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Women and Reproduction

Write By: Valentin Rosca on

Reproduction, the Family and the Social Relations of Gender

During the 1970s a new generation of female sociologists and others struggled to bring health and gender to the heart of sociological analysis. The objective was not only to illuminate women’s health concerns – although that was achievement enough – but to undertake the more fundamental task of arguing that the association between gender and health was actually key to the wider social relations of gender. This was a long hard journey, and one that is still being taken today. Feminist academics, sociologists included, were beginning to appreciate, as Robin Saltonstall (1993) was later to elaborate, that it was not simply that gender could help us to understand health but that health could help us to understand gender. This prompted those who might not have been interested in health per se to appreciate its potential. The central place of reproduction in this enterprise is not surprising since it came to be seen as the pre-eminent – and often vexed – juncture around which women’s lives pivoted. As Ann Oakley put it, ‘a repossession of female control over reproductive care is a basic prerequisite for all freedoms’ (1976). Alice Rossi (1968) pointed out that up to this point research on maternity and parenting had been directed almost exclusively towards what the child needs from the mother, while women’s own experience, especially privations such as reduced involvement in non-family activities, had been totally neglected. Concerns such as Rossi’s need to be situated in relation to the bi-polar social script. Although women’s employment and employment rights were being actively campaigned for, wider social attitudes were slow to move away from traditional expectations of women’s domestic and maternal roles in the home. Tradition and change sat uneasily side by side, prompting all kinds of anxiety. Researchers began to argue that maternity was taking the place of marriage as the major transition point in women’s lives. Rossi explained that pregnancy and parenthood disrupted the expectations of young women who had been ‘reared with highly diversified interests and social expectations concerning adult life and that this was leading ‘to a depressed sense of self worth’ (1968). Similarly, Ann Oakley (1975) argued that the main factor marking the difference between the lives of twenty-five year olds during the early to mid-1970s and those of their grandmothers’ generation was not, as was conventionally believed, changes in education and employment but those in reproduction. Life had become much more complicated, since women’s identity was now doubly defined in terms of paid employment and being a housewife. Specifically, the fact that they no longer simply ‘gave up’ their work for marriage in the manner of their grandmothers had, made ‘the birth of a first child an unequalled crisis for women. Interestingly, Oakley tied this to the preoccupation – clearly popular even in the mid1970s – of whether ‘women are becoming more like men and men more like women’, arguing that the unknown effects of the medicalisation of childbirth, such as mental and emotional problems, needed to be taken seriously as factors that could stall the narrowing gap between the social behaviour of men and women. But in taking up these issues researchers faced a problem: there simply was no useful body of research to draw upon. It can be difficult looking back after the subsequent outpouring of research to appreciate that, back in the mid-1970s, there was a dearth of academic research on the experience of childbirth. As Oakley put it, there was ‘no study of childbirth from the woman’s point of view’, only personal accounts and impressions (1976). The lack of knowledge about ‘normal’ birth in different cultures was hardly surprising given that, up to that point, most research had been carried out by male anthropologists who did not have access to women’s spheres (Rich 1977). 

 

pregnant-womanWithin sociology, the prevailing ethos was to approach reproduction through marriage and the family were highly influenced by structural functionalism. Maternity was construed as a marital affair, of interest only insofar as it was a woman’s passport to proper femininity and the affirmation of her normative role within the family as the emotional carer of children. Thus, as Oakley put it, the failure of sociologists to ‘detach themselves from prevailing cultural norms’ distanced women from their own experiences (1980). For example, in Family and Kinship in Modern Britain, Christopher Turner (1969) simply took it for granted, and thereby tacitly accepted, that childbearing and childrearing would curtail the mother’s activities outside the home. The related failure by sociologists to problematize notions such as maternal instinct and its corollaries, such as the belief that childbearing is woman’s highest, yet most basic, function, meant that ‘normal’ reproduction was taken for granted as part of the natural order (Macintyre 1978). When reproduction was considered, it was the ‘problematic’ such as abortion, illegitimacy and ‘single mothers’ that drew attention. As Sally Macintyre (1978) discussed, ‘single mothers’ could not fail to be anything other than a disturbance to the social order when it was assumed that single women do not want to be (and should not be) pregnant. The yoking of reproductive activities to marriage and the family had also deflected attention away from a critical analysis of the profession of obstetrics and gynaecology (Oakley 1980), which, to the extent that it was contemplated at all, was positioned as a neutral player as researchers focused on matters such as women’s lack of compliance with medical regimens and missed attendance at antenatal clinics. Medicine’s role was to police normal pregnancy and birth and to sort things out when they ‘went wrong’, such as when pregnancy and birth occurred outside of marriage. In sum, medico-centrism and the normative assumptions inherent in prevailing research on the family resulted in an embryonic sociology of reproduction ensnared in the assumption that woman’s normative maternal role flowed from her biology. The feminist challenge rested upon making clear that givens, such as ‘maternal instinct’, were socially constructed. This challenged the yoking of reproduction to marriage and, to paraphrase Sally Macintyre (1978), the assumption that people have babies because they are married, or marry in order to have babies; that people have babies because they have had sex, or that they have sex in order to produce babies. Medicine quite quickly became politically laden within sociology as its purported neutrality was questioned. For example, Macintyre’s (1977) research revealed that assumptions on the part of doctors that marriage and motherhood are women’s natural role in life had a marked impact on the care that they received when single and pregnant. She showed that the assumptions of British general practitioners that childbirth was only acceptable within marriage highly coloured their response to patients. Those who intended to get married were treated ‘as-if-married’ and encouraged not to terminate their pregnancies. Those who did not intend to get married were categorised either as ‘good’ girls, who were typically young, had used birth control and were known by them, or as ‘bad’ girls, who were judged to be promiscuous, had a past history of vaginal infections and did not use birth control. Whereas good girls who could give a valid reason for why they could not get married were usually referred for an abortion, bad girls were typically punished and not referred. Kristen Luker’s (1975) study of a Californian abortion clinic also drew attention to the association between the acceptability of contraceptive ‘risk taking’ and marital status.

 

Although abortion was legally permitted on certain grounds, the total number of women seeking terminations on grounds of rape, incest or threat to physical health was less than 5 per cent. Consequently, most presented ‘a threat to mental health’ as their reason for abortion, and this required a psychiatric examination. Even though, more often than not, this was a ritual step in ‘earning’ an abortion, it still involved a process of labelling based on marital status. Luker found that married women were far more likely to have their pregnancy put down to contraceptive failure and to be diagnosed as having ‘transitional situational disturbances’ than as having personality disorders or depressive neuroses. The latter diagnoses were more likely to be reserved for widowed, divorced or separated women – women who should have ‘known better’ than to get pregnant. Luker concludes that this difference probably occurred ‘because a woman’s social category triggers certain assumptions in the minds of those who put labels on her as she goes through an abortion clinic’. Since it was now seen as foundational to women’s life chances, reproduction became the centrepiece of feminist endeavours to challenge the existing androcentric sociology. The sex (biology)/gender (social) distinction was drawn upon to counter the normative assumptions – held within medicine and more widely – that women’s biology is their destiny. This meant showing that the female biological body is invested with problematic social ideologies that have been imported into medical and social science. Researchers turned to topics such as the dynamics of interaction between the male dominated medical profession and female patients and their consequences for quality of care (e.g. Doyal 1979; Fisher 1984; Fisher and Groce 1985; Scully and Bart 1973; Shapiro et al. 1983; Wallen et al. 1979). But, for some, the problem ran a lot deeper than questioning particular biological ascriptions; female biology itself needed to be radically revalued.

 

Pure Difference?

happy-pregnant-womanFrequently maligned and often wilfully misunderstood (Morgan 1996; Stanley and Wise 1993), radical or ‘difference feminism’ is not only the feminism that the media loves to hate (Zalewski 2000) but also the feminism that other feminists often disparage. Radical feminism has the character of a dancing light – iridescent and full of colour but difficult to pin down. As Marysia Zalewski remarks: [it is] susceptible to being presented in ways that make it easy to dismiss it as outdated and over the top. There has been a tendency, amongst feminists and non-feminists alike, to look back to the early texts and search out the most outrageous and dogmatic statements and use them as evidence of radical feminism’s contemporary uselessness. It is my contention that, even though the influence of the radical feminist vision of the 1970s and early 1980s has diminished with time, its influence lives on in research on reproduction and childbirth. It is therefore important to capture its underlying premises. One way of trying to avoid the kind of distortion that Zalewski refers to is to use its proponents’ own words. Thus Elaine Morgan makes clear what radical feminism is not. It is not socialist or Marxist feminism, since from that perspective patriarchy is simply the by-product of capitalism and women will be free when capitalism has been superseded. It is not liberal or ‘equality feminism’ since, as she puts it, this kind of feminism plays by patriarchy’s own rules. By assuming that ‘imitating establishment men’ is good for women, ‘equality feminism’ settles for a ‘piece of the pie as currently and poisonously baked’ (Morgan 1996). Thus the very rights to which equality feminists aspire are not simply male-defined, but defined against women (a point also made by critics of equality feminism from other theoretical perspectives; see, for example, Gatens 1983; Jaggar 1983; Vogel 1995). Women have not simply been excluded from the rational (male) world of reason; rationality itself has been defined against them by denying the specificity of the female body. Treating women as equal to men will not always produce fair results for women; the special needs of pregnant women in employment, for example, could be denied. Robyn Rowland and Renate Klein concretise radical feminism in two tenets: first and foremost, ‘women as a social group are oppressed by men as a social group and . . . this oppression is the primary oppression for women’; second, it is woman-centred, created ‘by women for women’ (1996. Although patriarchy differs in form across time and place, it is universal in its impact: all women are oppressed, though in different ways and to different extents. Women therefore always exist as a social caste or class. This means that, although differences between them such as those based on ‘race’, age and social class matter, more often than not, they are superseded by their interests qua women. In this conceptualisation women’s common biological difference to men will always matter. As Rowland and Klein argue, ‘internationally, it is a woman’s body which is the currency of patriarchy’ and the major site of women’s oppression, witnessed in the worldwide experience of rape, violence, forced pregnancy and sexual slavery (pornography, sex tourism, the international traffic in women). 

 

From this perspective the notion of androgyny – or the mixture of feminine and masculine virtues, or a vision of a world where gender is no longer relevant, espoused by authors such as Judith Lorber, who writes that she would ‘like to see the genders unified (degendered) as a way of repairing the world’ (Lorber 2005) – is a ploy on the part of men, since all it intends is to eliminate the powerful female presence. In this sense, the summary, ‘equal, but different’ depicted does not do justice to this stronger position since, for some, it is not just a matter of appreciating women’s ‘difference’ from men, or even of recognising that, untrammelled by patriarchy, women’s physicality is in many ways superior and powerful; it is a matter of rejecting ‘difference from’ and asserting a positive difference outside the patriarchal binary. 

Philosopher and theologian Mary Daly (1984) insists that androgyny is men’s last-ditch attempt to invite women into the patriarchal plot by appropriating all that is best about women. Patriarchy, she argues, has deprived women of their bona fide passions and substituted ‘plastic’ or ‘potted’ versions in their place. Daly’s thesis comprises a double move: the transvaluation of patriarchal ascriptions and the revaluing of women’s ‘true nature’. Her ambition in writing the book Pure Lust was to inspire women to release themselves from the pots and plastic moulds blocking their passions. She argues that once patriarchal notions such as ‘femininity’ are stripped away, women can experience their original (pre-patriarchal) female power. Terms such as ‘hag’, ‘crone’ and ‘spinster’ become the metaphors for women’s creation of a new culture beyond patriarchy.

The writing of Mary Daly – and the poetry and prose of others such as Adrienne Rich – has a visceral power that convinces with not only the ‘sharp clarity of its substantive position but the sheer force if its literary style – so able to move the heart, and surely almost able to move the world’ (Cocks 1988: 30). It evokes an idea of the self as a ‘vital, passionate being’. This is very apparent in the early writing of Susan Griffin who, in the preface to the book Woman and Nature, remarks: ‘my prose in this book is like poetry, and like poetry always begins with feeling’ (1978). Her voice in the book is embodied and impassioned. In the place of what she calls patriarchy’s ‘separations’ – of mind and emotion, body and soul – she envisions a different way of seeing through women’s deep connection with nature. By transvaluing the male connection where the female body is a vessel of death – wilful, evil, devouring, even deadly – women gain their new space. Here woman’s nature and nature in her connection with woman are separate from – and superior to – manufactured culture. Daly (1993) conceptualises feminists as ‘outer coursing’, moving beyond the imprisoning mental, physical, emotional and spiritual walls of patriarchy (the state of possession) to find their elemental connections with the natural world and each other. In Pure Lust, she formulates a new philosophy, a new way of being for women that is in harmony with nature, where the force of reason is ‘rooted in instinct, intuition, passion’ (1984).

 

Reproduction and the Body Politic

Pregnant-Pregnancy-Park-Mom-Girl-JoyIt is important to appreciate the distinction between what has been viewed critically by some as the individualising tendencies of early feminist health activism (Bell 1994; Bell and Reverby 2005; Kuhlmann forthcoming) and the feminist philosophy outlined above. Susan Griffin, Mary Daly and others approach the female body from the vantage point that it is the body politic that matters. Rejecting the distanced and purportedly objective ‘masculine’ stance, their writing on women and the reproductive body is embodied insofar as it grows from experience. For some, reproduction became a trope for the ‘doing’ of feminist theory itself. Mary O’Brien, for example, referred to feminists ‘labouring to give birth to a new philosophy of birth’, which will show that male dominance is much more than economic in form (1981). In turning attention from the social relations of production to the social relations of reproduction, many feminists – sociologists included – saw themselves as engaging critically with Marx’s materialist conception of history and with the debate over the relative primacy of social class and gender as organising principles, which was dominant within sociology and the social sciences generally during the 1970s and early 1980s. Although they recognised that social class could divide women, they nonetheless maintained that, above all, women exist as a ‘sex class’, and this was the principle that drove the theoretical agenda on reproductive health forward. For many it was not so much a matter of jettisoning Marx’s dialectical and material conception of history but of turning it to feminism’s advantage by extending it to encompass socially reproductive or procreative labour. However, it can be argued that feminists sympathetic to Marxism did not give reproduction the attention that it deserved during the 1970s and early 1980s. This was the case despite some support for the importance of reproduction in Friedrich Engels’ Origin of the Family, Private Property and the State (1972). Thus Nicky Hart later argued that, following the lead of classical social theory, they had ‘abandoned procreation to a pre-social “natural” backwater, accepting that its social relations caused no more than a ripple on the surface of real material life – the production of saleable goods and services’ (1996). Although latterly feminists have conceded this neglect, many have remained wary of any latent ‘biologism’ inherent in the emphasis on women’s ‘unique’ reproductive functions. Juliet Mitchell, for example, emphasises that ‘it is important that the difficult question of the social place of motherhood, which is historically variable, does not collapse into the timeless mystique of earth-motherdom’ (1996). Given these disputes, it should come as no surprise that reproduction quickly became not only the rallying point for feminist health politics but also a rather bloody theoretical battle ground in its own right. 

Firestone and O’Brien

This was thrown into early relief in the 1970s in the contrasting views of Shulamith Firestone and Mary O’Brien. In the subtitle to her book The Dialectic of Sex, ‘the case for a feminist revolution’, Firestone signals that her concern extends way beyond reproduction per se. Reproduction is, in her own words, the driving force of history. But women have been dealt a cruel hand: a biologically based ‘sexual imbalance of power’ based on their childbearing and childrearing roles (Firestone 1971). Nature has set up oppressive power structures that have been ‘reinforced by man’ through the cult of romance and the tyranny of the biological family, which yokes women to men. Women are a slave class that exists to maintain the species in order to free men for the business of the world. In Firestone’s view, there is no more reason to accept this ‘biological disadvantage’ than there is to accept bourgeois rule. In the same way that workers’ liberation necessitates the overthrow of the means of production, women’s liberation demands the overthrow of the means of reproduction: the false dichotomy that biology has created between men and women must be swept away. Seizure of the control of reproduction will restore women’s ownership of their own bodies to themselves, along with ‘feminine control of human fertility, including the new technology and all the social institutions of childbearing’. Just as proletarian class action will eventually destroy not only bourgeois private property but the whole notion of private property, feminist action will eliminate not only male privilege but the relevance of the biological (sex) distinction itself. As Firestone puts it, genital differences between human beings would no longer be of cultural or political importance. In somewhat emotive terms, Firestone writes that feminists now ‘have the knowledge to create a paradise on earth anew’. The harbinger of this new freedom is reproductive technology. At the time of writing in the late 1960s, Firestone’s reference to ectogenesis belonged far more to the realms of fantasy than reality (Wajcman 1994). She stipulates using every means available to free women from their reproductive tyranny, from artificial contraception to ‘more distant solutions based on the potentials of modern embryology’, that is, artificial reproduction, the possibilities of which, she felt, were still so frightening that they were seldom discussed seriously (Firestone 1971) .What about the so-called joy of childbirth? It is just a myth. Anticipating disapproval from the women’s movement and what she called the ‘cult of natural childbirth’, Firestone insisted that childbirth is barbaric, maintaining that when the blood tie to the mother is broken by technology, the role of childbearing and childrearing can be diffused to society as a whole, ‘to men and other children as well as women’. Pregnancy, which is ‘clumsy, inefficient, and painful would be indulged in, if at all, only as a tongue-in-cheek archaism’.

 

pregnant-woman-with-small-shoesThe critical responses to Firestone’s thesis are well known: pregnancy and childbirth are not inherently barbaric; it is not biology that has dealt women a cruel hand, but patriarchal control of it. By resorting to technological control of reproduction, women are giving away their ability to give life. The Dialectic of Sex certainly asks women to abnegate natural reproduction. But it also anticipates opposition to the argument. Consequently, Firestone entreats women to at least consider the technological options. To be sure, technology can be misused by men, and, consequently, women need to be more involved in scientific research. But the point is that ‘artificial reproduction is not inherently dehumanising’ and ‘at the very least, development of an option should make possible an honest re-examination of the ancient value of motherhood’. Firestone’s plea that feminists at least consider the possibilities received a mainly hostile reaction in the 1970s and 1980s (see, for example, Arditti et al. 1984). She did not continue this particular debate. After suffering a nervous breakdown, she published her account of the journey of mental patients through the US health system in the evocatively titled Airless Spaces (Firestone 1998). While few have fully embraced Firestone’s argument, it was to have greater appeal decades on as feminists began to draw attention to the potential of biotechnologies to disrupt conventional notions of parenthood, identity and the naturalness of ‘ordinary’ sexual reproduction in ways that could benefit women (e.g. Farquhar 1996; Shildrick 1997). Moreover, her suggestion that reproductive technology can – to use her own term – ‘evaporate’ the false dichotomy that biology has created between men and women echoes in Donna Haraway’s argument that cyber technology not only opens up the possibility for women to define themselves outside conventional binary categories but sounds the death knell for biological authority itself (1997).

 

But, in the early 1970s such debates were some time in the future. At that juncture, the gut reaction was to assert that to take woman’s natural power to give life away ‘is to take away her trump card and to leave her with an empty hand, entirely vulnerable to men’s power’ (Tong 1998). Like Firestone, Mary O’Brien (1981) conceived of reproduction as the essential material base of human history. She also wished to show, contra Marxism, that male dominance is much more than economic in form. For O’Brien, reproduction is the central concern of feminist theory and practice and the subject and object of an integrative philosophy. She urged feminists not to eschew their natural reproductive function but to make it ‘the central concern of feminist theory and practice’. Responding directly to Firestone and drawing upon her own experience as a midwife, she asserted that childbirth is not inherently barbaric; it is a social and cultural affair – a cultural and social affair that, untrammelled by the distortions of patriarchy, which make hospital birth an occasion presided over by obstetrical entrepreneurs, is a ‘quintessentially social celebration of the strength of being female’. O’Brien maintained that birth is much more than the material or biological base of the social relations of production; it is a dialectical process that changes historically. Reproductive consciousness was fundamentally altered, for example, when men became aware of physiological paternity and when, with the advent of birth control, women became (at least in theory) able to choose parenthood. In common with many others, she argued that women of the 1970s and early 1980s had become alienated from their bodies, as birth was abstracted from its social context by male-dominated reproductive medicine as it fractured the experience of pregnancy and childbirth into a series of artificially separate moments: the moment of ovulation; the moment of copulation; the moment of conception; the moment of gestation; the moment of labour; the moment of birth, and so on. This fragmentation was seen as intrinsic to the male appropriation of birth by turning it into an abstract medicalised process.

 

Disputes over ‘who controls birth’ have been querulous to say the least. Indeed, as the early Firestone–O’Brien debate attests, arguments between feminists have sometimes been as (if not more) heated as those against medicine. Much pivots on the vexed issue of essentialism. In its stronger form, represented by the arguments of Daly, O’Brien and others, women’s bodies have been stripped of their biological potential by patriarchy. But there is no pure physical category prior to meaning waiting to be reclaimed, even for these writers. As O’Brien put it, reproductive experience is ‘rooted in the dialectical structure of the primordial biological experience of our lived bodies’ and therefore transformed by history (1981). Either we can distort the raw material or potentiality of the female biological body by patriarchal ideologies that construe it as precarious and inefficient, with extremely damaging consequences for women’s health, or we can cultivate the health-enhancing qualities of women’s capacity to reproduce and to give birth without undue or ‘unnatural’ intervention. The latter, of course, is entrusted to feminism. The problem, as noted earlier, is that making this feminist case always risks essentialism since it evokes difference at every turn. This is most evident in the contrasts that are drawn between ‘natural-women controlled’ and ‘unnatural-male controlled’ birth. The principal organising contrast is the male takeover of a female domain, at the heart of which lies the boundary line between normal/natural and abnormal/unnatural birth. It is therefore useful to take a very brief look at the history of ‘who controls childbirth’, before turning to recent thinking.

Two Models of Childbirth

pregnant-women-holding-handsFeminists, and others sympathetic to midwifery and natural birth, highlight the authoritative place of midwifery before the male-medical takeover, which began in seventeenth-century Europe (Beckett 2005; Michie and Cahn 1996). The question posed is: if both numerically and in terms of skill, female midwives were far superior to the emerging male-midwife of the 1600s, then how were men able to usurp their domain? The answer lies in the rise of modern ‘scientific’ medicine and the opportunities that it provided for specialisation. As Roy Porter put it, ‘the division of labour was one of the nineteenth-century’s big ideas, and it affected medicine no less than other spheres of life’ (1997). Before this time there had been little to commend midwifery to men, since it was not ‘proper’ medicine. The association of childbirth with pollution alone was enough to deter them. Birth was far better left to female midwives who, by dint of their sex, were suited to be the cleaners-up in domestic life (Oakley 1976). By the 1700s, the new respectability of anatomy meant that doctors who specialised in obstetrics could study the structure of the gravid uterus. The discovery of auscultation meant they could listen to the pregnant abdomen. The use of ergotamine to stem post-partum haemorrhage – a major cause of death – and the use of anaesthesia to manage pain provided the possibility of real intervention. The making available of the previously jealously guarded medical forceps in the early eighteenth century was particularly important in promoting the medical management of birth. A major catalyst for change, and a blow to female midwifery in England, came in the 1830s when obstetrics was incorporated into the medical curriculum. It is possible within this general narrative to construe the development of obstetrics simply as part of the increasing acceptance of doctors in all aspects of health care. But it was not just a change in the management of birth that was at issue but the fact that the new practitioners were men. The man-midwife or accoucher – the forerunner of the modern obstetrician – initially troubled expectations about what was appropriate for men and women. The unacceptability of mixing the sexes, who ought to be distinct, was highlighted, for example, in the bisected figures of mid- to late nineteenth-century prints (Jordanova 1999). Although the man-midwife on the frontispiece to John Blunt’s Man-Midwife Dissected (1793) has an aristocratic bearing, the written legend describes him as a monster in his propensity to crudity and indecency. This is represented in the drawing by his dubious use of savage potions and instruments, such as the forceps (a particular worry of Blunt’s). The body in the drawing is bisected by a hard vertical line, with the man-midwife on one side and the traditional female-midwife on the other. Although by countering the new developments Blunt seems to be protecting women from the attentions of male medicine, he is actually more concerned with protecting what is natural to women. He made clear that midwifery is really only the superintending of nature and therefore natural women’s work. Thus he remarked that the notion of a ‘man-midwife is as absurd as that of woman-coachman’. Moreover, his text was directed not to pregnant women, but to their husbands in order that they might learn how to counteract, as he put it, this ‘national evil’. Blunt’s worry, then, was more with the unnaturalness of men’s movement into this sphere, which was female by right (or nature), than with the usurpation of a female domain.

 

But most believed that although birth may have been ‘natural to women’, it by no means followed that they were equipped to deal with it. As Marjorie Tew explains, obstetrics triumphed through ‘captivating bluff and dishonest disparagement’ of rival midwives and enticing clients to transfer their custom (1990). Defamation of their character and denigration of their empirical skill was intrinsic to the de-skilling of midwives, which allowed obstetricians to police the boundaries of practice by claiming the ‘abnormal’ as their own and confining midwives to the ‘normal’ (itself constructed as a voluble state). In England, the Midwives Act of 1902 eventually left midwives as independent practitioners in charge of natural births, but with an obligation to call on a medical practitioner if abnormalities arose. The catch, of course, was that definitions of what counts as normal would be in the hands of obstetricians, not midwives. Obstetrical control over birth was consolidated in the 1920s and 1930s as appeals to safety and women’s desire for pain relief provided the opportunity to transfer birth from the home to the hospital. Even though hospitals were not necessarily more safe, they were part of ‘the bright new sanitised world of medical science’, which made them attractive to women (Symonds and Hunt 1996). In this context, pain seemed a throwback to the ‘dark ages’. In England, for example, 70 per cent of births took place in hospital by 1965. By the early 1970s, Dublin obstetrician Kieran O’Driscoll was asserting that ‘the permissive attitude to labour is now an anachronism’ and assuring every woman that her first baby would be born within twelve hours of labour (O’Driscoll et al. 1972). Rigid protocols were applied, such as mandatory intervention by artificial rupture of the membranes and oxytocin infusion if cervical dilation did not exceed one centimetre each hour. In the United States, the so-called Freidman curve – after obstetrician Emanuel Freidman – mapped the ideal evolution of cervical dilation and foetal descent in labour, setting the second stage at 76 minutes for women having their first, and 32 minutes for women having subsequent babies (Freidman 1978). O’Driscoll and colleagues extolled this as turning birth into ‘an intensive care situation’ (O’Driscoll et al. 1972). By 1970, 100 per cent hospital birth was being recommended in England based on the reported finding that, as the proportion of hospital births increased, the incidence of maternal and infant mortality decreased. But as Tew (1990) explains, this confuses covariance with cause and effect. In the course of teaching her students how much they could learn about various diseases from official statistics, Tew discovered to her ‘complete surprise’ that routine statistics did not support the widely accepted hypothesis that hospitalisation had caused the decline in maternal and infant mortality. On the contrary, her analysis revealed that ‘obstetrical intervention rarely improves the natural process’ and birth is safer the less the process is interfered with. She argued that downward trends are explainable by the gradual spread of prosperity, which means that far fewer women are malnourished and ‘reproductively inefficient’.


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