The medicalisation of childbearing

К оглавлению
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 
34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 

The area of medicine and related practices, then, provides a rich arena in

which to see the characteristics of late modernity played out. In relation to

reproduction and childbearing, perceptions of risk are increasingly ‘filtered

through contact with expert knowledge’ (Lupton, 1999:77), and the

reorganisation of time and space plays out in particular ways in relation

to women’s embodied experiences of becoming mothers. For example,

regimes during antenatal preparation, during labour and birth and

following birth are all measured in terms of ‘the calendar and the clock’

(Adams, 1995:48). Endogenous, body time is only alluded to, for

example, in establishing the intensity of contractions during labour, but

regularity of contractions are measured against ‘clock time’. And so during

birth, ‘the woman is forced to oscillate between the all-encompassing body

time of her labour and the rational framework of her clock-time

environment’ (Adams, 1995:49). The placing of childbirth within a

medical, expert context and hospital setting, increasingly shaped by

deference to ‘authoritative knowledge’ and particular constructions of

time, is well documented (Oakley, 1979; Leavitt, 1986; Tew, 1990;

Davis-Floyd, 1992; Jordan, 1993; Adams, 1995; Chase, 2001). A move

away from home-based, midwife care to hospital-based, male-dominated

care, has occurred in many industrialised societies. These changes have

reinforced the illness view of pregnancy and childbearing and the need for

expert knowledge, technology and management. By the 1970s, virtually all

babies in the United Kingdom and America were born in hospital, the

normality of pregnancy and childbirth only being acknowledged once

delivery had taken place (Garcia, Kilpatrick and Richards, 1990; Davis-

Floyd, 1992; Davis-Floyd and Sargent, 1997). It is now well documented

that pregnancy and childbirth in the West have become medicalised and

Mothering in late-modern society 49

redefined as pathological, rather than natural states. As such they have

become bound up with medical regulation and supervision and professional,

expert management (Tew 1990; Nettleton, 1995; Foster, 1995).

Along with the shift in place of birth, the development of routinised

antenatal care has also occurred. Normative practices around preparation

have developed, involving regular visits to health practitioners and

hospital clinics. Women have generally come to accept these practices

as an integral and necessary part of the childbearing process in which

there is a ‘cultural dependence on professional health care’ (Oakley,

1979:15). Indeed, research in the UK and North America has demonstrated

the ways in which women endorse the medicalisation of birth,

leading to the conclusion that ‘most women willingly submit themselves

to the authority of the medical view’ (Sargent and Bascope, 1997:185;

Fox and Worts, 1999; Miller, 2000).

The shift in place of birth from home to hospital reflects both changes

in wider society and the changes and continuities in women’s lives in the

Western world that have occurred over the last century. The placing of

childbirth into the hospital setting has been explained in terms of patriarchy,

male dominance and control over women’s bodies (Oakley, 1979;

Martin, 1990; Treichler, 1990; Foster, 1995). But it is also the case that

in the UK women campaigned for the right to anaesthesia and hospital

births during the earlier part of the last century (Lewis, 1990:15).

Demand came from both middle-class and working-class women who,

for very different reasons, wanted access to hospital beds and facilities for

childbirth. In conjunction with this, a concern with high infant mortality

and maternal mortality rates during this period, led policy-makers and

doctors to conclude that ‘the answer was to hospitalise childbirth’ (Lewis,

1990:21). Similarly, in the USA of the 1940s, Davis-Floyd and Sargent

document growing pressure from both wealthy women and doctors ‘to

convince the general public that the progressive ‘‘modern’’ way of giving

birth was to divorce oneself from outdated servitude to biology by giving

birt h in the hospita l unde r total anaesthe sia’ (1997 :9). B y 1946 54 per

cent of all births in the UK occurred in hospital, and by 2003 the figure

had risen to 98 per cent (Social Trends, 2003). This trend was echoed

across other industrialised countries: 99 per cent of women in the USA

cur rently give birth in hospit al (Natio nal Vital Sta tistics Reports , 2000) .

The lowering of both perinatal and maternal mortality rates and issues

of safety and perceptions of risk have become inextricably bound in

defending the shift to hospital-based deliveries and the expert management

of pregnancy and childbirth. It has been noted that ‘state interests in

maternity care often use the language of safety and paternity’ (Treichler,

1990:128). The extent to which safety, measured in terms of lowered

perinatal mortality rates, can be attributed to better maternity care has

been challenged (Tew, 1990; Campbell and MacFarlane, 1990; Foster,

1995). However, notions of risk and safety continue to be used to justify

practices around childbirth across Europe and North America (Szurek,

1997). The practice of medicine in attributing better safety in childbirth

to improved medical care has also been challenged in the light of other

factors such as women having fewer children and the population as a

whole being healthier (Oakley, 1993). Similarly, the relationship between

outcomes and increased use of technology has also been explored. In the

USA, the use of electronic foetal monitoring equipment was found to

have resulted ‘only in higher caesarean rate(s), not in better outcomes’

(Davis-Floyd and Davis, 1997:316). Yet perceptions of risk, safety and

responsibility remain persuasive factors in the antenatal period and the

shaping of women’s ‘choices’ in relation to place of birth. The concept of

choice is of course particularly problematic in a pronatalist society. Davis-

Floyd and Sargent have also noted the ways in which ‘race, religion and

socio-economic class still circumscribe most choices in overwhelming

ways’ (1 997:11). The y point to the dominan ce of techn obirth in

America, in spite of ‘the apparently vast range of options for childbirth

in America in the 1990s’ (ibid.:11). The same observation holds for

women becoming mothers in the UK. For a woman expecting a child in

late-modern societies, then, interaction with the medical model, that is,

services and health professionals during the antenatal period, can be

seductive, as compliance is equated with safety and behaving responsibly.

As noted in the previous chapter, in both the UK and USA, biomedicine

is increasingly regarded as providing ‘authoritative knowledge’ in

relation to antena tal prep aratio n for childbirth ( Jordan , 1993 ; 1997 ;

Browner and Press, 1997). Women who do not use antenatal services in

‘appropriate’ ways, or do not conform to particular societal expectations,

may be regarded as ‘feckless’ or irresponsible (Miller, 1995:17). By

attending clinic appointments, submitting to routine blood and urine

tests and other technological interventions, a woman is perceived as

preparing in an appropriate way for motherhood. In return, responsibility

for the pregnancy is in some way transposed, a ‘safe birth’ becoming part

of an equation in which a woman’s control and power may be eroded

(Lupton, 1994; Foster, 1995). Yet, as Tew has pointed out, ‘scientific

research in recent years has shown that most of the medical elements of

antenatal care are ineffective . . . antenatal clinics are, however, very effective

in inculcating the rightness of and necessity for, obstetric intranatal care

and so maintaining control of the maternity service by obstetricians’

(1998 :379). We can see, the n, that a depen dence on bodies of expert

knowledge has evolved, reinforced by antenatal practices, which has led

to the reconceptualisation of childbirth in terms of risk and ‘clinical

safety’. At the same time, the forms of authoritative knowledge that

shape reproduction and childbirth have correspondingly shifted (Davis-

Floyd, 1992; Tew, 1998).

The development of new technologies around reproduction and childbearing

has further reinforced claims of expertise. These developments

have provided practitioners with the tools to detect ‘abnormalities’ and

monitor pregnancy and childbirth. For example, screening has become a

normative practice, a routine part of medical, antenatal care. It has enabled

the detection of women and their unborn babies who may be ‘at risk’ of

particular disorders and has contributed to ‘the production of ‘‘authoritative

knowledge’’ about pregnancy’ (Davis-Floyd and Sargent, 1997:18;

Reid, 199 0; Georges, 1997; Rapp, 199 9). Yet whilst screening has become

an integral part of pregnancy, the social and moral issues it raises in

societies where powerful pronatalist ideologies exist, are complex (Rapp,

1999). As Reid has pointed out, ‘one of the critical issues inherent in any

discussion of screening concerns abortion’ (1990:313). And whilst women

may eagerly anticipate their first ultrasound scan – taking along partners

and other family members and purchasing the resulting photograph – far

from being routine, the ultrasound may reveal serious deformities and

place the pregnancy in jeopardy (Reid, 1990; Rapp, 19 99 ). Screening

then represents a further aspect of the medicalisation of pregnancy and

childbearing and again encompasses the themes of power, risk, responsibility

and expert knowledge. And whilst many women willingly engage

with routine screening antenatally, and derive comfort from results confirming

the ‘normality’ of their unborn child, the continuing shifts in how

pregnancy is expertly managed are in danger of further distancing women

fromknowing their own bodies (BostonWomen’s Health BookCollective,

1978; Treichler, 1990; Lupton, 1994). Clearly this has implications for the

period following the birth of a baby when women may feel that they do not

instinctively know what to do, that they have lost a sense of control in their

lives (Lupton, 1994; see chapters 5 and 6, this volume).

The medicalisation of childbearing has been a gradual process. It has

involved claims of safety and perceptions of risk being used to justify

the relocation and the reprioritising, from midwife to obstetrician, of who

has responsibility and who cares for, childbearing women, and importantl

y, wh ere (Robi nson, 1990; Oakley, 1993 ; An nandale, 1998 ). More

recently, in the UK attempts have been made to reverse this trend and for

midwives to re-establish their previously held positions in relation to

childbearing women (Page and Sandall, 2000). This movement has also

been active in Northern E uropean coun tries (De Vries et al ., 2001) .

However, the vast majority of women in Western societies continue to

give birth in hospital and debates around medicalisation have continued.

One graphic measure of the ‘medicalisation of birth . . . is the caesarean

section rate’, which has increased rapidly across North America and

Europe (Sargent and Bascope, 1997:192). In the UK 21 per cent of

births were by caesarean section in 2001 whilst the rate was slightly higher

in the USA at 24 per cent (Parliamentary Office of Science and

Technology, October 2002, no.184). Rates for caesarean section have

risen dramatically since the 1950s, when only 3 per cent of births in the

UK were by caesarean section. This trend clearly raises questions about

professional perceptions of risk and growing concerns over litigation. It

also prompts us to think about the ways in which women have come to

regard their bodies. Of course, debates on risk, responsibility and expert

bodies of knowledge are played out in the context of gendered knowledge

claims, against a backdrop of patriarchy. Feminists have differed on the

positions they have taken to explain the shifts which have occurred

around childbearing and the place of childbearing itself in women’s

lives. This, ‘like the competing claims of patriarchy and capitalism as

controlling structures, has been a theme of debate for feminists’ (Oakley,

1993:11). However, shared by most feminisms is the ‘understanding that

patriarchy privileges men by taking the male body as the ‘‘standard’’ . . . and,

through a comparison, viewing the female body as deficient, associated

with illness, with lack of control and intuitive rather than reasoned’

(Annandale and Clark, 1997:19; Martin, 1990; Davis-Floyd, 1992;

Helman, 2001). It is on this basis that feminists and others have argued

that male control over reproduction and childbearing has been achieved

and maintained.

But whilst feminisms may share a common understanding regarding

patriarchy, ‘motherhood holds different meanings for different feminists’

(Chase, 2001:9). An extreme and well-publicised position was expounded

by Firestone, who argued that women would only be liberated from

oppression ‘when technology released them from pregnancy and

childbirth altogether’ (Chase, 2001:9; Firestone, 1971). This position

has given rise to the misperception that feminists don’t like men or babies,

a myth that Chase and Rogers (2001) set out to challenge, demonstrating

in the course of their book that ‘the preponderance of feminist approaches

to motherh ood have been posit ive’ (20 01:4). Ad dressing the wider context

of medicine, Lupton has usefully encapsulated the tensions that have

existed in feminist writing over ‘the uniqueness of women’s embodied

experi ence and the des ire to deny that any suc h uni quene ss exist s’ (1994:

131). Whilst radical feminists have argued that ‘patriarchy seeks to control

reproduction’ (Annandale, 1998:72) and some talk of the oppressive

nature of entering motherhood, others have celebrated the unique power

of women’s bodies to produce children. Here, reproduction is seen not as

oppressive, but as offering women the possibility of experiencing a ‘pure

and original femininity’ beyond patriarchal and social control (Daly,

1973; Chodorow, 1978; Gilligan, 1982; Annandale and Clark, 1997).

The dilemma for feminists, however, has been ‘how to retain the

empowering or pleasurable aspects of motherhood without reinforcing

the straitjacket of traditional gender arrangements’ (Blum, 1993:292).

The ‘profound ambivalence’ experienced as a mother – and a feminist –

has been described by Gieve, who writes of ‘the unexpected passion and

joy and physical attachment on one side, and on the other side the

relentless obligation and the necessity to respond which has deprived

me of my own direction and brought the fear that I myself would

be exting uished ’ (19 87:39). Journ eys into mothe rhood, then, have

implications for our sense of who we are. Old recognisable selves can

become subsumed within different identities associated with being a

mother and motherhood. This pathway continues to be a tricky one to

negotiate, both for women becoming mothers, and for those of us who,

from different disciplinary positions, set out to document the journeys.

Ideologies of motherhood

The implications of the medicalisation of childbearing for women have

been to shift ‘the focus of birth from the social and emotional to the

physiological and medical’ (Garcia, Kilpatrick and Richards, 1990:3).

Yet the ideologies which can be clearly discerned before and long after a

child is born also remain a powerful force in shaping expectations. The

biological fact of giving birth within Western cultures simultaneously

leads to a redefinition of an individual’s identity, an identity which is

inextricably linked to family and motherhood – implying that a woman’s

fate is tied to her biological role in reproduction (Oakley, 1979;

Richardson, 1993; Romito, 1997). This transition occurs ‘against a background

of personal and cultural assumptions that all women are, or want

to be m others’ (Leth erby, 1994:525 ). An d wh ilst the se assum ptions have

increasingly been challenged, and attempts made to separate motherhood

from female identity, the tendency to conflate these identities has

continued (Phoenix and Woollett, 1991; Ireland, 1993; Letherby, 1994).

In the context of societies underpinned by pronatalist ideologies, it has

been argued that whether women become mothers or not, ‘motherhood is

central to the ways in which they are defined by others and to their

perceptions of themselves’ (Phoenix and Woollett, 1991:13). The category

mother is clearly problematic and dynamic, for as Lawler notes,

‘the advent of new reproductive technologies potentially destabilizes the

category ‘‘mot her’’ (2000, 19). Yet, wh atever the pote ntial for diffe rent

constructions of mother/motherhood, dominant ideologies remain:

powerfully rooted in assumptions of biological determinism and the

inevitability of women’s destiny to become mothers. Fundamental to

such ideo logies is the no tion tha t mothering is instinct ive and theref ore

univers ally expe rienced and cons tant. Yet histo rical, social an d cultu ral

variations have been clearly demonstrated, which ‘confirms that mothering,

like other relationships and institutions, is socially constructed, not

biologi cally inscri bed’ (Glen n, 1994 :3).

Ideologies, then, also shift over time, and ideas about what a ‘good’

mother should do – stay at home and devote herself to childrearing and

housework – shift according to public and political changes and economic

demands. Good parenting, and specifically good mothering, is premised

on ideas of being with children, fulfilling the demands of intensive nurturing,

whilst at the same time it involves taking up paid work and providing

financially for a child. Current policies in the UK and the USA, for

example the New Deal in the UK, appear to encourage (certain groups

of) women to combine mothering with paid employment (which may

indeed be paid ‘mothering’ of other women’s children). Once again, this

serves to redefine the roles and expectations of what constitutes a ‘good’

mothe r (Phoe nix an d Woollett , 1991 ; Seg ura, 1994 ; Miller, 1998;

Duncan an d Edw ards, 1999) . This lin k betw een shif ting polic y an d

ideological commitments and particular constructions of maternal bodies

and mothe rhood is echoed across p ost-industri al societie s (Sta cey, 1996;

Chas e, 2001 ). But cl ass, race and culture have also alw ays underpi nned

individual expectations and experiences of mothering. The notion of the

‘good’mother, who stays at home or experiences guilt or ambivalence as a

result of combining mothering with paid work outside the home, has been

premised on particular groups of white, privileged women. Such constructions

lack relevance for ‘less privileged women (for instance, immigrant

women, women of color) who have historically been important

econo mic actors b oth inside and outside the hom e’ (Segu ra, 1994 :212).

The material and cultural circumstances in which women live their lives

is, then, a crucial feature in any analysis of motherhood. As Collins has

argued, ‘for women of color, the subjective experience of mothering/

motherhood is inextricably linked to the sociocultural concern of racial

ethnic comm unities – one does not exist without the othe r’ (199 4:47).

Equally, as noted in earlier chapters, for women becoming mothers, or

mothering, in the developing world, day-to-day survival may well be a

primary concern overriding any (Western) notion of individualised control

in a life. So, contexts differ, but within the Western world dominant

ideologies surrounding motherhood can be seen to represent the ideas

and beliefs of more powerful groups and do not recognise or accommodate

the diversity of women’s lived experiences. And they are pervasive,

and powerfully shape the cultural scripts and public and ‘meta narratives’

(Some rs, 1994) wh ich both inform normative p ractices an d wome n’s

own expectations, of what mothering will be like.

Since the 1960s, feminists have challenged essentialist constructions of

maternal bodies and motherhood. Attempts to theorise motherhood without

recourse to ‘natural or biological explanations’ have been attempted

(Glenn, 1994). Using psychoanalytic object relations theory, Chodorow

(1978) has sought to demonstrate how being mothered transmits and

reinforces a pattern of female mothering. This is not biologically determined

but a product of the dynamics of the mother–daughter relationship,

which differs fromthe mother–son relationship. In order to change expectations

around mothering, Chodorow has argued that men must participate

more equally in childrearing to redress the gender balance of nurturing/

caring. Ruddick (19 80 ) too has argued that mothers’ concerns for nurturing

and protecting their children can be explained through ‘maternal

practice’. The physical, emotional and intellectual dimensions of mothering

are not, then, biologically determined but arise through constant

practice. The positions taken by both Chodorow and Ruddick have been

criticised for, amongst other things, universalising experiences of motherhood

and not challenging the status quo, and the debate continues

(Phoenix and Woollett, 1991; Delphy, 1992; Glenn, 19 94 ; Chase and

Rogers, 200 1). In particular, Chodorow has been criticised for conflating

motherhood with femininity, so that ‘female desire is thus analytically

erased’ (Elliott, 20 01 :110). In stark contrast to these positions, pro-family

ideologies, which have been dominant in America and bound up with the

political Right in Britain and more recently New Labour, are rooted in

perceptions of motherhood as biologically determined. The belief associated

with cultural feminism, that women’s capacity for motherhood

provides ‘an essential, unifying principle’, reinforces such ideas (Chase,

2001:14). Similarly, conservative and pro-family feminism has focused on

the ‘life giving values associated with mothering’ (Delphy, 19 92 :1 8) . T he se

positions have served to emphasise ‘mothering as women’s primary and

exclusive identity’ and in so doing locate women firmly in the home, the

private sphere (Richardson, 1993; Glenn, 199 4).

It is these essentialist constructions of mothering as biologically determined

and shared and shaped in relation to patriarchy, that other feminists

have long argued turn mothering into such an alienating and oppressive

experience (Rich, 19 77 ; Oakley, 1979). And yet such challenges have not

radically changed the dominant ideologies that powerfully and pervasively

surround and shape motherhood. Even though household and living

arrangements have changed dramatically in recent decades, ideologies

around ‘good’ mothering persist and override current living arrangements

(Garcia Coll et al., 1998) . Change, then, has b een slow and ‘while divorce

rate s an d women’s p aid employment have increased, women s till do not

have adequate day care, enough support f rom male p artners, and workplaces

atten tive to empl oyees ’ f amily responsibilities’ ( Chase, 2001:18). Clearly,

the challen ges persist, for the problem accord ing to Romito ‘is that despite

twenty-five years of the n ew feminism, m otherhood still retains its sacred

aura. Mothers still do not dare to admit how burdensome the constraints

and di fficulti es o f their cond ition can be’ (1997:172). Reflectin g o n her own

experiences of being a mother,Gieve has also noted that the ‘fear of the knot

of motherhood has m ade u s turn away f rom confronting it’ (1987:39 ). And

therein lies the parad o x f or women. The u nique p osition ing of child beari ng –

at t he interface bet ween the b iological and the social – both shapes

expectations and renders experiences which do n ot conform to some

ide al ised n ot ion o f m otherhood d iffic ult to make s ense of, to confront and

to voice. The compell ing an d confusing contexts in which transitio n to

mothe rhood is lived and experi ence d in late modern ity provide a

particul arly chall enging backd rop agai nst wh ich to do this. The focus

on ind ividualisation app arent in late modern societ ies encourage s

reflexiv ity, through activel y work ing on the self to m ake se nse of new

experi ences in the absence of ‘tra ditional norms and certain ties’. Yet, it is

the absence of these ‘tradit ional no rms and certainti es’, toget her with

unrea listic expec tations, whic h can mak e experi ences of first-ti me

mothe rhood par ticularly ‘baffl ing’ (Fr ank, 1995 ; Lupton , 1999 ).

Ideol ogies that surrou nd an d shape notion s of m otherho od are, then,

pervasi ve, dynamic and linked to power. Ye t this is to ignore that wome n

are able to exercise some agency in their lives, albeit dependent on their

structura l location and mater ial circu mstances (Ba rclay et al., 1997;

Rajan, 1996 ; Fox and Worts , 1999 ; Du ncan and Edwar ds, 1999).

However, such powerful ideologies override individual experience, and

continue to reinforce idealised notions of motherhood, that in turn fail to

accommodate the diversity that exists in experiences of mothering.

Commenting on the importance of theorising women’s differences,

Phoenix and Woollett caution that failure to do so ‘helps to maintain

the status quo as ‘‘normal mothers’’ being white, middle class, married

women and othe r mothe rs being devi ant/ab errant’ (1991:226) . As no ted

in chapter 1, the women wh ose experience s provide the first-ha nd

accounts in this book apparently conform to stereotypes of ‘good’ and

‘normal’ mothers. They are white, educated and partnered, but their

early experiences of motherhood were diverse and different from their

own expec tations and at times difficu lt to make sense of (Chas e, 2001 ).

Yet, however invidious the ideologies, women continue to become

mothers and ‘to hold images of what motherhood and childhood should

be like’ (Rib bens, 1998 :28). Havin g been soci alised into roles that continue

to anticipate mothering, a majority of women at some time in their

live s bec ome mothe rs (Abbo tt and Wallace, 1990 ). Indeed, in most

societies to choose to remain childless is perceived as somehow ‘unnatural’,

so deeply inscribed and culturally scripted are essentialist ideas of

womanhood. The current decline in fertility rates across many European

countries and the USA might eventually lead to different, less essentialist

constructions of womanhood, or conversely, may further reinforce

notions of ‘unnaturalness’. However, for those women who anticipate

having at least one child during their lives, studies have shown that

expectations of motherhood often do not resonate with experiences.

Despite many years of academic study and calls for change, it is noteworthy

that women continue to come to motherhood with ‘quite unrealistic

expec tation s’ (Boulton, 1983 ; Oa kley, 1993 ; Ri chardso n, 1993;

Bar clay et al ., 1997; Chas e and Roge rs, 2001 ; Mauth ner, 2002).

Normative practices

As was note d in chapt er 2, in Wes tern soci eties wome n beco ming preg -

nant are ‘exposed to a variety of ideas about pregnancy, childbirth and

childcare’ which will be filtered according to cultural location, social

clas s, age etc. (Phoenix an d Woolle tt, 1991:66–7) . Prep aration for most

mothers is located within highly developed systems of preventive antenatal

care, which is clearly located within a biomedical context: the clinic

and the hospita l (Mi ller, 1995 ; Graha m and Oa kley, 1986; Oakley, 1993 ;

Bro wner an d Pre ss, 1997 ). It is interestin g to no te that atte mpts to

‘right’ to choice, control and continuity of care have failed (The

Wint erton Repo rt, 1992 ; Page and Sand all, 2000 ). This may in par t be

due to the nationalised system of health care that exists in the UK, in

contrast to the largely privatised system of health care in the US, where

more women would identify with the term ‘consumer’, whilst others are

wholly reliant on Medicaid. However, given the diversity of women’s

lives, both within and across different societies in the West, services

around childbirth continue to be provided in particularly uniform ways.

For example, the hospital is regarded by most women as the ‘natural’

place to give birth (Tre ichler, 1990 ; Szu rek, 1997). In m any ways this

confirms, were confirmation needed, the power and dominance of

‘authoritative knowledge’ as discussed in the previous chapter. By focusing

on the normative practices in the West that have resulted from

particular forms of authoritative knowledge, we can see when, where and

how constructions of the expert are played out. The acceptance by a

majority of women of the hospital as the natural place to give birth,

reflects both the dynamic qualities and power of authoritative knowledge

in which ‘all participants come to see the current social order as a natural

order, that is, the way thin gs (obv iously) are’ (Jorda n, 1997 :56).

As already noted, even before the birth of a child, women begin to be

defined in accordancewith notions of ‘good’ mothering. They are expected

to prepare appropriately – attend antenatal classes, wear appropriate clothing,

change socialising patterns and behaviours to conform to some ‘ideal

type’. Clearly, antenatal practices and ‘the rituals of obstetrics’ help to

transmit and reinforce gendered values held in Western societies (Davis-

Floyd, 1992). Beyond regular antenatal visits, women (and their partners)

are invited to attend parent-craft classes in order to prepare appropriately

for parenthood. Yet, as was demonstrated in the preceding chapter, the

perception of need for such classes is filtered through cultural ways of

knowing, and preparing for childbirth: the Bangladeshi women did not

think they were necessary (Miller, 19 95 ). Following the birth, care in the

postnatal period is much less highly developed in the UK. It is operationalised

within the clinic setting and the private sphere of the home, and in

relation to essentialist ideas of mothering (Glazener, MacArthur and

Garcia, 1993; Garcia and Marchant, 1996). Although medical regulation

and supervision characterise normative practices during the antenatal

period, the medical gaze switches swiftly from the mother to the baby in

the postnatal period. When Lawler writes of the ‘apparent’ rather than

‘real’ demise in the position of expert knowledges in late modernity, she

concludes that ‘there seems little evidence that there has been a loosening

of surveillance of mothers and their children’ (2000:20). Clearly, a whole

host of different experts – midwives, doctors, health visitors – are involved

in monitoring the antenatal and postnatal periods but, according to

Lawler, this monitoring has become increasingly ‘bound up with processes

of self-surveillance’ (2000:20). In the postnatal period this is expected to

come to the fore. Certainly, from conception and sometimes preconception,

expert advice is offered on what is best for the child, and

mothers are expected to act responsibly in providing care and meeting

their child’s needs (Jessop, 2001). Being a mother involves responsibility,

an intrinsic feature of which is self-surveillance. This involves evaluating

one’s self against others, in a confusing context where ‘normal’ mothering

is not defined but powerfully reinforces expectations.

In the postnatal period, the form of monitoring shifts and the focus

of early postnatal check-ups ‘is almost entirely on the baby, or the mother

in relation to the baby; her independent status as a woman is discounted’

 (Urwin, 1985:177). The development and introduction of the Edinburgh

Postnatal Depression Scale in the UK is one attempt to focus on women’s

mental health in the early weeks following childbirth. A health visitor

administers the questionnaire when she visits the mother in her home.

Boxes are ticked according to how the woman says she has felt over

the p receding seven days. Responses are then coded and a ‘diagnosis’

made. Whilst this initiative could be welcomed as an attempt to collate

women’s experiences of earlymothering, it is a blunt instrument with which

to gather sensitive material and questions have been raised about its

useful ness (Barke r, 1998 ). Indeed , it could be seen as yet anothe r

practice that medicalises and, in turn, problematises normal early

mothering experiences. Many women would agree that they felt tearful

and at times unhappy in the days and weeks and sometimes months

following the birth of their child. Patterns of care following the birth of a

child are, then, largely normatively preoccupied and task-based, with an

emphasis on routine measures being taken to indicate a ‘return to normal’.

The close supervision and sense of shared responsibility engendered by

professional antenatal practices and experienced from confirmation of

pregnancy, ceases in most Western societies shortly after the birth. Any

feelings which had been placed as secondary to authoritative, medical

knowledge in the antenatal period are now expected to come to the fore:

women are expected to instinctively know how to be mothers. Whilst

women may be socialised from birth into gendered, ‘female’ roles, the

experience of becoming a mother may not resonate with earlier expectations.

Births are often different from what had been expected, and the

tasks of early mothering can seem daunting and the responsibility for a

small baby overwhelming. The dominance of particular ways of knowing

in the antenatal period, which reinforce particular notions of good

mothering, can be seen to be potentially disempowering and ‘may make

it difficult to take back control after the birth, when (a mother) may have

no real know ledge of her own feeli ngs, or her baby’ (Lupt on, 1994:

148–9). Indeed, the technologies and practices involved in the medicalisation

of reproduction increasingly separate women from knowing their

own bodies. Thus ‘the history of Western obstetrics is the history of

technologies of separation (and) it is very, very hard to conceptually put

back together that which medicine has rendered asunder’ (Rothman

c ite d in Davis-Floyd a nd Davis, 1997:315)