In July this year Sir Marcus Setchell, recently retired surgeon gynaecologist to the Royal Family, made his first public statements about the birth of Prince George. Jenni Murray, interviewing him on Radio 4’s Woman’s Hour almost a year after the event, asked him whether he had been entirely necessary. His answer, that although what happens in labour is ‘an entirely private matter’ there are certain situations which might require a specialist to be in the room, prompted much speculation in the papers. The implication was clear – was The Duchess of Cambridge’s delivery really as ‘natural’ as we have been led to believe? That this arose, and indeed, that the interview was conducted at all, clearly has much to do with our contemporary obsession with celebrities’ personal business. However, it also reflects the extent to which the reproductive experiences of all women come under scrutiny in a neoliberal culture.
In the late 1980s, the World Health Organization (WHO) adopted a definition of ‘normal birth’ that suggested that unnecessary interventions should be avoided in low-risk labour and delivery. By the 2000s the term had become common among Western activists and health professionals. The UK National Health Service also adopted the slogan ‘breast is best’, which built upon WHO recommendations that suckling should be encouraged immediately postpartum. Today, there is an institutionalized arena of policy, practice and activism around breastfeeding and ‘natural’ childbirth, produced by a broad coalition of national and international organisations, non-profit and profit-making companies, health professionals’ associations, community and religious groups, and a multitude of interested individuals.
As Sir Marcus Setchell acknowledged in his interview, the development of the ‘natural birth’ movement in the West owed much to feminist activism against the medicalization of reproduction. This began in the 1970s and was led by experts such as British anthropologist Sheila Kitzinger, American midwife Ina May Gaskin, French obstetrician Michel Odent and British gynaecologist Wendy Savage. They rightly argued that women had been alienated from their bodies by a male-dominated and masculinised establishment, which treated pregnancy and childbirth as medical conditions rather than normal life events, was overly focused on risk and had been co-opted by market forces, particularly the infant formula industry. However, today’s ‘natural birth’ and breastfeeding movement has also been influenced by neoliberal values, which turns it from a feminist victory into something altogether more complicated.
For example, the privatisation of health services intensifies the pressure for us to become personally responsible for managing risk and preventing disease. Parents (mothers especially) have been tasked with ensuring their children’s wellbeing, and breastfeeding in particular has acquired magical status as the means of avoiding a plethora of childhood ailments, promoting emotional development, even purportedly increasing IQ. Within the contemporary logic of self-improvement, ‘natural birth’ and exclusive breastfeeding have been suffused with the language of achievement, seen as defining characteristics of successful motherhood and routes to women’s self-actualisation. Activists report their reproductive and parenting triumphs on social media, often with no attention to the economic, social and cultural privilege that has made them possible.
At the same time, neoliberalised healthcare systems have appropriated ‘normal birth’ and successful breastfeeding as performance measures. In 2007, the UK Maternity Care Working Party recommended that maternity services increase their ‘normal birth’ rates to 60 per cent within three years. The US Centers for Disease Control and Prevention produces a ‘breastfeeding report card’, monitoring rates at state and national levels. This outcome-focused model coincides with cost-cutting agendas, as minimising caesareans and encouraging exclusive breastfeeding are seen as ways to reduce healthcare spending.
Although originally rooted in attempts to empower women, today’s approach to ‘natural’ birth and breastfeeding puts intense pressure on mothers who cannot achieve these goals, often for structural reasons such as poverty and social disadvantage, family or other burdens or medical issues affecting mother or infant. Furthermore, in a neoliberal milieu that depends on economic and social competition and individual responsibility, these women do not receive empathy but are berated for making the wrong choices, and defined as both ignorant and lazy. The reproductive experiences of the Duchess of Cambridge and other celebrities then become ammunition in these ‘Mummy/Mommy wars’, which are very much a product of the age.
In recent years, veteran activist Sheila Kitzinger has expressed dismay at the mutation of reproduction into a goal-oriented agenda. Many women share this opinion and some are fighting back – for example, the ‘I Support You’ movement in North America brings together breast- and formula-feeding parents in mutual validation of each others’ choices. We should use initiatives like this to re-politicise reproduction, this time within a critique of the neoliberal culture which pits us against one another in cycles of assessment, judgment and shame. Setchell is wrong – what happens in labour is not an ‘entirely private matter’ for any woman, celebrity or not – but hopefully one day it will stop being a stick to beat her with.
About the author: Alison Phipps is Director of Gender Studies at the University of Sussex and works on issues to do with women’s bodies: childbirth, breastfeeding, abortion, sexual violence and sex work. Her book The Politics of the Body: Gender in a Neoliberal and Neoconservative Age is published by Polity Press.
One Response
Lorna Davies on Aug 31, 2014
Thank you for a thought provoking article Alison that positioned reproduction within a neoliberal framework clearly and concisely. As a midwife my thought is that we now have the most amazing support in the form of birth physiology that may help us to transcend the neoliberal agenda.
Our ever increasing knowledge and understanding of neurophyisology and the human microbiome makes it ever more apparent that supporting the mother/baby dyad and encouraging attachment is probably the most effective way of optimising health and well being of both mother and baby and this can only be beneficial for both health and social outcomes in the long run.
All women regardless of modality of birth, decision around providing nutrition for their baby or their prevailing social circumstances, deserve support to optimise the development of a strongly established mother/ baby relationship. There is little argument from a biological perspective that undisturbed birth and prolonged breastfeeding will give the best chances of this occurring and midwives should be pulling out the stops to faciliatate this wherever possible. However, the reality in this complex messy world is that this is often not happening for a multitude of reasons. There are though things that can be put into place quite simply to improve any given circumstances such as actively encouraging engagement between the woman and her baby in pregnancy; applying ‘gentle birth’ principles when a C. section is inevitableas well as a vaginal birth; seeking out alternatives such as breast milk banks or using the services of good lactation consultants when women want to breastfeed but are struggling and supporting the mothering skills of women who decide (I refuse to use the term choose as it supports the whole neoliberal context) to use breast milk substitute.
I am privileged to work in a maternity system where midwifery is grounded in ‘new professionalism’ and partnership, where women have continuity of carer throughout pregnancy, birth and until six weeks postnatally. However, the spectre of neoliberalism is here just as much as it is in other western healthcare systems. The sociopolitical context it would seem is far stronger than philosophical or ideological premise. But I steadfastly believe that we have the power and should strive to effect change even within a neoiberal environment.
Lorna Davies. Principal Lecturer in Midwifery. CPIT. Christchurch. New Zealand.