Reproduction in the Technocracy: The Technocratic, Humanistic, and Holistic Paradigms of Birth and Health Care

Robbie (Davis-Floyd 2003) has long defined a technocracy as a capitalistic, hierarchical, bureaucratic, institution-laden, and (still) patriarchal society organized around an ideology of ongoing progress through the development of ever- higher technologies and the global flow of information via those technologies. In Chapter 1, she and Melissa Cheyney identify technocracies as the 6th subsistence strategy, very different from the industrial societies that preceded them. Two decades ago, Robbie named and placed on a spectrum “the technocratic, humanistic, and holistic paradigms (or models) of birth (Davis-Floyd 2001, 2018). Pier identification of these ideologies and their effects on practitioners and childbearers has been widely referenced, has stood the test of time, and has been utilized by many practitioners to help them understand the huge influence of ideology and to make conscious choices about which paradigm they wish to put into practice. Many have worked hard to make intentional paradigm shifts from technocratic to humanistic or holistic ideologies and practice (see Davis-Floyd and Georges 2018).

To briefly summarize: in the technocratic model, the body is metaphorized as a machine, and the laboring body as a dysfunctional machine in constant need of technological surveillance and intervention. This ideology is encapsulated in Reynold’s (1991) theory of the “1-2 Punch” of the technocracy. Punch 1: Technologically intervene in a natural process to improve it, thereby mutilating it

1 Please note that throughout this book, we will not be using the commonly employed term “cesarean section” but rather “cesarean” or “cesarean births” (CBs), to index the fact that these are births, and that those who experience cesareans are not simply passive but actively cope with what is happening to them on the operating table. According to Melissa Cheyney, current editor of Birth: Issues in Perinatal Care, this change in terminology reflects the rapid changes in the social sciences of reproduction that often stem from consumer demand (personal communication, August 2020).

and causing harm. Punch 2: Prosthetically fix the damage done with more technology (see Chapter 1). In this 1-2 Punch of mutilation and prosthesis, Reynolds insisted that Punch 2 is the point: we believe that we improve on a natural process, such as childbirth, when we fix its perceived dysfunctions with technology; hence the large numbers of technological interventions in labor and birth.

In the humanistic paradigm, the body is viewed as an organism, the focus is on the birthing woman, and kind and compassionate, relationship-based care prevails. Robbie (Davis-Floyd 2001, 2018) is careful to distinguish between superficial humanism, in which many interventions are still performed but with a compassionate overlay, and deep humanism, in which the normal physiology of birth is facilitated and the childbearer’s emotional needs are addressed.

The holistic model goes deeply into the realm of the spiritual and the intuitive: the body is viewed as an energy field in constant interaction with the other energy fields around it, and the outcome of a birth can be facilitated by paying attention to the energy surrounding it and changing that energy if needed—for example, by sending someone with “negative” energy out of the birthing room, or helping the laboring person to dance, to laugh, to cry if needed, or to chant or sing. Most homebirth midwives in the US perceive an energetic connection between the throat and the cervix—if the throat is tight and closed, the cervix will be too. So they encourage the laboring person to chant or make deep guttural sounds that open the throat so the cervix can follow (Davis-Floyd et al. 2018; Chapter 13). It is within this holistic paradigm that “calling the baby” makes sense: many midwives believe that when a baby does not immediately breathe after birth, its spirit or soul is hovering on the brink, trying to make the decision to come into the body or remain on the other side. Many midwives believe that having the parents immediately call the baby before or during resuscitation can make all the difference in that choice. Robbie (Davis-Floyd 2018) shows that holism in birth, which mainly characterizes births at home or in freestanding birth centers where the midwifery model of care—a combination of the humanistic and holistic models—can prevail, is highly economically and racially stratified, as most such care has to be paid for out of pocket, and thus remains inaccessible to many—unless the community midwives in question are covered by insurance, as indeed they all should be.

These three paradigms—technocratic, humanistic, and holistic—though not necessarily mentioned in all chapters, set the ideological tone of our book, as the chapters in Part I are generally grounded in the technocratic approach to birthing techno-sapiens, while those in Part II are more grounded in the humanistic and holistic approaches to creating this new planetary species in the Anthropocene Era.

Eco-Obstetrics or the Technological Imperative?

Thus herein we ask such questions as: What will be midwives’ roles in the future of birth? Will they become the primary attendants for the vast majority of births, with obstetricians reserved for the truly high-risk cases—as the scientific evidence would demand? (Chalmers 2017:156). Can technocratic obstetrics be transformed into eco-obstetrics, or holistic obstetrics, or at least humanistic obstetrics, as the authors envisage in Chapters 13 and 14? What will we do with our knowledge and ability to perform cesareans (Chapter 9)? Will we replace these with practices that honor water birth or vagal nerve stimulation (Chapters 12-13)? Will home birth again take a place of prominence as statistics continue to demonstrate its safety? (See Cheyney et al. 2014; de Jonge et al. 2009, 2015). This question is especially pertinent in light of the recent coro- navirus pandemic, during which homebirth rates rapidly rose in many countries, along with births in freestanding birth centers, as women sought to avoid the contagion of the hospital and separation from their partners and doulas (see Davis-Floyd, Gutschow, and Schwartz 2020). Will that trend continue as more women come to realize the advantages of avoiding the non-evidence-based technological surveillance and frequent interventions in labor and birth that characterize hospital birth “management”? Can more women learn to let go of their fear of birth (described in Chapters 9 and 13) and simply flow with the physiologic process, supported by midwives and doulas?

Or must we continue to follow the technological imperative—if you can do it with technology, you must and will do it with technology (Davis-Floyd 2003)—ending up with normal vaginal birth a distant species memory? Who will we be then? We keep climbing up the technological ladder, clearing more and more land to build our cities and towns and polluting our environments with pesticides and chemicals, with disastrous consequences to our own health, massive species extinctions (Wallace-Wells 2020), and the Climate Crisis (see Chapter 16 and Conclusions)—so we wonder, can we find “a prosperous way down,” as Odem and Odem (2001) suggest?

We also ask, how will our newly emerging knowledge of assisted reproduction impact religion, science, society, kinship, and family life? What does egg freezing mean to us today and tomorrow? Will it liberate women to achieve their career goals before having children, and/or will it result in more cesarean births for women coded as “high-risk” because of their advanced age? Regarding genetic editing, which is increasingly becoming possible (Chapters 4, 6, 7), will it only be used benignly to eliminate devastating hereditary diseases? Or for other purposes, such as creating enhanced humans? Where do we draw the line on that?

As shown in Chapter 7, the academic “assumed consensus” on refraining from creating actual pregnancies from genetically edited embryos was broken by a Chinese scientist in 2018, resulting in the births of cyborgian twins. His work was roundly condemned and he was imprisoned, yet if the technological imperative holds, others, somewhere, someday, will do the same. And then where will the line be drawn? Will political systems manipulate genes to achieve genocidal goals, or implement ethnic cleansing, as happened in the Nazi era—as exposed in Beverley’s multiple-award-winning book Birth, Sex and Abuse: Women’s Voices under Nazi Rule (Chalmers 2015)? Could fearful perceptions in some societies that have suffered from mass sterilizations make people believe these are still happening, as in the Quechua of Peru (Chapter 10)? Or, as discussed in Chapter 17, will we be able to learn from utopian reproductive creations such as those shown in the Star Trek film and television series and emerge as better people? We are asking these questions here as binaries, yet our chapters provide nuanced answers. Herein we provide fantastical yet achievable imaginaries based on current understandings of the normal physiology of birth that should, in fact, come to pass, and make recommendations for how that can happen (Chapters 11-17).

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