Liberating the Pregnant Body

My paper ‘Liberating the Pregnant Body: disempowerment and disembodiment in maternity care’ on my new research project on a care ethical view of maternity was enthusiastically responded to by the audience of the Global Carework Summit in Toronto last week. One response came from a mother present together with her baby. She responded as a carework researcher and a mother. She had never realized, and was now stunned at, how little she had thought about the pregnant body with regard to carework, even during her own recent pregnancy. Like myself she was amazed at how it is largely lacking in philosophy, sociology, and political (care) ethics.

Logo Global Carework Summit

CARE-study into maternity and midwifery

Symbolically, for 9 months a group of committed researchers cooperated closely to write a grant proposal for a research project into ethical controversies in the mother-midwife relation during childbirth. This CARE-study (Controversies surrounding Autonomy and Responsibility: a care-Ethical study into the mother-midwife relation) is now granted, which means that a young and gifted researcher, philosopher and midwife Rodante van der Waal, is funded to perform her four year PhD study. Next to an empirical research into the advancements of respectful maternity care, the project involves a philosophical study into the ontology and history of pregnancy, childbirth and midwifery care. The project will be performed at the University of Humanistic Studies (Utrecht, The Netherlands) under the supervision of prof dr Carlo Leget. I am proud to be involved in this as co-supervisor.

Matrescence: changes in the mother and father brains

Matrescence is the term coined by anthropologist Dana Raphael in 1973 for the fundamental changes women go through when becoming mothers. She compares it to the other, common, and well described transition to adulthood: adolescence. In this Ted talk reproductive psychiatrist Alexandra Sacks reinvigorates this term for her own practice. She tells that postpartum women are calling her, saying that motherhood ‘isn’t supposed to feel like this’. They feel discomfort and wonder whether they have a disease. ‘Matrescence’ to her is helpful to describe the transition to motherhood, e.g. the normality of it. It is amazing how little we know about it in common life as well as in academia.

The same amazement is expressed in this Dutch TV-show by brain researcher Elseline Hoekzema, neuro endocrinologist Peter Bos and pedagogue Marian Bakermans, who researched both mothers’ and fathers’ reaction to becoming a parent. At delivery women do have a head start to fathers because of hormonal changes during pregnancy. Their brains show substantial differences that remain for two years, and never disappear completely. However, if fathers are (substantially) involved in babycare, they can easily catch up in becoming attentive, responsive parents. This is not what a few days of father’s leave can help accomplish, I think.

Interesting: women who are mothers are still quite ‘terra incognita’ for research, and what traditionally has been reduced to a gender or hormonal difference can now be refuted: it is an involvement in practices of care that makes the difference.

Care ethics: adequate for midwifery

With great interest I have read this study by Elizabeth Newnham and Mavis Kirkham who develop a care ethical outlook on midwifery as adequate alternative to bioethical and medical emphasis on respect for autonomy. The authors argue convincingly that the concept of autonomy is as such inadequate in ethical questions in midwifery care. Not only is a relational instead of an individualistic view required, as the pregnant woman is two-in-one, also autonomy does not represent the actual obstetric practice that already focuses on the unborn and is not free from paternalism. Hence attention and arguments for autonomy in everyday midwifery practice seem to be primarily rhetorical. An adequate alternative, the authors claim, is care ethics as it uncovers power relations (instead of covering them up) and focuses on concrete relational practices rather than abstract principles. A view that importantly underpins our research.

Caring responsibility: a phenomenological view

Click here to read the article that I recently co-authored with colleague Merel Visse on responsibility in care. We believe that care ethics offers various important critical views on caring responsibility that mutually complement each other. However, by drawing upon the phenomenology of Jean-Luc Marion we believe these views can still be complemented by looking more at the passive, fragile, decentring aspect of responsibility. If we take it more literally, as being a response, it comes second to something else, to something that has preceded it and to which it responds. Responsibility might be less a one-person-task, a personal assignment, an individual burden, if we look at it this way.

Duden on maternity

Reading and studying Barbara Duden’s book is both a thrilling and shocking experience. She writes on the disembodiment of pregnancy, i.e. how pregnancy became a concept that can be thought of – even by pregnant women themselves – without including a woman’s body. Even after 25 years it has lost nothing of its relevance, considered in the light of many recent developments.

In this extended essay I want to call attention to the profound consequences, for women and for society, that accompany this public [Pro Life, IvN] dispute. Politicians and jurists, theologians and physicians are engaged in a major effort of social creation whose object is “life.” As a result of this effort, a new idea has become universally accepted: just as the Blue Planet – “seen” from space – is the environment of all life, so woman is the environment of new life. Almost overnight, these beliefs have become growth industries for new professional establishments, from ecological systems engineers to bioethicists, to manage. Concurrently, the term life (and a life) has become an idol, and controversy has attached a halo to this idol that precludes its dispassionate use in ordinary discourse. This book deals with the history of this idol – the history of life not as an object but as a notion. I want to examine the conditions under which a new discourse has transformed pregnancy into a process to be managed, the expected child into a fetus, the mother into an ecosystem, the unborn into a life, and life into a supreme value. (Duden, 1993, p.2)

Tronto’s Moral Boundaries

Each year I teach the introductory course on care ethics during which we do a close reading of this groundbreaking book. Joan Tronto lays the groundwork for thinking about care as practice, as morality, and as political orientation. Her analysis of how ‘moral boundaries’ prevent us from interweaving the public and the private, moral theory and everyday practical ethics, and morality and politics, inspires me every time. Liminality, to me and drawing upon Tronto’s thought, would mean moving back and forth between others and myself, between society and personal sphere, between what I do on a daily basis and what I have learned from philosophy, between morality and political views. This movement in the space between us and its repercussions for care, have been beautifully expressed in this sentence: 

“Responsiveness suggests a different way to understand the needs of others rather than to put our selves into their position. Instead, it suggests that we consider the other’s poistion as that other expresses it. Thus, one is engaged from the standpoint of the other, but not simply by presuming that the other is exactly like the self. From such a perspective, we may well imagine that questions of otherness would be more adequately addressed than they are in current moral frameworks that presume that people are interchangeable.
Adequate responsiveness requires attentiveness, which again shows the way in which these moral elements of care are intertwined.”

(Tronto, 1993, p. 136)

Duden’s historical research of pregnancy

Today I started to study this classical work by Barbara Duden: a fascinating analysis of our culture’s preoccupation with the visible, i.e. everything that can be witnessed, measured, controlled and interpreted. With regard to pregnancy the consequences are unreflected but severe: the disembodiment of women. Historically women’s experience of pregnancy was fundamentally different. A must read!

Women’s traumatic childbirth experiences

New research concerning maternity. Women’s traumatic childbirth experiences in the Netherlands shows that maternity care needs improvement. Women are too often neglected, not asked for consent, etc. Even when care is given with the best intentions, professionals may harm women during childbirth and cause trauma. Women-centred care is one of the options to improve care, according to the authors.

Yelling mom and baby’s blood pressure

An interesting research on the consequences of a yelling or verbally agressive mom: the child develops high blood pressure and long term stress. Click here for the English research and here for a Dutch interview with the researcher. At the end of the interview the researcher raises most relevant questions Continue reading “Yelling mom and baby’s blood pressure”