Unknown Speaker  00:01
And sometimes in and other nonfiction analysis, it's also put that women traded, have traded their power over the what they produce for the protection to produce it. According to Barbara Katz Rothman she says a part of the argument is that the ideology of society is such that it controls reproductive process by saying that the the, the baby is in fact, the man's. So that man historically has in patriarchal society has missed out on the baby, it's referred to in common conversation as Pope George has baby, that Martha is nurturing. And that's part of the way that control is exercised over women so that even though women produce the baby, it's conceived of in society as not, but the man's fate, and that the whole conception of an illegitimate child can only occur because people conceive of the child as being the man, if it's continued on as a woman's, there's no such thing as the technology of reproduction, I think is sort of has been critical to look at at every stage. But there are some areas, as I mentioned before that going over the literature have received the most attention by women, both to the technology itself, and to the meaning that it has for women's role. And I just want to go through some of these areas. And then as I said, go back to some, those that have received the most attention, start off with think with contraception, and include sterilization. And they've included technologies that women have examined that have prevented ovulation that have prevented conception that have prevented implantation, so that women had been concerned with contraceptive technologies, if not, in the creation process, in the analysis process of what they do and how they're used, what impact they have on women, and so forth. And all of the different technologies in that respect. Women have also been concerned with the birth process and the technologies of the birth process. Again, in all different areas, maternal interventions, including historical movements, by women, for for example, Twilight sleep, and women have been consistently at the forefront of movements that they felt would give them more control over the birth process, or more control over their lives as a result of the way technologies were applied during childbirth. Secondly, attention has been paid to diagnostic technologies for the fetus, and particularly to electronic fetal monitoring. Thirdly, therapeutic technologies for the benefit of the baby, and for women are paid attention to the technologies of the place of birth the organization. Now, there are other areas in reproduction that have received feminist attention, I think, but little attention to the technological aspects. One area is abortion, in which women have been focused on issues of control, issues of time issue or issues of legal rights, ethical issues, less so with the impact of actual technologies on the abortion process. What difference it makes, if the abortion process is a DNC or DNA doesn't make a difference to a doctor, the way that abortion is looked on doesn't make a difference to the woman. What impact does the fact that a fifth month abortion does a certain kind of technological procedure have on the rulings of the court on the attitudes of society on women's on position herself? So what impact do the medical technologists themselves have on abortion? Sure, I think has not been an area. There are also areas in which that reverse in which women have paid attention to the technology, but not to a feminist analysis of the impact of that technology. One area is prenatal diagnosis. And there are lots of technological issues that have received a great deal of attention. But very little of it, if any has received attention from a perspective of what this means in terms of women, and her reproductive role.

Unknown Speaker  05:20
And within that general category is amniocentesis. And these are consequences or not to get back to, which tests for numerous conditions from some of the effects and sex June obviously, which was a whole issue and ultrasound, in which there are issues that are related to recent studies on very early bonding. There are issues of untested technology and the use of little tests of technology. There are a whole assortment of routine diagnostic procedures during pregnancy, are considered routine diagnostic procedures and have never received any kind of analysis as to what they mean in terms of the woman her pregnancy or birth. And her situation as someone who is playing a reproductive role. There are also related issues again, in which women have paid a great deal of attention but not in any terms of of feminist analysis that have to do with prenatal care. And generally, they've been along the lines of creating the perfect environment and a woman's responsibility as it were to create the perfect environment within her for the fetus to grow. diets, drugs, alcohol exposures, a whole host of restrictions and prescriptions that have become for many women a routine part of her pregnancy prenatal care. But again, which aren't really considered in the light of anything, but the routine treatment of creating an environment not of the woman, as the creator of that environment. Okay, this is the third area that women have paid attention to, but not in any terms of feminist analysis. And that's nursing, and postnatal nurturing. Now, how many of you saw the Cynthia Epstein letter and MS magazine in which she she argues that, that there's a lot of pressure for women to nurse in today's society, that it's something that restricts women's other roles, and that people have to reassess whether, in fact, nursing is something that women should be bound to do. Essentially, it's a reactionary, kind of move to push back. Then there are areas of research that have received very little attention, either as a feminist issue, or as a woman's issue in any way. And that they tend to be most closely examined by by men, and without even usually, a passing thought to women's role. Although I think that they were critical issues, genetic screening is one of them. And that there are three aspects to that all of which are very important. One is genetic screening of the newborn, which generally has the same medical intervention. And the second is carrier screening. genetic screening of the biological and genetic and the third is prenatal screening. There was recently a report by the President's Commission on bioethics is one in which I can give you a full reference for which is available to anyone which is a quite a comprehensive report on genetic screening and all its aspects, again, which does not deal with what it means in terms of women in her relationship to production. The second area is in vitro fertilization. And all of these sorts of birth order on the technological futures that

Unknown Speaker  09:47
were brought up this morning. Third, which is very closely related is fetal surgery. And actually, it's most most closely related to the fourth, which is neonatal intensive care.

Unknown Speaker  10:09
And I think is very much a part of that is the whole issue of extra corporal gestation nurturing baby, your fetus outside of the mother's womb. Now one of the things that I think is, is, to me, it's important to try to think about why there has been no feminist analysis of most of these issues. And, I mean, I have some reasons, hopefully, other people will have others. I think that, that a lot of the current concern about sociobiology, has made women are reluctant to be labeled as sociobiology just shy away from social analysis of biological issues. I think that that's been part of the problem most recently. These are biologic reproductive issues that are biological aspects of women that are unquestionably different from man. And to confront those is, is very difficult. I mean, it's easy to confront them, if you just jumped the gap, and you're talking about a utopian future, it's not so easy to actually confront them in terms of what the very near future possibilities are. The very near future is not far from the far future. Most of the technologies that I've just talked about, including, of course, genetic screening, and in vitro fertilization, are not technologies in the future, that technologies of the present. And they make many other technologies, a matter of months and not of years, of years and not decades. And it's no accident that in any of the projections about reproductive engineering that have been made have all been wide of the mark. And they've all shot 1015 2025 50 years ahead of what's actually happened. And most of the technological advances have happened much sooner than we expect. And I think that, to me, they have very serious implications for women that women are not dealing with. That at this point, they're the whole spectrum is basically medical honest, and is seen within a context, a much narrower context of medical therapies and intervention. And it will have an effect on women's role, the role that women have always felt that women have often said that they would rather not. But yet, when it comes to that, I think it needs a lot of both rethinking. My own research has been has come from the other direction, in the sense that I've been interested in the technologies of childbirth, and particularly of cesarean delivery. And to me, it presents a case study of an application of technology to women that is applied differently to different women. And I think that that's critical, and raises issues of medical control, and other other kinds of control that I think can be applied to any of the other areas of reproductions that I've mentioned. And I thought I'd tell you a little bit about cesarean delivery and why I think it's interesting as a case study, and then move on to some of the areas that have not been as thoroughly score.

Unknown Speaker  13:57
There are, as I said, other ways at this point that you'd like to proceed kind of introduced most of theirs that I think are important. One other piece, I would like

Unknown Speaker  14:14
to add, I love your your outline. Okay. Oh, my work. So I've tried to focus on that as well as what I think one of the problems that women's studies by its definition gets into women's studies and, and where I worked, we tried to call it gender rather than women. Certainly men need to be studied. As much as as women and particularly on the issue of reproduction. The sperm turns out to be terribly sensitive to health and safety questions. And so if an atmosphere I mean, this came up with the whole thing about women being sterilized to work in dangerous environments, it turns out that the male sperm was being damaged much more rapidly as a female lay. And, and the good thing about this is that Men produce for regulated existence. And so if they stand unlike a woman's neck, which are worn with, if an alpaca lasts a lifetime, if a man sperm is destroyed, he can produce new sperm. I mean, so it isn't necessarily a lifetime today. And also you can test the nature of the environment, I have a guy Jack often check testing firm, right so that we have something that goes both ways. And we both in terms of protecting unborn children, fetuses from from being the product of defective sperm, but also a mechana human mechanism that enhance the environment. Environment.

Unknown Speaker  15:42
I guess my own approach has been reaction reaction to most most of the literature on reproductive technologies that has treated the genetic parents essentially as a unit, that the issues are ethical issues for men, men and women on the unit. And that's also been related to policy which has been made toward, for the most part, married couples in the unit in which the newer reproductive technologies are applied. And that the prospective since it's been a prospective, generally set forth by man has not looked at nor back to normal, but certainly hasn't looked at what does a future without a unique role for women in terms of reproduction look like for women? And is that a relinquishing of control that women are doing? Because it's a willing trade off? Is it something that they have any control over who women have, and willing to have decisions over any part, all of that reproductive process? Those are issues that don't come up in the literature, and they're just not approached enough perspective? So there's no question but that there are men's issues involve. But what I'd like to explore in the workshop is, can we look at it from a woman's perspective, and from the perspective of the people who have had the unique grow relationship to the means of reproduction? And for whom it's had such such really overwhelming consequences in terms of our other roles? And what would a change in that relationship really mean? And where do we want the change to occur? And is there any way that we have any say over that? Now, like thick, the piece that I've just read, by Grossman is a futuristic view by a man that equality and as I said, it sounds like shoma. Firestone. But it doesn't sound. Women are not sounding one way or the other about it. My sense is that it's one of those things. Can I just ask, does everyone have access? I don't have enough for everyone, but I have enough working for everybody. Before on the set. I just wanted to clarify

Unknown Speaker  18:34
a point that I thought you were making

Unknown Speaker  18:38
sure that you were making that point that you were suggesting one of the reasons women have not dealt with some of these issues, is that technology has gone so fast that we have not yet become aware of how fast it's gone, that it's a timeline Are you suggesting?

Unknown Speaker  18:54
I don't think it really timeline. And I don't mean to suggest that. I think that the movement is very rapid. Because the sign also scientific advances are there. And it really is a matter of perfecting technologies for a lot of theories that I mentioned. I don't think the reason why women haven't dealt with it is because it's moving so quickly. I think that there were other inhibiting factors. And, you know, partly it does tread on a lot of other issues that have to do with childhood, for example, on the relationship between bearing children and rearing children. The whole border boundary between genetic or biological, social, and ideas of the quality that are easier to confront, in a much more abstract way than they actually are to look at the process. Now, I think it's me it's not because things are moving quickly, in fact this at the time Schulman Firestone was writing, I guess the book came out in 1970. But it was in the early 70s. It was the late 60s and early 70s, that most of the actual scientific advances and important technology took place in areas like in vitro fertilization. And although the first no Louise Graham was born until 1978, it was 1967, or there abouts that the cells divided sufficiently in vitro that it was quite clear that it was gonna be a matter of time before successful implementation could occur. And yet, the flurry of literature that in the early seven days, was not from sort of, hasn't really been sense, except the very, very recently in which most of the people who are thinking about it writing about it are right here. Just a few. The the area that's interested man and childbirth as case studies is about a cesarean delivery, and I don't I don't know how many of you know very much about what's been happening childbirth technologies. But this is very a delivery rate. And then the country now, nationally, is 18%. In 1981, I guess so the last figures. And that means, nationally, one out of every five women. And that's quite in and of itself an astounding figure, what in fact is happening is that that's not spread evenly throughout the population. But the the rates and teaching hospitals, for example, hover around 25%, which is one in every four one. And that even that rate doesn't reflect the fact that that physicians, private physicians, and teaching hospitals have rates that range from the low of sometimes 5%. And some usual, to a high of sometimes 50%. And the women who have private care in hospitals, are the ones who have much higher rates in general than clinics. And that is one of the things that really interested me, why the class difference and why in that direction, when you would expect it to be. And if you look back, and the history of Obstetrics and Gynecology has always manifested that difference in plants are treated in different social classes. And for women, we're always used to practice and experiment on when technologies were perfected. They were then generally moved to women of middle classes, women who private patients.

Unknown Speaker  23:12
And the early hospitals, for example, first took in the word the poor, and then when hospitals were needed for, again for teaching and for practice, they became open to the unworthy poor. So Women's Hospital in New York is the most often cited example which was started by a very famous gynecological surgeon in Marion St. Paul, and he perfected a technique for repairing vaginal fistulas and perfected the technique on slave women in the south. And then for his own health reasons moved north. And in order to ensure a population that he could work on he opened Women's Hospital to the to the poor and indigent in New York City. And that's a blatant example but one it's sort of often cited that the various earliest institutions were open to the quote, yeah, where the poor truly be the truly needing the respectable for and the either the temporarily for or the people who are referred by churches for morally upright for charity cases and where the poor were unwed mothers were down and out on the streets, people who are not affiliated with social institutions, and they're in cost in the history of hospitals. This nurse was real distinction between who hospitals served and for what purpose

Unknown Speaker  24:59
now Um, the interesting thing, to me about the the uses of technology on poor and middle income women in childbirth are that they contradict medical indication. So the poor women are indisputably of higher risk. And I'm talking about a population, not individuals at higher medical risk, that have lower birth weight, babies, poor outcomes, and more complications themselves during pregnancy, as a group, they have less prenatal care. All the indications that would project complications in childbirth are more true, the lower the income level. And so based on medical risk alone, you would project that there would be more interventions in childbirth, the lower the socio economic status of the group, and in fact, it works in reverse. And what I've done is give you some tables that show, particularly in your city, sometimes it's a little bit easier to look at figures, and then to just listen to them, what the changes necessary rates have been and how they affect women at different institutions. Now, these rates vary by the characteristics of the mother, including age, education, and other indications of income of social class, and also the characteristics of the place of birth. So the different hospitals have different rates. To the extent that Andrew fleck was the Assistant Commissioner of Health in New York state, has posited a high risk hospital versus saying that there are certain hospitals that have certain cesarean rates. And he did a study on Long Island, in fact, of women who are in the same socio economic situation came from the same area, went to Southampton hospital or a local hospital, and there was a rate attached to the hospital rather than to the group. Now, if you look at table one, which looks like this

Unknown Speaker  27:27
you'll see that in the three types of hospitals in New York City, that the rates vary, and that they always have and the proprietary private hospitals, which in the city have a decreasing proportion of the population to care for, are quite close to the voluntary snare rate. So the real differences between municipal and voluntary hospitals. So again, the question comes up is the hospital or is it the characteristics of the women within the hospital. So we divided voluntary into the two parts of the hospital, which are general service, private service, and the second table. And General Service patients or clinic patients. They're cared for by how staff and they essentially are cared for in a whole different system of care within the same institution, as private patients are including most of the time, different parts of the hospital, different floors, sometimes all different areas, different caregivers, different hospital timetables. And in fact, there's the clinic patients or the general service patients have cesarean rates that are much closer to women who go to municipal hospitals than to women in the very same institution for private patients.

Unknown Speaker  29:02
The second figure gives you some idea of the increase in both groups of women and Sarah and deliver them you New York City. And also has a peculiar kind of gap at the end. So that the increase, that the difference between the rates of private patients to General Service patients actually has increased rather than decreased. And the second table says the same thing, but in a different way. It's a relative risk table. So it asks, well, what's the risk of having cesarean if you're probably the patient compared to the risk of having cesarean if you're gentle service patient. And the closer it is to one the more equal that risk is, so as the line drops, and nearly seven days That means that the two populations of women were treated almost the same in terms of sarin delivered, and then it rises again. Which means that, again, there's that class difference, which is spreading out. And in order to examine it a little bit more closely, the next table shows the same thing in one particular hospital. What's going on that that risk seems to come together that poor women and middle income women appear to have similar rates of cesarean delivery at a certain time and then again, diverge? And you can see the same thing happening at the hospital at this one hospital, and 7374 where the rates come together and then diverge again.

Unknown Speaker  30:51
Yeah. I'm just curious if you have any idea of what's been done over

Unknown Speaker  30:59
something going on in institutions?

Unknown Speaker  31:03
Well, that's what yeah, that's, that's what I was gonna last. But no, that's all right. effect. Does anyone know what was going on at the class? I mean, the most significant factor in terms of childbirth technology was the introduction to monitor. And it's, it's an interesting case study, because it also shows the interrelationship of these two technologies, the diagnostic technology, and presumably, therapeutic technology. And electronic fetal monitoring, was introduced in this particular hospital in the years that you see that start coming together, introduced in the city in the early seven days, and then became routine practice later on. So in fact, what what's happening is the pattern of when the new technology is introduced, it's introduced on poor women, on service patients. And then, so that you see the rates tend to come together. And then once it's generally accepted, it's used much more widely on provocations, and the rates diverge. So that accounts for the blip. Now, the question is, is how much of this is unique to Sarah delivering, or whether there, it's, Sarah just substitutes one intervention for another that the final figures, in fact, are a look at forceps delivery. And whether that query has any relationship to Sarah and delivery, and the rate of forceps and the top figure declines as the rate of cesarean deliveries increase. So the one technology essentially taking over from another, and I just mentioned second table questions. And in the second table, you can see that the pattern for forceps delivery was very similar as as necessary and delivery in that it was service patients who are having more interventions. I'll be it with a different technology. We're having fewer interventions and private patients who are having more interventions

Unknown Speaker  33:31
start with making various procedure effective, lot longer than that, and this is where the forceps starts to decline. Why didn't it happen sooner? Why is that happening now? And why did it start happening earlier?

Unknown Speaker  33:48
Well, we have maybe at this point, we should also say that we have a lot of people have very different backgrounds, and other people should feel free to answer the questions that fit. I mean, lawyers or some other people from medical schools or physicians who want to talk about it. It's there was clearly a fashion in the in the use of technology necessary instruction was was a technology that was there. And again, I think it points out points the fact that an existing technology is not as we said this morning, necessarily one that fits in with need. And so that there were other patterns of practice, and particularly in private care that fit in with an increased use of cesarean delivery. And that part of that pattern is a whole emphasis on more technological, high technological kinds of emotions and diagnostic techniques. And that begins to pick up in the late 60s and early 70s. Probably

Unknown Speaker  34:59
today until you see a laundry. It's a direct consequence of another technology. And it's it's also very much a medical legal thing that as the electronic fetal monitoring came more of what was accepted medical practice than a blip on a piece of paper became abnormal. And then if another intervention, another technological intervention wasn't then applied, it was married, that someone later could look back and say that was not accepted medical practices in terms of practice, and all that kind of thing. I think that's where

Unknown Speaker  35:35
the malpractice crisis builds during this period. So that in New York State in a decade, the malpractice rates for Obstetricians and Gynecologists went from something like 3500 a year to 50,000 years. So that, according to Helen Mariska, and in her study, she found that was the major factor, and it's certainly an important factor.

Unknown Speaker  36:01
Maybe we will do a series but she could not do that be later accused. Now, I mean, the defensive sort of thing

Unknown Speaker  36:11
that became, according to physicians and nurses can study, they a part of defense or medical practice that they felt that it was important to use every kind of technology that was available, because then they could not be accused of not intervening was necessary and that observation sort of suit, I'll get to in a second 10 times more than other specialties. They don't, they're not. Awards are not granted against them at with any more frequency, but when the awards are granted, they tend to be very, very high, I hit the newspaper. So the malpractice issue has been a big factor

Unknown Speaker  36:58
with the fact that it's more the

Unknown Speaker  37:02
nation because Absolutely. Now very much so. Now, another factor involved is just fertility trends and population. The perfect baby, yeah, which has been very important. Yeah, one one aspect is perfect baby, which I think I want to explain it more. So let me say something else before explaining that, as fertility rates have declined, hospital, obstetrical departments, many of them were built during a period of time in which physicians projected, you know, large numbers across and big families. And in fact, the literature, the obstetric literature in the 60s, emphasizes, for example, the need for nurse midwives to return to normal births, because there were so many girls that we, you know, we're going to need help with them. And then there's a decline in fertility so that there have been a couple of studies that tried to show whether there was a relationship between cesarean rates and bed use on the hypothesis that first Susteren you have to stay in hospital longer, and it occupies the beds longer. And since there were fewer births, and too many beds in an apartment, the studies have been basically inconclusive, which is not to say that that may not be effective, but it's not a very clear cut one. What is interesting is that in in the one hospital, for example, that the hospital data were taken from, and I think it's a typical example of a large teaching hospital, the birth rate declined drastically over, say, 1210 12 year period. So there were 5000 births and 68 and maybe 3000 births and 80. And yet the number of Syrians remain same, so that the Cesarean rate increased over the same time, and the numbers, you know, that were being done, remained steady. And it's just it's strange phenomena, but shows that there are two fifths less births, I put the same number of operations somehow. And that I think, also deals with with the same kind of the perfect baby phenomena, I think it's sort of a critical one for the other technologies that come on the other end of the reproductive spectrum. And it has to do with creating the perfect baby and the environmental perfect baby. And basically, it's claimed by obstetricians in terms of who their private patients are, and that private patients are women who have fewer babies at a later age and are very conscious of their own health and health of their children and who want to Therefore, who the obstetricians want as well as the women want to have a perfect baby. And this, the concept that birth is a surgical procedure is an old one and surgical literature, even vaginal birth was seen as a surgical procedure. So that that's not as qualitative elite as we see it. The perfect baby is one that is delivered by the obstetrician rather than being birthed by the woman because more factors are are in the obstetricians control. And this less, they're seen as ideologically being less potential harm to the baby. If the more there is under control, the more likely or less likely to harm. And so the risk factors, most of which are to the mother for cesarean delivery, or many of which are become if not denied, or at least not confronted. The biggest risk, of course, is maternal mortality. cesarean delivery is major surgery, and the mortality rate is anywhere from one to four per 1000. Sorry, delivered. And it's quite a bit higher than for vaginal delivery. So that plus the fact that there are anywhere from routine surgical complications to very serious kinds of complications from for cesarean delivery are mainly risks to the mother. The perfect baby can then merge or risk another's environment,

Unknown Speaker  41:38
sort of another aspect is going to talk about the transplant to the mother. It reminds me of a whole different side of the issue, which is the issue of IgM, which is related to this, really the baby's becoming the focal point of women, in some sense, becoming what I see almost the vessels for childbirth, which I find very frightening in specific cases of, you know, basically women being pregnant and being in accidents that have a range of support extreme streams before. And I think it's sort of this

Unknown Speaker  42:12
idea of the importance of being put on the baby of the baby's health rather than the mother's health experience.

Unknown Speaker  42:20
You said you just gave about

Unknown Speaker  42:23
letting go. Could you introduce yourself and maybe now as we get into discussion could just take me off because mine was started in childhood.

Unknown Speaker  42:40
But in response to that the fact of figures of risk to the woman do not stop an obstetrician at a private hospital, do you recommend to me to return the classroom students that all babies should be more or less taken for that, but that should get an obstetrician gynecologist in practice. I mean, when you talk about the family, not when they're not being a feminist analysis, and women not having control of it know,

Unknown Speaker  43:22
the certain delivery rate, mom, private patients in Brazil, this stuff, it's just 75%. And it's 25%, I think for service patients. But the there's been speculation periodically staring right in this country will level on a one to five, there hasn't been much, much sign don't know whether we're ready to move on

Unknown Speaker  44:01
to some other issues? Because I don't I must confess that I don't see the connection between male supremacy which I see a lot and well and you know, most areas of our society, but I assume that you are positing that the male medical establishment is doing something in these things that you listed. But I don't see the connection, for example, nurturing the fetus outside the womb, what interests does the state have in that? What are the interests of doctors having that that's inimical to women's interests, maybe want to prepare their own children? And I just can't make a connection?

Unknown Speaker  44:35
Well, I mean, I wouldn't I guess I wouldn't be as conspiratorial as that. I think that the the technological process, a lot of it has gone on in order to benefit women or to benefit couples who want to be biological children, and not just be social paths. And so most of the reproductive advances have gone on Now, the research has gone on with the applications for infertility or at the other end of spectrum applications to premature infants or infants who need neonatal intensive care. So that, I mean, in fact, that's one of the reasons why we haven't looked at it in any other way. The fact of the matter is that those applications are, are are restricted at this point, by general consensus that they shouldn't be restricted, but there's not much reason why they won't be. And then another movement pushing the perfect baby. Really well. The right

Unknown Speaker  45:52
to lifers, though are similar in the sense that they always put the theater first.

Unknown Speaker  45:56
Right? They're similar in that sense, but they're

Unknown Speaker  45:59
different in terms of which babies about the use of the technology

Unknown Speaker  46:05
and neither one seems to have a very informed they both run up against a lot of

Unknown Speaker  46:19
them and one of the one of the conflicts I think isn't that isn't an autonomy or control issue which feminist perspective has always emphasized that has value a woman's right to

Unknown Speaker  46:40
control over the issue and that in fact, the presidential commission I was talking about discussing autonomy but not as a woman's controller should

Unknown Speaker  47:00
be more after that a lot of people are selling way back naturally it possible to

Unknown Speaker  47:44
have a thinking of the various

Unknown Speaker  47:49
characters

Unknown Speaker  47:52
to have a natural childhood experience. How does that tie in to that? How did they square off with your fourth? Support each other right? Yeah. I mean, it was bad enough. Depends on the course on what to the other courses.

Unknown Speaker  48:46
They vary in how much they spent on natural

Unknown Speaker  48:48
versus opposed to preparation for birth in the hospital where

Unknown Speaker  48:51
they're taught. So that there's quite a range of courses in what people are prepared. To go to a hospital given childbirth preparation class, they will take you through and show you, you know, a delivery room. And this is where

Unknown Speaker  49:05
you might get your epidural. And this is what happens when you have to scare me.

Unknown Speaker  49:09
I mean, they'll do that too. But I think the bottom line is arbitrage lots

Unknown Speaker  49:13
of stuff on limited power in

Unknown Speaker  49:15
place of birth, convenient. All those courses and things like that are still within the context of an institutional structure, which is not giving the woman power in that setting. And still within a medicalized context, which is still doing delivery rather than the process. So that I mean those most of those principles, without a whole argument against the whole concept of Prepared Childbirth. First of all, thank you doctor, the laws like here's this man who's done this wonderful thing and now I can have a normal birth I mean, for the same thing with any of the men who provided innovations for how it have a baby. I don't think that there's a problem with the way in which that's happened. But I think the bottom line is still just the structural analysis

Unknown Speaker  50:10
issue. whole process from conception to the actual normal vertical kinds of things going on, and what benefits there might be to the woman and a couple, for the various points of intervention. There being with me on computers, for example, we are going to check down syndrome and then a couple of tools, whether or not they want to have the child or not have to. And that might be seen as a benefit to people to other other people who have certain other things than they are other thing is I'm not quite sure. On the sort of what you were talking about whether or not there's some possible there might be other defects in the fetus, where fetal monitoring during infection earlier on, and the operation might be better or not, there's a lot of discussion on that now, as a present relatively ignorant about that. I don't know what the pros and cons of that are, again, where this might be a benefit to the woman in the individual rather than only or mixture of adopted perfect. The third thing is, are there any benefits to the woman? Section, age and a factor in that? And young thing is a sexually transmitted diseases a lot of people have herpes

Unknown Speaker  51:45
is another thing.

Unknown Speaker  51:49
At different points, and there may be other benefits. Maybe your father? I know, I know, the lines are very method, but

Unknown Speaker  52:05
I think we would all agree there clear benefits for the woman and to the couple of every one of these

Unknown Speaker  52:15
technologies that we've talked about. And certainly there are benefits to certain times to fetal monitoring. What the reason why they're of interest, I guess, is that there's no direct relationship between the medical benefits and the medical benefit. It's also not, it's not a fact. So it's, it's interpreted by environment. By position. But no one questions the fact that the clear benefits are there. It's just that there's also so much gray that's involved, the reproductive technology is influenced by other factors that are social factors, economic factors, political factors. And I guess that's true Banik technology came out this morning, to never stand on its own, nor is it invented in us in any kind of a vacuum. And it's that environment of its use, that I think is of most concern to us. And almost every technology that I mentioned, and there are others have enormous benefits to women in particular want to be and we are happy children to couples. And yet each one from genetic screening on is also going to have lots of other applications. Mother election,

Unknown Speaker  54:12
what are the indications you want to go I don't know.

Unknown Speaker  54:24
The the electricity barons are or what you call like there's no necessarily considered totally electric because surgery is

Unknown Speaker  54:35
like the delivery of vital location and

Unknown Speaker  54:41
there are very limited cases now which that's considered good medical policy. Know I mean, there are there are a few studies of cesarean delivery or other applications of childbirth technology by I can't say a day a week. There's one hospital in upstate New York in which there happened to be necessarily. In a whole year there were no serious. There are very clear variations. The surgical rates on Monday emphasis on delivery, which I'll mention in a minute, there are very few legitimate elective reasons for having weights are higher on Monday for example, than they are Wednesdays is low point, Saturdays, kind of low Sunday. So there are social fluctuations. There are legitimate elective reasons which are in timing so that there are people who could legitimately be scheduled for cesarean delivery that don't constantly large proportion of society these days, but

Unknown Speaker  55:58
classy diabetics general herpes I thought originally they don't have to do. Repeats repeats his hands has been a focus of a lot of attention because they're always the

Unknown Speaker  56:32
ones that's really been challenged by Well, medical research but also by government bodies, increasing Susteren rates and targeted that repeats just one area so that most physicians will. And the language I'm using is not my language. It's medical language allow a child to have labor before they'll allow a woman to go into labor. And see how the labor goes before they decide whether to do a repeat cesarean or not. Now there's some repeats insurance that are done routinely, to me, because the indication for the first was such that it will repeat itself. But most of the experience or policy is that they not be elected. So in fact, the number of electors is decreasing by medical research and medical. The one of the interesting things that that we found on the difference between warm and cold patients is that they have their peak seven times a day are different. And it tells you something about the structure of the hospital. But for Jonathan's patients, he says Aryan time, like 11% of all Susteren work done. And for private patients, the pizzeria in the morning. And it appears to correspond to the social structure of the two parts of the two sets of physicians actually working in the hospital. attendings usually have office hours in the afternoon, so that if they're going to do a cesarean, then they're more likely to do it in the morning before office hours. And it may mean they come in at the middle of the night and start inducing a patient. And if by morning, adduction hasn't worked. And they'll do it this morning. How staff, on the other hand, don't have that restriction of office hours. And they'll generally start an induction in the morning, see how it goes and then do a Susteren and they asked to know if it hasn't progressed another session in the afternoon before the next shift takes over. And there are shift changes that affect that shift changes in nursing as well as among staff that are affected, but it's bad policy, for example, to leave someone who's likely to have a cesarean for the next shift. So that the patterns of surgery are very different.

Unknown Speaker  59:21
In the case of is very

Unknown Speaker  59:21
bad or any use of technology and

Unknown Speaker  59:24
interesting thing it doesn't have. You know, even if you believe that the majority of the caretakers have the true desire to continually take the best care possible of the woman and the baby. It's still within the context of that sweating and multiple times. It's one dimension that demands that another one that you've done and it becomes a whole cascade of intervention. That's mean that to me is where it's not just in terms of birth, but the whole range of technologies. The justification for their user indication for their use. Who makes that decision and in what context.

Unknown Speaker  1:00:10
Or hospital, you've got such a large number of people involved, that standard routine comes into planning, even if your doctor might not do certain things, you get there, somebody's going to stick an IV in you, whether your doctor would have that done or not, perhaps because it's something like standard procedure and the left hand is necessarily talked to the right hand. At least that's the sensation you get when you're in the middle of it.

Unknown Speaker  1:00:39
The interesting effect of that is that this bundle then becomes not shopping for the perfect doctor. Right. But as well as the whole community, within hospital. I mean, you can change them, procedure, you don't get kicked

Unknown Speaker  1:00:55
out before you get there, right. You know, in the thinking of even if you had all the best intentions,

Unknown Speaker  1:01:04
but the advantage of the focusing on changing things around pregnancy is unlike many other medical procedures, you do have warning me, you know, you're getting pregnant, you know, when the baby's gonna be born, you just have time?

Unknown Speaker  1:01:23
Yeah, I mean, I think most women find that they at the at the critical time, they don't have time, in a way in and as long as it's an individual process. And there is that and part of the childbirth education classes, I think emphasize the risk involved in any birth, that no birth is risk free. And that there are risks that are related to factors, for example. Other factors in that there's always potential but something go wrong, which is why in fact, you're in the hospital. And what goes wrong usually? Or what, what the couple is, a woman told goes wrong goes wrong at a time in which there is there's no recourse. There's no way to question a situation in which question, maybe it shouldn't be questioned in any individual situation. So that the challenging on an individual level like that it's not possible. And as you said, there's a whole structure for that preceded. And well, the brown baby, for example, was born by cesarean. I think that there we see the whole process from the very beginning of the in vitro fertilization, and every kind of testing that can go on in between creating a perfect environment and making sure that that perfection is carried through now on an individual case, which one of us would want to say that we would challenge that for ourselves? That's a very difficult issue. I mean, who would be the grounds should have said no one wants to say, the perfect baby has been created, to great benefit to the individual family, certainly, with all the best intentions. And yet, the co creation process was a creation process that I think, conceptually is is external to a woman and the baby was nurtured in a womb, but that was almost incidental. Strategies for doctors to

Unknown Speaker  1:03:52
go through a

Unknown Speaker  1:03:55
medication intervention, at the last moment, the medical COVID isn't out of their hands. Maybe, you know, I mean, after you like that, and your parents have to say, well, maybe they shouldn't. And the second thing is, people who've gone through that have often said, Okay, now, the only way I'm gonna have to do it, and so then we have to question it. So, we should have alternatives should work for those alternatives. But the energy then go into building alternative structures and self help mutual aid model and the system just continue this entry indicated with the rate of increasing, developed technology growing up that we haven't really challenged and I want to go back to your initial point of how do we then organize, begin to take seriously some, you know, very much more, more collective way the technology and I understand the thing you have noticed that there's been a lot of moving around until the point at which to become reality in our lives.

Unknown Speaker  1:05:06
That That point is so strong,

Unknown Speaker  1:05:09
you end up dealing with, you know, some of the anti technology is coming to terms of what is the value of this technology that we might be able to take back and use for our own benefit? Let's get out to that we have no more serious, no more, you know, whatever else. I'm just wondering if you have any political

Unknown Speaker  1:05:33
sense of what we might begin to think of?

Unknown Speaker  1:05:35
Well, I mean, one thing, I think it's probably to take a look at those areas in which women really have confronted a reproductive issue from a feminist perspective, including issues of technology. And it's ironic to say that contraception is one of those issues have been very successful in advancing contraception, safe and real control. On the other hand, politically, contraception and abortion are probably models of the kinds of strategies that politically have been used. And including organization, including dissemination of knowledge, including high visibility, and accountability to government activity, the kinds of there have been a number of conferences actually organized by, by NIH, government about surgical technologies, many, many of international international conferences on genetic screening, and on areas related to vitro fertilization. And there has not been a feminist presence. And that's a very sort of simplistic answer. But on the other hand, it's a beginning. It's not that there are sometimes there aren't sometimes women at those conferences, but they tend to be women who speak as researchers or as part of particular institutions, and not addressed the kind of issue of how how these technologies can affect women and how, how can they be changed? I think that, that the alternative institutions that are organized by women are another way, although not a mass force, are the potential for one there are now 150. Our passport centers around the country, it doesn't mean that that's that every woman now has a choice. But it does mean that there are 150 More than they were not considering, which is a whole lot. And that is harder to do once we get into areas that are now really controlled by what you would call more laboratory scientists. Number one, number two areas in which infertility is the major issue in which the discussion of rights and control when it relates to abortion. I'm not saying that we're all comfortable with that. One level, you know, we, we've learned to deal with any confronted when it comes to rights and control as to whether a woman is entitled to a genetic or biological child. And what that means is something that I'm not sure that anybody has really confronted. They only confrontation of sex choice issues, for example, which are quite eminent issues have not been by women. In fact, studies I think, overwhelmingly show that when it's the first time now, the follow up to that is that women prefer sons as first children. Families, given sex control, usually follow up the first son by a second daughter. Well, that's not very futuristic. The issue first came up in amniocentesis. And where there was a great fear that people would choose to have abortions on the basis of not promised on any kind of a condition that was shown, but on the basis of it being the wrong text child, it has not materialized. I think it's a good very small example of the lack of a woman's voice in that, in that whole discussion. There was almost I can't remember anything that I've read that to confronted the issue of what it's like for a woman to terminate a pregnancy at 20 weeks or 22 weeks. And that was just not part of any of the discussion of sex selection. So that all the analysis that goes on about whether people will terminate pregnancies what they will do whether this is going to be an important social issue went on without woman's own voice in that discussion, and I could still goes on sex selection now has a much wider possibility because with the vitro fertilization, you don't have to implant that

Unknown Speaker  1:10:15
bladder cyst

Unknown Speaker  1:10:19
almost embryos that it's up the wrong, the sex that you don't want, so that you can determine. Apparently, we're very close to being able to just fertilize with those firms that have one such another. But even if that's not reached, in the very near future, you definitely cannot plan to choose a certain sex. So sex election is something that is not a future issue, its present issue. And it would have enormous implications for women's position in society if all of our daughters were second children. First, if not ours in the room, and I wanted the daughter both times and God sons, but then if most of the country, in fact, set up so the family structure was that way they would have I don't know if it's a utopian future or not. But it's a future, not far fetched possibility. To enter the country that

Unknown Speaker  1:11:23
alternative structures, I think it's also a real concern in terms of the crack tissue, because generally is contained to this point onward. Middle class,

Unknown Speaker  1:11:40
families. And

Unknown Speaker  1:11:43
so in a way, it's the access to those kinds of alternative structures that I think we need to do a deal with. Here, it's just that I think I was so taken by one of the earlier points that we made in terms of our need for feminists. Now. I think it's interesting that a lot of us have, in this room have focused a little bit more on the technology of childbirth issues. Because in a way, maybe that's more comfortable, it's easier, you can come to a clear feminist analysis, without as many thorny issues of the whole technology of childbirth stuff. I know that Barbara Kasparov is embarking on a study related to genetic screening from a prospective, but I mean, that's really it's just much more trouble. So in a way, it's like, how do we begin to formulate a feminist analysis of the issues with genetic screening, prenatal screening, with vitro fertilization?

Unknown Speaker  1:12:42
I just want to sort of pick up, it's much harder to have thoughts on that than to pick up on the earlier point of social class differences. One of the reasons why I'm interested, I'm interested in salary and example is because it points out all of these issues that I think I can then think about in terms of other reproductive technologies. And the social class issue is one now that is significant. And almost all the other technologies talked about, for economic reasons, mainly, but I was just reading about the, one of the in vitro fertilization programs in the United States. The criteria for couples that are chosen to be part of the program, one of the criteria is that you can afford $4,000 It's not covered by insurance, to go through the procedures that you have to go through. So there are very definite economic issues. Now they've worked on us in some direction, but they've had the experimental stage any woman who was willing to be part come be part of the experiment and there are some ethical issues that were involved in the Edwards and Steptoe experimental stages, particularly in terms of the difficult problem was getting enough eggs to be fertilized was released that many so that women hormones were administered in order to produce multiple eggs and then ovulation and then for most of us, women, 99% of them, they then whenever the recipient of the benefits of that just was not advanced enough technologically so that fertilized egg could then be implanted. So there were ethical questions surrounding that stage. Those women were there was in England, as far as I can understand there were any women who volunteered who had been part of an infertility program who were willing to be part of the experiment in order to potentially benefit themselves later on. The Browns were working class. Now in the more widely available in vitro fertilization programs and this one just set up now but they generally require a great deal of money. It's not covered by insurance. They're also

Unknown Speaker  1:15:11
sexuality. Which completely

Unknown Speaker  1:15:16
lacking just in terms of the general

Unknown Speaker  1:15:20
discussion and discussion, we wanted

Unknown Speaker  1:15:24
to do that. If there were, obviously our social situation was different there, the whole issue of artificial insemination could be that could be a huge issue. Discussion,

Unknown Speaker  1:15:40
the response and I'll throw it away. There was one mentioned in an article again, by a man of some of the what he saw as difficult future issues and technology was the man would be rendered irrelevant. Now. I mean, I guess I'd always seen it in the way that women separated from the reproductive process then puts women's whole role in a different life, what he was talking about responding, which in fact, renders men totally analysis, irrelevant. And cloning hasn't begun to be analyzed. Almost with any perspective, there is a whole journal in medical school library that comes out every month or four times, or whatever it is, it's full of articles. And so it's not something that is science fiction. And I guess there was a frog was first clone somebody another day better than Ivan in the early 70s, early to mid 70s. And no mammal has yet what I've read, which is not hardcore scientific literature, but the people who sort of look at the scientific literature and analyze that again, the technology is there. There is no scientific reason why a mandolin, even a human phone that we know how to take the nucleus out of the fertilized egg and replace it by another nucleus. And that's essentially what cloning is. And so that that if it's replaced by the nucleus of a cell from a woman, then clones a woman and there's no man that's really essential.

Unknown Speaker  1:17:32
So that's sort of your perspective on looking at the man the man sand.

Unknown Speaker  1:17:41
But there is a whole assumption is not just an assumption, but there's explicit policy on the part of most people apply these programs. But they will be applied only to usually not heterosexual but people who are involved in heterosexual relations

Unknown Speaker  1:18:02
birth control methods method, you know, all the enormous masterpieces all married people.

Unknown Speaker  1:18:09
I'm married people don't use that, I'm curious as to what what one could come up with in terms of genetic screening, as it seems to me, the only thing that occurs to me in terms of the feminist analysis would be one, the business of sex selection, which quite happily is is and, and secondly, insofar as, as feminism implies a degree of autonomy, if you had the state of Nazi Germany's pretensions or whatever, which says that, you know, these are, this is the state's definition of a perfect baby, any other child, any child who doesn't meet these criteria will be aborted like it or not, you will be screened to make sure that you don't inflict any of these non perfect babies.

Unknown Speaker  1:19:07
Well, I'm part of the analysis is to have a basis upon which to make decisions and that woman's relationship to that baby, whether it's a partner or not, apart from whether it's the man's baby that you carry, whether it's a baby that belongs to somebody else, and

Unknown Speaker  1:19:40
all those things have to deal with a whole range of decisions that are almost routine. Carriers are screen. There are a whole host of problems that are picked up by parents before they become parents. about their decisions about whether you base your reproduction when you base your your mating, essentially on those kinds of genetic characteristics, and increasing numbers of screening programs for carriers that are meant for people to begin to think about before they plan to have children, before they affect form unions, certainly has to do with women with who are artificially inseminated, and what kinds of genetic information will be possible, and many argue should be possible about donor. And then, in terms of prenatal screening, again, there are a whole host of decision

Unknown Speaker  1:20:48
very narrowly vignettes, yeah, which is

Unknown Speaker  1:20:51
part of melee, you know, a whole complex of increased knowledge and decisions that have to be made on the basis of that. And to me, it makes a difference what the framework is, I mean, is the decision being made about something that's very separate about reproduction, that is a separate process apart from one non central part of which one creates a perfect baby or the best baby possible that bearing and rearing children are not necessarily finished, typically boundary appointment as being that would present a whole different light on decisions than if the child was considered, particularly the fetus, and we'll move on as part of a woman, for them to be as something that she uses to enhance her sense of self. And if you just if you look at the way these things are played on the courts, you sometimes get a better idea of the kinds of issues that are involved. Who is claiming control over them? Wrongful life since the whole set of suits

Unknown Speaker  1:22:20
should have been given their whole range of suits in which hospitals have decided to perform a cesarean delivery, or to perform a life saving measure on a newborn, opposed to the woman or the parents desires.

Unknown Speaker  1:22:39
So whose babies? That's

Unknown Speaker  1:22:43
not a very good way to put it, but I'm not quite sure what to tell, but it seems like the relationship between two children and I guess, for that rearing has to be part of the way we make this decision. So

Unknown Speaker  1:23:00
a lot of that is the question altogether,

Unknown Speaker  1:23:02
apart from genetic screening, together, I mean, you're talking about what is the relationship of the mother to the child.

Unknown Speaker  1:23:12
The technology exacerbate

Unknown Speaker  1:23:13
some of them by giving you more information.

Unknown Speaker  1:23:17
And the technology somebody else, the obviously basis of those decisions, and a woman hasn't decided what they're basically somebody else decides what the public policy by social forces by economic factors. So I think if women don't have a way that they approached their relationship to the means of reproduction, then it will be defined and is being defined by others.

Unknown Speaker  1:23:58
Think about the most successful

Unknown Speaker  1:23:59
when?

Unknown Speaker  1:24:02
Has there been a model that one can set up for doing in terms of who works together women from outside the medical profession,

Unknown Speaker  1:24:10
along with

Unknown Speaker  1:24:12
procurement women inside the medical profession? Or is there a model that works? Or has there been a charismatic woman somewhere? Who has had the vision to figure out what might what was really happening and what the various points are that have to do with women, I just won't be able to convince other people of the dangers or the possibilities inherent in particularly technology because you're an individual charismatic conception of feminist analysis or has very, very various groups of people in our institutional system working together or they're totally out of the institution criticizing within the institution.

Unknown Speaker  1:25:02
My sense is the analysis has gone on, apart from, apart from scientific research, and apart from the medical applications, so that that that divorce, as it were, I'm not sure that we're talking about an agreeable dialogue, the permeation of boundaries. And what some of that the research its applications, and even it's even the concepts that are developed as a result of it have gone on with some sort of invisible boundary between them. And feminist analysis, which tends to go on in academic environment problems

Unknown Speaker  1:25:51
with an ideal model. Some of the things you mentioned, like broken,

Unknown Speaker  1:25:57
abortion have been much more

Unknown Speaker  1:26:00
feminist thinking it's a matter of autonomy and freedom. And you don't have to go into the technology to demonstrate on those issues. And in these things that we've been talking about today, I'm not sure where autonomy and women's census is why, therefore,

Unknown Speaker  1:26:18
look at something like that, which has received a lot of really very constructive attention, and a lot of controversy. And it's number one, it's it's been exposed. I mean, I'm not saying it's been exposed to as bad. I mean, that's another issue. But the class bias is involved in international issues. The medical risks have been I mean, it's been a public controversy, maybe it should be more public, but nevertheless, model, that's one step. I think it's to make these things, public issues and issues, which

Unknown Speaker  1:26:52
would you say was instrumental in keeping? One

Unknown Speaker  1:26:57
one organization has been a national phenomenon involved in childbirth Educators Association,

Unknown Speaker  1:27:07
and a few others have tried to do some organizing.

Unknown Speaker  1:27:23
One of the things that I keep thinking of looking at your baby in the way that I'm interested in issues around sterilization, and I keep thinking of not only for sex or, or social deformities. But other issues about what kinds of aid we shouldn't be worn and who should should they are children, particularly in relation to class and race issues. I'm thinking of people like Charles Weston, divided between readers and workers, those who read things, and those who are sterilized are workers, and how that decision get implemented and how on one level, you have a policy decision made about around some of those issues. The bill that was proposed was trying to tie family planning money to with National Foreign Policy aid. And then other issues in which we see a real rise in the number of sterilization. Teachers particularly among for women, and have tried to issues like insurance, or insurance or co workers relation, but it won't cover and abortion or prenatal care, or other kinds of more nebulous things like education, housing, employment issues, which made decisions around childhood. And so they should, or which have an impact. And I think we need to talk about some of that stuff, too. And now I'm thinking also about one of the things that you were talking about before, which is real scary to me what happens when a woman has sort of thought of reproduction, its relationship to production, been used against us to pay a price for that weight, but all this stuff in a social context and what happens to women when they don't need our bodies will reproduction in a world in which women don't have a voice and we're not important, that's well, that's fine. You're not wondering, you know, she won't apply so because the answer, you know, take away the biological difference in that everything. And I sort of wonder, what are the questions? I mean, then you start doing, you know, determining the sex of the baby, eliminating women who don't really need too many possibilities.

Unknown Speaker  1:29:56
Yeah, that's what I meant when I start off by saying that I think that there's real gap in Now between utopian future in which eliminating those differences means equality and the present in which the road seems to be very different seems to be eliminating those differences means not increased policy. One less

Unknown Speaker  1:30:22
but are there other kinds of things that national one thing that I think of, well, you know, if we live in our bodies anymore, then they can start eliminating that drastic, but other other kinds of things that people have read about whether it's possible results, getting rid of the reproductive

Unknown Speaker  1:30:43
fear of sort of women being done Raceland sort of not yet.

Unknown Speaker  1:30:48
I think that's what he

Unknown Speaker  1:30:50
had to worry about at all. I think that there was a chance that women are becoming much much more focused emotionally but the society associated with production issues.

Unknown Speaker  1:31:04
I am curious

Unknown Speaker  1:31:11
if it is just a temporary trend that we're getting rid of. And that may be one reason that we'll be focused on as child