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Birth

Birth

In humans, the process of delivering a child from the uterus, usually by passage through the birth canal at the end of pregnancy, normally after a gestation period of about 267 days; also called parturition, or labor.

Childbearing is often viewed as the transition to adult female sexuality . Birth labor is divided into several stages. During the latent phase (Stage 0), which lasts from several hours to as long as three days, uterine contractions (either regular or irregular) are present, but the cervix has not dilated more than three or four centimeters. The mucus plug may be passed at this stage. The first stage of labor begins with uterine contractions accompanied by mild pain at intervals of about 10 to 20 minutes and sensations of discomfort in the small of the back which eventually become stronger and spread to the entire abdominal area. The cervix, or neck of the uterus, dilates rapidly from three or four centimeters until its opening is large enough to allow the passage of the child (10 centimeters). By the end of the first stage (although sometimes much earlier), the sac containing the amniotic fluid which surrounds the child breaks. The first stage can take up to 12 hours with first-time mothers, although it may be very rapid in women who have had several children. It can last many hours in obstructed labor, where the baby is unusually large or badly angled.

The second stage of labor begins with the complete dilation and effacement (thinning) of the cervix and ends when the baby is born. At this stage, the contractions are

increasingly frequent and intense, ultimately recurring at intervals of two to three minutes and lasting about a minute. The mother begins contracting her abdominal muscles voluntarily ("bearing down"), and the baby is expelled, usually head first, by a combination of this voluntary contraction and the involuntary contractions of the uterine muscles. The physician aids in the delivery by guiding the infant's head and shoulders out of the birth canal. About 2 to 3 percent of babies are born feet first (breech babies). Obstetrical forceps may be applied during the second stage of labor to speed delivery in order to ease either maternal exhaustion or infant distress. Other medical techniques utilized include the episiotomy, a surgical incision along the back of the vagina to enlarge the opening. (This procedure is now performed less frequently than it was in the past.)

When the baby is born, mucus and blood are removed from the nose and mouth by means of suctioning. The umbilical cord is clamped and cut, and the child is given to the mother to hold. The infant's physical condition is then assessed by the Apgar score , which evaluates the overall level of health based on heart rate, skin color, muscular activity and respiratory effort, and response to stimuli. During the third stage of labor, which occurs within the first hour after the child is born, placental material, or afterbirth, is expelled through the birth canal by strong uterine contractions called after-birth pains. These contractions also help the uterus to return to its normal size. The doctor examines the placenta and amniotic sac to confirm that all tissue has been expelled from the uterus, as serious complications may result if fragments remain inside, especially hemorrhaging. If parts of the placenta or sac are missing, the doctor removes them by hand. Finally, the episiotomy (if one has been performed) is sutured with absorbable stitches. The total duration of labor averages about 13 hours for first deliveries and about eight hours for subsequent deliveries, although there are large individual variances from these figures.

The pain of the birth process can be relieved by drugs, but many of these drugs also have the effect of slowing uterine contractions or depressing the respiratory system of the child. Drugs are either not usedor used with special carein the case of twins or premature infants. Moderate doses of narcotic analgesics may be given to the mother, which are metabolized quickly and nearly absent by the time of delivery. Local anesthetics similar to Novocaine may be administered to provide pain relief in the cervical and vaginal areas, offering more localized relief with fewer side effects than narcotics. Methods of childbirth have been developed in which the use of drugs is kept to a minimum.

The natural childbirth movement begun by Fernand Lamaze, which advocates birth without drugs or medical intervention, departed from the practices of the 1940s and 1950s, when the administration of drugs and medical procedures such as episiotomies were standard obstetrical procedure. Natural childbirth methods use nonmedical relaxation techniques for pain control and allow for more active participation in labor by the mother and a lay coach, usually the husband. They typically include prenatal classes for the mother and coach. Women who use the Lamaze method are taught to perform three activities simultaneously during contractions: breathing in a special pattern, chanting a nonsense or meaningless phrase coordinated with the rhythm of her breathing, and staring intently at an object.

The home delivery movement, which became popular in the United States during the 1970s, gave way to the establishment of birthing centers (in or affiliated with hospitals) staffed by nurse-midwives and obstetricians in an attempt to duplicate the family-centered, drug-free experience of home birth but without the risks posed by the absence of medical professionals. The natural childbirth movement has also focused on easing the birth experience for the infant. In Birth Without Violence, the physician Frederick Leboyer described modern hospital birth as "torture of the innocent" and proposed measures to make the transition to life outside the womb a more gentle one for the newborn. These measures include dim lights and a quiet atmosphere in the delivery room, postponing cutting of the umbilical cord, and bathing the infant in lukewarm water. Psychologists Otto Rank and R.D. Laing have elaborated on the idea of birth trauma as a factor in adult mental and emotional problems, and Leonard Orr developed rebirthing in the 1970s as a holistic healing technique for eliminating negative beliefs that influence an adult's behavior and attitudes.

Occasionally, complicating factors that can affect the mother, the child, or both are encountered in the birth process. These factors include, for example, poor health, anatomical abnormalities, prematurity, and unusual orientation of the child in the uterus, such as breech presentation, in which the child moves through the birth canal head last, and (rarely) transverse presentation, in which the child is positioned sideways. In some women, the pelvic space is too small for spontaneous birth of a baby, and the delivery of the child is accomplished through a surgical opening made in the mother's abdominal wall and uterus, in a procedure called a cesarean section. For a healthy mother and child, the risks of childbirth are extremely low. Premature labor, which occurs in about one pregnancy out of 20, is the primary danger to mother and child during the last trimester of pregnancy and the major cause of newborn death. About 40 to 50 percent of mothersespecially first-time mothersexperience mild post-partum depression , thought to be caused by a combination of biochemical factors and adjustment to the pressures and demands of parenthood. A smaller percentage between 5 and 10 percentbecome severely depressed. Postpartum depression usually lasts up to 90 days.

Abnormalities present at the time of birth, known as birth defects or congenital defects, occur in one of every 14 babies born in the United States. More than 3,000 birth defects have been identified, ranging from minor dark sports or a birthmarks to serious disfigurements or limited lifespans. Congenital heart defects occur to one of every 125 to 150 infants born in the U.S., making heart defects among the most common birth defects and the leading cause of birth defect-related deaths. Down syndrome is the most frequently occurring chromosomal abnormality, occurring to one of every 800 to 1,000 infants born in the United States. Annually, care of children with birth defects in the U.S. costs billions of dollars.

Birth defects have two causes: heredity and environment . Environment includes maternal illness, such as German measles. Other environmental factors include: alcohol and drugs, consumed during the pregnancy, and exposure to certain medicines or chemicals. Heavy alcohol consumption during pregnancy can trigger fetal alcohol syndrome in newborns, characterized by underweight, small eyes, a short upturned nose with a broad bridge, and often a degree of mental retardation . Thalidomide, prescribed in the 1950s as a mild sedative, led to the birth of 7,000 severely deformed babies, suffering from a condition called phocomelia, characterized by extremely short limbs that were often without fingers or toes.

For some diseases, like spina bifida, the causes are unknown but believed to be a combination of heredity and environment. Spina bifida, a neural tube defect, is the most frequently occurring permanently disabling birth defect in the United States, affecting one out of every 1,000 newborns. In spina bifida, the spine fails to close properly during the first month of pregnancy. In worst cases, the spinal cord protrudes through the back. A large percentage of children born with spina bifida have hydrocephalus, an accumulation of fluid in the brain which requires a surgical procedures called "shunting" to relieve the fluid build up and redirect it into the abdominal area. Sophisticated medical techniques allow most children with spina bifida to live well into adulthood. Based on research, the U.S. Public Health Service recommends that women of childbearing age in the U.S. consume 0.4 mg of folic acid daily to reduce the risk of having a pregnancy with spinal bifida or the other two neural two defects: anencephaly or encephalocele. Amniocentesis or ultrasound testing can diagnose spina bifida before birth.

Sickle-cell anemia, Tay-Sachs, color blindness, deafness, and extra digits on the hand or feet are hereditary birth defects passed on through generations by abnormal genes. Birth defects may not impact each generation, but the abnormal gene is passed on.

Further Reading

Hotchner, Tracy. Pregnancy and Childbirth: The Complete Guide for a New Life. 2nd ed. New York: Avon, 1990.

Martin, Margaret. The Illustrated Book of Pregnancy and Childbirth. New York: Facts on File, 1991.

Nathaniels, Peter. Life Before Birth and a Time to Be Born. Ithaca, NY: Promethean Press, 1992.

See also Fetal alcohol effect and syndrome

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birth

birth Although childbirth is a universal fact of human physiology, where, how, with whom, and even when a woman gives birth are often culturally determined.

Anthropological awareness of the social nature of human birth owes much to the pioneering work of Wenda Trevathan, an evolutionary anthropologist who studied the differences between human and higher primate birth. Because higher primates walk on all fours, their pelvis is wide enough to allow the direct descent of the fetal head, making for easy labours and uncomplicated births. When humans began to walk on two feet, the upright stance they had to adopt made the pelvis narrower, so that the baby has to rotate as it descends in order to pass through. Non-human primate babies can climb onto their mothers' backs and cling immediately after birth, but the larger brains of human infants made it necessary for them to be born earlier in their developmental cycle, ensuring that human babies would be relatively helpless at birth and require immediate nurturing. These factors encouraged the evolution of birth as a highly social process; women give birth alone and unaided in only a very few societies.

For these reasons, Trevathan postulated that midwifery evolved along with human birth. The presence of other women would have enhanced the success of the birth process as these women acquired skills such as turning the baby in utero to ensure the optimal position for birth, assisting rotation of the head and shoulders at birth, massaging the mother's uterus and administering herbs to stop postpartum bleeding, and facilitating breastfeeding. Trevathan suggests that more mothers and babies would have survived in societies that developed midwifery traditions early on, giving such societies a distinct evolutionary advantage.

Both ancient and contemporary figurines and paintings from indigenous cultures all over the world show women giving birth upright: kneeling, sitting on a low stool or chair, or standing with women behind or on either side of them to hold and support them with a midwife kneeling in front with her hands out, waiting to catch the baby. This upright position, with its physiological advantages of facilitating fetal rotation and descent and the mother's ability to push effectively, was pervasive in birth until the advent of Western obstetrics. Its replacement by the flat-on-the-back position common in Western-style hospitals demonstrates the extensive cultural restructuring that has been applied to birth in industrialized countries.

The social nature of birth and its importance for survival ensure that this biological and intensely personal process will carry a heavy cultural overlay. In 1908, Arnold van Gennep noted that cultures ritualize important life transitions — of which birth is a prime example. Anthropologist and childbirth educator Sheila Kitzinger has noted that birth practices point ‘as sharply as an arrowhead’ to the core values and beliefs of the culture, telling the observer a great deal about the way that culture views the world and women's place in it. Where women's status is high, a rich set of nurturant traditions tends to develop around birth; where it is low, the opposite may occur. For example, in the highly patriarchal Islamic society of Bangladesh, in which the status of women is low, childbirth (like menstruation) has traditionally been regarded as highly polluting. It was believed that women should give birth on dirty linens, attended only by female relatives. An indigenous midwifery tradition never developed, and rates of infant mortality and puerperal infections are high. In contrast, in the matrilineal societies of Polynesia, where the status of women is high, pregnant women are pampered and nurtured. Skilled midwives administer frequent full-body massages during pregnancy and have a rich repertoire of techniques for assisting women during labour and birth.

Brigitte Jordan's comparative study of birthing systems in Holland, Sweden, the US, and Mexico's Yucatan was the first to demonstrate this wide variation in the definition, the locus, the attendants, and the artifacts of childbirth; it sparked general interest in the anthropology of birth. Jordan's work on American birth was expanded by anthropologists Emily Martin and Robbie Davis-Floyd. They have suggested that American hospital birth, like much of American society, is organized around models of factory production and the technological control of natural processes. In many American hospitals, over 80% of women have their labours artificially speeded up or induced, are routinely hooked up to the electronic fetal monitor, often for long periods, have IVs inserted into their arms to provide the fluids that they are not allowed to drink, and lie flat with their feet in stirrups to give birth. While such technological interventions can sometimes be lifesaving, their routine overuse often generates problems. (The degree of overuse of birth technologies in the US is highlighted by the much lower rates of most such interventions in Great Britain, where a vocal, active, and influential consumer movement arguing for evidence-based care has had a significant impact on obstetrical policies.) Such routine procedures have been interpreted by Davis-Floyd as rituals that symbolically enact and display the core values of the American technocracy, which centre around the supervaluation of technology in many aspects of American life.

The prestige of Western ‘high technologies’ has induced many developing countries to stamp out viable indigenous midwifery systems and import the Western model even when it is ill-suited to the local situation. Western style hospitals built in the Third World may lack the most basic supplies but are often stocked with several expensive machines that few know how to use or repair. The medically trained personnel who staff these hospitals often have little understanding of or respect for local birth traditions, with the result that local women often avoid such hospitals whenever possible. From Northern India to the Yucatan, indigenous women echo each other's concerns: ‘They expose you,’ ‘they shave you,’ ‘they cut you,’ ‘they leave you alone and ignore you, but won't let your family come in’. Ironically, none of the rules and procedures these women find so alarming are essential to good obstetric care; rather, they reflect the importation of the mechanistic Western model and its culturally insensitive imposition on indigenous groups.

In an effort to counteract this trend and build a bridge between technology and tradition, the World Health Organization and UNICEF have been promoting programs to ‘upgrade’ the skills of traditional midwives. Anthropological studies have shown, however, that because the medically trained personnel in these programmes tend to place a higher value on the Western techomedical approach, they generally fail to take advantage of the knowledge and skills developed by community midwives within the context of their own cultural traditions.

In 1978, Brigitte Jordan called for the ‘mutual accommodation’ of indigenous and Western birthing systems. In northern Brazil, an obstetrician, Dr Galba Araujo, demonstrated one form this ‘mutual accommodation’ might take: he oversaw the building of rural community clinics staffed by local midwives (who received culturally sensitive training that honoured their skills while imparting useful biomedical information), and linked them to one city hospital through a government funded ambulance system. (Lack of transportation to a hospital in emergencies is a significant cause of maternal death in the developing world.)

In the US, obstetricians solidified their control over birth during the first half of the twentieth century and nearly eliminated midwifery by the 1950s. Since then the demands of many women for natural childbirth, coupled with scientific research into the dangers of interventionist hospital birth and the benefits of planned, midwife attended births at home or in freestanding birth centres, have generated a midwifery renaissance. Indeed, in the four countries in which infant perinatal mortality statistics are the lowest in the world — Japan, Holland, Sweden, and Denmark — over 70% of births are attended by midwives who serve as the woman's primary caregiver.

Deep in the evolutionary past, our ancestors came to understand the benefits of women helping other women to give birth. Today, the most successful birthing systems combine midwifery care with solid scientific research on the physiology of birth. Contemporary midwives work in all settings, from hospital to home, and support women to avoid unnecessary interventions, to give birth in upright positions, to breastfeed, and to enjoy uninterrupted contact with their babies after birth. It has been repeatedly demonstrated that midwifery care results in fewer interventions, less iatrogenic damage to mothers and babies, improved outcomes (both psychological and physical), and lower costs. It is to be hoped that in short order the world will pass through the current phase of high-technology interventions in normal birth and come full spiral, uniting evolutionary understandings with contemporary science through midwives' skilled, nurturant, and woman-centered care.

Robbie Davis-Floyd

Bibliography

Davis-Floyd, R. E. (1992). Birth as an American rite of passage. University of California Press, Berkeley and London
Davis-Floyd, R. E. and and Sargent, C. (1997). Childbirth and authoritative knowledge: cross-cultural perspectives. University of California Press, Berkeley, California.
Jordan, Brigitte (1993; orig. pub. 1978). Birth in four cultures: a cross-cultural investigation of childbirth in Yucatan, Holland, Sweden and the United States, (4th edn) Waveland Press, Prospect Heights, Ohio.


See also labour; pregnancy.

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Birth

46. Birth

See also 281. MOTHER ; 327. PREGNANCY

amniomancy
a form of divination by examining the embryonic sac or amniotic fluid.
autogeny, autogony
the spontaneous generation of an organism in an inorganic fluid medium. autogenous, autogenic, autogonic, autogonous, adj. autogenously, autogonously, adv.
digoneutism
the ability to produce two broods in a year. digoneutic , adj.
epigenesis
the theory that embryonic development is totally controlled by the cells environment. Cf. syngenesis. epigenesist , n. epigenetic , adj.
epimorphosis
development of an organism or form of animal life in which body segmentation is complete before hatching. epimorphic , adj.
fetation, foetation
the development of a fetus; gestation.
geniture
Obsolete, birth; the process of generation.
gestation
1. the process of carrying in the womb.
2. fetation; the process of development of the fetus in the womb.
gravidity
pregnancy. gravid , adj.
hysterology
scientific study of the uterus.
Lamaze technique
psychoprophylaxis.
maieusiophobia
tocophobia.
midwifery
the prineiples and practice of a midwife. Cf. tocology.
multiparity
the condition or process of producing more than one offspring at one birth. multiparous , adj.
nativity
1. the time, place, and circumstances of a persons birth.
2. the configuration of the planets at the time of a persons birth and a representation, as a chart, of that configuration.
nulliparity
the condition in a woman of never having given birth. nullipara , n. nulliparous , adj.
obstetrics
the branch of medicine that deals with prenatal and postnatal care and with the delivery of a child. obstetrician , n. obstetric, obstetrical, adj.
omphalomancy
a form of divination in which the number of knots in a newborns umbilical cord are counted to foretell the number of children the mother will have later.
omphalotomy
the surgical process of dividing the umbilical cord.
oviparism
the bearing of offspring by laying eggs that mature outside of the body. oviparity , n. oviparous , adj.
ovoviviparism
the bearing of offspring by producing eggs that mature within the body, with the young born alive. ovoviviparity , n. ovoviviparous , adj.
oxytocic
a substance or drug that induces or stimulates childbirth. oxytocic , adj.
palingenesis
1. partial or complete regeneration.
2. the doctrine that a soul passes through several bodies in a series of rebirths. Also palingenesia, palingenesy. palingenetic , adj.
parity
the state, quality, or fact of having given birth to or having borne offspring.
parturiency
the state or condition of bringing forth young or being about to begin parturition. parturient , adj.
parturition
childbirth; the act or process of giving birth. parturient , adj.
primigravida
a woman who is pregnant for the first time.
primipara
a woman who has given birth to one child or who is giving birth for the first time. primiparity , n. primiparous , adj.
psychoprophylaxis
a method of preparing women for childbirth without anesthetic, by means of education, psychological and physical conditioning, and breathing exercises. Also called Lamaze technique. psychoprophylactic , adj.
puerperium
the state or condition of a woman during and immediately following childbirth. puerperal , adj.
recrudescence
the process of renewal or rebirth. recrudescent , adj.
regeneracy
the act or quality of being renewed, reformed, or reborn, especially in a spiritual rebirth. regenerate , adj.
regenesis
the act or process of renewal or rebirth.
secundigravida
a woman who is pregnant for the second time.
spermicide
a substance or preparation used for killing sperm, used in contraception. spermicidal , adj.
superfetation
a conception occurring after the onset of a pregnancy from an earlier conception.
syngenesis
the theory that the form and development of the embryo are the result of the combined influence of sperm and egg. Cf. epigenesis. syngenetic , adj.
thoracopagus
a fetal abnormality, consisting of twins joined at the thorax.
tocology, tokology
the science of obstetrics or midwifery. tocologist, tokologist, n. tocological, tokological, adj.
tocophobia, tokophobia
an abnormal fear of childbirth. Also called maieusiophobia.
unigravida
primigravida.
uterogestation
the process of gestation taking place in the womb from conception to birth.
vasectomy
surgical excision of part of the vas deferens, the duet which carries sperm from the testes, performed as a form of male contraception.
viviparism
the bearing of living offspring, characteristic of almost all mammals, many reptiles, and some fishes. viviparity , n. viviparous , adj.

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Birth

Birth

Birth, or parturition (pronounced pahr-chuh-RIH-shuhn), in mammals is the process during which a fully developed fetus emerges from the mother's uterus (or womb) by the force of strong, rhythmic muscle contractions. The birth of live offspring is a reproductive feature shared by mammals, some fishes, and certain invertebrates (such as scorpions), as well as some reptiles and amphibians. Animals that give birth to live offspring are called viviparous (pronounced vie-VIP-uh-rus, meaning "live birth").

In contrast to viviparous animals, other animals such as birds and frogs give birth to eggs; these animals are called oviparous (meaning "egg birth"). Still other animals, such as some fish and reptiles, are ovoviviparous, meaning that the young develop in eggs within the mother's body and hatch either before or immediately after emerging from the mother.

Viviparous animals

In viviparous animals, fertilization of the mother's egg with the father's sperm takes place inside the mother's body. Nutrients are passed from the mother to the developing fetus. In certain mammals, such as humans, this transfer of nutrients occurs through an organ called the placenta, which is formed from the embryo and the mother's uterus.

Words to Know

Amniotic fluid: The fluid in which the fetus is suspended while in the uterus.

Amniotic sac: A thin membrane forming a sac that contains the amniotic fluid.

Cervix: The narrow, bottom end of the uterus; the opening of the uterus.

Fetus: An unborn mammal at the later stages of development. A human embryo is considered a fetus after eight weeks.

Gestation: The period of carrying young in the uterus before birth.

Labor: The strong, rhythmic contractions of the uterus that result in birth.

Placenta: An organ that develops in certain mammals during gestation through which a fetus receives nourishment from the mother.

Umbilical cord: The cord in most mammals that connects the fetus to the placenta.

Uterus (womb): A muscular organ inside the female mammal in which a baby develops.

Viviparous: Animals that give birth to live offspring.

The carrying of young in the uterus is called gestation (pronounced jes-TAY-shun). The length of time between fertilization and birth in viviparous animals is called the gestation period. The gestation period varies, depending on species. In humans, it is about nine months. Elephants have one of the longest gestation periods of all animals, lasting 22 months.

The birth process

The process of birth in humans normally begins at the end of the gestation period with the release of several hormones that stimulate the mother's uterus to contract. Contractions signal the first stage of labor. In order for the fetus to leave the uterus and enter the birth canal (comprised of the cervix and vagina), it must pass all the way through the cervix, the opening of the uterus.

During the first stage of labor, which can last 12 hours or more, the contractions of the uterus move the fetus toward the cervix, causing the cervix to dilate (widen). With dilation, the cervix opens to accommodate the passage of the baby's head. The amniotic sac also usually ruptures, releasing amniotic fluid that streams out of the vagina. (The amniotic sac is a membrane filled with fluid in which the fetus floats while developing in the uterus.)

During the second stage of labor, lasting anywhere from 30 minutes to 2 hours, the mother uses her abdominal muscles to help push the fetus through and out of the birth canal. In a normal delivery, the baby's head appears first (called crowning) and the rest of the body follows. The umbilical cord that connects the fetus to the placenta is tied and cut. The place on the baby's abdomen where the umbilical cord is attached is the navel, or belly button. The baby is now separated from the mother and must breathe air through its own lungs.

In the third stage of labor, usually lasting from a few minutes to a half hour, contractions cause the placenta and fetal membranes to separate from the wall of the uterus and be expelled from the vagina. The placenta and fetal membranes together are called the afterbirth.

[See also Embryo and embryonic development; Fertilization; Hormones; Reproduction; Reproductive system ]

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birth

birth or labor, delivery of the fetus by the viviparous mammal. Birth is also known as parturition. Human birth normally occurs about 280 days after onset of the last menstrual period before conception.

The Stages of Labor

Onset of labor, the first stage, is heralded by contractions of the uterus felt as cramplike pains in the abdomen or lower back that recur at intervals of 10 to 30 minutes and last about 40 seconds; they increase in frequency until they occur at about 2-minute intervals. With each contraction the cervix, or neck of the uterus, dilates until it becomes wide enough, about 4 in. (10 cm), to permit emergence of the baby.

In the second stage of labor the baby passes through the birth canal, most commonly head first, and is born. The effectiveness of uterine contractions in this stage is enhanced by the bearing-down abdominal contractions of the mother.

The third stage of labor, which occurs about 15 to 30 minutes after the child is born, is characterized by the separation of the placenta from the uterine wall and its expulsion. The total time of labor averages 13 to 14 hours in women pregnant for the first time and 8 to 9 hours in women who have previously borne children.

Methods of Analgesia

The pain of childbirth can be relieved with a variety of analgesic and sedative drugs, including morphine, barbiturates, and chloroform. However, many drugs that relieve pain also slow the uterine contractions or dangerously depress the baby's respiratory system. Spinal anesthetics, injected directly into the spinal cord, while not dangerous to the child, are difficult to administer accurately and are therefore potentially dangerous to the mother. Hypnosis has also been used experimentally.

Natural Childbirth

In recent years so-called natural childbirth has come into wide use; the advantages are that the child is born undrugged and the mother can be conscious at the moment of birth. Natural childbirth emphasizes the ability of many women to give birth with a minimal amount of pain-killing drugs or none at all. The Dick-Read method, formulated by the British obstetrician of that name, emphasizes maternal understanding of the birth process as an aid to relaxation, and exercises to strengthen muscles and encourage proper breathing. The Lamaze method, or psychoprophylaxis, is of Russian origin; it uses breathing exercises as a conditioned response to uterine contractions.

Complications of Childbirth

Birth often cannot proceed normally because of a defect of the cervix or weak uterine contractions; breech births, in which the feet or buttocks emerge first, and transverse births, in which the child is positioned across the uterus, usually require obstetrical intervention, such as forceps delivery, manually turning the baby, or performing a cesarean section. About 10% of pregnancies terminate in deliveries that are too early, producing (after at least 200 days of gestation) premature infants requiring special care. Birth of a fetus prior to about 200 days of gestation is termed a miscarriage; birth within the first three months, an abortion. Stillbirth is the delivery of a dead child.

Complications of childbirth affecting the newborn include infant blindness attributable to gonorrhea infection, now largely eliminated by routine administration of silver nitrate to the eyes; retrolental fibroplasia, a type of blindness common for some years in premature infants that was found to result from administration of high concentrations of oxygen and is now largely avoided; and erythroblastosis fetalis, or Rh disease, which can often be prevented. Puerperal fever, an infection of the mother's genital tract once common following labor and delivery, has now also been largely eliminated by preventive hygiene, especially in labor, and by antibiotic therapy.

See pregnancy; obstetrics.

Bibliography

See D. Caton, What a Blessing She Had Chloroform (1999).

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Birth

BIRTH

Birth is the prototype for all discontinuities in the relation between a mind and its objects. Otto Rank's The Myth of the Birth of the Hero (1909) introduced this theme into psychoanalytic literature.

In the same year Freud took an interest in dreams of birth in an addendum to The Interpretation of Dreams (1900a). Birth, as a passage from intra-uterine life to extra-uterine life became for him "the first experience of anxiety, and thus the source and prototype of the affect of anxiety" (SE, 5: 525, note 2). He returns to this theme in Introductory Lectures on Psychoanalysis (1916-17a [1915-17]), in which he speaks of the "separation"(SE, 15: 397) of birth.

This is the theme that Wilfred Bion developed in Caesura (1975) when he made birth the paradigm for all psychic discontinuity, which means that experiences lived through before the caesura must be capable of being retranscribed in a psychically assimilable form after the caesura. Taking a more genetic point of view, other authors have applied the term "psychic birth" to the moment when children become conscious of their individuation and the separation between them and their libidinal objects (Mahler, Margaret, 1975; Tustin, Frances, 1981).

Didier Houzel

See also: Constitution; Dream symbolism; Infant development; Infant observation; Infant observation (therapeutic); Infantile psychosis; Intergenerational; Maternal; Memoirs of the future; Myth of the Birth of the Hero, The ; Narcissistic elation; Parenthood; Postnatal/postpartum depression; Premature-Prematurity; Primary love; Reversal into the opposite; Seduction; Sexual theories of children; Social feeling (individual psychology); Trauma of Birth, The .

Bibliography

Bion, Wifred R. (1975). The grid and Caesura. Rio de Janeiro: Imago.

Freud, Sigmund. (1900a). The interpretation of dreams. Part I. SE, 4, 1-338.

. (1900a). The interpretation of dreams. Part II. SE, 5 : 339-625.

. (1916-17a [1915-17]). Introductory lectures on psycho-analysis. Parts I and II. SE, Part I, 15 ; Part II, 16.

Mahler, Margaret, Pine, Fred, and Bergman, Anni. (1975). The psychological birth of the human infant. New York: Basic Books.

Tustin, Frances. (1981). Autistic states in children. London: Routledge.

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birth

birth / bər[unvoicedth]/ • n. the emergence of a baby or other young from the body of its mother; the start of life as a physically separate being: he was blind from birth despite a difficult birth he's fit and healthy. ∎  a baby born: the overall rate of incidence of Down syndrome is one in every 800 live births. ∎  the beginning or coming into existence of something: the birth of democracy. ∎  origin, descent, or ancestry: the mother is American by birth. ∎  high or noble descent: she was proud of her beauty and her birth. • v. [tr.] inf. give birth to (a baby or other young): she had carried him and birthed him [intr.] in spring the cows birthed. PHRASES: give birth bear a child or young: she's due to give birth in March she gave birth to a son.

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birth

birth XII. — ON. byrð birth, descent, corr. to Goth.(ga)baurps, f. Gmc. *bur- *ber- BEAR2; see -TH1.
Hence birthday XIV; cf. OE. ġebyrddæġ.

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birth

birth (berth) n. (in obstetrics) see labour.

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birth

birth See parturition.

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birth

birthberth, birth, dearth, earth, firth, girth, mirth, Perth, worth •stillbirth • childbirth • afterbirth •Edgeworth • Hepworth • Ellsworth •Whitworth • halfpennyworth •Bosworth • jobsworth • Iorwerth

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Birth

BIRTH

The injunction to "be fruitful and multiply" (Gen. 1:28) is regarded as the first commandment of the Bible. As a consequence of the disobedience of Eve in the Garden of Eden, the pangs of childbirth were foretold (Gen. 3:16). References to pangs of travail as the most intense of pains are very frequent in the books of the prophets (e.g., Jer. 6:24; 22:23; 49:24; 50:43; and Micah 4:9–10). Midwives assisted in the delivery (Gen. 35:17), and it seems that a birthstool, called ovnayim, was often used (Ex. 1:16). The Bible records the deaths of Rachel (Gen. 35:18) and the daughter-in-law of Eli (i Sam. 4:20) in childbirth. The Talmud states that Michal (ii Sam. 6:23) also died during childbirth (Sanh. 21a).

Biblical law regarding birth is confined to laying down the period of ritual impurity of the mother (Lev. 12). The mother of a male child is unclean for seven days, followed by a 33-day period of impurity; these periods are doubled in the case of a female child. At the conclusion of these periods a sin-offering and burnt-offering were brought by the mother. According to the Talmud, the sin-offering is incumbent upon her because during the anguish of childbirth, she foreswears any future relations with her husband, which she later regrets (Nid. 31b).

In the Talmud and the Midrash

The sages attributed death during childbirth to neglect of the laws of family purity, failure to separate the dough-offering, and carelessness in kindling the Sabbath lights (Shab. 2:6). Viability began from the time the fetus was six months and one day old, although it was considered as a fact that an eight-month-old fetus was not viable (Tosef., Shah. 15:7; see *Abortion). However, many midrashim and later commentaries report births of a seven-month-old fetus. Thus, according to the commentaries, many of Jacob's sons were born at age seven months. Before birth, it is permissible to perform an embryotomy when the mother's life is in danger, since "her life comes before that of the child." Once the greater part of the child has been born, or his head alone has emerged from the birth canal, he is considered a living being and the mother's life no longer takes precedence (Oho. 7:6). The child is not considered viable until it is 30 days old. No death penalty is therefore incurred for killing a newborn child unless it is certain that he could otherwise have lived for 30 days (Nid. 5:3, Nid. 44b). All work necessary for the delivery of a child may be performed on the Sabbath (Shab. 18:3); if the mother dies during labor, the Sabbath must still be desecrated and all attempts made to save the unborn child (Ar. 7a).

For the purposes of birthdate and setting the time of circumcision, birth is determined by the projection of the fetus' head out of the birth canal (Nid. 42b). Midwives were considered reliable witnesses for accounting for the hour of the birth. The delivery of a child by Caesarean section was not regarded as "an opening of the womb" (Ex. 13:2), and the child had neither the privileges nor the obligations of the firstborn (Bek. 8:2).

Throughout Jewish history, male offspring were desired. However, despite differing opinions, Bet Hillel's position that the birth of a son and a daughter constituted the fulfillment to be fruitful and multiply was eventually accepted (Yev. 62a). In addition, despite contrary opinions in the Talmud, it became accepted that the injunction to be fruitful and multiply was a male and not a female responsibility.

Customs and Folklore Among Ashkenazi Jews

Most of the customs surrounding birth belong to the category of popular folklore, much of which is not specifically Jewish but was adapted from local cultural surroundings (Tosef., Shab. 6:4; Sh. Ar. yd 178). The following biblical selections were recited for a woman in labor: Psalms 20; i Samuel 1; Genesis 21:1–8 or Exodus 8:11. Precious stones and a variety of herbs were used to facilitate delivery, which was usually supervised by an experienced midwife and friends and relatives of the parturient. A magic circle was drawn with chalk or charcoal on the floor of the room to guard against evil spirits. As a good omen for easy and speedy delivery, all the ties and knots in a woman's garments were undone and in some societies all doors in the house were opened wide. If her travail was difficult, the keys of the synagogue were placed in her hand, she was girded with the band of a Torah Scroll, and prayers were recited at the graveside of pious relatives. In extreme danger, prayers were said for the parturient in the synagogue and a Torah scroll was brought to the house and was left in the corner of the birthing chamber. At times the circumference of the cemetery walls was measured and according to their length a number of candles were donated to the synagogue. Mother and child were surrounded by various charms and talismans from the moment of birth until the circumcision (see *Amulet). Most of these charms were to guard them against the female demon *Lilith and her counterparts, such as Frau Holle, and they were known by different names, such as kimpetsetl (from kindbet, "child bed" and tsetl, "a note"), Shir Hamalos-Tsetl (from Shir ha-Ma'alot – the Song of Degrees), and Shmir-Tsetl (from shemirah, "guarding"). They were placed above the bed of the woman and above the doorposts of the room. In medieval and early modern Germany, it was customary for the woman to keep an object made out of iron (barzel – an acronym of Bilhah, Rachel, Zilpah and Leah, Jacob's wives) with her at all times during the weeks following the birth, to protect her from evil spirits. Some of these amulets used kabbalistic names of God, especially the 42-letter name beginning with abag yatatz, which is derived from the abbreviation of the prayer hymn Anna be-Kho'aḥ.

A popular custom until modern times, in the case of the birth of a male child, was the vigil ceremony which was performed every night. In Oriental communities it was called taḥdid. Friends and relatives nightly gathered at the home of the newborn to recite the *Shema in order to protect the child from demons. Schoolchildren led by their teachers also participated in this ceremony and were rewarded with apples, nuts, and sweets.

Whereas a boy is named at the circumcision, there is no evidence concerning the naming of girls until the 15th century. In early modern sources, we hear of a naming ceremony in the synagogue or at home. In Germany and Western Europe the naming took place in a home ceremony on Sabbath afternoons. Called Hollekreisch, the custom originated in German folklore and superstition. This custom, which was observed for boys and girls, included the lifting of the cradle and the giving of a name. For boys, this was a non-Jewish name, a shem ḥol, whereas for girls, this was the only naming ceremony. This ritual took place on the afternoon of the Sabbath when the parturient left her home for the first time, about a month after the birth. During the 16th and 17th centuries, in some communities, it became a customary to name girls in the synagogue when the father was called to the reading of the Torah. This custom is still commonly found today. More recently, many families in Israel and the Diaspora have adapted the Sephardi custom of having a special ceremony, often called Zeved ha-Bat or Simḥat Bat, at which the girl is named.

[Elisheva Baumgarten (2nd ed.)]

Middle Eastern Customs

Among the methods utilized to protect the mother and infant from evil spirits – particularly Broshah, the female demon who steals newborn children – was the hanging of a hamsikah, an *amulet in the shape of the palm of the hand with fingers, or a seven-branched candelabrum. Amulets containing biblical verses were also used, and it was customary to place sweet-meats under the bed so that the evil spirits would be occupied with eating them. In Salonika it was customary to leave the doors of the house and all its cupboards open during pregnancy to ensure that the mother would not miscarry. It was also customary to measure a string seven times around the grave of a renowned rabbi and then bind it around the stomach of the pregnant woman to ensure an easy pregnancy. The mother and her relatives also prayed at the graves of pious men in the fifth month of her pregnancy. To ensure that the child would be a male, the mother pronounced the intended name of a boy every Friday. She was guarded for 15 days after birth, and blue beads or pieces of ivory and coral were hung above the cradle of the child. Garlic and other plants were hung in the room, and an open hand was painted on the door. An attempt was made to keep the mother awake for the first three days after birth to prevent Lilith from harming her. In Yemen, a festive meal, at which the name was given, was held on the third day. In Kurdistan the mother was not allowed to leave the house after nightfall for 40 days. Since delivery usually takes place now in modern hospitals, most of these traditional customs at childbirth have tended to disappear, particularly since they were primarily based on medieval superstitious folklore. Naming a daughter at the synagogue, however, has been retained in traditional, Conservative, and Reform Jewish practice.

Contemporary Developments in Birth Rituals for Girls

The Jewish feminist movement that began in the 1970s encouraged the development of ceremonies to publicly sanctify the entry of Jewish baby girls into the covenant. By the beginning of the 21st century, public welcomes for baby girls had become normative in American Judaism. Numerous versions of Brit Bat (the covenant of a daughter) or Simḥat Bat (the joy of a daughter) rituals were available for home and synagogue use by parents and rabbis from all Jewish religious movements. Some of the ceremonies made use of symbols such as candles (brit ha-nerot). Although ceremonies for baby girls are most often held in synagogues during services where the Torah is read, many are now conducted at home like those that accompany circumcisions. In Israel the ceremony or party celebrating the birth of a daughter is sometimes called brita (a feminization of the word for covenant).

Simḥat bat ceremonies may include a formal welcome by those present as the baby girl is carried in; spelling the child's Hebrew name out with biblical verses; bestowing the priestly benediction and traditional Friday night daughter's blessing; a naming prayer including both father's and mother's names in that of the daughter; explaining the rationale for the name; an expression of thanks for return to good health by the mother (birkat ha-gomel); a series of short blessings including the one over wine and sometimes in the format of the seven benedictions (sheva brakhot) of the traditional Jewish wedding ceremony; and special added benedictions to the grace after meals after the festive meal (se'udah shel mitzvah) which follows the ritual. Often, booklets are printed and distributed which announce the name and provide a "script" for the ceremony so that all present may participate. These manuals serve as vehicles for innovation and as educational tools to enable assimilated Jews and the growing number of non-Jews who attend Jewish life cycle rituals to understand and follow what is going on before them.

Another evolving aspect of contemporary rituals connected with birth is the inclusion of the mother in ceremonies for sons and daughters. Until the last quarter of the 20th century mothers were often absent from the ceremonies for their sons and the naming of their daughters in the synagogue. Today, in some circles the family waits to name the daughter until the mother is able to be present. She may have a Torah honor in the synagogue and recite the prayer for a safe recovery. Both boys and girls may be named as the children of both mother and father. At a circumcision, the mother as well as the father may be in the room and say the prescribed benedictions.

[Rela Mintz Geffen (2nd ed.)]

See also *Circumcision.

bibliography:

I. Jakobovits, Jewish Medical Ethics (1959), 170–91; M. Perlman, Midrash ha-Refu'ah, 1 (1926), 18–25; E. Ilinson, in: Sinai, 66 (1969/70), 20–49. customs and folklore: Y. Yehoshua, Yaldut bi-Y'rushalayim ha-Yeshanah, 2 (1966), 79–91; Molcho, in: Saloniki, Ir va-Em be-Yisrael (1967), 188–93; M. Zadok, Yehudei Teiman (1967), 213–4; N.B. Gamlieli, Telman u-Maḥaneh "Ge'ullah" (1966). add. bibliography: R. Barkai, A History of Jewish Gynaecological Texts in the Middle Ages (1998); E. Baumgarten, Mothers and Children: Jewish Family Life in Medieval Europe (2004); R.M. Geffen (ed.), Celebration & RenewalRites of Passage in Judaism (1993), 12–31; E. Horowitz, "The Eve of Circumcision: A Chapter in the History of Jewish Nightlife," in: Journal of Social History, 13 (1989/90), 45–69; M. Klein, A Time To Be Born: Customs and Folklore of Jewish Birth (1999); I.G. Marcus, The Jewish Life Cycle: Rites of Passage From BiblicalTo Modern Times (2004); R.L. Millen, Women, Birth, and Death in Jewish Law and Practice (2004), 70–108; S. Sabar, "Childbirth and Magic. Jewish Folklore and Material Culture," in: D. Biale (ed.), Cultures of the Jews: A New History (2002), 671–722.

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Birth

BIRTH

BIRTH . The mystery associated with birth forms a central motif in every religion. The motif may be appreciated in its irreducible physical form or may become a highly abstract symbol or ritual. Religiously, birth is not regarded as merely a physiological process, or even a ritualized physiological event, but is associated with the evolution and transcendence of spiritual powers or the soul. Transmuted through myth, ritual, and symbol, the concept of birth becomes a major cipher for understanding existence and expressing wonder at creation.

Most religions explore the motif of birth through these three areas of myth, ritual, and symbol. Mythic narratives about important births or mythic figures who give birth are found in most religious traditions, and these myths shed light on the theological and ethical importance of rituals surrounding birth and rebirth. The ritual concerning physical childbirth itself makes this physiological event a religious experience. A third important motif is symbolic rebirth. Many religions speak of the central transformations in the religious life as rebirth. Whether as a collective initiation or as a solitary conversion, members of most religions are expected to undergo a second birth, which sometimes closely duplicates the first, physiological birth. At other times it is intended to undo the inadequacies of the first birth, so that there is an opposition between physiological birth and spiritual or social rebirth. This kind of second birth can often involve great tension or even hostility between women and men. This second birth can be so abstract that the way in which it duplicates one's first birth is unclear.

Primal Religions

Statues of pregnant women dating from the Paleolithic period are important as indicators of the earliest attachment of religious significance to birth. Found in archaeological sites from Spain to Russia, these statues date from about 25,000 bce on. Since they are found in the remains of old settlements and dwellings, they are thus assumed to be part of domestic religion. Although the exact use and significance of these figures cannot be determined, it seems undeniable that they reflect and express concern with birth specifically and with feminine energy in general as central existential and religious symbols.

For the Neolithic period, the evidence for a religion centered on goddesses and for a matrifocal society in Old Europe between 6500 and 3500 bce is convincingly presented by Marija Gimbutas (1982). According to Gimbutas, the appropriate collective title for the goddesses is "the Goddess-Creatrix in her many aspects." Among the most important of these aspects is "the life-giving goddess, her legs widely parted" (p. 176). Reliefs of this goddess found in the temples of the Anatolian village of Çatal Hüyük (excavated and reported by James Mellaart) have become especially well known. Contemporary interpreters of this culture have suggested that one may contemplate the impact of entering a religious sanctuary and finding the large, central, elevated image of the Great Birth-Giver with widely parted legs. Such sanctuaries were common in Çatal Hüyük for at least a millennium. In addition, according to Gimbutas, the schematic diagram for this birth-giving goddess was widespread in Old Europe.

The religious significance of birth in primal religions can also be studied in the context of the present ethnographic data. Rituals surrounding first and second birth have been minutely described and analyzed for many societies. Small-scale societies provide reference points for many classic analyses of birth and rebirth ritual. The links between these rituals of birth and mythologies about birth have not been thoroughly studied, but many small-scale societies also possess a significant mythology concerning births.

Physiological birth is the occasion for rituals in almost all small-scale societies. The well-known pattern for transition ritualswithdrawal, seclusion, and returnis evident in the activities surrounding physiological childbirth. In this case there is an especially close connection between physiological requirements and ritual elaboration. Other transition rituals do not carry the same physiological necessity for withdrawal and seclusion, which strengthens the hypothesis that the experience of giving birth is the model upon which other transition rituals are based. This observation also intensifies the impression that the religious meaning of birth extends far beyond physiological childbirth, which is nevertheless one of the most powerful and pervasive root metaphors of religion.

The pattern of withdrawal, seclusion, and return can take many forms and can include other ritual details. The withdrawal may begin some time before the actual delivery, or it may begin only with the onset of labor, as among the !Kung of southern Africa. The seclusion may be short and solitary, an unusual pattern found among the !Kung and, among them, only for uncomplicated deliveries. Usually the woman giving birth is secluded with appropriate relatives and helpers. Though there are exceptions, as among the inhabitants of Tikopia and the Marquesas, one of the most reliable generalizations that can be made about childbirth seclusion in primal religions is the absence of men. Usually their absence is not merely an accident or a practical arrangement but rather a deeply felt religious requirement. However, the woman's husband may participate vicariously in childbirth through practicing couvade, a series of work and food taboos, physical symptoms, and seclusion. These practices are especially associated with South American Indians. While male absence from childbirth is a general requirement, exceptions are sometimes made in special circumstances such as a difficult delivery; then the shaman or the father may attempt to help the delivery.

After childbirth, the seclusion for the woman continues usually for at least a few days and frequently for a month or more. During this seclusion period, both mother and child receive special treatment and are subject to special restrictions. In most cases, during the entire period of the withdrawal, seclusion, and return, normal routines of eating, working, and human association are disrupted. Normal activities or associations may be restricted to protect either the mother and child or those with whom the mother comes in contact or both. On the other hand, the mother may also be indulged with special foods, a lighter workload, and the solicitous companionship of her friends and relatives. Generally, some ritual elaboration of physiological childbirth seems to be universal among the women of primal cultures.

Almost all of the observances of childbirth outlined above are found among the Aboriginal Australians. The ethnographic literature on these groups concentrates heavily on the second birth, or initiation, as the important birth. In fact, many analyses of Australian Aboriginal religion suggest that physiological birth is the low point in the life cycle relative to membership in the sacred or religious community, and that this situation begins to change only with a second or so-called real birth during initiation. For the birth-giver, however, childbirth is definitely a religious experience that also serves to advance her ritual status. She experiences and practices all the rituals associated with participation in a sacred ceremony and thus emulates models from the mythic Dreaming that sanction her experience and behavior.

For members of many primal religions, birth is believed to be something that must be reexperienced at least once, especially by men. Frequently, for this purpose, boys are forcibly removed from their familiar surroundings, isolated from women, subjected to painful ordeals and physical operations, and taught secret lore that only men may know (although, in fact, women often surreptitiously find out these secrets). When the boys are reintegrated into the society, they have become "men" through the agency of their male initiators.

Though there are exceptions, as among the Mende of West Africa, this process of a prolonged and tedious rebirth is more typically expected of males than of females. Some scholars analyze this male rebirth ritual as a symbolic gesture whereby boys enter the masculine realm and are freed of the feminine world in which they had previously lived. The second-birth ceremonies of Australian Aborigines may also be seen as experiences that serve as a transition from profane to sacred status. This analysis suggests that the second symbolic birth is the real birth, and that male initiation is needed to accomplish what women cannot do when they give birth. This analysis stresses the differences and tensions between the two modes of birththat given by women and that given by menand focuses often on male-female tension and hostility in the culture. However, other analyses emphasize the continuity between first and second births and see the second birth as a duplication rather than an undoing of the first birth. More significantly, the male initiators finally experience vicarious childbirth in a kind of delayed couvade as they duplicate the pattern of childbirth. This kind of analysis stresses the extent to which the ceremonies of male second birth are based on awe of, not scorn for, the women's accomplishment in giving birth.

Aboriginal Australian male ceremonies of second birth give clear evidence for the dual meaning of second birth as both a transformation of boys into men and as a birth-giving experience for men. During the ceremonies, boys are carried about by men in the same way that women carry babies. After the initiation operation, the boys are taught a new language, and the men engage in the same purificatory and healing practices as do women after childbirth like the mythic sisters of the Dreaming. The operation itself is symbolic of severing the umbilical cord. In other ceremonies, a trench, symbolizing a uterus, is dug on sacred ritual ground and boys are made to lie in it until the proper time for their emergence, which is indicated by the correct sequence in the dance dramas conducted by the men. In some ceremonies, men ritually wound themselves and correlate their blood with the blood that flows in childbirth.

Many primal religions focus on mythic births and birth-givers. No mythological system among primal religions is devoid of female personalities and activities that focus on birth and rebirth. Among the Aborigines of Australia, there are several well-known mythologies of birth-givers, who are also models for current ritual practices that both women and men engage in. Ronald M. Berndt has reported on two major myth cycles in Kunapipi (Melbourne, 1951) and Djanggawul (Melbourne, 1952). The Djanggawul epic concerns a brother and two sisters who travel together; the sisters are perpetually pregnant and constantly give birth, assisted by their brother. The other epic concerns two sisters, the Wawalag, one of whom is pregnant and gives birth. The sisters reveal their experiences to men through dreams that become the basis for the men's ritual drama that accompanies second birth. In some Aboriginal mythologies, the ritual process of second birth is itself identified with the great All-Mother or Birth-Giver.

Indian Religions

In the Indian religious context, especially in Indian folk religions, childbirth remains an occasion for religious observances. These rituals follow familiar patterns of withdrawal, seclusion, return, and disruption of normal daily routines. Usually both women and men take part in some birth observances, though the rituals are much more extensive for women. Indian childbirth practices are characterized by uniquely Hindu notions and practices of ritual purity and pollution and are colored by the highly patriarchal character of the Indian family.

The childbirth rituals of an Indian village have been described in a study by Doranne Jacobsen (1980). Though restrictions on food and activity during pregnancy are minimal, with the onset of labor the woman giving birth is separated from others. It is believed that during labor and for a short period immediately following childbirth, the woman and her baby are in a highly polluted and polluting state, similar to the state of people in the lowest untouchable classes. Anyone who contacts the mother and child contracts this pollution, so the two are carefully isolated. Only the midwife, who belongs to a very low class because of the polluting nature of her work, and one married female relative stay with the woman. This childbirth pollution extends to a lesser extent to all members of the husband's family. They also observe some of the restrictions incumbent upon one in a state of pollution and undergo purificatory practices.

The delivery is followed by a series of ceremonies gradually reintegrating the woman and child into the ongoing life of the village. On the evening of the birth girls and women gather in the courtyard of the house to sing. After three days, the level of pollution is lessened when the woman is given purifying baths; she then begins to have limited contact with her household. After ten days, in an important women's ceremony, the woman and her baby leave the house momentarily for the first time, and the mother blesses the family water pots and water supply. For the next month, the woman is still in a transitional state, participating in some of the family's activities, but not cooking or participating in worship services for the deities. Usually the pollution period ends about forty days after the birth, when the mother performs a ceremony at the village well at night, symbolically extending her fertility to the village water supply and completing her reintegration into the community.

This transition period in the woman's life is significant not only for her but for her entire family and community. Both male and female members of her husband's family, who often make the young wife's life very difficult, recognize the new mother's ritual status and must change their behavior appropriately. For the new mother herself, the forty-day seclusion is not so much a period of liability and deprivation as a period of healthful rest and indulgence. She receives special foods, attention, and a new, respected status in her husband's family, especially if she has just given birth to her first son. These rituals surrounding childbirth support and validate women's vital role in a society that often expresses ambivalence toward women and projects strong male dominance.

Second symbolic birth is important in some Indian castes and some religious groups. During the Vedic period (c. 1500900 bce) and in those castes that are still heavily involved in rituals and privileges having Vedic antecedents, second birth is an important affair. During Vedic times it was important in its own right; in contemporary Hinduism it is more important because of the privileges associated with being eligible to undergo a second birth.

The upper levels of Hindu society call themselves "twice-born"; their second birth gives them privileges, status, and responsibilities unavailable to the rest of the population. The privileges include the right to study the Vedic sacred texts and to practice religious ceremonies derived from Vedic models. The visible symbol of this status is a cotton cord worn by men across the left shoulder and resting on the right hip. A boy's second birth occurs when he is invested with this sacred thread, receives a sacred verse from his mentor, and undertakes, for at least a few moments, the ascetic discipline of a religious student.

The ancient texts regarding this initiation ceremony regard it as a second birth conferred by the male preceptor. The preceptor transforms the boy into an embryo, conceiving him at the moment when he puts his hand on the boy's shoulder. The preceptor becomes the boy's mother and father and symbolically carries him in his belly for three nights; on the third day the boy is reborn as a member of the privileged twice-born group. After his initiation the twice-born man can perform further sacrifices, which also begin with an initiation involving return to embryonic status and rebirth. Some Indian cultic traditions that still rely heavily on initiation continue to employ these motifs. For example, some Buddhist initiations begin with a series of rites in which the neophyte, deliberately compared to an infant, is washed, dressed, decorated, taught to speak, given a name, and so on.

However, though the theme of second birth occurs in the Indian contexts, many of the great soteriological themes of the Indian tradition do not rely on metaphors of birth and rebirth. Neither Hindu yoga nor the Buddhist Eightfold Path are a process of second birth; neither Hindu brahman nor Buddhist nirvāa results from second birth. They destroy delusion and result in insight and understanding. Images of maturation and death, rather than images of birth and rebirth, more accurately describe this attainment of an otherworldly attitude.

In the Indian context both stories of mythic birth and images of great birth-givers are ambiguous. The two most familiar birth stories, that of the Buddha and that of Ka, are highly unusual. Rather than serving as paradigms of birth-giving, they tell of the extraordinary futures awaiting the infants Buddha and Ka. Goddesses are numerous and important, but they are never simple mother goddesses. Though the creative power of the goddesses is stressed, none of the great goddesses of Hindu mythology experiences a pregnancy and delivery with which a human female could identify, not even Pārvatī, the wife of Śiva and the mother of two of his children. But the veneration of symbols of male and female sexuality is widespread. Temple reliefs of goddesses, naked, hands on hips, knees turned outward to display their sex, recall the Creatrix of Çatal Hüyük. As Sakti, vital energy, she is the energy that fuels the entire phenomenal world. Moreover, without the touch of her energizing dancing feet even the greatest god, Śiva, is a mere sava or corpse.

Monotheistic Religions

In the ancient Near East, the concept of monotheism involved the suppression of the goddess as the legitimate symbol of divine creativity and resulted in her replacement by a solitary sovereign, an abstract and nonsexual, though male, creator. Many mythologies from the third millennium onward display an increasing attempt to present males as primordially creative, even as the first birth-givers. They become pregnant and give birth, despite their anatomical limitations. Even if they are not directly involved in birth-giving, they are depicted as performing creative acts. Perhaps the most dramatic account of this reversal occurs in the creation epic of ancient Mesopotamia (mid-second millennium bce). The older generation of gods are the primordial parents Apsu and Tiamat. After Apsu is killed by younger gods, Tiamat engages in battle against the younger gods. The battle is a confrontation between Marduk, a young male hero, and Tiamat, the Original Mother. He kills her and creates the cosmos out of her lifeless body. The gender identification of the two protagonists, though often ignored, is extremely significant. It is also found in one of the most important myths of Western culture, the creation of the female (Eve) out of the male (Adam).

Against this mythological background, physiological childbearing is not an especially important or religiously valued activity in monotheistic religions. The pains of childbirth are explained as punishment for Eve's curiosity and disobedience; the most noteworthy birth, Jesus' virgin birth, can no more be a model for ordinary women than can the births of the Buddha or Ka. Throughout the centuries, though women have been exhorted to bear children and even have been declared saved by their childbearing (1 Tm. 2:15), their childbearing has neither been given value by significant religious rituals nor been utilized as a significant symbol in the mythological system. In the Christian, Jewish, and Muslim traditions, childbirth has nevertheless been surrounded by folk rituals, taboos, and superstitions. Even in modern secular societies, the activities surrounding childbirth are highly ritualized, as has been pointed out by several anthropological analyses of modern Western cultures. These rituals are changing at present, as indicated by the growing popularity of home births, birthing centers, and so on, and by much more direct participation of fathers in the childbirth process than is found in most other societies.

In the context of these Western religious traditions, mothering as an activity has been a more significant religious symbol than birth itself, as is evidenced by the madonna-and-child imagery that is popular in Christian piety. Scholars are beginning to notice aspects of motherly energy in the symbolism of the divine. Yahveh of the Hebrew scriptures is also depicted as a mother eagle. The word for his mercy (raamim ) derives from the word meaning "womb" (reem ); some suggest that the phrase "merciful father" could be translated as "motherly father." The words for his spirit may be masculine or feminine, while the word for his wisdom is definitely feminine, as is shekhinah, the term for his presence on earth. In medieval times Christ was depicted as being motherly and feminine. Anselm, in his ontological proof of the existence of God, pictured Christ as a mother hen, an image that appears in the Bible (Mt. 2337, Lk. 1334).

Second birth has remained a central motif in monotheistic religions, especially in Christianity. Physiological birth by itself is insufficient to initiate a person into complete membership in the religious community, which is accomplished by the second and real birth. In Judaism and Islam the circumcision ritual does not stress, or even recognize, circumcision as rebirth. In Judaism it is simply "entry into the covenant," and is the first religiously significant event, but is not modeled on an earlier birth.

In Christianity, the necessity of second birth has been especially strong. The contrast between the "Old Adam" and the "New Man" is deeply built into the Christian symbol system. Transition from one birth to the other is a necessary individual experience, verified in baptism, or more recently, in the psychological experience of being "born again." Inasmuch as baptism is performed by a traditionally all-male clergy, the ritual resembles the second births performed by men in other religions. However, rebirth is not a duplication of physiological childbearing but instead emphasizes the need to die to the "old life." In Christianity, everyone, whether female or male, needs to be individually reborn. In this way the Christian understanding of true rebirth departs significantly from other traditions. However, this rebirth occurs through the ritual agency of a male clergy and is almost always understood as a rebirth into the graces of a male monotheistic deity. Perhaps in no other context is the need to be reborn so strongly felt yet so strongly removed from the arenas of feminine symbolism and replication of female activity.

See Also

Couvade; Initiation; Prehistoric Religions.

Bibliography

Literature about rituals of birth and rebirth as well as the mythology and symbolism of the Great Birth-Giver is scattered in many sources. Only rarely, or not at all, are such materials easily found in a few sources. Two classic discussions of transition rituals are Mircea Eliade's Rites and Symbols of Initiation: The Mysteries of Birth and Rebirth (New York, 1958) and Arnold van Gennep's The Rites of Passage (Chicago, 1960). More recent books that include significant comparative discussions of birth rituals include Martha Nemes Fried and Morton H. Fried's Transitions: Four Rituals in Eight Cultures (New York, 2001) and Sheila Kitzinger's Women as Mothers: How They See Themselves in Different Cultures (New York, 1978).

The Old European religion is discussed in Marija Gimbutas's The Goddesses and Gods of Old Europe, 65003500 B. C. (Berkeley, 1982) and in Anne Barstow's "The Prehistoric Goddess," in The Book of the Goddess: Past and Present, edited by Carl Olson (New York, 1983). The ceremonies of birth and rebirth among Aboriginal Australians are summarized in my essay "Menstruation and Childbirth as Ritual and Religious Experience among Native Australians," in Unspoken Worlds, edited by Nancy Auer Falk and me (San Francisco, 2001), where Doranne Jacobson's "Golden Handprints and Red-Painted Feet: Hindu Childbirth Rituals in Central India" can also be found. Rebirth ceremonies are described in David G. Mandelbaum's Society in India, 2 vols. (Berkeley, 1970), and Abbé Jean Antoine Dubois's Hindu Manners, Customs and Ceremonies, 3d ed. (1906; reprint, Oxford, 1968). The many qualities of Hindu goddesses and mythic birth-givers can be seen in N. N. Bhattacharyya's The Indian Mother Goddess, 2d ed. (Columbia, Mo., 1977), and in The Divine Consort, edited by John Stratton Hawley and Donna Marie Wulff (Berkeley, 1982).

Shifts in the core symbolism of the ancient Near East become apparent when the older worldview is first studied. Diane Wolkstein and Samuel Noah Kramer present a moving portrait in Inanna: Queen of Heaven and Earth (New York, 1983). The prebiblical shifts in symbolism are presented by Thorkild Jacobsen's The Treasures of Darkness (New Haven, 1976), and the struggle to enforce the biblical shift in symbolism is discussed by Raphael Patai's The Hebrew Goddess (New York, 1967). For symbolism of second birth in Christianity, see Marion J. Hatchett's Sanctifying Life, Time and Space (New York, 1976) and Joseph Martos's Doors to the Sacred (New York, 1982). Finally an older source containing much valuable information, including chapters on Palestine and the church, is E. O. James's The Cult of the Mother Goddess (New York, 1959).

Rita M. Gross (1987 and 2005)

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Birth

Birth ★★ 2004 (R)

Creepy psychological thriller finds widowed Anna (Kidman) finally making a commitment to marry Joseph (Huston) ten years after her husband Sean's death. That is until a strange 10yearold, also named Sean (Bright), turns up insisting that Anna cannot remarry because he is her spouse. Sean is impervious to any suggestion otherwise and his very insistence comes to convince the emotionally fragile woman. None of this goes over well with Anna's imperious mother (Bacall) or the rest of her family, let alone her frustrated fiance. Various explanations are offered and director Glazer elegantly camouflages plot holes. Kidman, with her severe pixie haircut, somewhat resembles Mia Farrow in “Rosemary's Baby,” but one thing you can be certain of is here, the devil didn't do it. 100m/C DVD . US Nicole Kidman, Cameron Bright, Danny Huston, Lauren Bacall, Arliss Howard, Alison Elliot, Anne Heche, Peter Stormare, Ted Levine, Cara Seymour, Zoe Caldwell, Milo Addica; D: Jonathan Glazer; W: Milo Addica, Jonathan Glazer, JeanClaude Carriere; C: Harris Savides; M: Alexandre Desplat.

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Birth

Birth

Viviparous animals

How does birth begin?

Maternal progesterone

Oxytocin

Fetal endocrine control

Birth in humans

History of childbirth

Types of childbirth preparation

Types of anesthesia

Resources

Birth, or parturition, in mammals is the process in which a fully developed fetus is expelled from the mothers uterus by the force of strong, rhythmic muscle contractions. The birth of live offspring is a reproductive feature shared by mammals, some fishes, and select invertebrates (such as scorpions), as well as some reptiles and amphibians. Animals who give birth to live offspring are called viviparous (live birth).

In contrast to viviparous animals, other animals produce eggs; these animals are called oviparous (egg birth). Some oviparous species, such as birds, retain their eggs inside their bodies for long periods of time; in these animals, the eggs are laid at an advanced stage of development. Other animals, such as frogs, give birth to less developed eggs, which undergo development outside the mothers body.

Viviparous animals

In both viviparous and oviparous animals, fertilization of the mothers egg with the fathers sperm takes place inside the mothers body. One of the advantages to giving birth to live young is that the mother protects the fetus inside her body as it develops. The developing fetus derives nutrients from the mothers body, and so is assured of receiving all the nourishment it needs to complete development.

The length of time between fertilization and birth in viviparous animals is the gestation period, which varies according to species. The gestation period of mice is 21 days, of rabbits is 30-36 days, and of dogs and cats is 60 days. The largest mammal, the baleen whale, has a gestation period of 12 monthsonly three months longer than the gestation period of humans. Elephants have one of the longest gestation periods of all animals, 22 months.

Some viviparous animals such as humans, horses, and cows, usually give birth to only one offspring at a time, although occasionally these animals produce twins or triplets. Other animals give birth to many offspring at a time. Usually, multiple offspring in a litter are each derived from a separate eggs, but the armadillo gives birth to four identical offspring that are derived from the same fertilized egg.

How does birth begin?

At the end of the gestation period, the mothers uterus begins to contract rhythmically, a process called labor. The initiation of labor leading up to birth is the result of a number of hormones, notably oxytocin.

Maternal progesterone

Shortly after fertilization the hormone progesterone increases and is maintained at high levels in the

mothers bloodstream. The high levels of progesterone prevent the uterus from contracting. The progesterone prepares the lining of the uterus (the endonestrium) for its supporting role in nurturing the developing fetus, and helps form the placenta. Maternal progesterone levels begin to drop during the last weeks of gestation, while the levels of estrogen begin to rise. When progesterone levels drop to very low levels and estrogen levels are high, the uterus begins to contract.

Oxytocin

Oxytocin is a hormone released from the pituitary gland in the brain, which stimulates uterine contractions and also controls the production of milk in the mammary glands of the breast (a process called lactation). Synthetic oxytocin is sometimes given to women in labor to induce labor.

The mechanism that prompts the secretion of oxytocin from the pituitary during labor is thought to be

initiated by the pressure of the fetuss head against the cervix, the opening of the uterus. As the fetuss head presses against the cervix, the uterus stretches, and relays a message along nerves to the pituitary, which responds by releasing oxytocin. The more the uterus stretches, the more oxytocin is released.

Fetal endocrine control

Fetal hormones are also thought to play a role in initiating labor. At the end of gestation, the fetal adrenal glands secrete steroid hormones called corticosteroids, which stimulate the production of hormonelike substances known as prostaglandins that contribute to the contraction of the uterus during labor.

Birth in humans

Labor culminating in birth in humans begins with the rhythmic contractions of the uterus, which dilate the cervix. This causes the fetus to move down the birth canal and be expelled together with the placenta, which had supplied the developing fetus with nutrients from the mother. Usually the entire birth process takes about 16 hours, but it can range anywhere from less than one hour to 48 hours.

The first stage: Dilation of the cervix

In order for the fetus to leave the uterus and to enter the birth canal, it must pass through the cervix, the opening of the uterus. The cervix is normally tightly closed, and sealed with a plug of mucus during gestation to protect the fetus from invading microorganisms. During the first stages of labor, the contractions of the uterus dilate the cervix, which widens to about 4 inches (10 cm), to accommodate the passage of the babys head.

In the last weeks of pregnancy, before labor begins, the uterus undergoes irregular contractions, which serve to exercise the muscles of the uterus and may even dilate the cervix; its not unusual for a woman to go into active labor with a cervix that is already dilated to 1 or 2 centimeters. During the last weeks of pregnancy, the cervix also thins out (or effaces), which makes dilation easier.

In preparation for birth, the fetus moves further down into the mothers pelvis. When labor begins, the fetus is usually positioned with its head engaged with the top of the cervix. This engagement is called lightening or dropping. When labor begins, the contractions loosen the mucus plug in the cervix causing small capillaries in the cervix to break, and the mucus and blood are discharged from the vagina. This discharge is sometimes called bloody show and signals the onset of labor.

Another sign that may signal the beginning of labor is the rupturing of the amniotic sac. In the uterus the fetus is encased in a membrane and literally floats in amniotic fluid. When uterine contractions begin, this sac ruptures and the amniotic fluid can leak from the uterus. Not all women experience an abrupt rupturing of the amniotic sac; in some, the amniotic fluid gradually leaks out as labor progresses. Once the amniotic sac has ruptured, or the amniotic fluid begins to leak, labor usually progresses more rapidly. During the first stage of labor, the cervix dilates about 0.5-0.6 inches (1.2-1.5 cm) an hour. The uterine contractions are 5-30 minutes apart, and last for 15-40 seconds. The end of the first stage of labor is associated with the strongest uterine contractions. Contractions are two to five minutes apart, and last for 45-60 seconds. The cervix opens rapidly at this point. This period of labor, sometimes called transition, is usually the most difficult for the mother. The contractions are very strong and close together, and nausea and vomiting are common. After the cervix has dilated to its full width of 4 inches (10 cm), the contractions slow down somewhat to about three to five minutes apart. The fetus is then ready to be born, and the second stage of labor begins.

The second stage: Birth

During the second stage, lasting about one to two hours, the mother uses her abdominal muscles to push the fetus through and out of the birth canal.

The pushing is actually a reflex action, but if a woman can help the reflex by actively using her muscles, birth goes much faster. As the fetus moves

down the birth canal to the vaginal opening, the head begins to appear. The appearance of the head at the opening of the vagina is called crowning. After the head is delivered, first one shoulder is delivered, then the other. The rest of the body follows.

After the baby is born, the umbilical cord that has attached the fetus to the placenta is clamped. The clamping cuts off the circulation of the cord, which eventually stops pulsing due to the interruption of its blood supply. The baby now must breathe air through its own lungs.

The third stage: Delivery of the placenta

Before delivery, the placenta separates from the wall of the uterus. Since the placenta contains many blood vessels, its separation from the wall of the uterus causes bleeding. This bleeding, if not excessive, is normal. After the placenta separates from the uterine wall, it moves into the birth canal and is expelled from the vagina. The uterus continues to contract even after the placenta is delivered, and it is thought that these contractions serve to control bleeding.

History of childbirth

Until the twentieth century, childbirth was the province of women. A woman giving birth was attended by her female relatives and perhaps a woman in the community known for her midwifing skills. As the scientific revolution of the seventeenth century took place, concerned physicians noticed that childbirth was a dangerous, often fatal, process. Infections, injury, and even death were the result to both baby and mother when unskilled midwives attempted to manage

complications. Gradually, childbirth changed from an entirely female-centered activity to a medical process overseen by predominantly male physicians. By the early twentieth century, childbirth moved from the home to the hospital. By the mid-twentieth century, childbirth had become a completely medical process, attended by physicians and managed by medical equipment and procedures, such as fetal monitors, anesthesia, and surgical interventions.

Later in the twentieth century, some women became dissatisfied with this medical approach to birth. Many felt that the medical establishment had taken control of a natural biological process. Women wanted more control over labor and birth and new ways of giving birth that sought to reduce or eliminate the medical interventions became popular. With the increasing concern about the effect of anesthesia on the fetus, many women refused artificial means of controlling pain, and instead relied on breathing and relaxation techniques. Fathers, once banished from labor and delivery rooms, were now welcomed as partners in the birth process.

Today, women have many options for labor and birth. Some women deliver in a hospital with doctors and nurses close by to supervise the birth process. Others choose a nurse-midwife, a person who has been trained to deliver babies but who is not a doctor. Still others choose home birth, attended either by a doctor or midwife, or sometimes both. Whichever option a woman chooses, it is important to get good medical care throughout pregnancy. Periodic prenatal checkups are one of the best ways to avoid birth complications.

KEY TERMS

Amniotic fluid The fluid in which the fetus lives in the uterus.

Amniotic sac The sac that contains amniotic fluid.

Gestation The period of carrying developing offspring in the uterus after conception; pregnancy.

Labor Strong, rhythmic uterine contractions leading to birth.

Placenta The organ that develops during gestation through which a fetus receives nourishment from the mother.

Prostaglandins A substance released by uterine cells that cause uterine contractions.

Umbilical cord The cord that attaches the fetus to the placenta.

Types of childbirth preparation

Many childbirth experts believe that the more a mother knows about the birth process, the less fear and apprehension she will feel. Many childbirth preparation methods prepare both mother and father for the birth experience and teach relaxation and breathing techniques. The Read method, for instance (named after its founder, British physician Grantley Dick-Read), is based on the notion that fear leads to pain. The Read method includes childbirth education, exercises to improve muscle tone, and relaxation techniques. The Lamaze method (named for Dr. Ferdinand Lamaze) takes a psychological approach to managing labor. The Lamaze method teaches women to relax and breathe in response to pain, the theory being that this substitution of favorable activity for negative sensations reduces pain. The Bradley method focuses on deep relaxation and slow, deep breathing, and ascribes an important role to the father.

Types of anesthesia

Two types of anesthesia are commonly used during labor and birth. In general anesthesia, the mother is given drugs that put her to sleep, but this type of anesthesia is rarely used today, since the drugs can depress the fetal heartbeat. In regional anesthesia, drugs are injected to deaden sensation around the spinal nerves that carry sensations from the pelvic region. Controversy about whether these drugs affect the fetus is ongoing, although some kinds of regional anesthesia affect the fetus less than others.

See also Embryo and embryonic development;Reproductive system; Sexual reproduction; Viviparity.

Resources

BOOKS

Bean, Constance A. Methods of Childbirth. Second edition. Garden City, New York: Doubleday, 1990.

Karmel, Marjorie. Thank You, Dr. Lamaze. New York: Harper and Row, 1993.

Knobil, Ernst and Neill, Jimmy D., eds. The Physiology of Reproduction. 2nd ed. New York: Raven Press, 1994.

Korte, Diana. The VBAC Companion: The Expectant Mothers Guide to Vaginal Birth after Cesarean. Cambridge, MA: Harvard Common Press, 1999.

Mitford, Jessica. The American Way of Birth. New York: Dutton, 1992.

Moore, Michele, and Caroline De Costa. Cesarean Section: Understanding and Celebrating Your Babys Birth. Baltimore, MD: Johns Hopkins Medical Press, 2003.

PERIODICALS

Deciding to Be Born. Discover 13 (10 May 1992).

Fischman, Joshua. Putting a New Spin on the Birth of Human Birth. Science 264 (20 May 1994): 1082.

Ventura, S.J. Births: Final Data for 1999. Service Today 49, no. (2001): 1-100.

OTHER

Babycenter, LLC. Labor and Delivery <http://www.babycenter.com/childbirth> (accessed November 2, 2006).

March of Dimes. Pregnancy and Newborn Health and Education Center Giving Birth <http://www.marchofdimes.com/pnhec/240_1034.asp> (accessed November 2, 2006).

Kathleen Scogna

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Birth

Birth

For most of human history, birth was exclusively the work of women who labored to push their babies from the private inner world of their wombs into the larger world of society and culture. Yet in the early twenty-first century, increasing numbers of babies are pulled from the vaginal canal with forceps or vacuum extractors, or are cut from their mothers' wombs via cesarean section. The medical definition of birth is the emergence of a baby from a womb—a definition that ignores women's involvement and agency.

BIRTH AND HUMAN EVOLUTION

Higher primates walk on all fours and have pelvises wide enough to allow the direct descent of the fetal head, making for easy labors and uncomplicated births. When humans began to walk upright, the pelvis narrowed, so that the human baby has to rotate as it descends through the birth canal. Non-human primate babies can climb onto their mothers' backs and cling immediately after birth. But the larger brains of human infants make it necessary for them to be born earlier in the developmental cycle, ensuring that human babies are relatively helpless at birth and require immediate nurturing. These factors encouraged the evolution of birth as a highly social process; women give birth alone and unaided in very few societies.

Evolutionary scientists postulate that midwifery evolved along with human birth. The presence of other women at a birth would have enhanced the success of the birth process, as these women acquired skills such as turning the baby in utero to ensure the optimal position for birth, assisting rotation of the head and shoulders at birth, massaging the mother's uterus and administering herbs to stop postpartum bleeding, and facilitating breastfeeding. For these reasons, more mothers and babies survived in societies that developed midwifery traditions early on, giving them a distinct evolutionary advantage.

BIRTH, CULTURE, AND WOMEN'S STATUS

Although childbirth is a universal fact of human physiology, the social nature of birth and its importance for survival ensure that this biological and intensely personal process carries heavy cultural overlay, resulting in wide variation in childbirth practices: Where, how, with whom, and even when a woman gives birth are increasingly culturally determined. In 1908 French ethnographer Arnold van Gennep (1873–1957) noted that cultures ritualize important life transitions—of which birth is a prime example. Birth practices reflect and reveal the core values and beliefs of the culture, telling the observer a great deal about the way that culture views the world and the place of women in it. Many religions, including Judiaism and Zoroastrianism, regard birth as polluting and require ablution and isolation for purification afterward.

Where women's status is high, a rich set of nurturant traditions tends to develop around birth; where it is low, the opposite may occur. For example, in the highly patriarchal Islamic society of Bangladesh in which the status of women is low, childbirth (like menstruation) has traditionally been regarded as highly polluting. Before modernization, women gave birth on dirty linens, attended only by female relatives or traditional midwives who were themselves regarded as polluting. In contrast, in the matrilineal societies of Polynesia where the status of women is high, pregnant women are pampered and nurtured. Skilled midwives administer frequent full-body massages during pregnancy and have a rich repertoire of techniques for assisting women during labor and birth.

THE EFFECTS OF PLACE OF BIRTH

Anthropologist Brigitte Jordan's comparative study of birthing systems in the Netherlands, Sweden, the United States, and Mexico's Yucatan, originally published in 1978, was the first to comprehensively document the wide cultural variations in birth. Her biocultural approach utilized the definition of birth, the place of birth, birth attendants, artifacts utilized to facilitate or control birth, and differences in knowledge systems about birth as foci for cross-cultural comparison.

Among these factors, place of birth has emerged as most salient for how birth happens. In home settings across cultures, from huts to houses, childbirth occurs according to the natural rhythms of labor and women's social routines. In early labor, women move about at will, stopping their activities during the 45 seconds or so per contraction, and then continuing their activities (which may include doing chores, chatting, walking, eating, singing, and dancing). Such activities subside as the women begin to concentrate more on the work of birthing, often aided in this labor by massage and emotional support from their labor companions, who are usually midwives. Many cultures have set patterns about who should be present at the birth (sometimes the father, sometimes only women, sometimes the whole family and/or friends), how labor support should be provided, what rituals should be performed to invoke the help of ancestors or spirits, and what herbs and hand maneuvers may be helpful to assist a birth or stop a postpartum hemorrhage. When birth is imminent, women at home usually take upright positions, squatting, sitting, standing, or balancing on hands and knees, often pulling on a rope or pole or on the necks or arms of their companions, and work hard to give birth. Postpartum practices vary widely: Some cultures encourage early breastfeeding, some define colustrum as harmful and feed the baby other fluids until breastmilk comes in (a practice now known to be medically dangerous—many babies die from imbibing contaminated water). Steam and herbal baths and periods of postpartum confinement are often culturally prescribed, varying in length from a few to forty days.

Where freestanding birth centers exist staffed by professional midwives, the experience of birth is resonant with the experience of birthing at home—a free flow. There are no absolute rules for how long birth should take. As long as the mother's vital signs are good and the baby's heartbeat is relatively stable, trained attendants allow the birth process to proceed at its own pace, keeping their focus on the needs of the mother, encouraging her to eat and drink at will, and to move about freely, adopting positions of her choice.

Birth in the hospital is an entirely different experience. The biomedical model dominant in hospitals demands that birth follow a certain pattern, including cervical dilation of 1 centimeter per hour—an arbitrary rule unsupported by science but consistent with industrial patterns of production. Ensuring the mechanical consistency of labor requires frequent manual checking of cervical dilation, which, if determined to be proceeding too slowly, will be augmented by breaking the amniotic sac and intravenous administration of the synthetic hormone pitocin (syntocinon) to speed labor. Women are often not allowed to eat or drink, and thus are routinely hydrated through intravenous lines, which also facilitate the administration of pitocin and other drugs. Electronic fetal monitoring to record the strength of the mother's contractions and the baby's heartbeat is pervasive in hospitals in developed countries, in spite of the fact that its routine use does not improve birth outcomes but does significantly raise cesarean rates because hospital personnel often misinterpret the monitor tracings, seeing an impending crisis where there is none. (Intermittent auscultation by a nurse, doctor, or midwife has been proven to be far more effective in identifying emerging problems.) Episiotomies to widen the vaginal outlet at the moment of birth are also common, although scientifically demonstrated to be unnecessary in 90 percent of births. Such routine obstetric procedures have been interpreted by cultural anthropologist Robbie Davis-Floyd as rituals that symbolically enact and display the core values of the technocracy, which supervalues progress through the development and application of increasingly advanced technologies to every aspect of human life, including reproduction.

IMPACT OF THE BIOMEDICAL MODEL ON BIRTH IN DEVELOPING COUNTRIES

The growing worldwide supervaluation of high technologies has induced many developing countries to suppress viable indigenous birthing systems and import the biomedical model from developed nations even when it is ill suited to the local situation. Hospitals built in the Third World may lack basic supplies such as bandages, clean sheets, and fresh needles yet be stocked with high-tech equipment. Hospital staff often has little understanding of or respect for local birth traditions and values, with the result that local women often avoid such hospitals. From northern India to Papua New Guinea to Mexico, indigenous women voice concerns about biomedical hospitals and clinics in both rural and urban areas: "They expose you;" "they shave you;" "they cut you;" "they leave you alone and ignore you, but won't let your family come in;" "they give you nothing to eat or drink;" and "they yell at you and sometimes slap you if you do not do what they say." Ironically none of the rules and procedures these women find so alarming are essential to good obstetric care; rather they reflect the importation of the culturally insensitive technocratic approach.

The transglobal imposition of this model on childbirth, sold to goverments as modern health care and to women as managing risk and increasing safety in birth, has resulted in an explosion of technological interventions in birth unprecedented in human history, including numbers of cesarean sections. Despite the World Health Organization's (WHO) demonstration that cesarean rates should never be above 15 percent, cesarean rates for Taiwan, China, and Puerto Rico are well above 40 percent; for Mexico, Chile, and Brazil are at around 40 percent; for the United States are 30.2 percent, and for Canada and the United Kingdom are 22 percent. Physician convenience and economic gain, combined with deeply ingrained medical beliefs that birth is a pathological process that works best when technologically controlled, are other factors in the recent rise in the number of cesareans performed. The WHO standard is met in the Netherlands, with a cesarean rate of 12 percent, and is reinforced by the excellence of birth outcomes in that country. This success is entirely cultural: The definition of birth as a normal physiological process in the Netherlands, in combination with Dutch cultural values on family, midwifery care, and careful attention to scientific evidence, have led to minimal interventions in hospital birth and the high home birth rate (30%) in that country. In contrast, in most of the developed world, home birth rates hover around 1 percent, despite the demonstrated efficacy and safety of a planned, midwife-attended home birth.

CONTESTING BIOMEDICAL HEGEMONY

The massive disparity between the scientific evidence in favor of less intervention in birth and the increasing interventions in actual practice reflect widespread acceptance of the technocratic model of medicine—a model developed by white male physicians—as the model on which to base developing health care systems. The hegemony of this approach is ensured by the political and economic benefits to physicians and technocrats from the imposition of the model, the forces of globalization and their concurrent trends toward increasing technologization, and women's concomitant faith in the model as the safest practice.

Nevertheless this hegemony is heavily contested. In addition to the thousands of local birthing systems, two other paradigms for contemporary childbirth exist throughout the world: The humanistic and holistic models. The highly patriarchal technocratic model of biomedicine metaphorizes women's birthing bodies as dysfunctional machines and encourages aggressive intervention in the mechanistic process of birth. The reform effort located in the humanistic model stresses that the birthing body is an organism influenced by stress and emotion and calls for relationship-centered care; respect for women's needs and desires; and a physiological, evidence-based approach to birth. The more radical holistic model defines the body as an energy system, stresses spiritual and intuitive approaches to birth, and places high value on the feminine. In dozens of countries, humanistic and holistic practitioners and consumer members of growing birth activist movements are utilizing scientific evidence and anthropological research to challenge the technocratic model of birth. They seek to combine the best of indigenous and professional knowledge systems to create healthier, safer, and more cost-effective systems of birth care.

Yet, from a crosscultural point of view, the focus on care of the individual limits all three paradigms. For example mortality resulting from birth is widely recognized as a massive global problem; more than 529,000 women die annually from complications of pregnancy and birth (including unsafe abortion). Biomedicine identifies conditions such as hemorrhage and toxemia as major causes of maternal death, and advises investment in doctors, hospitals, and rural clinics to provide prenatal care to prevent toxemia, and active intervention immediately after birth (i.e., administration of pitocin, cord traction for rapid removal of the placenta) to prevent hemorrhage. This biomedical approach makes it appear that problems inhere in individuals and should be treated on an individual basis, patient by patient, hospital by hospital. In contrast social science research in countries with the highest maternal mortality rates highlights the general poor health of women, who in many patriarchal societies suffer from overwork, exhaustion, anemia, malnutrition, and a variety of diseases resulting from polluted water, showing that the most important interventions required for improving women's health and for increasing safety in birth are clean water, adequate nutrition, and improved educational and economic opportunities for women.

BACK TO THE FUTURE: SCIENCE AND MIDWIFERY CARE

In the United States, obstetricians solidified their control over birth during the first half of the twentieth century and nearly eliminated midwifery by the 1950s. Since then the demands of many women for natural childbirth, coupled with scientific research into the dangers of interventionist hospital birth and the benefits of planned, midwife-attended births at home or in freestanding birth centers have generated a midwifery renaissance. Indeed in the four countries in which infant perinatal mortality statistics are the lowest in the world—Japan, the Netherlands, Sweden, and Denmark—more than 70 percent of births are attended by midwives who serve as the woman's primary caregiver throughout pregnancy, birth, and the postpartum period.

see also Anthropology; Fatherhood; Motherhood.

BIBLIOGRAPHY

Davis-Floyd, Robbie E. 1992. Birth as an American Rite of Passage. Berkeley: University of California Press.

Davis-Floyd, Robbie E., and Carolyn Sargent, eds. 1997. Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives. Berkeley: University of California Press.

DeVries, Raymond; Edwin van Teijlingen; Sirpa Wrede; and Cecilia Benoit, eds. 2001. Birth by Design: Pregnancy, Maternity Care and Midwifery in North America and Europe. New York: Routledge.

Jordan, Brigitte (1993). Birth in Four Cultures: A Cross-Cultural Investigation of Childbirth in Yucatan, Holland, Sweden and the United States. 4th edition. Prospect Heights, IL: Waveland Press.

Kalpana, Ram, and Margaret Jolly, eds. 1998. Maternities and Modernities: Colonial and Post-Colonial Experiences in Asia and the Pacific. Cambridge, UK: Cambridge University Press.

Lukere, Vicki, and Margaret Jolly, eds. 2002. Birthing in the Pacific: Beyond Tradition and Modernity? Honolulu: University of Hawaii Press.

Murphy-Lawless, Jo. 1998. Reading Birth and Death: A History of Obstetric Thinking. Bloomington: Indiana University Press.

Van Hollen, Cecilia. 2003. Birth on the Threshold: Childbirth and Modernity in South India. Berkeley: University of California Press.

                                            Robbie Davis-Floyd

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Birth

Birth

A BIRTHING REGIMEN

Sources

Women's Domain. Throughout the entire period from 1350 to 1600, childbirth was strictly a female affair. The husband was not present unless his wife was dying, and male doctors took little interest in delivery. Male physicians were only called in if the child, mother, or both were dead or dying, so their presence was dreaded. As the time of the birth approached, a woman began to make preparations. She decided which friends and neighbors she would invite to assist her. This determination was a matter taken seriously, for witchcraft accusations occasionally stemmed from the curses and anger of a neighbor who had not been invited. If the expectant mother lived in a rural area, she would generally contact a woman known to be experienced in handling childbirth, along with other friends and relatives. If she lived in a city, however, professional midwives who had undergone a long period of training and apprenticeship might also be available to assist her.

Labor. Whether in the countryside or city, once a woman knew she was in labor, the women assisting her transformed a room of the house, or in small houses a bed, into a “lying-in chamber,” according to local traditions of what was proper. In many parts of Europe, air was viewed as harmful to the mother, so doors and windows were shut and candles lit. Special objects believed to be helpful in speeding delivery were brought in, such as amulets, relics of saints, or certain herbs. Special prayers were offered, and the women prepared broth or mulled wine (termed “caudle” in England) to nourish the mother through the delivery. They also arranged swaddling clothes for the infant.

Delivery. The actual techniques of delivery varied widely, even within the same town. Some midwives and mothers preferred to use a birthing stool, a special padded stool with handles that tipped the mother back slightly; other mothers lay in bed, kneeled, stood, or sat in another woman's lap. The level of intervention also varied from midwife to midwife. Some tried to speed the birth along by making the mother change positions or pulling on the child as it emerged, while others might wait for days during a difficult labor before attempting to interfere. The most-skillful and best-trained midwives took a middle route, intervening only when they thought it necessary. If they were able to read, they might consult a printed midwives’ guide, such as the Rosengarten für swangere Frauen und Hebammen (Rose-garden for Midwives and Pregnant Women, 1513) written by the German city doctor Eucharius Rösslin.

Risky Business. Childbirth was an event with many meanings, at once a source of joy and dread. Most women experienced multiple childbirths successfully, but all knew of or even had watched someone die while giving birth. Using English statistics, it has been estimated that the maternal mortality rate in the sixteenth century was about 1 percent for each birth, which would make a lifetime risk of 5 to 7 percent. Women knew these risks, which is why they attempted to obtain the services of the midwife they regarded as the most skilled. Midwives were responsible for the spiritual as well as the physical well-being of the children they delivered, for they were allowed to perform emergency baptisms on children they thought might die.

Birth Control. Mothers recognized that the dangers of childbirth might be intensified when children were born too close together, and attempted to space births through a variety of means. Many nursed their children until they were more than two years old, which acted as a contraceptive, for suckling encourages the release of the hormone prolactin, which promotes the production of milk and inhibits the function of the ovaries. They also sought to abstain from sexual relations during the time of their monthly cycle regarded as most fertile, though this “rhythm method” was based on an incorrect view of the menstrual cycle and was not very effective. Couples regularly attempted to restrict fertility through coitus interruptus, magical charms, and herbal potions, though all of these methods were condemned by religious leaders. Condoms made from animal intestines or bladders were available by the mid sixteenth century to

those who could afford them, but they were originally designed to protect men from venereal disease carried by prostitutes and were only slowly seen as a possible means of birth control for married couples.

Postpartum Rituals. The experience of childbirth did not end with actual birth. In most parts of Europe, mothers were advised to undergo a period of “lying-in” after the birth, in which they sharply restricted their activities and contacts with the outside world. Although this seclusion was difficult for many rural and poor women, religious taboos that made a recently delivered mother impure meant that such restrictions were often followed even when this activity brought hardship to the family because the woman was not working. Russia had perhaps the strongest taboos, for Orthodox Christianity taught that everything associated with childbirth, including the midwife, attendants, place, and even the child, was impure. Not until her ritual of purification, which occurred forty days after birth, was anyone supposed to eat in the woman's company; baptism was often delayed until the same day so that the newborn remained impure and could nurse from its impure mother. Judaism and Catholicism had a similar ritual of purification, though contacts with the mother were not so sharply restricted. Her movements outside the home were, however, which meant a Catholic woman could not attend her own child's baptism; in Italy the midwife who carried the child was the only woman normally present at a baptism. In some parts of Catholic Europe, this purification ceremony was seen as so important that it was performed over the coffin of a woman who had died in childbirth.

New Rituals. After the Reformation, Protestants rejected the idea that women needed to be purified after giving birth, but some Protestants retained the ceremony, commonly called churching, terming it instead a service of thanksgiving. In some Lutheran areas, churching was required of all married mothers and forbidden to those who gave birth out of wedlock, which created a distinction between honorable and dishonorable women. Among Protestants in England, unmarried women who had given birth were only to be churched if they named the father and wore a white sheet signifying that they were sorry for their actions during the service. A woman attended her churching in the presence of the women who had been with her during the birth, including the midwife, and often saw churching as the final stage of childbirth; many of the rituals that were part of churching were devised by women themselves, not highly learned theologians. Churching is, in fact, only one of many popular rituals and beliefs surrounding birth that did not die out by 1600. Evidence gathered in the mid twentieth century indicates that people in many parts of Europe continued to regard a woman who had recently given birth as unlucky, and they prohibited her from touching wells or stalls or visiting her neighbors.

A BIRTHING REGIMEN

This selection is from a popular midwives’ manual, Rosengarten für swangere Frum und Hebammen (Rosegarden for Midwives and Pregnant Women), written by a German city doctor, Eucharius Rösslin, and published in 1513.

When the pregnant woman nears delivery, she should drink mature wine mixed with water. She should also have a regimen of food and drink, a regimen a month before birth which makes one moist but not too fat, and one should avoid what makes one dry, constipated, weighs down, presses or constricts. When the woman is even nearer to delivery, when she still has twelve or fourteen days and feels some pain and pressure, she should sit in a bath up to her navel every day, sometimes more often, but not too long (so that she doesn't get weak). She should move around with easy work and movements, walking and standing more than she did before. Such things help the fetus come into position.

Another regimen for the time of delivery which the woman should need if she feels pressure, pain and some moistness begins to show and flow out of the vagina. This regimen takes place in two ways. The first is that one brings on a quick descent and delivery. The other way to lessen complications, labor pains, and pain is for her to sit down for an hour and then stand and climb up and down the stairs shouting loudly. The woman should force out and hold her breath (breathe heavily) so that she puts pressure on her intestines and bears down. The woman should also drink those medicines that are written about afterwards for they force the child downward into delivery position. When she feels the uterus dilate and plenty of fluid flow to her genitals (i.e., water breaks), she should lie on her back, but not complete lying down or standing. It should be a middle position between lying and standing. She should tilt her head more towards the back than the front. In southern German and in Italian/French areas, the midwives have special chairs for delivery. They are not high, but hollowed out with an opening in the inside. The chair should be prepared so that the woman can lean on her back One should fill and cover the back of the same chair with cloth and when it is time, the midwife should lift the cloth and turn them first to the right and then to the left side. The midwife should sit in front of her and pay careful attention to the child's movement in the womb. The midwife should guide and control her arms and legs with her hands which are coated with white-lily or almond oil or the like. And with her hands in the same way, the midwife should also gently grasp the mother, as she well knows. The midwife should also instruct, guide, and teach the mother, and strengthen her with food and drink. She should urge the woman on to work with soft, kind words so that she begins to breathe deeply. One should dry her stomach off gently above the navel and hips. The midwife should comfort the woman by predicting a successful birth of a baby boy. And if the woman is fat, she should not sit, rather lie on her body and lay her forehead on the ground and pull her knees up underneath so that the womb has pressure applied to it. Afterwards, she should anoint her internally with white-lily oil and, if necessary, the mid-wife should open the woman's cervix with her hands and afterwards, the woman will deliver quickly.

Source: Euchamis Rösslin, Rosengarten für swangere Frauen und Hebammen (Frankfurt, 1513), Translation by Merry Wiesner-Hanks.

Sources

David Cressy, Birth, Marriage, and Death: Ritual, Religion, and the Life-Cycle in Tudor and Stuart England (Oxford & New York: Oxford University Press, 1997).

Jacques Gélis, History of Childbirth: Fertility, Pregnancy and Birth in Early Modern Europe, translated by Rosemary Morris (Cambridge: Polity Press, 1991; Boston: Northeastern University Press, 1991).

Jacqeuline Marie Musacchio, The Art and Ritual of Childbirth in Renaissance Italy (New Haven: Yale University Press, 1999).

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Birth

Birth

Sources

Etiology. In the ancient Egyptian language, mesi is the basic word for birth. It is a component in many names, often combined with a god’s name, such as in Ramesses (Re is born) and Thutmose (Thoth is born), which contain different grammatical forms of the verb “to be born.” Other phrases with a similar meaning were pery her ta (come down to the ground), pery em khet (come forth from the womb), and hay em khet (descend from the womb).

Conception. The Egyptians understood the basic cause of conception from earliest times. In the fifth century b.c.e. they thought that the father produced semen from his bones, but that it was then stored in the testicles. They understood that the penis was used to transfer semen to the womb. Mother’s milk, however, was thought to be the source of the new flesh and skin of a baby. The mother also provided the heart, considered to be the seat of thought and mind, for the newborn. Not only did this belief mean that the mother provided the physical organ but also the child’s character.

Infertility. The Egyptians also understood that infertility could be caused by the mother or father. Cures were tried for both potential parents and included prayers, letters to the dead requesting assistance, and prescriptions. These formulas do not have any known medical value.

Avoiding Pregnancy. Contraception consisted of both chemical and mechanical means. A compound similar to

“This text has been suppressed due to author restrictions.”

acidic contraceptive jelly was used, along with male prophylactics made from animal skins.

Pregnancy Tests. The Egyptians were aware of the physical changes in a woman’s body during pregnancy. They observed that a pause in menses, swollen breasts, nausea, changes in the face and eyes, and sensitivity to strong smells were among the signs that a woman had conceived. They also used a remarkable test to confirm pregnancy. The woman urinated on barley and emmer seed. If the seeds germinated, the test was positive. If no plant came from the seeds, the test was negative. In fact, the chemical changes in a pregnant woman’s urine will allow a seed to germinate, while ordinary urine is too acidic for the plant to grow. On the other hand, the Egyptians believed that if barley grew first, the child was a boy. If emmer sprouted, the child was a girl. This theory was based on the fact that the word barley is grammatically masculine in Egyptian and emmer is feminine. This test is not reliable.

Care of Pregnant Women. In ancient Egypt pregnant women massaged their bellies with oils. They believed that these lotions could prevent stretch marks and ease delivery. They were kept in calcite containers carved in the shape of a pregnant woman rubbing her abdomen. One such container showed a tampon in the shape of the Isis knot—a well-known amulet that associated pregnant woman with the goddess Isis when she carried her son, Horus—that allegedly eased the pregnancy. In an effort to prevent possible miscarriages, prescriptions were poured directly into the vagina.

Labor and Delivery. The Egyptians described human gestation as being nine months long. Actual labor and birth was assisted by a midwife, probably with other women

present. These women might have been associated with the goddesses Isis, her sister Nephthys, and Heket, the goddess of birth. During labor the attendants assisted by applying natron, a sodium nitrate, and poultices; casting magical spells; and offering intoxicating drinks. They also performed fumigations that they believed made the labor go faster. The birthing mother either squatted on bricks or sat in a specially built chair to deliver the child; they stayed in their homes, in a special hut located in the garden, or on the roof. A midwife cut the umbilical cord, placed the child on a brick, and pronounced the child’s name. In at least one case the new mother then observed a fourteen-day period of purification. Some scholars believe that the placenta was saved so it could later be buried in the child’s tomb.

Naming and Fate. In the only account of a birth preserved from ancient Egypt, found in the Papyrus Westcar, which was written during the Middle Kingdom (circa 1980-1630 b.c.e.), the midwife pronounced the name of the new child. Scholars believe the mother, with input from the father, chose this name. The Egyptians also believed that the child’s fate was determined in the womb by the goddesses called the Seven Hathors, who were assisted by Renenutet, the goddess of the birthing bricks.

Death during Childbirth. A woman’s life expectancy was two to four years shorter than a man’s because of the high incidence of death in childbirth. To prevent such deaths the Egyptians used magic spells and amulets. The dwarf-god Bes and the hippopotamus-goddess Taweret were both believed to protect pregnant women and unborn children. Special wands inscribed with images of these deities, for instance, were used to draw magic circles around a pregnant woman’s bed.

Neonatal Death. Newborns were also in danger. The Egyptians tested the strength of these infants by feeding them a portion of the placenta. If the child swallowed the offering, it was believed that it would live. The quality of a child’s cry could also predict its chances for survival.

Sources

Erika Feucht, “Birth,” in Oxford Encyclopedia of Ancient Egypt, volume 1, edited by Donald B. Redford (Oxford & New York: Oxford University Press, 2001), pp. 192–193.

Eugen Strouhal, Life in Ancient Egypt, translated by Deryck Viney (Cambridge: Cambridge University Press, 1992).

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Birth

BIRTH

Throughout the animal kingdom, birth is universally recognized as a miracle of renewal where, once again, a life begins. While humans are better than ever at saving the lives of even the smallest newborn, the whole process of birth is one of amazing change and brings finality to nine months of preparation.

Labor

Labor is the beginning of the active birth process. Many expectant mothers ask themselves the important question "Is this it?" more than once in the late weeks of pregnancy. Sometimes they feel a slight contraction and then nothing more. Such contractions, known as Braxton-Hicks contractions, are relatively painless and begin as early as the sixth month and may continue throughout the pregnancy. Real labor contractions cause more discomfort, occur with greater regularity, and are intensified by walking.

Other signs may or may not indicate that labor is beginning, such as an ache in the small of the back, abdominal cramps, diarrhea, indigestion, "show" (a small amount of blood-tinged mucus emerging from the vagina), and the "water breaking" (a discharge of fluid from the vagina). The discharge of fluid, which is caused by the rupture of membranes, can occur some time before actual labor begins. The only certain signs of labor are the appearance of the show and the onset of regular, rhythmic contractions that increase in frequency and strength. When the fluid from the amniotic sac is discharged, the first line of defense against infection is broken. Often, if labor does not begin after the water breaks, the physician may induce labor.

Stages of Labor

Labor progresses through three stages: dilation, or "the opening," expulsion, and placental. The first stage, dilation, can last anywhere from two hours to sixteen hours or more. At first, each contraction is thirty to forty-five seconds in duration and occurs about every fifteen to twenty minutes. The contractions are involuntary and the woman cannot start them or stop them at will or make them come faster or slower. Their function is to dilate the cervix until it is wide enough to let the baby through—usually about four inches (ten centimeters). In the course of the first stage of labor the contractions increase in frequency until they are only a minute or two apart. Each contraction itself also becomes longer and, toward the end of the first stage, may last ninety seconds.

At the end of the first stage there may be a series of very intense contractions; during this time the cervix has been stretched around the baby's head. The woman may feel ready to give up, but this phase, known as transition, is soon over. It rarely lasts more than half an hour and is often much shorter. In expulsion, the second stage of labor, the involuntary contractions continue to be long in duration and closely spaced, but now the woman has a strong urge to bear down with her abdominal muscles. At each new contraction she pushes down with all her strength as the baby's scalp comes into view, only to disappear again when the contraction ends. This is known as crowning. With each contraction more and more of the baby's head can be seen. At this point in labor, some obstetricians may perform an episiotomy (making a small slit in the skin outside the vagina toward the anus) to prevent this tissue from tearing. When the baby's head comes out as far as its widest diameter, it stays out, and in a short time it is free. The head may be molded (elongated in shape as a result of its passage through the cervix), but the soft skull bones that have been squeezed together soon recover their normal shape.

Some babies will give their first cry at this point. With the next contractions the shoulders emerge, and the rest of the body slips out easily. The feelings of both parents at this time are almost impossible to put into words: elation, exhaustion, and great feelings of tenderness and caring.

It was once the practice for the doctor to hold the baby up by the feet immediately following delivery to allow fluid and mucus to escape from the baby's mouth and nose, so that the infant could start breathing, usually with a gasp and a cry. Today it is more usual to aspirate the mucus from the baby's mouth and nose by suction as soon as the head is delivered. This gives the baby a slight head start on independent breathing.

As soon as delivery is complete, the umbilical cord is clamped and cut. The baby is then wrapped in a receiving blanket, and someone performs a variety of procedures that vary from hospital to hospital. Typically, drops of silver nitrate are placed in the baby's eyes to prevent infection, both mother and baby are given plastic identification bracelets, and fingerprints of the mother and sometimes footprints of the baby are taken.

At this time the neonate's general state of health is evaluated using the APGAR scoring system. At one, five, and ten minutes after birth the baby is given a score of 0, 1, or 2 on Activity (muscle), Pulse (or heart rate), Grimace (or reflex action), Appearance (color), and Respiration (breathing). This test provides very general information on whether the baby's life-sustaining functions appear normal and what kinds of potentially dangerous problems may be present. The majority of children score between 5 and 10, and 90 percent have a score of 7 or better; there is no reason for concern unless the score is below 5.

During the third or placental stage, the afterbirth (the placenta and cord) is expelled from the uterus. Labor is now completed.

The length of the entire process varies greatly, as does the actual experience of labor. Fifteen hours is an average figure for the duration of birth from the first contraction to the expulsion of the afterbirth for a first birth. But this average covers a spectrum of labor as long as twenty-four hours and as short as three hours or less. Labor is usually longer for first babies than for later ones, and longer for boys than girls. Two reasons for a longer first labor might be the easier adaptation of the woman's body to the process and the reduced amount of anxiety present in subsequent births.

"Gentle Birth" Techniques

One way that the process of labor can be made easier for the expectant mother is the use of certain techniques often referred to as gentle births, such as the Lamaze and Dick-Read methods of childbirth. Both of these became very popular in the early 1970s. Grantly Dick-Read believed that pain during childbirth is not inevitable but is the result of fear passed on from mother to daughter over the generations. Dick-Read stressed that by educating the woman about the birth experience, the fear of the unknown can be removed. In its place a more positive view about delivery can be substituted. In 1967 a French obstetrician, Fernand Lamaze, developed a method for childbirth he called "childbirth without pain." This popular technique usually begins in the third trimester of pregnancy when the woman practices breathing and other exercises with her "coach" (usually the father). These exercises are used during labor to help a woman control her anxiety and be able to relax and push at the appropriate time. By practicing the exercises in advance, the command or suggestion of the coach is quick in coming and easy to maintain at the time of childbirth.

There are a substantial number of studies showing that prepared childbirth enhances feelings of self-esteem, increases the husband's degree of participation, and even strengthens the marital relationship. Whereas in the 1970s fathers were still marginally included in the birth of their children, it is almost the exception in the early twenty-first century when they are not.

What are the baby's first impressions of the world he or she is being thrust into? One French obstetrician, Frederick Leboyer, believes that the very act of being born can be a terrifying experience. In Leboyer's view, the violence of modern delivery techniques contributes a good deal to this "hell and white hot" experience.

The Leboyer technique involves a number of radical changes in the delivery procedure. As soon as the infant begins to emerge, the physicians and nurses attending the birth lower their voices, and the lights in the delivery room are turned down. Everyone handles the baby with the greatest possible tenderness. Immediately after delivery the baby is placed on the mother's abdomen, where the baby can start breathing before the umbilical cord is cut. After a few minutes the obstetrician places the baby in a lukewarm bath, an environment very much like the amniotic fluid. In this way the difference between the fetal environment and the world is minimized.

Is Leboyer's method better? Safe? Of the few studies that have been done, the results seem to indicate that babies delivered this way are similar to others delivered in a more conventional fashion. Whether or not there are any long-lasting effects will have to be judged after sufficient information is available about these "gentle birth" babies as they grow.

Alternate Birth Centers

Hospitals operate as bustling, crisis-oriented places. Such institutions are for sick people, and pregnancy is not considered an illness by supporters of a new kind of environment for giving birth—the alternate birth center. Alternate birth centers were developed because many parents objected to what they felt to be the impersonal, needlessly technological, and increasingly expensive childbirth procedures available in the conventional hospital setting. As a growing number of women chose to give birth at home, the risks involved became a concern. Alternate birth centers, then, are a response to both the dissatisfaction with hospitals and the hazards of home births.

These centers were all but unheard of in 1969. Within a few decades, at least 1,000 had been established, and the trend continued into the early twentyfirst century. In 1978 the medical establishment officially endorsed many elements of this alternate care, recommending that it be included in conventional maternity services. Out-of-hospital facilities for the management of low-risk deliveries were also established.

Alternate birth centers provide a relaxed, homelike atmosphere for the pregnant woman, her family, and the newborn. The most dramatic aspect of an alternate birth center compared with a conventional hospital is the room where the deliveries take place. Unlike the operating-room atmosphere to which laboring women are generally sent at the most uncomfortable, critical moment, the birthing room—the location of the woman's predelivery hours—is a cheerfully decorated suite resembling a bedroom. Women in labor move about freely. They rest as they choose and may be accompanied by their husbands, families, and friends. An attending nurse, midwife, or doctor delivers the baby into this low-key, family-oriented environment. It is dimly lit, quiet, and peaceful.

The new mothers, and those with them, report a sense of control and contentment in contrast to the anxiety and isolation experienced by many in the traditional delivery room. Many of these centers also encourage the participation of other siblings in various stages of the pregnancy and birth.

Following the birth, the new family remains in the birthing room, in close physical contact. The newborn is placed on the mother's bare skin (which can act almost like a "natural incubator") and has the first opportunity to suckle and enjoy eye contact. A soothing warm bath may be administered. In these first hours, bonding between the parents and child has a unique quality. In some birthing rooms, siblings may also share these special experiences. The entire family leaves the alternate birth center together, usually earlier than from the traditional setting.

For safety, birthing-room facilities keep a significant amount of emergency equipment hidden within the suite itself and deliver only low-risk births. Nonetheless, of these births, approximately 10 percent develop problems best handled in a more conventional setting. When located in a hospital, birthing rooms are usually adjacent to traditional delivery and operating rooms.

Midwives

At one time the use of a midwife conjured up visions of birth-attending barbarians in a dimly lit, unsanitary room. Today, nothing could be further from the truth. Midwifery as a profession has the status it deserves as an integral and indispensable component of prenatal care and childbirth. Popular in Europe for many years, it is becoming more so in the United States.

Midwives are increasingly associated with physicians, where they can handle the majority of the prenatal care that needs to be done and up to 90 percent of the actual births. The remaining births that are of high risk are usually under the physician's care.

A woman might choose to have a child delivered by a midwife for several reasons. One of the most important is that the traditional medical community continues to treat pregnancy as an illness and the pregnant woman as a sick person. This kind of thinking is slowly being rejected, in part as the result of a U.S. Supreme Court action ruling that pregnancy is a disability and not a disease. There are several other reasons why midwives are becoming more popular:

  • New changes in the law allow the licensing of midwives.
  • There is, as a result of the women's movement, a sharp increase in the demand for women practitioners to assist in deliveries.
  • Midwives are better trained today than ever and often go through intensive university-based classes in physiology and obstetrics.
  • The role of technology in childbirth has been questioned in that it tends to be dehumanizing. Midwives are less likely to resort to such techniques, which in some cases may present more dangers to the woman and the infant than not.
  • The federal government endorses the use of midwives and encourages institutions to employ them.

Perhaps the best combination is a midwife working directly with a physician so there is adequate technical backup if necessary.

Complications

Most "complications" can usually be dealt with successfully by the obstetrician and the hospital staff. The baby may, for example, come out bottom first in what is called a breech presentation. Sometimes one foot is first to appear, and sometimes the umbilical cord comes out alongside the head. The doctor must manage these variations and often actually turn the baby before birth with great skill to avoid any further complications.

Babies, for the most part, deliver themselves. It is when complications develop that the training and expertise of the health-care provider are needed. The fetal heartbeat is monitored during labor, and when there is cause for concern, a cesarean delivery may need to be performed.

A cesarean birth is one in which the baby is delivered through a surgical incision made into the woman's abdomen and uterus. Although it is generally considered a safe operation for both mother and baby, it is still major surgery. Babies delivered by cesarean do not have molded heads and look better in general than babies born vaginally. A cesarean delivery might be performed for reasons such as difficult and perhaps dangerous labor, fetal distress, breech presentation, and previous cesareans. These reasons explain some 50 percent of all cesareans being performed. As a rule, a cesarean delivery is planned ahead of time and performed before labor has a chance to begin. Today it can be performed even after the uterine contractions have started if the child cannot be delivered otherwise.

Another means of helping nature during birth is through a tonglike instrument, known as forceps. These concave, elongated tools are inserted as two separate units into the vagina. Each is placed on the baby's head. When the handles are joined, the baby be rotated and pulled.

A forceps delivery may be required if the mother's contractions slow down or stop. Today, hormones are usually given to make the contractions continue. But danger signs from either fetus or expectant mother could call for delivery with forceps.

The use of forceps either in the first stage of delivery or early second stage can cause brain damage to the child. At these stages it is important to place the forceps accurately on the child's head. It is also necessary to use considerable force to pull the baby's head out. This is called high forceps delivery and is almost never used today because of the danger involved. Low forceps delivery, that is, the use of forceps in the actual delivery stage, is rarely damaging to the child and is still commonly used in many hospitals.

See also:CESAREAN DELIVERY; PREGNANCY; PRENATAL DEVELOPMENT

Bibliography

Goer, Henci. The Thinking Woman's Guide to a Better Birth. New York: Berkley, 1999.

Leiter, Gila, and Rachel Kranz. Everything You Need to Know to Have a Healthy Twin Pregnancy. New York: Dell, 2000.

Mahler, Margaret S., Fred Pine, and Anni Bergman. The Psychological Birth of the Human Infant: Symbiosis and Individuation. New York: Basic Books, 2000.

Simkin, Penny. The Birth Partner Cambridge, MA: Harvard Common Press, 2001.

Stoppard, Miriam. Conception, Pregnancy, and Birth. New York: Dorling Kindersley, 2000.

Neil J.Salkind

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Birth

Birth

By 1960, American women were challenging the dominant medical model of childbirth from several political and religious perspectives. Today many "rituals" of hospital birth have changed as a result, and a vocal minority of women avoid the hospital altogether by giving birth at home or in birthing centers. Already in the 1950s, some women questioned what had become the conventional anesthetized hospital birth during which they lay alone on their backs with shaved pubic hair, hands strapped to a table, and legs in stirrups. They were encouraged by British obstetrician Grantly Dick-Read's (1890–1959) model of "natural childbirth" described in Childbirth without Fear (1959), which asserted that childbirth could be "spiritually uplifting." Women also joined grassroots organizations such as the La Leche League, begun in 1957 by a group of midwestern, middle-class Catholic women as a mother-to-mother support group that questioned medical attitudes toward childbirth and breast-feeding. In The Womanly Art of Breastfeeding (1958), the La Leche League urged mothers to ignore their doctors' orders about formula feeding and to breast-feed their babies, and advocated unanesthetized birth as an important benefit to a mother learning to nurse her baby. Religion played an important role in the turn of many Christian women to natural childbirth. In a religious context that was spawning the Christian Family Movement and other groups focused on family ethics, childbirth activists such as Helen Wessel (1924–), author of Natural Childbirth and the Christian Family (1963), argued that childbirth could prompt profound religious experiences.

Countercultural reformers who called for a return of childbirth to the home soon joined these more mainstream critics of medicalized birth. For example, Ina May Gaskin (1940–), a member of "The Farm," a Christian- and Buddhist-influenced alternative community in Tennessee, became renowned in the 1970s for her abilities as a home birth midwife, as documented in Spiritual Midwifery (1975). Feminism and the women's health movement soon brought a new perspective to childbirth reform, one that was decidedly less Christian. Feminist critics insisted on women's right to control over their birthing bodies, though many still insisted that childbirth was ripe with "spiritual" possibilities. The revitalization of midwifery in the United States was important for the growth of feminist interpretations of the spirituality of childbirth. The two national professional midwifery associations—the Midwives' Alliance of North America (MANA), formed in 1982; and the more medically mainstream American College of Nurse Midwives (ACNM), formed in 1955—both contend that birth is spiritually important for a birthing woman and her family and community. The emphasis that post-1960s midwifery placed on birth as not only a physical but also a spiritual event challenged medicalized portrayals of birth while drawing from deeply rooted midwifery traditions from various regions of the United States. Latina parteras in the Southwest, African-American grand-midwives in the South, and Amish midwives in Pennsylvania and the Midwest have all played important roles in sustaining alternatives to medical models of childbirth. Currently the legal status of midwifery and home birth varies throughout the United States. While certified nurse-midwives are legal throughout the country, most practice only in the hospital. Direct-entry (nonnurse) midwives, who constitute the majority of MANA and practice mostly in the home, are illegal in some states. Therefore, the religiously diverse home birth movement remains "underground" in many states.

With the exception of distinct religious communities such as the Amish and some New Age communal groups, religious traditions have rarely cared to articulate consensus about modes of birthing, despite the extensive network of religiously sponsored hospitals. However, women from a diversity of religions have seen childbirth as a religious act. For example, Jewish Reconstructionist rabbi Tikva Frymer-Kensky, author of Motherprayer (1995), and Lutheran pastor Margaret Hammer, author of A Spiritual Guide through Pregnancy (1997), have argued that with sufficient attention and preparation a woman can make her birth a religious experience, whether in the hospital or at home. Others—ranging from Marilyn Moran, a Catholic and author of Birth and the Dialogue of Love (1981); to Carol Balizet, Pentecostal author of Born in Zion (1996)—have insisted that childbirth be left in God's hands (with the husband as the chief earthly authority), to the point of advocating birth without medical or midwifery assistance. The meanings of childbirth are intimately tied to constructions of femininity and the maternal body, not all of which are shared by those working toward childbirth reform or those satisfied with medical models of birth. As a result, the religious meanings attributed to birth in America reflect all the diversity of American religion itself.


See alsoAlternative Medicine; Birth Control; Body; Feminist Spirituality; Matriarchy; New Age Spirituality; Religious Experience; Spirituality; Women's Studies.

Bibliography

American College of Nurse-Midwives (ACNM). "ACNM Philosophy." Website: http://acnm.org.

Davis-Floyd, Robbie E. Birth as an American Rite of Passage. 1992.

Fraser, Gertrude. "Modern Bodies, Modern Minds: Midwifery and Reproductive Change in an African American Community." In Conceiving the New WorldOrder: The Global Politics of Reproduction, edited by Faye D. Ginsburg and Rayna Rapp. 1995.

Klassen, Pamela E. Blessed Events: Religion and HomeBirth in America. Forthcoming.

Leavitt, Judith Walzer. Brought to Bed: Childbearing inAmerica, 1750 to 1950. 1986.

Midwives Alliance of North America (MANA). "MANA Core Competencies for Basis Midwifery Practice." Website: http://www.mana.org/manacore.html.

Rooks, Judith. Midwifery and Childbirth in America. 1997.

Wertz, Richard W., and Dorothy C. Wertz. Lying-In: AHistory of Childbirth in America. 1989.

Pamela E. Klassen

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Birth

Birth

Birth, or parturition, in mammals is the process in which a fully developed fetus is expelled from the mother's uterus by the force of strong, rhythmic muscle contractions. The birth of live offspring is a reproductive feature shared by mammals, some fishes, and selected

invertebrates (such as scorpions), as well as some reptiles and amphibians . Animals who give birth to live offspring are called viviparous (meaning "live birth").

In contrast to viviparous animals, other animals give birth to eggs; these animals are called oviparous (meaning "egg birth"). Some oviparous species , such as birds , retain their eggs inside their bodies for long periods of time ; in these animals, the eggs are laid at an advanced stage of development. Other animals, such as frogs , give birth to less developed eggs, which undergo development outside the mother's body.


Viviparous animals

In both viviparous animals and oviparous animals, fertilization of the mother's egg with the father's sperm takes place inside the mother's body. One of the advantages to giving birth to live young is that the mother protects the fetus inside her body as it develops. The developing fetus derives nutrients from the mother's body, and so is assured of receiving all the nourishment it needs to complete development.

The length of time between fertilization and birth in viviparous animals is called the gestation period. The length of the gestation period varies according to species. The gestation period of mice is 21 days, of rabbits is 30-36 days, and of dogs and cats is 60 days. The largest mammal, the baleen whale, has a gestation period of 12 months—only three months longer than the gestation period of humans. Elephants have one of the longest gestation periods of all animals, 22 months.

Some viviparous animals such as humans, horses , and cows, give birth to only one offspring at a time, although occasionally these animals produce twins or triplets. Other animals give birth to many offspring at a time. Usually, the multiple offspring in a litter are each derived from a separate egg, but the armadillo gives birth to four identical offspring that are derived from the same fertilized egg.


How does birth begin?

At the end of the gestation period, the mother's uterus begins to contract rhythmically, a process called labor. The initiation of labor leading up to birth is the result of a number of hormones , notably oxytocin.


Maternal progesterone

Shortly after fertilization the hormone progesterone increases and is maintained at high levels in the mother's bloodstream. The high levels of progesterone prevent the uterus from contracting. The progesterone prepares the

lining of the uterus (the endonestrium) for its supporting role in nurturing the developing fetus, and helps form the placenta. Maternal progesterone levels begin to drop during the last weeks of gestation, while the levels of estrogen begin to rise. When progesterone levels drop to very low levels and estrogen levels are high, the uterus begins to contract.


Oxytocin

Oxytocin is a hormone released from the pituitary gland in the brain , which stimulates uterine contractions and also controls the production of milk in the mammary glands of the breast (a process called lactation). Synthetic oxytocin is sometimes given to women in labor to induce labor.

The mechanism that prompts the secretion of oxytocin from the pituitary during labor is thought to be initiated by the pressure of the fetus's head against the cervix, the opening of the uterus. As the fetus's head presses against the cervix, the uterus stretches, and relays a message along nerves to the pituitary, which responds by releasing oxytocin. The more the uterus stretches, the more oxytocin is released.

Fetal endocrine control

Fetal hormones are also thought to play a role in initiating labor. At the end of gestation, the fetal adrenal glands secrete steroid hormones called cortico steroids, which cause the hormone-like substances known as prostaglandins. Prostaglandins contribute to the contraction of the uterus during labor.


Birth in humans

Labor culminating in birth in humans begins with the rhythmic contractions of the uterus, which dilate the cervix. This causes the fetus to move down the birth canal and be expelled together with the placenta, which had supplied the developing fetus with nutrients from the mother. Ususually, the entire birth process takes about 16 hours, but it can range anywhere from less than one hour to 48 hours.


The first stage: dilation of the cervix

In order for the fetus to leave the uterus and to enter the birth canal, it must pass through the cervix, the opening of the uterus. The cervix is normally tightly closed, and is sealed with a plug of mucus during gestation to protect the fetus from invading microorganisms . During the first stages of labor, the contractions of the uterus dilate the cervix, which widens to about 4 in (10 cm), to accommodate the passage of the fetal head.

In the last weeks of pregnancy, before labor begins, the uterus undergoes irregular contractions, which serve to exercise the muscles of the uterus and may even dilate the cervix; it's not unusual for a woman to go into active labor with a cervix that is already dilated to 1 or 2 cm. During the last weeks of pregnancy, the cervix also thins out (or effaces), which makes dilation easier.

In preparation for birth, the fetus moves further down into the mother's pelvis. When labor begins, the fetus is usually positioned with its head engaged with the top of the cervix. This engagement is called "lightening" or "dropping." When labor begins, the contractions loosen the mucus plug in the cervix causing small capillaries in the cervix to break, and the mucus and blood are discharged from the vagina. This discharge is sometimes called "bloody show" and signals the onset of labor.

Another sign that may signal the beginning of labor is the rupturing of the amniotic sac. In the uterus the fetus is encased in a membrane (the amniotic sac) and literally floats in amniotic fluid. When uterine contractions begin, this sac ruptures and the amniotic fluid can leak from the uterus. Not all women experience an abrupt rupturing of the amniotic sac; in some, the amniotic fluid gradually leaks out as labor progresses. Once the amniotic sac has ruptured, or the amniotic fluid begins to leak, labor usually progresses more rapidly. During the first stage of labor, the cervix dilates about 0.5-0.6 in (1.2-1.5 cm) an hour. The uterine contractions are 5-30 minutes apart, and last for 15-40 seconds. The end of the first stage of labor is associated with the strongest uterine contractions. Contractions are two to five minutes apart, and last for 45-60 seconds. The cervix opens rapidly at this point. This period of labor, sometimes called transition, is usually the most difficult for the mother. The contractions are very strong and close together, and nausea and vomiting are common. After the cervix has dilated to its full width of 4 in (10 cm), the contractions slow down somewhat to about three to five minutes apart. The fetus is then ready to be born, and the second stage of labor begins.


The second stage: birth

During the second stage, lasting about one to two hours, the mother uses her abdominal muscles to push the fetus through and out of the birth canal.

The pushing is actually a reflex action, but if a woman can help the reflex by actively using her muscles, birth goes much faster. As the fetus moves down the birth canal to the vaginal opening, the head begins to appear. The appearance of the head at the opening of the vagina is called crowning. After the head is delivered, first one shoulder is delivered, then the other. The rest of the body follows.

After the baby is born, the umbilical cord that has attached the fetus to the placenta is clamped. The clamping cuts off the circulation of the cord, which eventually stops pulsing due to the interruption of its blood supply. The baby now must breathe air through its own lungs.


The third stage: delivery of the placenta

Before delivery, the placenta separates from the wall of the uterus. Since the placenta contains many blood vessels, its separation from the wall of the uterus causes bleeding. This bleeding, if not excessive, is normal. After the placenta separates from the uterine wall, it moves into the birth canal and is expelled from the vagina. The uterus continues to contract even after the placenta is delivered, and it is thought that these contractions serve to control bleeding.

History of childbirth

Until the twentieth century, childbirth was the province of women. A woman giving birth was attended by her female relatives and perhaps a woman in the community known for her midwifing skills. As the scientific revolution of the seventeenth century took place, concerned physicians noticed that childbirth was sometimes a dangerous, often fatal, process. Infections, injury to the baby and mother, and death occurred when unskilled midwives attempted to manage complications. Gradually, childbirth changed from an entirely female-centered activity to a medical process overseen by predominately male physicians. By the early twentieth century, childbirth moved from the home to the hospital. By the mid- twentieth century, childbirth had become a completely medical process, attended by physicians and managed by medical equipment and procedures, such as fetal monitors, anesthesia , and surgical interventions.

Later in the twentieth century, some women became dissatisfied with this medical approach to birth. Many felt that the medical establishment had taken control of a natural biological process. Women wanted more control over labor and birth and new ways of giving birth that sought to reduce or eliminate the medical interventions became popular. With the increasing concern about the effect of anesthesia on the fetus, many women refused artificial means of controlling pain , and instead relied on breathing and relaxation techniques. Fathers, once banished from labor and delivery rooms, were now welcomed as partners in the birth process.

Today, women have many options for labor and birth. Some women deliver in a hospital with doctors and nurses close by to supervise the birth process. Others choose a nurse-midwife, a person who has been trained to deliver babies but who is not a doctor. Still others choose home birth, attended either by a doctor or midwife, or sometimes both. Whatever option a woman chooses, it is important to get good medical care throughout pregnancy. Periodic prenatal checkups are one of the best ways to avoid birth complications.


Types of childbirth preparation

Many childbirth experts believe that the more a mother knows about the birth process, the less fear and apprehension she will feel giving birth. Many childbirth preparation methods prepare both mother and father for the birth experience and teach relaxation and breathing techniques. The Read method, for instance (named after its founder, British physician Grantley Dick-Read), is based on the notion that fear leads to pain. The Read method includes childbirth education, exercises to improve muscle tone, and relaxation techniques. The Lamaze method (named for Dr. Ferdinand Lamaze) takes a psychological approach to managing labor. The Lamaze method teaches women to relax and breathe in response to pain, the theory being that this substitution of favorable activity for negative sensations reduces pain. The Bradley method focuses on deep relaxation and slow, deep breathing, and ascribes an important role to the father.


Types of anesthesia

Two types of anesthesia are commonly used during labor and birth. In general anesthesia, the mother is given drugs that put her to sleep , but this type of anesthesia is rarely used today, since the drugs can depress the fetal heart beat. In regional anesthesia, drugs are injected to deaden sensation around the spinal nerves that carry sensations from the pelvic region. Controversy about whether these drugs affect the fetus is ongoing, although some kinds of regional anesthesia affect the fetus less than others.

See also Embryo and embryonic development; Reproductive system; Sexual reproduction; Viviparity.


Resources

books

Bean, Constance A. Methods of Childbirth. 2nd ed. Garden City, NY: Doubleday, 1990.

Karmel, Marjorie. Thank You, Dr. Lamaze. New York: Harper and Row, 1993.

Knobil, Ernst, and Jimmy D. Neill, eds. The Physiology of Reproduction. 2nd ed. New York: Raven Press, 1994.

Korte, Diana. The VBAC Companion: The Expectant Mother'sGuide to Vaginal Birth After Cesarean. Cambridge, MA: Harvard Common Press, 1999.

Mitford, Jessica. The American Way of Birth. New York: Dutton, 1992.

Moore, Michele, and Caroline De Costa. Cesarean Section:Understanding and Celebrating Your Baby's Birth. Baltimore, MD: Johns Hopkins Medical Press, 2003.


periodicals

"Deciding to Be Born." Discover 13 (May 10, 1992).

Fischman, Joshua. "Putting a New Spin on the Birth of Human Birth." Science 264 (20 May 1994): 1082.

Ventura, S.J. "Births: Final Data for 1999." Service Today 49, no. (2001): 1-100.


Kathleen Scogna

KEY TERMS

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Amniotic fluid

—The fluid in which the fetus "floats" in the uterus.

Amniotic sac

—The sac that contains the amniotic fluid.

Gestation

—The period of carrying developing offspring in the uterus after conception; pregnancy.

Labor

—The strong, rhythmic contractions of the uterus leading to birth.

Placenta

—The organ that develops during gestation through which a fetus receives nourishment from the mother.

Prostaglandins

—A substance released by uterine cells that cause contraction of the uterus.

Umbilical cord

—The cord that attaches the fetus to the placenta.

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