Review: The Farmer and the Obstetrician
by Michel Odent
Review © 2002 Midwifery Today, Inc. All rights reserved.
[2002, London: Free Association Books Limited, 159 pages, hardcover.]
Here is a book that so encapsulates the historical demise of healthy food and of healthy birth, it could be the basis for two huge social movements. Indeed, it could form the basis of sweeping global changes in several arenas. This is one of those pivotal books that will hopefully return us to sane living and loving at a time in history when both are languishing. Every birth practitioner, especially every aspiring birth practitioner, should read this book because it teaches us like no other what women need, particularly in labor. It helps us to analyze our work with women and babies. The information here had me thinking about what I had done at births in the past-whether those decisions were physiologically sound. This book is a great analytical tool.
Odent brings together beautifully the work he has been doing in physiology and primal health. Primal health is the lifelong effects of things that happen or are inflicted upon mother and baby in pregnancy, birth and the first year of the baby’s life. Today this means a lot of damage. As well, Odent outlines the “explosive development of industrialized farming and the explosive development of industrialized childbirth.” He begins with the last straw-incidents of Mad Cow and Foot and Mouth diseases that have recently devastated Europe and have “suddenly rallied public opinion against industrialized farming.” Odent parallels agricultural history with birth history, outlining some of the dangers of insecticides, pesticides, herbicides, fungicides and fertilizers and how they “potentiate each other and mimic hormones...oestrogens female hormones.” He points out increased male genital tract disorders-undescended testicles, abnormalities of the penis such as hypospadias, and reduction in sperm count-all of which can be related to the additives of industrialized farming.
The dangerous histories of farming and birth have developed side by side in the 20th century, overpowering and overwhelming the processes of nature. Odent discusses important historical turning points that have led to the demise of midwifery: The midwife act in Britain in 1902 “established official links between midwifery and the medical profession. It institutionalized a subservient role of the midwife to the physician.” In 1920, Joseph DeLee, American obstetrics professor and inventor of obstetrical tools, noted in “The prophylactic use of forceps” that “‘...labor is a pathological process’” (p. 25). DeLee recommended the routine use of forceps and episiotomy at every birth. He suggested that the “patient” should be sedated. Odent then outlines more of this frightening history in an eloquent and well-written manner. He talks about how the electronic age of childbirth was established in the 1970s when we found a way to record the baby’s heartbeats continuously. Chapter 4 ends, “In the age of industrialized childbirth the mother has nothing to do. She is a ‘patient’” (p. 29).
Odent goes on to state that modern obstetricians doing primary care may establish a dangerous lack of experience. “The prerequisite for the replacement of medically controlled childbirth by a biodynamic attitude is the dramatic reduction in the number of obstetricians. The highly trained experts of the future will not have the time to control every birth. They will be at the service of women and midwives. They will appear on demand.” He discusses the Dutch model, where 80 percent of midwives are independent and they are able to have this kind of equitable relationship with physicians. He also explores the idea of civilization: “Researchers will have to look at the evolution of cultural characteristics in relation to how babies are born. One can already wonder why, for example, the streets of Amsterdam are safer than the streets of Paris, and why Holland has the lowest rates of abortion, imprisonment and teenage pregnancy in the West, with comparatively low rates of drug addiction in spite of the open sale of marijuana and hashish.”
Interestingly, Odent equates labor needs with the simple needs of falling asleep. In both “...being protected from useless words, being sheltered from bright lights, being in an atmosphere of privacy, feeling comfortable in terms of temperature and feeling secure.” The physiology of what women and babies need is well covered in several chapters. “Toward a Biodynamic Attitude to Childbirth” delineates a new way for midwives to examine our calling. He also ponders the problem of too many obstetricians doing the wrong work. “At the root of the problem is the medical control of childbirth, which is a modern variant of cultural control. This medical control is a corruption of the role of medicine. The role of medicine in general-and obstetrics in particular-is originally limited to the treatment of pathological or abnormal situations. It does not include the control of physiological processes.” He goes on to say, “Today any shift toward a biodynamic attitude leads first to a total reconsideration of the role of obstetrics and the reason for obstetrics.”
This book also examines the countermovements to industrialized farming and birth. The countermovements in farming are the biodynamic and organic farming movements. Mad Cow and Hoof and Mouth were the “eureka moment,” but “...nobody can predict what will trigger the ‘eureka moment’ where industrialized childbirth is concerned.” Chapter 8 is titled, “Which Disaster Are We Waiting For?” In talking about the countermovements, Odent says, “The natural childbirth movement would be hopeless without the activity of groups whose mission it is to prepare the revival of midwifery. The revival of midwifery is the prerequisite for entering the post-industrialized era of childbirth.” He mentions Midwifery Today along with other active birth change organizations. He mentions our international conferences. “The main theme of these conferences is always the rediscovery of authentic midwifery. Should the occasion arise, such groups have the capacity to raise questions in terms of civilization, and not only in terms of individuals.”
Odent says, “This difficulty in enlarging the issue of childbirth might delay the advent of a new awareness.” I consider this a challenge for all of us who are keepers of birth understanding. I will take up the challenge. Will you take up the challenge with me? If you have ideas about this, please share them with me. The time is now. Odent writes, “We are at a time when humanity must invent radically new strategies for survival.” We as birth practitioners are part of the answer, if we revive authentic midwifery and carry the issue to the larger question of civilization.
Odent then ponders how we can move “Toward Authentic Midwifery.” I do think we have to watch out for the brainwashing and co-opting process that can happen in midwifery school and obstetrical midwifery practice, even to those who once knew and understood. Odent says, “An authentic midwife is supposed to be first a ‘wise woman’ (sage-femme). Being a wise woman is the opposite of being a narrow technician.” And he ends “The Future of Midwifery” chapter with, “It is not usual to give so much importance to the selection of midwifery students. It is not usual to claim that those who are in charge of choosing the midwives of the future probably have greater responsibilities than the best-known political leaders, where the future of our civilization is concerned.” Not only the midwife, but also the mother herself has a responsibility to protect birth: “When a woman [gives] birth vaginally to her own baby [or babies] without any medication, this is a guarantee that her presence at birth will not hinder the progress of labour.”
Finally there is a great discussion on birth change. “It is noticeable that everywhere there are cores of people who are trying to challenge the current conventional attitudes. These people are the seeds for a widespread awareness.” We are the seeds of change. The book ends with our challenge: “That is why the current industrialization of childbirth should become the main preoccupation of those interested in the future of humanity. Let us dream that the vital objective of Hygieia College will be shared by millions of human beings within decades: ‘Healing the Earth by Healing Birth.’”
This little book is so packed with information, ideas, insights and relevant pieces of research that it is impossible to do it justice in a review. It is important that you read it yourself. To me it is one of the most important things I have ever read. We can use it as a foundation for change in childbirth, farming and indeed in saving the planet, both environmentally and in terms of the capacity to love. This book, if read and understood by every midwife, doula, childbirth educator, nurse, doctor, mother and father, could change the world. I recommend it to every birth practitioner as a guide to the understanding of the depth, breadth and importance of the work you do. The challenge for us all is to really ponder the far-reaching effects of what we do or don’t do in pregnancy and birth.
Reviewer Jan Tritten is the the founder and editor-in-chief of Midwifery Today magazine. She became a midwife in 1977 after the wonderful homebirth of one of her daughters. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world.