Not a Home

Since at least the seventeenth century and up to the present moment, the Anglo-American world has been asking a question that takes this form: Is a particular activity (caring for the sick, administering charity, education children, giving birth, doing paid labor) done best in a domestic or an institutional setting? Over that long span of time, the answers have tended to favor institutions like factories, schools, and hospitals although there has been regular and sometimes effective pushback, re-placing activities, for some people, within the walls of individual homes. For decades before the pandemic, new movements arose to re-center home as the appropriate place for life events like birth and death. And, how, of course, it is a privilege to be able to do as much as possible without crossing the domestic threshold.

The names of the institutions that came to replace home—the workhouse in early 19c Britain, the funeral home and the nursing home in contemporary culture, even the “houses” of boarding schools—bear the traces of this debate, as public institutions are framed as private and indeed as homes or homelike. The word “home” moves out into public life in an attempt to minimize—or at least to paper over—the radical shift our culture has undergone.

In Victorian Britain, for example, schools (especially but not only those for girls) would boast of their homelike atmosphere: their parlors, and living rooms, their motherly principals, and of course their home cooking. In the same period the places we would now called mental hospitals began to insist on their connections to domesticity; this was evident not only in the names and architecture of private facilities, but also in their dominant form of treatment. While pre-Victorian asylums were more like prisons, progressive Victorians preferred “moral treatment” that stressed the recuperative power (especially for women) of domestic activities: cooking and cleaning for the poor, and tea parties and “at homes” for wealthier inmates.

Today, as we tour nursing homes for our parents or ourselves, we are comforted by the idea that we can bring our belongings from home, deinstitutionalizing impersonal white boxes with personal effects in the form of artwork, coverlets, even a favorite chair or a rug to cover institutional tile. The more homelike an institution, the more expensive it tends to be: the replication of home is itself a high-end consumer good. 

It is not my intention to judge between home and institution, except to point out that institutionalization was rarely carried out with the needs of the persons served in mind; although they might have been cloaked in the language of morality, arguments for institutionalization tended to favor ideas of efficiency and affordability. The home birth and home death movements of the 1960s, to name just two, have critiqued the anonymity of institutional birthing, living, and dying, and it’s inevitable results: denial, isolation, the fragmentation of life cycles and experiences. The move to home, however, has also been problematic, as I have more than hinted in this blog. It assumes, in the teeth of evidence, that homes are safe places: that they include what people need to work, birth, and die well. This idea ignores poverty, domestic violence, and in general the radical unevenness of housing across this country and others. How can we think about the idea of home in an institutionalized world?

Home Birth

When I was pregnant with my first child, I explored, as many people of my social class are wont to do, the idea of home birth. I read many books that were ecstatic on the subject, promising a transformative experience of empowerment, femininity, and bonding with the baby. Although I was attracted to the idea that childbirth should not be treated as a disease—and thus that birthing should not necessarily take place in a hospital setting, the discourse around home birth made me uneasy. As the name of one birthing and nursing supply store put it, proponents of home birth often seemed to think of birthing as “woman’s work,” perhaps mostly in the sense that only women could do it, but also perhaps with a nod to the idea that giving birth to and taking care of infants was the only appropriate work for women. This celebration of female difference is sometimes known as “matriarchal feminism” or “difference feminism,” To me, arguments that emphasize “natural” differences between men and women and elevate women’s special connection to parenting let men off the hook for domestic and family responsibilities and keep women confined within the restrictive parameters of home. 

In any case, I am also something of a coward, and very superstitious. I wanted to make sure there was medical backup in case anything went wrong. Walking the fine line between home and hospital, I initially decided to hire a doula to help me labor at home before moving to the hospital. As I remember, my doula was recommended by a friend. When I met with Sandy (not her real name) my first feeling was one of distance. It was clear that Sandy would have preferred to be employed as my midwife in a home birth. Her own euphoric birthing story was, in her own words, a “long journey” towards home birth: of ten or eleven children only the last had been born at home. Her first two births had been very alienating and medicalized experiences; she had struggled with the middle children to resist being taken to the hospital.  My first (and unkind) thought was that Sandy had had so many children only to produce occasions for the perfect birth. As we got to know each other better, I became, I hope, less judgmental. I fell under the spell of Sandy’s voice, which exuded a tender confidence. She was clearly also uneasy about me; although in the course of her work she had come to tolerate husbands at the scene of birth, she recoiled from my sense that my husband should be equally involved with the baby from the beginning. She was horrified at the idea of bottle-feeding or of male participation in feeding young babies: for her these were sacred expressions of the maternal. Most sacred, however, was her sense of place: the female-only room for the last moments of birthing, the bedroom or bath that seemed most natural to her as places to give birth, the confinement (a Victorian word!) at home after giving birth when new mothers should not work or read or cook. At some point—and I think I have blocked what must have been a difficult conversation—I told her that my revised plan was to go to the hospital without her fairly early in the process, and that she could come help me in the period that really scared me—the two weeks immediately after birth.

It turned out that deciding on a hospital birth in no way provided an escape from the power of Homing. I may have forgotten many details about my pregnancy and birth(s), but I will never forget my tour of the hospital where I was lated to give birth, and the first glimpse of the its spanking-new birthing suite, with its carefully staged “home-like atmosphere.” In fact, my college roommate Naomi Cahn and I wrote a book about fertility and infertility that has part of a chapter devoted to that suite, with its cherry-wood furniture, its chintz sofas, its private jacuzzi bath, and an armoire which turned out to be hiding an IV set up. As I remember (and tell) the story, my uneasiness with this strange hybrid of hotel, home and hospital increased as the childbirth-educator cum-real-estate agent, pushed a button on the cheerful cherry bed, which began slowly to revert into medical furniture as metal parts began to unfold and a surgical lamp to descend slowly from the ceiling. The gothic transformation was completed by the educator diving into the closet for a pair of stirrups which she attached to the end of the bed. In an effort to avoid self-plagiarism and to remember the story afresh, I have changed some of the phrasing from the description in Confinements. But some words remain here and in my brain: bed, chair, surgical lamp, metal, armoire, and gothic. I was reminded then, as I am reminded now of how this room with its moving parts, stripped the veneer of home from the hospital, and revealed the unhomeliness of home itself. I end the story of this tour with a prayer to give birth in something tiled and institutional, in something that at least declared itself to be what it was.

The Homing of birth, and even some aspects of the admirable home birth movement, frankly scare me. It is no accident that home births are preferred by two distinct populations: somewhat countercultural people with some money, who resist the medicalization of birth, often in the name of a historical female tradition of midwives and female relatives, and religious fundamentalists who believe that a woman’s place is in the home. What is most frightening, perhaps—and I plan to explore this next week in talking about nursing homes—is the fantasy of home that papers over the physical and social structures of institutions. And sometimes we are literally talking about paper: brochures, contracts, wallpaper, that insist on the hominess of what are not, whatever they may be called, homes at all.

 

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