Immaculate Deception by Suzanne Arms

First published: 1975

Type of work: Social criticism

Form and Content

Suzanne Arms, a photojournalist and mother, was motivated by her own sour experience with hospital obstetrics to research the American birth experience. She interviewed and photographed not only credentialed experts—midwives, nurses, and doctors—but also experiential experts—mothers. Based on these interviews and her research into the literature of giving birth, she wrote Immaculate Deception: A New Look at Women and Childbirth in America. She presents a well-constructed argument against routing all births through the hospital, an institution designed to intervene in pathological conditions. Arms’s primary insight is that most births are normal births; that is, they are not pathological at all. The appropriate response to the healthy birth is watchful, unhurried support, not intervention. The appropriate source of this support is the patient and experienced midwife, not the highly paid medical doctor. In the hospital, with its predisposition to discern pathology, normal variations in labor are extremely likely to be labeled abnormal, which starts the laboring woman on a merry-go-round of intervention. Each obstetrical interference causes harm that requires another interference, until the woman loses all control of her own labor.

In Immaculate Deception, Arms interweaves several different types of presentation. Scores of photographs present the visual reality of the world that she describes in the text: harsh institutional labor and delivery rooms, masked doctors looming over trays of metal instruments or proudly presenting babies as if they had produced them themselves, the calm faces of midwives, the frightened eyes of young mothers, and one straining female hand, locked in a heavy leather handcuff. The photographs are generally small, literally “marginal” to the text, but they are nevertheless crucial to conveying on an emotional level the argument that Arms builds so solidly on an intellectual level.

Arms quotes many mothers, briefly or at length, on their experiences with hospital childbirth. With their birth stories, she also includes the words of American midwives, nurses, and doctors, as well as the bemused comments of foreign birth attendants, who often seem faintly puzzled as to why anyone would behave as Americans do toward birth. She not only presents the words of proponents of rehumanizing birth but also quotes from the doctors who frankly argue that modern women are unable to give birth safely without the assistance of their guardian angels, aggressive obstetricians. Arms supplies many facts and figures, with clear documentation of her sources. In tabular form, she presents statistical evidence, such as infant mortality rates that show the United States trailing behind many less wealthy nations. Arms’s multifaceted presentation leaves her reader with a sense of the sturdiness of her position.

Context

After many decades of scanty discussion of American birth customs, the mid-1970’s saw an abrupt crescendo of public debate. Contributing to this sudden interest was the popular experiential psychology movement of the late 1960’s and early 1970’s. Many of the schools of thought within that movement (such as transactional analysis, Gestalt therapy, and primal therapy) placed considerable importance on the psychological aftermath of early childhood trauma. It was perhaps only natural that the earliest childhood trauma, birth itself, should finally receive some attention. In addition, the liberalization of sexual behavior of the same period led, as day follows night, to an interest in reclaiming that common accompaniment of sex, the birth of a child.

The year 1975 was a milestone in the reevaluation of technologized obstetrics. By a miracle of synchronicity, this year saw the publication of Immaculate Deception, Frederick Leboyer’s Birth Without Violence, and Ina May Gaskin’s Spiritual Midwifery. In addition to these soon-to-be classics, such lesser-known works as Doris Haire’s The Cultural Warping of Childbirth (1972) and William Woolfolk and Joanna Woolfolk’s The Great American Birth Rite (1975) also appeared. Even in the midst of this sudden abundance of material, Immaculate Deception stood out. Its fine balance of photojournalism, polished prose, sound research, careful logic, and emotional impact earned it generally good reviews. Poet Adrienne Rich compared it favorably to Leboyer’s work.

Arms and her contemporaries left the American birth scene changed. By the very diversity of their approaches—the melodramatic prose of Leboyer, the hippie mysticism of Gaskin, and the good sense of Arms—they managed to establish beyond reasonable argument that American hospital obstetrical practices were damaging mothers and babies. Because of their attempts to demystify and reclaim birth, the intellectual landscape around reproduction shifted significantly. American women gained greater choice in how they can bring children into the world. Anesthetized, high-tech deliveries still occur, but the mother who wants a home birth, a birthing center, or rooming-in in a hospital can find these options if she takes the trouble to look. Breast-feeding is no longer considered odd and eccentric. Midwifery has gained public, if not legal, acceptance. Unfortunately, this progress in the United States has not halted the profit-oriented export of technologized birth fads to other countries. In the rush to Americanize, “progress” often comes to mean imitating the mistakes of the United States.

Bibliography

Behuniak-Long, Susan. “Bibliographic Essay: Feminism and Reproduction.” Choice 29 (October, 1991): 243-251. Lists and briefly describes scores of books that engage issues of reproductive technology from a feminist viewpoint.

Dwinell, Jane. Birth Stories: Mystery, Power, and Creation. Westport, Conn.: Bergin & Garvey, 1992. A midwife’s casebook containing the stories of twenty-one specific births in American hospitals, homes, and birthing centers. Each is accompanied by discussion of the general issues of women’s health care and spirituality that it exemplifies.

Ehrenreich, Barbara, and Deirdre English. For Her Own Good: 150 Years of the Experts’ Advice to Women. New York: Anchor Books, 1989. Examines not only the victory of the obstetrical establishment but also the ascendancy of the other psychomedical experts who assumed power over women’s lives: scientists, doctors, psychotherapists, home economists, and child-rearing specialists.

Gaskin, Ina May. Spiritual Midwifery. Rev. ed. Summertown, Tenn.: Book Publishing Company, 1978. This midwifery handbook and compilation of birth stories became one of the primers for the revolution against technologized hospital birth. It blends mysticism and practicality in a way that became typical of the resurgent midwifery movement.

Haire, Doris. The Cultural Warping of Childbirth. Hillside, N.J.: International Childbirth Education Association, 1972. This slender pamphlet is one of the sources to which Arms often refers in Immaculate Deception. Haire lists thirty hospital practices that tend to turn birth from a normal into a pathological process. Haire’s well-documented appeals are based less on emotions and more on cognitive reasoning.

Leboyer, Frederick. Birth Without Violence. New York: Alfred A. Knopf, 1975. Uses highly emotional photography and rhapsodic prose to advocate gentle handling of the infant immediately after birth. Although this French obstetrician’s method is decidedly doctor-centered, his focus on the experience of birth by the newborn was revolutionary in its time.

Mitford, Jessica. The American Way of Birth. New York: E. P. Dutton, 1992. Perhaps the most direct descendant of Immaculate Deception, this highly readable work surveys the history of power-hungry and profit-hungry male annexation of the traditional female territory of birth.

Rich, Adrienne. Of Woman Born: Motherhood as Experience and Institution. New York: W. W. Norton, 1976. Combining both historical-social and personal material, this in-depth analysis of the female nurturing role considers motherhood both as the self-defined potential relationship of each woman with children and her own powers of reproduction and as a socially defined institution directed toward keeping women under the control of men.

Rich, Adrienne. “The Theft of Childbirth.” New York Review of Books 22 (October 2, 1975): 25-30. A sensitive and sensible review which contrasts Immaculate Deception and Birth Without Violence. Also includes a concise review of the history of male intervention in normal childbirth, from the invention of the forceps and the first uses of obstetrical anesthesia, and gives a briefer treatment to some of the same concepts that are detailed in Of Woman Born.