Written by Emma Culley-Morgan, firstname.lastname@example.org
I have an ongoing dislike (to put it mildly) and equal fascination with Hollywood cinema’s representation of birthing. My “experience” and knowledge of birth up until I became pregnant was greatly shaped by film and television and the odd family member who, although having given birth, obviously didn’t see it fit to discuss the matter with children.
My interest has recently led me to really contemplate how Hollywood portrays medical intervention in childbirth. As many a birth worker and indeed, birth enthusiast will know, an intervention can be a multitude of things often not considered to be an intervention at all by others. Little things like turning a bright light on, a stranger entering the labouring space or a labouring woman leaving the comfort of her own home. The North American birthing culture, and indeed our British culture is full of intervening, sometimes absolutely necessarily but often unnecessarily and detrimental to the natural birthing process that has evolved over millennia to be kick-ass brilliant by the way. So, just to clarify, in this article, by the term intervention I am referring to medical interventions such as episiotomy, induction/augmentation methods, epidural/spinal anesthesia, forceps/ventouse and caesarean section.
It became apparent when I began enlightening myself about what birth actually is, that considering, for example in reality, the national c-section rate alone in the US is around 32%1, medical interventions are massively underrepresented in Hollywood cinema. “Well, thank goodness!” I hear advocates of natural birth exclaim and a large part of me agrees. But this absence might not be such a positive thing after all. Stay with me….
Around a third of women in the states have this experience and yet representation of this type of birth is almost non-existent. Not to mention those who have a multitude of other interventions, including forceps or ventouse and epidural or spinal for anesthesia which is extremely commonplace and routine (over 50% of women2). And then there is artificial induction and augmentation of labour (23.3%3) which there seems to be a complete absence of as far as Hollywood is concerned (please tell me if I’m wrong). Considering many women have more than one of these procedures in the same labour the reality is in stark contrast to what we see on our screens.
So why are we not seeing these represented? It seems more common to see representations of caesarean-like births in the Horror and Sci-Fi genres. For example, in Prometheus (Ridley Scott, 2012) we see a woman program a high-tech machine to perform a caesarean-like procedure on her in order to remove an alien foetus before it kills her. Although constructed as a deeply traumatic experience for the woman, the trauma derives from the alien creature and not from the procedure itself. The procedure has saved her life. What, of course, horror and sci-fi portrayals lack is believability. We believe the narrative events within the context of the story but in relation to our own world, it can be dismissed by most of us, as it just isn’t credible to our own life in terms of context of time and place. However, you could argue that certain ideologies such regarding pregnancy as sickness and technology as savior are reinforced.
In more believable (perhaps) genres of drama and pregnant comedies, c-sections seem to be rare. One example from my childhood that springs to mind is Father of the Bride part 2 ( Charles Shyer, 1996) where the woman and therefore c-section are absent from the screen as the labouring mother is whisked off hurriedly for calm-restoring surgery due to her baby not coping very well with the labour, leaving the father and us waiting in the corridor. Interestingly the scene is a double birth scene as both the wife (Diane Keaton) and daughter of the Father (Steve Martin) are in labour at the same time. Even more interestingly, the woman who is in need of the lifesaving procedure is the character in her forties (but that’s another article!). This example highlights that birth representations in Hollywood film are arguably not about the woman at all. How he is “handling” the event or indeed, handling her is often the central focus. But the absence of the caesarean on our screen, it transpires, is symbolic of a much wider issue of the paucity of representations of birth intervention in our dominant cinema.
(Father of the Bride part ll, Absent mother.)
A more contemporary example is in What to Expect When You’re Expecting (Kirk Jones, 2012). Where, after labouring as usual (well laying in a bed, hooked up to a monitor-usual) , although reaching full dilation, the baby is not descending. No attempt is made to help the baby descend by more natural means (like changing position for a start! ). The doctor simply says “you’re at ten centimetres but the baby’s not coming. We need to prepare for a c-section”. Is this really what we should expect? The caesarean is represented as a dream-like, even euphoric experience with the woman staring starry-eyed at the ceiling saying “I love morphine…we should get some for the house”. Again, a procedure that restores a sense of calm but this calm comes even before the safe delivery of the baby, somehow implying that through commencement of a c-section, safety is already guaranteed so we can relax now. It seems constructions of this intervention are ones where the intervention serves as a narrative device to save mother and baby from each other and to restore a sense of equilibrium. The drama and tension exists in the (felt) labouring that comes before and not in the procedure itself. There’s no fumbling of instruments or the mother feeling pain or a deep fear of the intervention itself.
What to Expect When You’re Expecting. A Euphoric birth?
In constructions of caesarean births and most births for that matter, the female is represented as having no autonomy. Rather than being an agent of the narrative she is peripheral to the story. Labour and birth is something that happens to her, not something she does. The common line of dialogue “the baby is in distress. We have to do a c-section” or thereabouts, is a convention in Hollywood labours, without any discussion of options or element of any choice of the mother. This can be seen to reinforce the common myth that you have to surrender your body and baby to the medical profession without question or discussion. “But I have a birth plan” exclaims and replace with ‘the mother’……… in What to Expect Met with simply “I’m sorry” from the obstetrician. Are we meant to feel she is stupid for having a plan? For attempting to have some choice in how her birthing unfolds?
The pain of natural childbirth seems to be the vehicle for drama and comedy. The woman red-faced and screaming, shouting abuse at loved ones around her. The aggression of a woman giving birth seems to provide an excuse for laughter. The aggressive power assigned to birthing women in film, in fact, can be seen to link to psychoanalysis and the fear of castration. This may be power but it certainly isn’t birthing power being represented. When a woman births she is her most powerful self. A force of nature. But at this time when women are exercising this innate power and strength, the classical representation strips her of that power and reduces her to nothing more than an object of fear and comedy. So what messages and values are communicated through these constructions of women in pain, vulnerable but aggressive?
To get close to answering this question and the question on why these constructions are the norm, it is essential to explore the possible impact of these portrayals of natural childbirth on women (to me this is an oxymoron as giving birth under the conditions of bright lights, strangers in masks and coached pushing is anything but natural to me). Rates of Tokaphobia have risen and it is possible to argue that the media has played a significant part in this. A common but sometimes unconscious response of female viewers to seeing such constructions may be to reject the very idea of giving birth at all. A more likely response, due to our instinctive urge to procreate, would be to reject the idea of giving birth in that way. As the few interventions we do see are ones that provide a rescue from the seemingly excruciating agony of birthing and the guarantee of baby’s well-being, a rejection of the idea of birthing in this felt way may often be juxtaposed with an acceptance of medical intervention, first and foremost, an epidural for anaesthesia. If medical procedures such as forceps, ventouse, episiotomies and induction are absent from our screens and kept invisible or at least, separate from drama, it makes it difficult to fear them. And if the rare Hollywood interventions we do see are constructed as a rescue from the trauma of natural childbirth and the defect in women’s bodies (FYI we are not defective!!!) it can be seen to incite the audience into accepting this ideology.
An interesting experiment is to take a moment to imagine what it would be like if Hollywood represented intervention to the degree that it exists in modern, western maternity services. Represented it not just as a device that provides rescue and allows a new state of equilibrium to emerge but represented as dramatic and comedic or represented it as the cascade of intervention it so often becomes, a long, drawn out, gruelling process that it can be. Not simply means to a happy ending but complicated and sometimes traumatic. What then? Then we would surely fear something else. We might fear medicalisation, we might fear routine episiotomies. We might question the regular use of forceps. We may start to want better and demand better for ourselves and our partners, our daughters, our sisters. We may reject giving birth in that way. Imagine what that would be like. Imagine what that would do to the American Health care system.
1 National Center for Health Statistics
2 American Pregnancy Association
3 Centers for Disease Control and Prevention