Managing the birthing body: how privileged women have made childbirth a project

Project management in tag cloud

Yesterday I wrote about privilege and breastfeeding, incorporating insights from the chapter Managing the Lactating Body: The Breastfeeding Project in the Age of Anxiety by Orit Avishai.

I suspect that I am not the only one who was struck by the parallels between the breastfeeding project and birth birthing project so dear to the hearts of natural childbirth advocates. The attitude toward breastfeeding that Avishai ascribes to privileged women applies equally to childbirth.

According to Avishai:

I demonstrate that this group of women constructs the lactating body as a carefully managed site and breastfeeding as a mothering project – a task to be researched, planned, implemented and assessed, with reliance on expert knowledge, professional advice and consumption.

Here’s my conclusion about natural childbirth advocates:

Natural childbirth advocates construct the birthing body as a carefully managed site and childbirth as a mothering project – a task to be researched, planned, implemented and assessed, with reliance on expert knowledge, professional advice and consumption.

The birth project involves 4 critical tasks:

  1. Consulting books and asking experts
  2. Setting goals and assessing the product
  3. Managing the uncooperative birthing body
  4. Investing in the project

The irony is that this view of birth as a project to be managed is diametrically opposed to childbirth in nature, where childbirth, like any other bodily function, just happens. But the view of childbirth as a project serves the interests, financial and emotional, of those who promote that view.


1. Consulting books and asking experts

If there is one thing that every natural childbirth advocate is absolutely, positively sure of it’s the idea that she has done her “research” and “educated” herself about childbirth. That’s because she has “consulted books and asked experts.” But, of course, she has done nothing of the kind. Obstetricians are the experts in childbirth and natural childbirth advocates generally ignore what they have to say. The natural childbirth advocate consults faux experts or experts in their own minds. She reads websites, books, blogs and message boards carefully curated to present an approved viewpoint and carefully monitored to delete any real scientific evidence. Natural childbirth “experts” are to birth what creationism “experts” are to evolution. They are quacks, cranks and laypeople who are so ignorant that they actually think they are knowledgeable.

The first step in the managing the birthing body, then, is not acquiring knowledge, it is indoctrination.

2. Setting goals and assessing the product

This, of course, is the real purpose of birth plans. Putting her plans in writing gives a women a way to determine if she has succeeded or failed at childbirth. The health of the baby is irrelevant; indeed the baby itself is irrelevant. The birth plan is about the project not the baby.

Years of experience, and a variety of scientific studies have demonstrated that birth plans are worse than useless.


  • Most birth plans are filled with outdated and irrelevant preferences.
  • Birth plans are gratuitously provocative.
  • Birth plans have no impact on outcomes.
  • Birth plans encourage unrealistic expectations. In fact, it appears that the birth plan may have actually set women up to be disappointed with their birth experience.

In the world of natural childbirth, the baby is not the goal, the fulfillment of the birth plan is the goal. Hence even the birth of a healthy baby after an uncomplicated labor can be a “failure” if the woman did not perform in the way that she specified in her birth plan.

3. Managing the uncooperative birthing body

In the world of obstetrics, managing childbirth complications is straightforward. The provider anticipates or diagnoses the problem, offers a treatment plan and successfully handles the complications.

It’s pretty straightforward in the world of natural childbirth, too, albeit very different. The provider denies the existence of the problem by claiming that it is a “variation of normal,” recommends wishful thinking (“trust” and birth affirmations), recommends idiotic “treatments” like chiropractic, herbs and supplements, and, when all else fails, blames the mother.

4. Investing in the project

Natural childbirth costs money. The pregnant woman must buy books, hire childbirth educators and doulas, and in the case of homebirth she must pay a midwife, buy a birth kit and rent a birth pool. Natural childbirth also costs tremendous psychic energy. She must “trust” and affirm, and be primed to argue with her caretakers if they don’t view the fulfillment of her birth plan as more important than the baby. She must also grapple with failure when, as is often the case, things do not go as planned. In the event that she is lucky enough to avoid complications, though, the payoff is that she can pretend that she is “empowered” by completing the project successfully.

Viewing childbirth as a project to be managed is only possible in a world of extraordinary privilege. It rests entirely on the notion that regardless of how absurd and unsafe the plans are, and no matter how close the mother comes to injuring or killing her baby or herself, obstetricians will successfully rescue them from her idiocy. Moreover, the idea that rejecting pain relief in labor is an achievement depends entirely on easy accessibility to pain relief. The same goes for the routine interventions of childbirth. You must have easy access to them in order to give meaning to rejecting them.

Hence natural childbirth is the province of Western, white, well off women. It has nothing to do with childbirth in nature as the millions of women forced to give birth in nature each year can tell you. Managing the birthing body is an affectation of the privileged. Everyone else merely hopes to survive.