act and in neurodynamics it does not inevitably induce, that is, pain during childbirth can be prevented. Pregnancy management in Russian clinics provides a whole range of measures to prevent the so-called “painful scoring” of non-painful signals: preventing physiological pregnancy disorders, maximizing the elimination of women’s false anxieties and fears, familiarizing the women in labor with the physiological laws of the birth act, and restructuring traditional views and ideas about the inevitability of suffering in childbirth.
For this purpose, medical and educational methods and measures are used, such as: consultations on methods of psychoprophylactic preparation of a pregnant woman for childbirth, if possible from her first visit to her obstetrician on, with the necessary broadening of training in the following weeks; special forms of patronage aimed at creating favorable psychological conditions in the woman’s immediate social environment (husband, mother, etc.); certain psychological tactics of consulting pregnant women in antenatal clinics and especially women in labor in the hospital; special tactics of personnel behavior when managing delivery in a hospital, based on a combination of modern obstetric methods and taking into account the psycho- and neurodynamic laws of the birth act; educating staff of obstetric institutions in the spirit of “sterility of words and behavior” and building a regime of these institutions that combines the principles of activating and stimulating the person of a woman in labor, and organizing targeted health education in the society (Gaidukov, Smetankina, Durnov 2002: 22–65).
However, the existence of such practices in Russia has one significant “but”: such complex measures are applied in our country nowise consistently or universally. As a rule, all of the listed methods of pain relief relate to the so-called “childbirth under contract”. Women who are able to pay for professional management of their pregnancy and childbirth, make a contract with the clinic, which provides for all the necessary measures, including training for pregnant women, and guarantees tactful behavior of obstetric personnel. In most cases, childbirth care under a mandatory health insurance (MHI) in Russian maternity hospitals does not include psycho-prophylactic support, which is often ignored in official records.
Most modern Russian maternity hospitals have inherited Soviet traditions: “This is because the buildings themselves remained the same, and with them the technical capability. Many professionals had worked in the Soviet maternity hospital and continue to reproduce the Soviet approach, considering it the right one. We are talking about the centralized system and about the attitude to the patient. The Soviet model is reproduced at all levels” (Novkunskaya 2017).
Such conclusions are indirectly supported by other studies done in Russia. One of them, conducted by this article’s author in 2016 using in-depth interviews of 25 women in the city of Reutov (Moscow Region), has showed that the main reason of discomfort during their stay in maternity hospitals is connected to a high level of loyalty of obstetric medical personnel to the regulations and norms for birth process that are recognized in Russian health care (AFM). Analogous conclusions were made as a result of a sociological survey conducted in 2014 by the New Life Charitable Fund in conjunction with the League of Midwives of Russia. According to this study, the medical staff of modern Russian maternity hospitals are mostly women around 45 years of age or older, who received their medical education in Soviet times and tend not to adopt modern obstetric technologies. It is emphasized that the very scheme of training obstetricians in Soviet times broke down the course materials as follows: the study of pregnancy pathologies (28.3%), the provision of surgery to women during childbirth (25.8%), the study of ways to resuscitate the mother and the fetus (14 ,5%) (Obstetrics today 2014).
Reproduction of past experience in modern conditions brings about a complex and ambiguous reflection on the part of Russian women. Older generations of women testify, for example, that in Soviet times, pregnancy was often seen by medical personnel as the result of a sin that midwives had to remedy: “Their attitude is horrible, everyone looks down at us in conversations, everyone has no free time. We are perceived as sinners, who should suffer and thus atone for the very fact that we had a copulation… and, needless to say, unmarried women are treated like dirt” (Horrors… 2017). In addition, a woman in labor was blamed, by default, for all the drawbacks of the maternity hospital, such as lack of medicines, midwives and technical staff working overtime, imperfection of legally set rules, etc. “Winter 1984… You were not allowed to have any of your own clothes or bed sheets. A terrible hospital gown with strings and disgusting slippers – that’s what we, the unwashed animals, were supposed to wear… Hygiene products consisted of reusable hospital napkins and diapers sandwiched between the legs…. It was very cold outside, minus 25C. There was no hot water, relatives were not allowed to pass us a water-heater. My mom hid a water-heater in a pack of sugar, and all my ward-mates secretly used it. There were 12 of us in the ward. No bathroom; in the toilet everything was about to fall apart. It’s scary even to remember this…” (Horrors… 2017).
Young Russian women, if faced with an insufficiently comfortable conditions in the hospital and neglect by obstetric medical staff, perceive this state of affairs less passively and qualify it as a form of violence. In 2003, an article by the Russian cultural scientist E. A. Belousova, “Maternity Rite,” was published, which details cases of manifestation of this kind of perceived violence towards lying-in women in Russian maternity hospitals. Using an ethnomethodological approach, the author proposed to consider this practice a sort of initiation rite, within the framework of which unconscious reproduction of ritual roles by all participants of the delivery process takes place on the basis of verbal communication. Methodologically, as Belousova notes, her own approach to considering this problem differs from the American one (Robbie Davis-Floyd) in that the analysis of empirical material focuses on the verbal channel of communications, rather than on the ritualistic techniques characteristic of the so-called American rite of initiation in maternity hospitals (Belousova 2003: 19).
Despite a logically coherent series of arguments and rich empirical material, Belousova’s interpretation of acts of violence in maternity hospitals based on ritual practices caused serious objections among researchers. E. g., the sociologist Zira Naurzbaeva in her article “The Soviet Maternity Hospital as Initiation” (Naurzbaeva 2014) expressed fear that ritualistic practices can be used to explain any deviant actions, including, for example, harassment among servicemen, the laws of prison culture, etc. And, if there happens to rise a “culturological wave” of similar explanations, “magically” transforming outright cruelty and rudeness into ritual actions, Naurzbaeva believes, then there inevitably will appear another version of the “Russia’s special, third way”, not subject to the natural course of development of the global civilization. In her conclusion about Belousova’s article, Naurzbaeva even suggested the possibility of fulfilling by the author of a certain “social order” aimed at discrediting Russian culture as a whole.
An interdisciplinary approach to the study of Russian obstetric care
Such harsh statements about ritual interpretations of violence in childbirth, although seemingly somewhat exaggerated, clearly characterize the severity of the problems concerning obstetric care in modern Russia. Obviously, a sociological or culturological (anthropological, psychological, demographic, etc.) approach alone to analyzing today’s problems in this area will not be enough. An interdisciplinary approach that takes into account a wide variety of concepts is needed. And in this case, the conclusion that the introduction of humanized principles of obstetric aid in Russia is inhibited only by the bureaucratization of the medical system, clearly does not take into account many other sociocultural factors. Canadian researchers, for example, while developing a program for introducing humanized births in a particular country, suggest relying on its peoples’ cultural traditions, customs, and rites. The concept of humanized childbirth, which many Canadian scientists adhere to, is based, among other principles, on the fact that the territory and its sociocultural values and beliefs regarding childbearing can have a profound effect on the practice of childbirth (Behruzi 2010).
To this we can add that not only ethnographic factography should be taken into account when developing appropriate programs, but also knowledge of a higher, anthropological level. In Soviet times, purely anthropological theories developed by scientists from other countries were not, as a rule, taken into account (and, most likely, in Soviet times they were completely unknown). Meanwhile, it is the anthropological theories that unravel deep symbolic layers of human reproduction practices that can add clarity to obstetric problems. Thus, for example, the universal scheme of rites of passage, developed in 1909 by the French ethnographer Ludwig van Gennep (1873–1957), was out of the spotlight of Soviet medical science. According to this scheme, the entire cultural realm of diverse obstetric practices is subject to a certain general rhythm, which is a logical sequence of ceremonies that accompany the transition from one state to another, from one world (cosmic or social) to another. The transition itself (or liminality) is always associated with the deformation of the structure, hierarchy and status of the elements that make up one or another integral system, that is, with the destruction of the initial state of this system. Uncertainty and multi-layered process of destruction (transition, transformation) makes it especially difficult to understand. Gennep distinguished between three categories of transition rites: separation rites (preliminal), intermediate (liminal) rites, and inclusion rites (postliminal). The first category of transitional rites (preliminal) aims to make the familiar unusual, the second one (liminal) creates a game with abstract meanings, and the third one (postliminal) involves the installation of a new semantic complex (Gennep 1999: 64–107).
The rituals associated with pregnancy and childbirth, according to Gennep’s classification, can be classified as intermediate (liminal), making the autonomous, independent stage in the general scheme of transition rites. One of the most characteristic features of this stage is the high degree of its abstractness and, for this reason, the usually inevitable conjugation of the transition ceremonies with the functions of other rites (protective, predictive, redemptive, purifying, initiating, functions of communion with the deity, etc.). For example, with the help of protective rites (such as consecration of amulets for a pregnant woman, holding ceremonies that protect against the effects of evil forces, the imposition of prohibitions, etc.), they try to protect the woman as much as possible from early termination of pregnancy and from various pathologies; the effect of predictive rites (divination of the baby’s sex, health, fate, etc.) is aimed at creating a psychological connection between the mother and the yet unborn child; purification rites are performed for indirect cleansing of the original sin, in order to avoid its transition to the child; redeeming rites are supposed to imitate the ransoming of the child, thus propitiating the higher forces responsible for the well-being of the child.
Obstetric practices in Russian maternity hospitals are still filled with instinctive, archetypal ideas. In the Russian tradition, the functions of midwives were generally very diverse and consisted of performing the established customs and exorcisms, as well as keeping up old beliefs associated with childbearing. To “unleash” (accelerate) the birth, the midwife would undo the woman’s braid, untie all the knots on her clothes, walk the woman in labor until the latter was exhausted, hang her by the arms, shake her, beat her on the genitals, spray “with water right from charcoal” (boiling water), knead her stomach for the setting the fetus “straight”, etc. Moreover, the more such methods, supposedly accelerating the birth, the midwife knew, the more experienced and knowledgeable she was considered in the “woman’s job” (Development of Obstetrics in Russia 2010). Malorossian (Ukrainian) midwives, for example, dealing with prolonged childbirth, when the relatively harmless methods were exhausted, could start pulling on the umbilical cord, pronouncing “chick-chick” as if they were calling chicken (Development of Obstetrics… 2010). The reaction of modern girls to this kind of obstetric practice is most often the following: “…You can laugh, but no more than 2 weeks ago in the middle of our capital city, the amused midwives tried to speed up the placenta by pulling it by the umbilical cord. I wanted to kill them, but I didn’t even have the strength to fight. But if, in addition to that, they were muttering “chick-chick”, I would have tried to… Fortunately, a normal doctor came, got my muscles relaxed and squeezed the placenta out” (National obstetrics 2011).
Despite the critical attitude of young Russians to folk customs, the latter continue to maintain their authority. True, what was formed in the distant past, today, in fact, does not lend itself to rational reflection. Ritual practices are rooted at an unconscious level and persist for several generations of the bearers of culture, gradually losing, as a rule, the rational meaning of the ceremonial actions. In every society or social group, custom is a habitually observed part of everyday behavior that, despite having lost its primary purpose, has retained the function of regulating the norms of everyday life. The ritual practice of Russian obstetric aid, notwithstanding significant transformations, still retains many of its cultural and historical features (Shalygina 2017: 49).
For example, even today in Russian maternity hospitals it is customary to “buy out” a child, that is give a certain amount of money to the nanny who presents the baby to the welcomers and passes it to the father (by “coincidence”, the sum of money is usually “indexed” and corresponds to the foreign currency exchange rate). Pregnant women (of any age) try to observe these unwritten but widely accepted rules: they do not have their hair cut (so that the child does not turn bald), do not knit (otherwise the child may get tangled in the umbilical cord), do not get a tooth extracted (so that the child does not grow toothless), do not kick cats or dogs (otherwise the baby may be born with hair all over his body, which in the Russian tradition is called “to be born with a bristle”), etc. That is, according to the tradition, the mother-to-be must, with the help of multiple restrictions, accept and, in a way, model the portrait and even the destiny of her future child (Ethnic and Cultural Rites 2011).
In addition to ethnoscience, Russians are becoming more interested in the child-bearing traditions adopted by various peoples of the world. Today, for example, information on Mexican types of massage for pregnant women, Rebozo (Marikababy.ru, Natidoula.ru, Floatstudio.ru, etc.) is especially in demand on women’s websites of Runet. Reboso massage is performed with a special scarf (which, in fact, is called reboso) and is used at various stages of pregnancy, as well as after childbirth for swaddling the woman. When preparing the woman for childbirth, Rebozo massage is done to improve blood circulation (by stimulating hormone production); it also helps to relax the female body, and to develop the sense of love to her own body. The Reboso massage helps the woman to take the most comfortable posture during childbirth, and creates a positive mood for the woman in labor. Rebozo is believed to be one of the mildest techniques for accompanying childbirth, because it excludes direct contact between the hands of the doula (woman assisting during childbirth) and the body of the woman in labor. Rebozo scarf wrapped around a woman’s body creates slight swaying, helping her body to take the most comfortable posture.
Over the past few decades, several types of changes have occurred in the minds of Russian women regarding pregnancy and childbirth:
– the appearance of openness and a desire to publicly discuss the previously tabooed problems in this area;
– the expansion of the semantic space in discussion of pregnancy and childbirth. In contrast to the Soviet era, when women were primarily concerned about the conditions of staying in maternity hospitals, modern discussions in social networks and on forums of popular websites are increasingly moving towards the topics of alternative births, the rights of women in labor, violation of their physical boundaries in childbirth, the competence of obstetrics personnel in maternity hospitals, etc.;
– women’s looking to the traditional practices of obstetric care and their adaptation to modern conditions (the formation of a market for services for conducting the ritual of concluding the childbirth, Mexican Reboso massage for pregnant women, etc.).
These transformations indicate the interest among young Russian women in the processes of humanization of obstetrics, i. e. expanding the rights of women in labor and the possibility of choosing forms of childbirth. However, the following factors should be recognized as obstacles to the humanization of Russian obstetrics:
– a fairly noticeable gap between the hardened system of obstetric medical personnel’s professional attitudes and the views of young women on modern practices of obstetric care;
– inarticulate state policy regarding the expansion of the resource base of reproductive activity in the country (maintenance of maternity hospitals, closure of obstetric centers across the country’s regions, etc.);
– the reluctance of developers of social programs in the obstetric field to consider the positive component of folk traditions and customs of maternity practices, as well as the unconscious orientation of many women towards the experience of previous generations.
Akusherstvo: natsional’noye rukovodstvo [Obstetrics: national leadership] (2014) M.: GEOTAR-Media.
Akusherstvo segodnya [Midwifery today] (2014) Sotsiologicheskoye issledovaniye rossiyskikh vrachey, akusherok i rozhenits [A case study of Russian doctors, midwives and women in childbirth] (http://www.midwifery.ru/today/opros.htm) (18.04.2019).
Atlasov, V.V. (2012) V Rossii vsego 184 rodil’nykh doma [In Russia there are only 184 maternity hospitals] (http://www.online812.ru/2012/09/24/006/) (18.04.2019).
Belousova, Ye. (2003) Rodil’nyy obryad [Maternity Rite], Sovremennyy gorodskoy fol’klor [Modern urban folklore], Moscow: Russian State Humanitarian University, p. 339–369.
Behruzi, R., Hatem, M., Fraser, W., Gaulet, L., Li, M., Misago, Ch. (2010) Facilitators and barriers in the humanization of childbirth practice in Japan, British Medical Journal Pregnancy & Childbirth, 10(1), p. 25–43.
Belizán, JM., Althabe, F., Barros, FC., Alexander, S. (1999) Rates and implications of caesarean sections in Latin America: ecological study, British Medical Journal, 319(7222), p.1397–400.
Brayan, S.T. (1994) Sovremennyye napravleniya razvitiya teorii tela [Current trends in the development of body theory], THESIS [THESIS], Vol. 6, p. 137–167.
Cardwell, C.N. (2000) The Diagnostic and Statistical Manual of Mental Disorders, 5th ed., American Psychiatric Publishing, Washington, DC.
Chalmers, B., Dzakpasu, S., Heaman, M., Kaczorovski, J., (2008) The Canadian maternity experiences survey: an overview of finding, Journal Obstet Gynaecol, 30(3), p. 217–228.
Chaudron, L. H. (2003) Postpartum depression: what pediatricians need to know Pediatric Review, Vol. 24, p. 154–161.
Davis-Floyd, R. (1994) The Technocratic Body: American childbirth as cultural expressions, Social Scince Medical, Vol. 38, N 8, p. 1125–1140.
Dillaway, H., Brubaker, S.J. (2006) Intersectionality and childbirth: how women from different social locations discuss epidural use, Race, Gender & Class, 13 (3–4), p.16–41.
Fiedler, D.C. (1996) Authoritative knowledge and birth territories in contemporary Japan, Medical Anthropology, 10 (2), p. 195–212.
Forum Roddoma.ru [Roddoma.ru forum] (http://www.roddoma.ru/roddoma/chelyabinskaya-blast/859/otzyvy/) (18.04.2019).
Gaidukov, S.N., Smetankina, A.A., Durnov, O.V. (2002) Novyye tekhnologii podgotovki beremennykh zhenshchin k rodam [New technologies for preparing pregnant women for childbirth], The Manual, St. Petersburg State Pediatric Medical Academy (http://service.biosvyaz.com/website/lit/novye-tekhnologiii-podgotovki-k-rodam.pdf) (18.04.2019).
Gennep, A., van (1999) Obryady perekhoda [Rites of passage], Moscow: Publishing House of Oriental Literature.
Hausman, B.L. (2005) Risky business: framing childbirth in hospital settings, Journal Medical Humanit, 26 (1), p. 23–58.
Jordan, B. (1993) Birth in four cultures: A cross-cultural investigation of childbirth in Yucatan, Holland, Sweden, and the United States, Waveland Press.
Klein, M., Sacata, C., Simkin, P., Davis-Floyd, R., Rooks, JP., Pincus, J. (2006) Why do women go along with this stuff? Birth, 33 (3), p. 245–250.
Kovalenko, N.P., Smagin, S.F. (2001) Depressivnyye rasstroystva v period beremennosti i posle rodov [Depressive disorders during pregnancy and after childbirth], AMCU materials, p. 53–61.
Kroeber, A.L., Parsons, T. (1958) The Concepts of Cultura and Social Systems, American Sociological Review, V.23, p. 582–583.
KupFerman, J. (1981) The Mistaken Body. A Fresh Perspective of the Women’s Movement, London.
Leone, T., Padmadas, SS., Matthews, Z. (2008) Community factors affecting rising caesarean section rates in developing countries: an analysis of six countries, Social Science Medical (67), p.1236–1246.
Merlo-Ponti, M. (1999) Fenomenologiya vospriyatiya [Phenomenology of Perception], Moscow: Science.
Narodnoye akusherstvo i pediatriya v Rossiyskoy imperii [Folk obstetrics and pediatrics in the Russian Empire] (https://nashenasledie.livejournal.com/1149585.html) (18.04.2019).
Naurzbayeva, Z. (2014) Sovetskiy roddom kak initsiatsiya [The Soviet hospital as an initiation] (http://otuken.kz/lr-14/) (18.04.2019).
Novkunskaya, A. (2018) Izmeneniye podkhodov k rodovspomozheniyu v malykh gorodakh Rossii: professional’nyye vozmozhnosti i ogranicheniya [Changing approaches to obstetric care in small cities of Russia: professional opportunities and limitations], Natsional’nyy kongress «Diskussionnyye voprosy sovremennogoakusherstva» [National Congress “Discussion issues of modern obstetrics.”], p. 55–62.
Novkunskaya, A. (2017) Rodovspomozhene v Rossii: reformy i posledstviya. [Obstetrics in Russia: reforms and consequences] (https://eu.spb.ru/news/17879-rodovspomozhenie-v-rossii-reformy-i-posledstviya) (18.04.2019).
Raddick, S. (1980) Maternal Thinking, Feminist Studies 6(2), p. 342.
Rich, A. (1977) Of Woman Born, Virago Press.
Rivkin-Fish, M. (2005) Women’s Health in Post-Soviet Russia: the Politics of Intervention, Indiana University Press.
Shalygina, N.V. (2017) Magicheskiye praktiki stimulirovaniya zachatiya v traditsionnykh kul’turakh[The magical practices of stimulating conception in traditional cultures], Nauchno-prakticheskiy zhurnal «Sovremennaya nauka. Aktual’nyye problemy teorii i praktiki (Seriya Gumanitarnyye nauki) [Scientific and practical journal “Modern science. Actual problems of theory and practice” (Humanities Series)], N 8, p. 47–53.
Tatano, B.C., Gable, R.K., Sakala, C. (2011) Postpartum Depressive symptomatology: results from a two-stage US national survey, Midwifery Womens Healt. Vol.56(5), p. 427– 435.
Temkina, A.A. (2013a) Ginekologi i patsiyentki v bor’be za distsiplinu: medikalizatsiya kontratseptsii v sovremennoĭ Rossii [Gynecologists and patients in the struggle for discipline: the medicalization of contraception in modern Russia], Professii sotsial’nogo gosudarstva [Professions of the social state], p. 40–74.
Temkina, A. A. (2013b) Sovety ginekologov o kontratseptsii i planirovanii beremennosti v kontekste sovremennoĭ biopolitiki [Gynecologists’ advice on contraception and pregnancy planning in the context of modern biopolitics], Zhurnal issledovaniĭ sotsial’noĭ politiki, [Journal of Social Policy Studies], Vol. 11, N 1, p. 7–24.
Terekhov, M.A. (2015) Poslerodovaya depressiya. Chto dolzhna znat’ akusherka? [Terekhov M.A. Postpartum depression. What should a midwife know? Education and training], Obrazovaniye i vospitaniye, N 5, p. 48–53.
Top 10 luchshikh roddomov po Rossii (2018) [Top 10 best maternity hospitals in Russia] (http://www.roddoma.ru/roddoma/) (18.04.2019).
Vel’vovskiy, I.Z. (1963) Sistema psikhoprofilakticheskogo obezbolivaniya rodov [The system of psychoprophylactic analgesia for childbirth], Moscow: Medgiz.
Wagner, G. (2001) Fish can’t see water: the need to humanize birth, Interna-tional Journal of Gynecology & Obstetrics, 75, S25– 37.
Zdravomyslova, Ye.A., Temkina, A.A. (2009) «Vracham ya ne doveryayu, no…» Preodoleniye nedoveriya k reproduktivnoĭ meditsine. [“I don’t trust doctors, but …” Overcoming distrust of reproductive medicine], Zdorov’ye i doveriye: gendernyĭ podkhod k reproduktivnoĭ meditsine [Health and trust: a gender approach to reproductive medicine], St. Petersburg: European University in St. Petersburg, p. 179–210.
Zhenshchiny i deti v SSSR [Women and Children in the USSR] (1969) Statisticheskiy sbornik[Statistical Digest], p. 167–169.