Friend of the blog Caroline Bazambanza is an anthropologist, PhD candidate at the London School of Economics (LSE). She has worked on projects with LSE Covid and Care, The Motherhood Group and the NHS Race and Health Observatory. gossip rag caught up with her to discuss amongst other things: the medicalisation of birth, disproportionate levels of maternal mortality among black women in the UK, and portrayals of birth in TV and film.
PART I - BIRTH STORIES
ESIEN: So do you want anything to eat? Or drink?
BAZAMBANZA: Hm… I kind of just want a negroni.
ESIEN: Ha! Fab, I’ll get the margherita! Shall we get into the questions? You liked the questions?
BAZAMBANZA: I liked the questions. Someone's been fully attentive.
ESIEN: I've been listening. We'll start with the first one, which is a question you usually start interviews with. ‘Tell me about how you were born?’ Can I ask why you start interviews in this way?
BAZAMBANZA: I ask that question because I think it's a good way to get someone talking about birth and seeing how significant it is in their own lives. But I’ve also realised that it helps to gauge how much someone knows about birth when they’re entering parenthood or a care providing journey, I've been surprised about how little people know, many people don’t talk about birth with their mothers and family members until they’re pregnant.
This question also lets me see what parts of the story are more pronounced and how they fit with a larger narrative, usually focused on, like the pain, or the rush of love. So, much of my project is about knowledge. So like, what kinds of knowledge matter? And from where does this knowledge derive?
Frida Kahlo, Henry Ford Hospital (La cama volando)1932), Dolores Olmedo Collection, Mexico City, Mexico 30.5 x 38 cm Image taken from wikiart.org
PART II - RACE, HOME BIRTHS
ESIEN: One of the things you're looking into is why the mortality rate for black women is disproportionately high. Why do you think this is?
BAZAMBANZA: Well, I think the obvious answer as to why the mortality rate is higher is because of racism. It's because of pervasive historical racism and its continued effects. When engaging with institutions that are supposed to provide care, there is an underlying level of risk because of the way that that institution as a body, but also the individuals within it, will perceive you. And so your circumstance also depends on whether or not that person sees you as someone who is deserving. Or even if they do, whether or not that's because of the colour of your skin, or the way that you speak and so on.
So I think that, you know, in theory, the reason why the disparity exists is really quite obvious. But what my project is trying to find out is what are the actual effects of this experience? And also, how do people learn about the significance of race in medical contexts — because, according to the Office for National Statistics, 97 to 99% of births are happening in hospitals.
ESIEN: Wow is it that high?
BAZAMBANZA: Yes, it's so high. And since the pandemic loads of Trusts have been closing down or dramatically reducing the size of home birthing teams. And this is partly because we've also got a shortage of midwives. But that means that the choice of where to give birth is becoming more and more limited.
ESIEN: You also told me something about the National Institute for …
BAZAMBANZA: for Health and Care Excellence. Yes, they publish the guidelines for the NHS. They updated the guidelines for induction of labour in 2021, and they stated that women with risk factors should be offered an induction of labour at around 37 weeks, but they included race/ethnicity as a risk factor. And this caused controversy because essentially what they're saying is that if you're black or brown, you should routinely be offered an induction of labour at 37 weeks. This was eventually taken out.
It’s not surprising that medical practitioners see race as a risk factor, it’s so embedded in the history of medicine to pathologize the black body and family. Medical students are taught to think of race as a risk factor but often need to make their own determinations about its effect in their practice. If your race is already seen as a risk factor in pregnancy or birth, it’s not hard to see why you might be more likely to experience tests and interventions. But what they don't see is that the medical care coming from these institutions can be a risk in itself. And I'm not the first to say this, Sheila Kitzinger in 1991 was writing about how hospitals can be a dangerous place to give birth.
ESIEN: I think that I often associate home births with danger. Because in my mind, for whatever reason, I think of Victorian England. But obviously things have advanced since the 19th century.
BAZAMBANZA: Well, the first thing I’d say about that, also drawing on Kitzinger, is that it doesn't make sense to compare the same event happening in different historical times. The past is often given as a reason as to why home birth is dangerous. But how much has the basis of how we live changed? Now, we have far better sanitation, can get to hospitals quicker if there are emergencies, we’re much more informed and knowledgeable generally about our bodies, and are healthier. I mean, there are so many factors that just make it absurd to compare home birthing now to 1863.
And secondly, birth is not a medical event, it’s a physiological process. We are designed to give birth. And there are a small number of cases in which people might need further assistance, but I think in most cases, if people feel able and allowed to let that process unfold, they'll be fine.
Disease and Organs Treated by a Vodoo Practitioner in Benin: A Pregnant Woman, Benin School, Wellcome Collection, Image taken from: artuk.org
PART III - BIRTHING IN MEDIA
ESIEN: We’ve spoken before about the series Fleishman is in trouble. Can you remind me what it was that you found interesting about it?
BAZAMBANZA: So in the series, which is about a divorced couple in New York, there’s a flashback to when the woman is giving birth. The doctor comes in and he’s kind of asking questions to the obstetric nurse, and he measures Fleishman’s cervix with his fingers, which is pretty routine. He speaks only to the obstetric nurse (midwifery is an increasingly marginalised profession in the US) and asks her to pass him a tool that they use to artificially rupture the membrane — that’s the amniotic fluid that surrounds the baby, like, a kind of sack. The reason why they think this is effective is that once you've artificially ruptured the membrane, the amniotic fluid touches on all the blood vessels, which can spur the hormones that bring on contractions. It's painful. And it's a procedure that requires consent.
ESIEN: Right, they have to ask.
BAZAMBANZA: Yes, ‘informed’ consent is actually the word they would want. But as is the case in the show, even though it’s an American context, it's similar in the UK where so many people report having a sweep, that's what we call it, without consent, or being offered it super casually between 39 and 40 weeks at midwife appointments. In the show, he doesn't even ask, and she feels the intense pain of it and she's asking, “What did you do?”. She is distressed because the feeling for her is of a (sexual) assault. And the trauma caused by it impacts her ability to bond with her baby and also to move into this new stage of life with her husband, who does not understand the gravity of what has taken place. I’ve come across similar stories in my work.
Film still of Claire Danes as Rachel Fleishman in Fleishman Is in Trouble (FX) Image taken from Msmagazine.com
ESIEN: Have you seen Pieces of a Woman? I think we’ve spoken about it before. Obviously that portrayed a homebirth, little medical intervention but a negative outcome. What did you think about that film?
BAZAMBANZA: Most of the portrayals we have in the media are medicalised. So I thought it was good to see a portrayal of birth that wasn't. And obviously, as in any experience, someone might not have a good one. What I find intriguing is that in my fieldwork, but also in my life generally, so many of the conversations about home births are framed around danger. And hospital births are hardly ever framed around danger, even though most of the danger happens in hospitals. Hospitals, by nature, are not designed to deal with ‘normalcy’, they’re designed for emergencies. And not only the danger in terms of mortality, but also danger in terms of long term trauma when you leave the hospital. Have you seen Parallel Mothers?
ESIEN: Oh I didn’t see that, but yes … it’s directed by what’s his name? Pedro Almodovar.
BAZAMBANZA: There’s a scene where the two mothers are giving birth. And it's essentially a big bright white light, hospital gown, legs spread apart and body upright, which isn’t the best way to give birth because the coccyx is rounded up, which can obstruct the baby’s head. And like four people in scrubs just peering in and doing things that the woman can't see. She is denied access — through the gown and their hands — to her own birth. And when I saw that film with my friends, they were like, “Oh, yeah, didn't even think about that scene”. But for me, that experience seemed horrible. I think we need to shift the way that we think about how birth unfolds. And I think people need to have an understanding of what birth entails that doesn't just come from medical sources of knowledge.
CAROLINE BAZAMBANZA'S READING LIST:
Sheila Kitzinger, Homebirth: and other alternatives to hospital (1991)
Dana Ain Davis, Reproductive Injustice (2019)
Khiara Bridges, Reproducing Race (2011)
Zora Neale Hurston Barracoon (2018)
Katherine McKittrick Dear Science and Other Stories (2020)
Stella Dadzie A Kick in the Belly (2020)