The technocratic model of birth assumes the body is a machine that often needs to be fixed with technology and other machines. The classic cascade of intervention during birth is the poster child for this model of ‘care’.
Three reasons why this model doesn’t work:
- Hierarchy within the system creates dysfunction and assumed compliance.
- Treats the body like a machine and is preoccupied with numbers and doesn’t usually take into account the individuals needs, wants, desires nor experiences.
- Many people leave feeling dissatisfied and not knowing how to help themselves
Within the healthcare system there is a hierarchy – which is an imbalance of power. Clients are not on a level playing field with their healthcare providers, healthcare providers are seen to have the most power in the relationship. With such an imbalance baked into the system the client/birthing mother will never be at the true center of care. This is a model with many routines and protocols. These routines and protocols also are more important than the client. The hierarchy assumes compliance and rarely offers a chance for true consent.
Today my daughter and I had a consultation with a gastrointestinal specialist and the person bringing us back to the room said “and we’ll stop here to take your height and weight”. I asked if that is necessary for a consult and if so how will it be helpful. The woman looked at her charts and said it’s what needs to be done. I asked why. She said the doctors want to know the BMI of patients. I didn’t see how it would be helpful to the appointment and she couldn’t tell me how it would be helpful so we declined it – though we were never really asked for consent in the first place. I could tell this person was a bit frazzled because she said “I don’t care if you do it.” in a rough tone then turned around and walked us towards the meeting room.
It was an uncomfortable interaction because I felt me questioning the protocol was disrespectful to the assistant woman. But, I am glad I did ask questions and then decline. Once we went into the room with her she asked “How about blood pressure” which my daughter decided she didn’t want to do. I know my daughter would have gone along with the height/weight and BP had I not questioned it in the first place (it’s hard for a child to say no to an adult in that situation). It was good seeing her take her time and deciding for herself if she wanted her blood pressure taken. That’s true consent. Though it would have been even better if we know how and why the BP would have been helpful or not.
Technocratic models are interested in routine and numbers more than the people the numbers represent. I didn’t want height and weight numbers on the cart because people might see those numbers to be my daughter. And, I wanted to put a ripple in the system – maybe the assistant I mentioned above swore under her breath at me then let it go, but, maybe the next time she brought someone back there was a glitch in her system and instead of assuming someone wanted their height/weight recorded she would as or explain why it is or isn’t helpful. Maybe.
Another reason the technocratic model doesn’t work is it usually doesn’t take into account the client’s needs, wants or experiences. In my next example below my needs and wants are taken into account. In the second they are not. The inconsistency throughout my three week stay in the children’s hospital was maddening.
When I was in the NICU with Olive, my oldest, she was on a picc line for the first few weeks of her life so I was told to pump every two hours (day and night) to keep my supply up. My supply was massive! (I asked about donating but was told “you don’t want to do that”) Eventually, the doctor (a new doctor every week) decided it was time to try some food in her intestines and announced to me they will give her formula. My jaw dropped. Before I could pull myself together he had noticed my facial expression and added “Unless you are gungho about breastfeeding.” to which I said I most definitely was. He said to go for it and left the timing up to me – she still had the picc line in. I was very relieved that he was the doctor that day as he was the most personable and friendly doctor in the rotation. I had the easiest time letting him know my needs and wants while we were together. He was off rotation the next day.
The next day an old school doctor decided to set limitations on Olive and my breastfeeding adventure. He said we could feed every hour for twelve minutes. Or every two hours for twelve minutes, I can’t remember which. (each nurse interpreted these instructions differently). When I asked what if she gets hungry at a different time he said if I did on-demand feeding I would be exhausted. So, he made a choice about me based research that showed babies only really need to eat for a set amount of time and on how he perceived I would feel. Never once asking how I felt or wanted to feel or was willing to feel. Eventually, the lactation consultant whispered in my ear that I ask to be transferred to the place on the other side of the hall to the NICU. A place I didn’t know existed nor knew that it would be our next step to getting out of that hospital for good. This other magical place was more breastfeeding friendly she said – and they were!!
When I asked the old school doctor about moving over there I let it slip that I had heard it from the lactation consultant and he spat out that he knows more than a lactation consultant. He definitely did not enjoy that I was taking counsel with a lowly lactation consultant. So, I added sweetly (like balm for his ego wound) that I hear they also have windows and I would really really like to see the light of day. We did move over there.
Our three weeks at the children’s hospital rocked me deeply. It has taken many years to stop having flashbacks or crying whenever someone asks me what Olive’s birth was like. Two years ago I was a doula for a friend at her hospital birth (with the hospital midwives) and came back from that retriggered. I was able to process it faster. It taught me I do not want to be a doula at a hospital and instead I want to be a homebirth midwife. As a midwife the care can be molded to and with the mama.
In the above birth the mama walked into the hospital in labor and was bombarded with questions for about ten minutes straight: do you feel safe at home? Are you mentally stable? And on and on. Her labor slowed. I had no idea that would happen nor how to make it stop. Then I found out it was the norm. So what were her prenatal appointments with the hospital midwives about? Couldn’t they have asked these questions then and not needed to suddenly ask personal questions to a laboring mom.
The information gathering interfered with her labor. The information was more important than the laboring mama. A schedule and routine was more important than noticing WHEN my daughter was hungry. Ugh, I still get so mad thinking about it.
And this is why the technocratic model doesn’t work. I left feeling beat up. In no way was I feeling like a powerful mama who could take care of her baby. I was confused about what to do – unsure of if I had motherly instincts, unsure that listening to my intuition or my own wisdom would be ok. Birth ought to be a time of growth and empowerment. As a midwife I will not model my care off the technocratic model. Most people have experienced this model and there will be a bit of unlearning for us all!
Find more from Maria at :
Her website: www.massageandmovement.org
Her YouTube channel: https://www.youtube.com/channel/UChbBWC4C8OJNGJ81XUNGgrg