Perceiving and Pursuing the Sacred in Birth
Moderator: Julie Gunby, PhD student, St. Louis University
Panelists: Brett McCarty, Assistant Professor, Population Health Sciences, and Assistant Research Professor, Theological Ethics, Duke University; Martha Carlough, Professor Family Medicine, and Consultant Faculty, Duke Divinity School; Aaron Cobb, Associate Professor, Philosophy, Auburn University at Montgomery
Birth, like death, brings us to the limits of human existence. The goal of this panel is to offer a robust view of what is sacred about medical practice at the beginning edge of life, while calling us towards deeper ways of engaging rightly with it. In this panel a certified nurse-midwife, a philosophical ethicist, a public health physician, and a theological ethicist offer a Christian account of birth that is historical, hopeful, hospitable, and communal.
The first panelist, a nurse-midwife, offers a theological history of obstetric practice and suggests a Christian account of the metaphysics of birth as poetic nativity. If all of creation is a gift, then the act of creation is likewise. In their capacity for childbirth, human beings are gifted the gift of nativity. But the act of birth, like all gifts, is one of simultaneous reception and response, and one that goes easily wrong. Drawing from Martin Heidegger’s critique of technology, and Hannah Arendt’s account of natality, it is possible to narrate the history of obstetrics as a series of failures to navigate the active passivity required by gift reception. Erring either on the side of doing far too much or too little, obstetric practice has left a trail of death in its wake. The tenuous posture of active-passivity needed to attend childbirth well is best supported by a theology of gift reception, cultivated along lines set forth by Simon Oliver, Hans Urs von Balthasar, Irenaeus of Lyon and John Milbank.
Next, a philosophical ethicist considers what ought to be done when birth is complicated by the prospects of death - that is, when prenatal diagnosis discloses the presence of a significantly life-limiting condition. In the context of a complicated pregnancy, families experience profound needs, including the need to maintain hope and meaning as they face the significant likelihood that the child will die before or shortly after birth. Perinatal hospice is a novel form of care that takes the unborn and its family into its ambit of concern. As a structured form of care, it offers a distinctive scaffolding for hope, assuring the family that there is deep meaning in enduring the difficulties of this experience. Drawing upon a Thomistic account of hope the second panelist profiles the ways perinatal hospice can reorient the relationship between physicians and their patients around the holistic care for the person. This profile of hope reveals important dimensions of a distinctively Christian conception of the nature of the physician-patient relationship, especially within the perinatal hospice setting.
Thirdly, a public health physician examines how birth can be a site for wholeness and healing, albeit often incompletely so. While protocols and evidenced based practice are critical to quick and effective care in emergencies, maternity care at its best must also be personal. Physicians and midwives must learn to see themselves as witnesses to a mother’s birth while being prepared to guard safety and provide care at any moment needed, whether this is a quickly administered medication to prevent life threatening blood pressure elevations or supportive word in a time of fear and pain. The Ignatian values of accompaniment and cura personalis invite practitioners to consider the whole of the life being accompanied. These values can create a framework for physicians, midwives, and nurses to be present to women for whom birth is often a critical time of claiming or reclaiming the personal agency and identity necessary for motherhood. Additionally, the Ignatian principle of magis, or acting for the greater good, reminds us that any effort to name what is sacred about attending to the wholeness of life in childbirth will remain insufficient if it ignores the structural failings and medicalization that have led morbidity and mortality rates to nearly double for US women in childbirth over the past twenty years, disproportionately impacting women of color, those living in poverty, and those in underserved and rural areas. Our third panelist reflects on the three levels - individual, health system, and communal - which practitioners ought to attend as they partner with mothers and families in childbirth.
Finally, the fourth panelist, a theological ethicist, describes the peculiar practice of medicine in obstetrics as both a vestige and sign of a Christian vision of care. If pregnancy and birth are phenomenologically unstable, open to several modes of gift reception, then care for pregnant and laboring people requires attending to the institutional pathways and practices that lend themselves to perceiving and receiving the body alternatively, if not simultaneously, as enemy, object, or friend. When (parts of) bodies are deemed dangerous, flesh is rent with scissors, or forceps, or scalpel. Objectified bodies are stripped bare, immobilized, and subjected to ceaseless litanies of protocols, examinations, and timeframes. But, at the same time, labor floors are one of the rare places in modern healthcare where that ancient medical imaginary can be granted space and time to play out: the task of care as the befriending of flesh made strange through bodily disruption. Drawing from the work of Annemarie Mol, Eugene Rogers, and Janet Soskice, the work of labor and delivery can be described as a practice of attending and attuning care in an effort to create conditions of possibility for the laboring woman to befriend her flesh made strange - and such befriending can be understood as participating in the Holy Spirit’s work of befriending human flesh, revealed paradigmatically and made possible in the person of Jesus Christ. This account of attending and attuning care offers a medical imaginary more fundamental than imaging and engaging the body as enemy or object, and with it, the fourth panelist offers a peaceable imaginary for healthcare.
Following their presentations, the panelists will engage in extended conversation with the audience and with one another, and will be particularly interested to explore the implications of their theological account of obstetrics for other varieties of medical practice.
The first panelist, a nurse-midwife, offers a theological history of obstetric practice and suggests a Christian account of the metaphysics of birth as poetic nativity. If all of creation is a gift, then the act of creation is likewise. In their capacity for childbirth, human beings are gifted the gift of nativity. But the act of birth, like all gifts, is one of simultaneous reception and response, and one that goes easily wrong. Drawing from Martin Heidegger’s critique of technology, and Hannah Arendt’s account of natality, it is possible to narrate the history of obstetrics as a series of failures to navigate the active passivity required by gift reception. Erring either on the side of doing far too much or too little, obstetric practice has left a trail of death in its wake. The tenuous posture of active-passivity needed to attend childbirth well is best supported by a theology of gift reception, cultivated along lines set forth by Simon Oliver, Hans Urs von Balthasar, Irenaeus of Lyon and John Milbank.
Next, a philosophical ethicist considers what ought to be done when birth is complicated by the prospects of death - that is, when prenatal diagnosis discloses the presence of a significantly life-limiting condition. In the context of a complicated pregnancy, families experience profound needs, including the need to maintain hope and meaning as they face the significant likelihood that the child will die before or shortly after birth. Perinatal hospice is a novel form of care that takes the unborn and its family into its ambit of concern. As a structured form of care, it offers a distinctive scaffolding for hope, assuring the family that there is deep meaning in enduring the difficulties of this experience. Drawing upon a Thomistic account of hope the second panelist profiles the ways perinatal hospice can reorient the relationship between physicians and their patients around the holistic care for the person. This profile of hope reveals important dimensions of a distinctively Christian conception of the nature of the physician-patient relationship, especially within the perinatal hospice setting.
Thirdly, a public health physician examines how birth can be a site for wholeness and healing, albeit often incompletely so. While protocols and evidenced based practice are critical to quick and effective care in emergencies, maternity care at its best must also be personal. Physicians and midwives must learn to see themselves as witnesses to a mother’s birth while being prepared to guard safety and provide care at any moment needed, whether this is a quickly administered medication to prevent life threatening blood pressure elevations or supportive word in a time of fear and pain. The Ignatian values of accompaniment and cura personalis invite practitioners to consider the whole of the life being accompanied. These values can create a framework for physicians, midwives, and nurses to be present to women for whom birth is often a critical time of claiming or reclaiming the personal agency and identity necessary for motherhood. Additionally, the Ignatian principle of magis, or acting for the greater good, reminds us that any effort to name what is sacred about attending to the wholeness of life in childbirth will remain insufficient if it ignores the structural failings and medicalization that have led morbidity and mortality rates to nearly double for US women in childbirth over the past twenty years, disproportionately impacting women of color, those living in poverty, and those in underserved and rural areas. Our third panelist reflects on the three levels - individual, health system, and communal - which practitioners ought to attend as they partner with mothers and families in childbirth.
Finally, the fourth panelist, a theological ethicist, describes the peculiar practice of medicine in obstetrics as both a vestige and sign of a Christian vision of care. If pregnancy and birth are phenomenologically unstable, open to several modes of gift reception, then care for pregnant and laboring people requires attending to the institutional pathways and practices that lend themselves to perceiving and receiving the body alternatively, if not simultaneously, as enemy, object, or friend. When (parts of) bodies are deemed dangerous, flesh is rent with scissors, or forceps, or scalpel. Objectified bodies are stripped bare, immobilized, and subjected to ceaseless litanies of protocols, examinations, and timeframes. But, at the same time, labor floors are one of the rare places in modern healthcare where that ancient medical imaginary can be granted space and time to play out: the task of care as the befriending of flesh made strange through bodily disruption. Drawing from the work of Annemarie Mol, Eugene Rogers, and Janet Soskice, the work of labor and delivery can be described as a practice of attending and attuning care in an effort to create conditions of possibility for the laboring woman to befriend her flesh made strange - and such befriending can be understood as participating in the Holy Spirit’s work of befriending human flesh, revealed paradigmatically and made possible in the person of Jesus Christ. This account of attending and attuning care offers a medical imaginary more fundamental than imaging and engaging the body as enemy or object, and with it, the fourth panelist offers a peaceable imaginary for healthcare.
Following their presentations, the panelists will engage in extended conversation with the audience and with one another, and will be particularly interested to explore the implications of their theological account of obstetrics for other varieties of medical practice.