Were you born? Do you know? Did you ever think about it, or just assume that you were born because 'everybody is'? If you have children: were they born? Did you ever think that many people you see around yourself were never born? How do you define 'birth'? Have you ever thought about it?

The word 'birth' is used in our society of any kind of passage of the baby from the womb to the world outside, rather like the word 'sail' can be used of any kind of passage by sea. Both words are often anachronisms: words that do not reflect the present reality.

To be born is to be given birth. It is to make a journey, with and within one's mother; to travel, in the mother's and the baby's own good time, at the mother's and baby's own pace; in an alert state, fully experiencing the event; from the embrace of the mother's womb, through the embrace of her vagina, into the embrace of her arms and breasts; to begin to breathe, to look about, to suck. In this right of passage, the passage from the womb to the arms, the sensual, the emotional and the spiritual elements are fused.

In our society, and increasingly in other societies, man, or most, babies are not born; many, or most, mothers do not give birth. The disappearance of birth, being born, as a basic human experience, shared by all, and the disappearance of giving birth, as a basic female maternal experience, shared by all women who are mothers, in an inevitable consequence of the male, medical misappropriation of childbirth.

In our society, the word 'birth' is used as if it meant merely 'transfer of viable fetus from uterine to extrauterine environment and commencement of respiration'. That definition applies to the medicalized delivery, but leaves much that is vitally important in birth, much that was perhaps never articulated as being such, because it was taken for granted before it was lost, just as silence, open space and small animal sounds were perhaps never fully recognized as indispensable parts of human living environment before they became scarce.

To birth, medicalized delivery bears the same relation as rape to lovemaking. We respect adult human beings enough to recognize that intercourse is not synonymous with lovemaking: the locative description 'penis in vagina'- comparable to 'transfer of baby from the womb to the world outside'- is not sufficient definition of lovemaking. Intercourse may be lovemaking or rape, depending on the how, when, on whose terms. How, when, and on whose terms does a baby emerge from the womb in a medicalized delivery?

The time and the speed may be forced; the whole experience may be drug-blurred; and everything made unnecessarily painful and difficult, for the baby, too, by restrictions on the mother as to position, mobility etc. The vaginal journey may be finished off by the force of forceps or a vacuum extractor. More and more often, there is no vaginal journey at all: the baby is lifted, by gloved hands, out of a knife-cut womb.

And the very meaning of that word 'out' has changed: from warmly welcoming arms of the baby's own family, to stranger's hands, manipulating painfully.

Out of force, and then? Into independent life, by force. The beginning of breathing- the very sign of independent life, and the second component of our current, reduced definition of 'birth'- is in medicalized delivery often artificially hastened by the untimely cutting of the still pulsating umbilical cord, so that breathing, instead of being naturally, gradually established, starts suddenly and painfully.

And we speak of this violation as 'birth'.

In describing parallel cases of violence we do not misuse words thus. I have referred to rape as one example. One could think of many others. We don't say that we have walked from one place to another, if we have in fact been abducted and transported there by motor vehicle; we don't say that we have eaten, if we have been in fact been fed involuntarily, intravenously. Yet we say that to be forcefully, surgically removed from the womb is to be born. We don't say that we have been having a walk, if we have in fact been forced to to get up, drugged, and dragged along the street, stumbling in a stupor; we don't say that we have eaten, if we have in fact been force-fed with a spoon. Yet we say that to be extracted from the womb through an induced, drugged, forceps delivery is to be born.

Think about the word 'choice'. That is a sacred word in our society. If you want to lift a concept or a practice above criticism, link the word "Choice" to it, borrow some of the halo of that word. So women in our society are to 'choose' to be hospitalized for childbirth.

Now think of women in other cultures, submitting to the custom, or ritual of bee-waist corsets, foot-binding and genital mutilation - I'm referring to non-obstetric genital mutilation; that is, not episiotomy, but so-called 'female circumcision'. All these rituals are based on a notion that women's bodies are not good enough as they are, and should not be allowed to function naturally. So is the hospitalization of healthy women for childbirth. And all these rituals are essentially disabling: foot-bound women lost their ability to walk freely, corseted women lost their ability to breathe freely, and 'circumcised' women lose their ability to fully express their sexuality. Women brought under medical-technological control lose all of this, and besides, more fundamentally, they lost their ability to give birth, the very knowledge that they can give birth, that their babies can be born, without medical supervision and intervention.

We recognize easily enough that women in other cultures have submitted, or submit, to the rituals of bee-waist corsets, foot-binding or non-obstetrical genital mutilation, not as a result of a free and informed choice, but from the force of custom and conformity, lack of power, information and support. We have difficulty in perceiving that this applies also to the medicalization of childbirth in our culture. The rituals of other cultures that result in the deformation of the female body can be recognized by us as 'customs', but the ritual of hospitalization that results in the deformation of mothers' and babies' and whole families' experience is portrayed by many as an exercise of 'choice'.

What is choice? What is a free, informed choice? How free, how well informed must an act be to deserve the name of choice, as opposed to unthinking imitation of others, or, indeed, doing the only thing that circumstances allow?

One of the prerequisites for a choice of any kind is the existance of alternatives to choose from, and for the person to be aware of these alternatives. With respect to birth, this means, among other things, absence of laws and regulations disallowing women to choose where, when, how and with whom they give birth, and access to birth attendants for any setting they may choose.

To assess how informed a choice is, we must take into account all the misinformation, as a minus: all the misinformation about birth that women have received, consciously or unconsciously, from many sources, all their lives, from the time they themselves entered the world outside the womb, usually via medicalized delivery. Of course, a woman does not need any particular information, about human physiology or hospital practices; indeed, does not need to be able to read or write, in order to be able to give birth safely and happily in her own home. But in our society a woman needs the support of information to be able to resist, with confidence, the power of big business that human reproduction has become and which many have vested interests in keeping it that way. She must be able to recognize the ubiquitous misinformation for what it is; she must - having had her innate self-assurance destroyed - be reassured that indeed she can give birth, by herself.

In our society, women have neither intellectual nor emotional nor practical support to be able to 'choose' homebirth. The information is systematically suppressed, women's trust in themselves and in their bodies systematically eroded and practical support systematically withheld.

We talk of 'widening options' in many fields of life. In reality, one option is usually merely an exchange for another. The 'option' of motorized traffic soon almost closed off the option of non-motorized traffic. The 'option' of hospital delivery soon almost closed off the option of homebirth. Resources are directed to build structures for the new 'option'; old structures are neglected and may collapse; old skills and readinesses may die.

Options change; customs change; and our perceptions of what is acceptable and 'normal' change.

What is normal? We must distinguish between what may be a cultural norm given in a society and what is physically and psychologically normal for human beings. What is common and customary is not necessarily natural or healthy; this applies to a wide range of phenomena, from being drugged at delivery to being drugged by television, from being slapped as a newborn to being beaten by one's husband, from having one's intestines damaged by formula sucked from a bottle to having one's lungs blackened by tobacco sucked from a cigarette.

Medicalized delivery, a cultural norm in our society, is both physically and psychologically abnormal, an altered event altogether. The W.H.O. acknowledges - but most do not - that 'it is no longer known what normal (i.e. "non-medicalized") delivery is.

The hospital staff do not know of normal birth, they do not witness it; the women who are delivered in hospitals do not know, they do not experience it. Birth knowledge, birth wisdom, is very scarce in our society. And what the women do know - their own stories of their hospital experiences, their own body language, intuition - is dismissed, even by themselves. Experiential knowledge is devalued, inexperienced 'experts' data is revered as truth.

But what are these data about? Research on hospital delivery - an aberration in the history of human parturition - is merely research on hospital delivery, with no general validity with respect to birth.

The very nature of labour and birth - a spontaneous, natural process where physical, emotional, social and spiritual aspects are interlinked - is beyond the comprehension of those who - not open and humble enough to respect birth - only study some technical aspects of parturition, in order to better control it. And using hospital delivery as the norm, we have come to regard many abnormalities, such as maternal indifference towards the newborn - a characteristic of non-human mammals in captivity of zoo and human mammals in the captivity of maternity hospitals - as normal, and many normal variations of labour and birth, such as several hours long stage, as abnormal, a 'complication'.

And the existing information - what is known about hospital deliveries and hospital practices - is not widely disseminated. Basic information on frequency of medical interventions, unlikelihood of an even relatively natural birth, is not freely divulged. Practices known to be harmful, and practices not fully evaluated, are continued, and presented to prospective 'patients' as safe.

Safety, indeed, is falsely promoted as the one great advantage of hospital delivery. Women, told that 'science' shows hospitals to be safer, have believed the claim without asking for evidence: the name of science has been enough without substance. So, many women, misinformed, 'feel safer' in a hospital; many even believe that to be surgically removed from the womb is better than birth.

One the whole, however, the question: why hospital? is not even asked, Homebirthers, on the other hand, are asked: why homebirth? - as if birth in its natural setting would need special justification, besides a new, special name: homebirth. The very setting of that question reveals how the very frames of our thinking have toppled. It is hospital delivery - delivery in an artificial setting, the new, the technological alternative - that always needs special justification, in each case anew. This applies to every medical intervention, of which hospitalization, in itself, is of course a very major one.

Why hospital delivery? Who needs maternity hospitals, and why? Not women, for 'medical need'. Only a tiny minority of mothers need assistance at birth, and usually even this assistance could be given at home, if trained, equipped attendants were available. We cannot see ourselves, our strength, if we keep the mask of medical need on. It is obstetricians and other medical professionals - from anaestheticians to neonatologists, and manufacturers of drugs and hospital administrators, who 'need' mothers and babies, for status and self-image, money and power: control of birth.

If we found ourselves in a country where the inhabitants would move about in wheelchairs rather than their own legs, we would ask, aghast: what calamity has fallen upon them? And what if we found simply that they 'chose' not to move on their own power? That would be a calamity indeed: not a loss of limb, but a loss of trust in one's own healthy legs. Living in a society where women's birthpower is largely unperceived and unactualized, like healthy legs hidden under a rug tossed over a wheelchair, should we not be equally aghast and ask: what has happened to our fellow-women? Should we not openly examine the forces - social, psychological and practical - behind women's apparent disinclination to give birth by them- selves, without medical technology and medical control?

The medical 'help' that women receive in the hospitals is usually, in fact, a hindrance to the natural unfolding of labour. The whole birth environment in a hospital - the place and the people - makes it difficult for a woman to give birth. Giving birth is not a matter of pushing, 'expelling' the baby, but of yielding, surrendering to birth energy - the force that medical men do not even admit to exist. At home, in an environment which she can control a woman can more easily lose control - be herself and lose herself: surrender, let herself open and give birth. In hospitals, women are made, instead, to submit to men and their machines and manipulations.

What we witness in a modern maternity hospital is, thus, not something quintessentially female - a woman giving birth - but something quintessentially male: men's age-old womb-envy, here acted on with more power than ever before, the power of big money and high technology.

Men can, indeed, enter the magical circle of birth, without destroying it, if they act respectfully; and if man is fully involved in his wife's labour, and aware of his own significance and usefulness to her, if he is her - not 'midwife' but 'withwife' - he is less likely to feel biologically inadequate and envious.

But medical men do not wait to be invited in, on women's terms; they invade, on their own terms. Of course, unable to give birth, they cannot usurp women's birthpower; what they have done is to replace it with the power of technology.

So natural human procreation has been turned into reproduction - from creation to industrial-mode production; women, the actual producers of babies, are seen as 'consumers' of 'services' which, in fact, do them more disservice than service. Women's labour of love is replaced by paid shiftwork of hospital staff, who are seen as producers - even owners - of the babies. From being subjects of the birth experience, active agents, the primary participants in the event - acting together, labouring together, mothers and babies have been reduced to objects of medical treatment, incapacitated into passive recipients of 'care', to which the women at most give their 'consent'. Treatment without consent - common enough - constitutes, legally, assault, but that term is not used much, and the assaulters are seldom prosecuted. There is no giving of birth, the babies are taken out; mothers and babies are 'delivered' from each other in a mechanical manoeuvre performed by professionals.

And authority follows action: women under medical authority do not do, do not even dare to think about doing, or ask permission to do, and anyhow usually would not be allowed to do, what would come naturally in childbirth. From the start of pregnancy, a woman, to be seen as 'responsible', must be irresponsible; that is, she must not take on herself the responsibility - and the decision-making - for herself and her baby, but must hand it over to outsiders, who in fact do not embrace the responsibility, only the power.

And this we call 'maternity care'. What is maternity care? Can it just be a subsection of medical care - is motherhood a disease? - or should it be the task of the whole community? And whom should 'maternity services' serve - the health of the women and babies and so the whole community, or the wealth of the obstetricians and manufacturers?

Our 'maternity services', our 'maternity care' - antepartum, intrapartum and postpartum - is the very opposite of caring for, and serving, mothers. Instead of encouraging, it discourages mothers in their natural task. Women can give birth. They only need to be able to trust themselves, their bodies and their babies, to be able to act powerfully, satisfyingly, fulfillingly. They need community support - practical and emotional; good health; and at the time of childbirth, midwifery care - and occasionally, though rarely, also medical assistance.

Midwifery hardly exists today. Most of our 'midwives' are so only in name. A true midwife is an independent attendant of birthing women, an almost invisible worker, whose task is to be there: to attend, respectfully, responsively; a woman amidst women, not an agent of medical control and authority.

Birth is not an event of a medical nature (though seen through medical spectacles a normal birth appears 'uneventful'). Undisturbed, it seldom presents medical problems warranting a medical approach. Thus a routine medical management of birth - making healthy women into 'patients' - is by definition mismanagement: 'patient management' is, in fact, impatient mismanagement. Medical meddling with nature often does produce both immediate medical problems and long-term problems of many kinds: psychological, sexual, social and also narrowly medical.

This is the true 'birth outcome': not just a few physical easy-to-measure aspects of the condition of the mother and the baby immediately after delivery, but all the life-long consequences for the mother and the baby and their relationship, and the whole family, and so the whole society - extending to following generations. The consequences - direct and indirect, individual and social - range from achievement-madness to technology worship, from a discontented dismissal of womanness. And of course, the consequences include all the waste and pollution that a high-technology, hospital-based system of 'care' necessarily generates.

Such is our mainstream 'maternity care'; there are some small upstreams too, but the noise made about them should not deafen us so that we do not notice where the mainstream - ever more invitro fertilizations, pre-natal manipulations and caesareans - is going: towards completely artificial reproduction, where the necessity of women as active, voluntary participants has been removed, towards the disappearance of birth, and the disappearance of mothering.

What is a mother? To mother is to conceive, to carry, to be heavy with child - only a man who has never felt the presence of a child in his body could have invented the concept of bonding at birth, or indeed, 'expecting' a child -; to give birth; and to go on nourishing and cherishing, caring and growing. Today, mothering is being fragmented into small parts, piecework: a source of an ovum, a location of a fallopian tube or a womb, an object of prenatal testing and manipulation and finally foetal extraction, and then, a kind of child care worker. The essential unity of mothering - the lifelong link, the deep bond of belonging - is being lost.

And what is a human being? A human being is a mammal, conceived in the fallopian tube, carried in the womb, birthed through the vagina, and suckled from the breasts, of a female of the species: growing, from a spontaneous start, in a living, human environment. How far can we, how far should we, extend that definition to products of artificial reproduction who have human genes, but lack some or all of these fundamental human experiences? Does artificial reproduction lead to the extinction of the human species?

Should we not face these questions and not turn away from them, as 'too big to handle'? A frog, in water that gets slowly and gradually hotter and hotter until it is boiling, does not notice the increase of the water temperature until it is too late. Should we not take notice while we still have time? Should we not try to see through the veils of misconceptions - the ones discussed here, and others - and push aside the verbal screens put up to cover from sight the reality of male reproductive technology - like a screen sometimes placed on the mother's belly during a 'caesarean birth'?

The medical grip on woman's wombs - from forced caesareans to epidemic hysterectomies - is getting even tighter. Should we not act now while we still can - can we? for the medical establishment has money, power, support structures and even governments on their side. Should we not acknowledge birth as an intrinsic part of human life, and as such, a fundamental, inalienable right, and work to demedicalize, renormalize birth, to make homebirth, normal birth, the cultural norm again?

At present, there are many who want to medicalize even homebirth; and of course, the mere place, without power, is not enough: medical attitudes an authority can be brought home in a doctor's or 'midwife's' bag - like ether to anesthetize a supine Victorian woman during her 'home confinement'.