Having recently told our families and friends that we are expecting our first child, I was surprised by the immediate advice and interrogation regarding our birth plans. I was expecting unsolicited input on our infant feeding choices—pressure to breastfeed is widespread, even as the health benefits of breastfeeding and the morality of breastfeeding advocacy are increasingly contested (Barnhill and Morain 2015; Colen and Ramey 2014; Rosin 2009). Doubtful as the empirical evidence may be, both those opposing the medicalization of motherhood and those in the medical establishment agree on the benefits of breastfeeding (see my earlier post on breastfeeding). But I was surprised that childbirth was subject to similar social monitoring, and even more surprised by the diversity of advice.

Discourses of childbirth are as charged as those over infant feeding practices, but less unanimous (Malacrida and Boulton, 2012). The doctrine of intensive motherhood holds women accountable for achieving an “ideal,” “perfect” birth, thus maximizing the baby’s wellbeing and achieving the proper rite of passage to motherhood (Malacrida and Boulton, 2012; Malacrida 2014; Pearson 2014). Expounding this pressure, mothers are subject to competing discourses of “ideal” birthing.

On the one side, advocates of natural birth favor minimizing medical intervention, including the use of pain medications, as a means of liberating women from the control of the medical establishment and ensuring the “right” birth experience (Malacrida 2014). Medical practitioners are seen as pressuring women toward unneeded interventions (Malacrida 2014; Torres 2015). Indeed, modern medicine does sometimes impose invasive interventions without adequate justification—for example, an expert taskforce recently acknowledged that routine pelvic exams are unnecessary and may do more harm than good (Rabin 2016). But the natural childbirth movement may be equally threatening to women’s autonomy and agency. Although intended to empower women, many women experience natural childbirth as a standard they must meet to prove their maternal dedication and preparation. This pressure to “achieve” a natural birth can be oppressive (Malacrida 2014).

On the other side, the medical establishment favors risk-minimization through monitoring and (often) intervention (Malacrida 2014). This perspective argues that the natural birth movement romanticizes childbirth and understates risks. Indeed, although it can certainly be argued that interventions are not always necessary, modern medical advances have dramatically reduced maternal and infant mortality (Helmuth 2013; CDC 1999). Yet, particularly for those mothers aspiring to natural births, the medical establishment is perceived as the antagonist and interventions are experienced as a loss of control and autonomy (Malacrida 2014; Torres 2015). In turn, medical practitioners often perceive doulas and other advocates of natural childbirth as combative and resistant to interventions that are necessary to ensure the health of the mother and baby (Torres 2015).

Feminist perspectives on childbirth argue that both approaches—pressure toward natural childbirth and toward medicalization—undermine women’s autonomy, choice, and control over their own bodies (Malacrida 2014). That is, it is not whether birth is natural or medicalized that matters, but whether women feel respected and autonomous. (I would add that outcomes matter too—to me, women’s safety is crucial.) Minimizing judgement and guilt is important too, since many women feel that they have “failed” or “caved” if they accept pain-control or need a C-section—and social feedback often promotes this sense of inadequacy (Malacrida 2014; Pearson 2014; Tuteur 2017).

In my experience, the friends and family who have been most helpful are those who adopted the feminist viewpoint. They have been supportive of our plans, even though our intentions may differ from their choices. The least supportive are those who immediately start recounting horror stories and speculating what might go wrong. (Also unsupportive: My dentist's unsolicited and opinionated obstetric advice.) Most interesting is the diversity of advice—one close relative immediately recommended that I seek all possible pain control while another advocated hiring a doula. Clearly, opinion is divided as to the best birth plan. Fortunately for me, most have been supportive.

So what is the “right” approach to birth? I’d argue that there isn’t one answer that is right for everyone. Obviously, safety certainly matters and women should discuss their intentions and expectations with their health care providers. But within the scope of safe choices, women should be free from pressure to adhere to a rigid ideal.

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References

Barnhill and Morain. 2015. “Latch on or Back Off?: Public Health, Choice, and the Ethics of Breastfeeding Promotion Campaigns.” International Journal of Feminist Approaches to Bioethics 8(2):139‐171.

CDC. 1999. “Achievements in Public Health, 1900-1999: Healthier Mothers and Babies.” https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm

Colen and Ramey. 2014. “Is breast truly best? Estimating the effects of breastfeeding on long‐term child health and wellbeing in the United States using sibling comparisons.” Social Science & Medicine 109:55‐65.

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