Defensive mothering

Last week I wrote about how contemporary societal beliefs about risk lead to defensive medicine.

There have always been risks, of course, but they have traditionally been viewed as outside the control of human beings. The risk society has arisen because of new beliefs that we can and (especially) that we should control every aspect of risk…

What does this have to do with defensive medicine? Consider that in our risk society we are supposed to reduce our risk to zero. How do we do that? We do that by acting to reduce risk regardless of how small the risk might be.

Defensive medicine is a direct result of our societal beliefs about risk, but doctors are not the only ones whose stance has become defensive in response. In our risk society we have come to believe that mothering itself is about managing risks. Ironically, those most obsessed with risk belong to the “natural” mothering crowd. In fact, it is hardly an exaggeration to say that “natural” mothering is really “defensive mothering” at the extreme. And natural childbirth is no exception.

Joan Wolf, in a fabulous new book entitled Is Breast Best?: Taking on the Breastfeeding Experts and the New High Stakes of Motherhood explains that in a society obsessed with risk:

… In a risk culture, when virtually everything from conception through childbirth can ostensibly be either controlled or optimized, nature becomes a beacon …

But nature, apparently, is just as obsessed with reducing risk as doctors are with reducing liability. While natural childbirth advocates claim to reject science as the primary lens through which we should view childbirth:

In natural mothering advice … the virtues of nature are filtered by science and expertise and much of what opponents of medical intervention champion is less a rejection that a selective embrace of scientific authority. Natural childbirth and parenting are mediated by classes and experts, and books are written by authors whose credentials are prominently displayed next to their their names.

The advice dispensing Sears’ family is paradigmatic examples. Father and son (William and Bob) are pediatricians and mother (Martha) is a nurse. While the Sears’ claim to disavow the belief that experts know more about parenting than parents:

The eponymous Sears Parenting Library … is itself an example of the expert culture that that infuses the discourse of total motherhood … The back cover of The Baby Book seeks to establish Sears as an authority in pediatric science. He and his wife are “the pediatrics experts to whom American parents are increasingly turning for advice and information …

So much for trusting your intuition.

Not only do Sears’ books position him as a scientific expert, he, too, is obsessed with risk. After identifying a seemingly interminable list of risks posed by various maternal behaviors:

…Sears and Sears suggest that even hypothetical risks should be avoided… The Sears state that “there is no pain-relieving drug that has ever been proven to be totally safe for mother and baby” in childbirth. But this is true, without exception, of every drug and consumer on the market; no medication has ever been shown to be completely safe for anyone…


Sears and Sears selectively employ science in ways that exacerbate public misunderstanding of risk. They ignore costs and trade-offs, and they hold decision making in pregnancy to an impossible standard. In embracing the notion that mothers are responsible for elimination all conceivable risks to their children, natural mothering furthers an ideology of total motherhood that is fundamentally similar to more mainstream approaches.

… Pregnancy in total motherhood literally embodies the essence of risk culture: the hyperawareneness of potential danger, the illusion of control, and the conviction that proper planning can eliminate risk…

Total motherhood is really defensive motherhood because:

[It] stipulates that mothers’ primary occupation is to predict and prevent all less-than-optimal social, emotional, cognitive and physical outcomes; that mothers are responsible for anticipating and eradication every imaginable risk to their children, regardless of the degree or severity of the risk or what the trade-offs might be; and any potential diminution in harm trumps all other considerations …

Sound familiar? It ought to, because that is the rationale for defensive medicine, the expectation that obstetricians must anticipate and eradicate every imaginable risk regardless of severity or what the trade-offs might be.

When we, as a society, become obsessed with risk, everyone is forced to behave defensively, not just doctors. That’s why solution to defensive medicine does not lie with doctors, it lies with all of us. Defensive medicine is not the only, or even the worst, manifestation of our obsession with risk. Defensive mothering is far more pervasive, entirely unrecognized, and is having a far greater impact on our children and ourselves than defensive medicine ever could.