The ideology of Amy Tuteur: her baby, her body, her choice!

Core Values written on recycled paper

When my boys were small and were angry with me, they would respond with what they considered a devastating insult: “You are a poopy-head.”

Needless to say, it rarely produced the desired response. Instead I laughed.

I was reminded of that when I came across Milli Hill’s latest tweet berating loss father James Titcombe:

[S]ince you regularly align yourself with the ideology of Amy Tuteur, I consider it a great compliment that you find my ideological perspective unhelpful.

Needless to say, neither James nor I is devastated. I don’t know what James did when he read it, but I laughed.

There is NO right way to have a baby.

I also reflected that Hill, as usual, has got it completely backward. I have been deeply affected by the ideology of James Titcombe, not the other way round. His experience, and that of other bereaved mothers and fathers, helped me recognize radical midwifery theory for the arrogant, self-dealing, deadly philosophy that it is. And that in turn led to me to read more deeply about biological essentialism, feminism and medical ethics.

To the extent that James Titcombe might be aligned with “the philosophy of Amy Tuteur,” it’s worth spelling out exactly what that it. It can be summed up as follows:

Her baby, her body, HER choice!

My ideology is informed by my political liberalism. I believe that each individual has a different concept of the “good life,” generally knows best what will make him or her happy and should be allowed to pursue it to the extent that it doesn’t actively harm others.

So, for example, despite the fact that I happily raised four children within a permanent heterosexual relationship and consider it the ideal family arrangement, each individual has a different conception of the “good life.” It might be more, less or no children; marriage, cohabitation, celibacy; homosexuality or bisexuality.

Each individual knows far better than I what will make him or her happy; they aren’t in need of more “education” if they make a choice that is different from mine. And each individual should be allowed to pursue his or her aims to the extent that it doesn’t actively harm others.

As another example, despite the fact that I had four vaginal births (two with epidurals and two without), breastfed all my children, and considered that optimal, other women have different ideas about optimal childbearing and feeding. It might be adoption, elective C-section or gestational surrogacy. For those experiencing labor, they might view the pain as empowering or excruciating. For those who have the option to breastfeed, they might view it as difficult, distasteful or triggering.

Each woman knows far better than I what will make her happy; she isn’t in need of more “education” so she will make the same choices I made. And she should be allowed to pursue her aims to the extent that it doesn’t actively harm others.

As a result, I view the dichotomy beloved of midwives — between the technocratic and the midwifery model of childbirth — as both antiquated and fallacious. In my reading of contemporary childbearing/rearing philosophy, the central dichotomy is between biological essentialism and equality feminism.

It is the difference between viewing women as all having the same need for expression of their reproductive capacities vs. individual women — like individual men — as having different needs. It is the difference between postulating that all women are empowered by using their reproductive organs vs. acknowledging that many women find the use of their intellects and talents far more empowering than the use of their uteri, vaginas and breasts.

What does that mean in practice?

It means:

There is NO “right way” to have a baby. Some women find unmedicated vaginal birth empowering; others find it disempowering; still others feel something in between. All views are philosophically and morally equivalent.

Therefore, it follows that women who don’t find empowerment through their reproductive functions are NOT suffering from lack of knowledge or false consciousness. They don’t need to be educated or “supported” into making choices that are different than the ones they articulate.

It does NOT mean that births involving technology are to be favored. It means that NO specific form of birth is to be favored.

It does NOT mean that having a healthy baby is all that counts. It means that for some women having a healthy baby will be all that counts, and some women will find that a healthy baby is NOT compensation for being traumatized by labor or traumatized by their caregivers.

It means that the arbiter of clinical practice MUST be scientific evidence, not intuition and certainly not providers seeking validation of their own choices by patients mirroring them back.

It means that the arrogance of believing ‘doctor knows best’ should NOT be substituted by the arrogance of ‘nature knows best.’

It applies equally to breastfeeding. As between breastfeeding and formula feeding there is NO right way to feed a baby. Both choices are philosophically and morally equivalent.

That, in brief, is the ideology of Amy Tuteur.

Milli Hill — as well as Sheena Byrom, Hannah Dahlen, and the international clique of radical midwifery theorists — might disagree with it or even despise it; that’s their choice. But they have no right to mischaracterize it.

  • yentavegan

    Surrogacy is a human rights violation. Paying a fertile women to hyper produce eggs jeopardizes her own future ability to have children and puts her at risk for cancer. Removing her eggs, fertilizing them in a lab and then implanting them in another woman’s body is another human rights violation.

    • LaMont

      Wait, are you saying egg donation is a human rights violation, or the surrogacy? Why do you think it’s impossible for women to choose what to do with their bodies? Is live organ donation a human rights violation?

      • yentavegan

        Unlike the movie “Baby Mamma” where a willing woman agrees to be fertilized with donated sperm to produce a baby for a third party, egg donation requires the young women to take a cocktail of various drugs to produce dozens of eggs for multiple cycles in order to be compensated. It is an unregulated industry that jeopardizes her reproductive health. The woman who agrees to be implanted with the embryo ( embryos) is not the egg donor. She is a hired vessel. Also required to be put on a cocktail of drugs in order to facilitate implantation. The whole industry is rife with abuse.

        • EC

          What about women who have IVF to retrieve their own eggs and then carry those pregnancies themselves? Did you save any of your condescension for us?

          Why are men who work as miners, loggers, and on oil rigs (all very dangerous industries) allowed to make their own decisions, but when a women wants to earn money by the comparatively safe processes of egg donation or gestational surrogacy, busybodies have to swoop in and “protect” her from earning money?

          • Nicole Thomas

            This person has no idea what IVF entails and is sensationalizing it. Yes the process can be hard and time consuming which is why donors are compensated. You can tell they don’t have a clue because it is an embryo transfer. They don’t implant embryos. They either do that on their own and you are pregnant or they don’t and the cycle didn’t work. The “cocktail” of drugs after transfer is just progesterone. Maybe some baby aspirin. I personally also took lovenox but that was for recurrent miscarriage issues and a donor would not need to take that. They don’t take “dozens” of eggs with a cycle. The average number in my personal experience with IVF (not as a donor) is 12 and that is what I can find with a simple google search as well. Hyperbole?

            Also my job had serious risks working in a lab with chemicals that could kill me and I was “compensated.” Should have I have someone swoop in and save me because I was being exploited and put at risk? Donors can make their own decisions. They are told the risks.

          • demodocus

            I actually did produce upwards of 2 dozen eggs, but I’m an outlier there.

    • Even if she’s not coerced into it? I’ve read stories from surrogates who were perfectly happy with their experience. I think surrogacy can easily lead to human rights violations, but I don’t think it itself is a violation–just as I think that prostitution is not necessarily a human rights violation, but can easily lead to being such.

  • You and I are on the same page, Dr. Amy.

  • Clarene Wong

    Surrogacy isn’t a morally neutral reproductive choice unless it’s unpaid and voluntary. Paid surrogacy is an industry that preys upon poor women, much like paid organ donation does. Theres no real choice given to surrogates who endure pregnancies by force of poverty.

    • Zornorph

      I have to say I disagree with you. Having used a surrogate, I honestly wonder what gives you that idea? Most of the women who ‘endure’ being a surrogate do it because they enjoy being pregnant and this is a good way to do that and also make some money and help out somebody else. Not a small percentage of them are motivated by Christian faith. This idea that women are running around renting out their wombs to pay their rent like plasma donors exists only in the minds of extreme feminists and busybodies who think that if you were not granted a healthy, working uterus, you have no right to have children that are biologically related to you.

      • A

        I think this depends on where the surrogates are – there are poorer countries in which this is definitely a market.

        • Sarah

          Yes that’s what I thought reading both posts. It seems Clarene is talking globally and Zornorph is referring to wealthier countries.

          • Amazed

            Definitely. Honestly, as I was reading Zornorph’s post, I wondered, “Hey, what planet does he live on?” The answer is clear: he lives in a wealthier country. In my corner of the world, black market surrogacy is a big business, ways to flaunt regulations abound, and the motives of many, if not most surrogates, are indeed to pay the rent. Many of the countries here await with horror the crumbling of the retirement system which will leave millions without means in their dotage. Many people can’t afford a good life for the kids they already have. This is a way to support their families like any other. Find me a hundred well-off women in this part of the world who become surrogates purely for the joy of being pregnant, and I may be convinced to reexamine my views. But you won’t succeed.

            In poorer countries, paid surrogacy generally isn’t a matter of a happy agreement.

            What can I say, I’m just a raging feminist and a busybody who thinks economic conditions are a factor in surrogacy.

          • EC

            Most people, male and female, in those countries are also working just to pay the rent. It seems more paternalistic than feminist to deny women in those countries the opportunity to do work such as surrogacy that they may prefer over the other available opportunities.

          • Amazed

            Why, thank you for finishing my words for me.. not. Where did I say that women should be denied anything? I was answering a post claiming that no such thing existed. I can’t help but notice that you didn’t correct him – you chose to accuse me of being paternalistic.

          • Who?

            Most people work to put food on the table, pay rent etc not for the love of their job.

            I share EC’s concern that telling women how they should use their bodies for work is problematic, and also acknowledge that the same women may not be making an entirely free choice about it.

            When I think of the health risks of surrogacy I then think of men working down mines and women working in sweatshops where the doors are locked to keep them in. The more poor a country is, the more likely its workers’ rights and protections won’t be in a good way.

            Even in our wealthy bit of the world life is harder than it was-wages stagnant but the bills keep climbing, work increasingly casualised. If they are ready to do it, why should women not be paid for egg donation or surrogacy?

            All that said I’m always concerned about how things are managed when the product ie baby is not up to specifications-who takes responsibilty for that? As with most commercial arrangements, I fear the risk ends up with those least able to cast it off ie the surrogate mother.

          • Amazed

            I am not saying that women should be denied the opportunity to become surrogate mothers. All that I am saying is that the idyllic picture Zornorph presents is far from the truth in poorer countries and I found his tone, especially in the last sentence, quite offensive. We know about clinics that take more women than they could serve adequately and subsequently short-change them. We know of cases of harrassment by medical staff or intended parents themselves. We know of surrogates who did not receive anything since they miscarried and whatnot. Fortunately, this has not happened in my country, although the only reason is that surrogacy isn’t allowed here. I have no illusions what’s going to happen when it does. But it does happen in my part of the world and actually, here, in my own country, we have cases of people selling their organs to survive financially. Adds offering said organs, actually. No one can convince me that this is a choice borne out of genuine desire to be helpful and walk around minus a, say, kidney. It’s the same with surrogacy.

            Again, I am not saying that anyone should be forbidden from doing it. But painting it as this always unproblematic agreement between equals is far from the truth when one side is far more vulnerable than the other.

            BTW, if I ever decide to use a surrogate mother, the only way to do it will be if it is a business agreement and I pay her. Which, here, is going to be very problematic for the reasons I stated. But voluntarily surrogacy is not for me.

  • mabelcruet

    Not being an obstetrician, I come at this from what may be a naively simplistic point of view. Surely one of the reasons why child birth is becoming increasingly ‘complex’ and in need of medical or surgical input is because women are becoming more complex. We have women nowadays that 30 years ago would have been very strongly advised not to get pregnant-women with surgically corrected congenital cardiac disease, transplant recipients, women with major underlying medical conditions, and then mums generally are tending towards being older and bigger with all that brings, like gestational diabetes and hypertension. So this is a sizeable cohort who need to be medically supervised. But the midwife ‘leaders’ like Byrom and Dahlen trained many years ago when natural (non medicalised) pregnancy was far more common, and they seem to be harking back to this ‘golden age’. We don’t medicalise pregnancy because we want to, or because it brings in more income, we medicalise pregnancy when we need to, when that is appropriate for the mum and baby to ensure their safety. Byrom and her twitterati fangirls are putting women and babies at risk by pushing this agenda. Remember Caroline Flint’s comment about doctors being hopeless at birth and we should get rid of obstetricians? This is a horribly ingrained culture amongst a certain group of political midwives, they are too wrapped up in their own agenda.

    Edit-I stand by my previous thoughts on Milli Hill-she is a uni neuronal nematode who embodies the very worst of bullying culture on Twitter.
    .

    • Who?

      Yes this.

      And I did feel bad for the nematode, until I looked it up. Ick.

    • Anna

      Would you believe Dahlen had 3 failed homebirths herself – and two planned c-sections? Without medicalised birth she would possibly have no children and quite likely have died herself. 2 of her babies died due to rare genetic conditions and she lobbied hard to get the testing for that condition made available in Australia. But ya know, trust birth!

    • Sarah

      To this I’d add, we also have women giving birth now who simply wouldn’t have survived even in the fairly recent past. Think of all the advances in transplants, for example, in the past 30 years.

      • mabelcruet

        Absolutely. Though these women’s babies probably have a safer birth because they are obstetric managed with a very low threshold for intervention. In the UK we are beginning to get sub specialised midwives, e.g trained to work with women with various health concerns, but now that midwifery training is direct entry without having to train as a nurse first it means they aren’t getting exposed to general adult medicine so they don’t really see the whole gamut of chronic illness in women.

  • Sarah

    Doubtless James was every bit as offended as Churchill was that time when Hitler called him a half American, Jew-ridden drunk.

  • RudyTooty

    A midwifery ideology that adheres to only promoting “natural” “spontaneous” “physiological” labor and birth will restrict the profession to only caring for a small subset of pregnant patients.

    I’m wondering if this is one reason why midwife-attended births in the US seem stuck at 9-10% – and are unchanging.

    Maybe midwifery is not providing the care the majority of patients want.