Natural mothering and the subversion of women’s empowerment

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On the face of it, it makes no sense.

  • How can women be empowered by rejecting the lifesaving technologies of modern obstetrics in favor of “natural” childbirth?
  • How can women be empowered by refusing pain relief and laboring in agony?
  • How can women be empowered by breastfeeding exclusively for years at a time?
  • How can women be empowered by re-immuring themselves in the home, devoted only to the care of their children?

They can’t. Indeed, the raison d’etre of natural childbirth, breastfeeding promotion and attachment parenting — as articulated by their founders — was specifically to disempower women by convincing them to forgo political and economic emancipation.

The irony of natural mothering: the women with the least power imagine themselves as the most “empowered.”

So how can women claim to be empowered by natural mothering?

It’s not merely a failure to understand the term, it reflects a subversion of the meaning of empowerment. Empowerment has been reduced to consumer choice. Thus natural mothering ideologues can camouflage women’s disempowerment as “empowering.”

As Oana Crusmac explains, empowerment has been subverted. It no longer means “the acquisition of power” but rather “self-expression through consumer choice.”

The self-expression right … comes along with the encouragement to “embark on projects of individualized self-definition exemplified in the celebration of lifestyle and consumption choices.” …

But it is not choice per se that is being promoted, but specific, highly restricted and restrictive choices.

Hence you can be “empowered” by choosing homebirth, but not by choosing maternal request C-section.
You can be “empowered” by choosing to forgo pain relief, but not by choosing an epidural.
You can be “empowered” by surrendering your freedom to exclusive breastfeeding, but not by claiming your freedom and using formula.
You can be “empowered” by being so bound to your children that you literally “wear” them, but you can’t be empowered by a high paying job or a satisfying career.

And who decides which choices are empowering? Those who seek to disempower women.

…The autonomy promoted by postfeminism is determined by the fact that “patriarchy has produced desires in women to want the very things that patriarchy needs them to choose.” Hirschmann refers to this subversive elaboration of women’s autonomy as ‘oppressive socialization’ that leads to their false impression that they act freely and autonomously when in fact, women are not the ones which set their preferences and goals.

In this subversion of empowerment, women can only be “empowered” by choosing re-domestication.

As Kumarini Silva notes in Got Milk?: Motherhood, Breastfeeding, and (Re)domesticating Feminism:

…[W]omen are discouraged from making connections with and to other women … that will make a systemic shift for the equitable distribution of recourses and rights. Instead, young women … are encouraged to disarticulate from the systems that question or make visible their own oppressions. In place of the very real work of making these connections and building on them, we are increasingly asked to celebrate various ‘faux feminist’ symbols that permeate (popular) culture.

Indeed:

…When motherhood is discussed within this broader celebratory context of women’s progress and ‘arrival,’ it tends to ignore larger, deeply historical, systemic inequalities associated with race, class, gender, and sexuality that sustain narratives of idealized motherhood. This disarticulation, between the past and present, speaks to the ways in which feminism and feminist discourses become co-opted in the neo-valorizing of motherhood as a domesticated practice.

Breastfeeding is the paradigmatic example.

Silva asks:

Breast is best: for whom?

It’s been touted as best for babies and mothers. But is that the real reason why breastfeeding is now promoted aggressively?

Silva asks us to consider that the explanations typically offered are revealing in ways its proponents perhaps did not intend:

One such example from 2003 is from a brief introduction to the journal Obstetric and Gynecology by Dr John T. Queenan… Queenan noted that during ‘World War II, while men were off to war, women entered the workforce in droves. During the war and in the good times that followed, fewer and fewer American women practiced breastfeeding. Formula feeding was on the rise as breastfeeding fell to an all-time low of 25 percent in 1971.’ … In his description and summary, Queenan seems to imply that women’s transition from private spaces to public spaces, in the form of professional work (and war efforts), jeopardized the ‘important gift’ of mothering vis-à-vis breastfeeding.

“Good” mothers stay home:

…[W]hat is assumed here is a common connection made between women’s transition to the workforce (and the ‘good times’), and the decline in ‘good mothering,’ including breastfeeding. While not explicit, it speaks to the myriad of ways that women’s work outside the home continues to be positioned as ‘bad’ for the welfare of the infant, the family, and, consequently, even the nation state…

That’s why we are endlessly bombarded with unvalidated mathematical models that predict economic benefits of breastfeeding that never actually come to pass:

…[B]reastfeeding becomes … a way of helping the country, and doing one’s part, as a woman. But unlike the past, instead of joining the workforce and earning a living wage, women’s participation in the economy, in this instance, is reduced to her breasts. While breastfeeding is touted as a boon for the nation’s economy, and the family, there is little-to-no conversation about the connections between these macro-economics and the micro economy of women’s lives.

What would it look like if women were truly empowered in their mothering choices?

Both homebirth AND maternal request C-sections would be viewed as empowering.
Both unmedicated AND medicated births would be viewed as empowering.
Both breastfeeding AND formula feeding would be viewed as empowering.
Both stay-at-home mothering AND working mothering would be viewed as empowering.

Instead we have the ultimate irony of natural mothering: women with the least power imagine themselves as the most “empowered”!

  • demodocus

    Glad for those who feel like they won the marathon that is l&d but it was not my experience. There’s nothing empowering to me about a process I had precious little control over and a blood pressure that soared to 200/?

  • andrea
    • PeggySue

      This is horrific. If Ms. Lentz considers herself a sovereign citizen, though, nothing this court or criminal court if it comes to that will make an impression on her, as I don’t think she feels bound by them. She will continue in her practice.

    • rational thinker

      What a disgusting excuse for a human being. The fact that she is still taking clients after the judge told her she can no longer practice shows she has no respect for life whatsoever. If I were to speculate a little further I would also say I think she also pushes lotus birth on clients being its is part of her “company” name. Another thing though is didnt mom realize at any point that normal labor does not last ten days or 7 or four or 3. Maybe she was truly just deceived and I do feel sorry for her, and what makes it worse is because of an infection like that she may not even be able to have any more children.

  • CanDoc

    ?Typo:

    “But it is not choice
    that is being promoted, but specific, highly restricted and choices.”
    (Before I share widely to my highly “empowered” (but not really) social media network).
    Beautiful piece.

    • Amy Tuteur, MD

      Thanks! Fixed it.

  • mabelcruet

    Another OT-but can I pick obstetricians/midwife brains please? I was asked about this article recently and its generated some discussion in the department, split very definitely between pathology and OBGYN:

    https://www.bloodtobaby.com/post/nuchal-cord-how-to-optimise-neonatal-outcomes

    It’s about cords from a delivery point of view-I’ve noticed over the years that cord knots and nuchal cords cause a lot of worry clinically, with one of the common specimens I get being a placenta with the clinical history of ‘true knot in cord’. But as a pathologist, we’ve always been taught (and continue to be taught and to teach) that cord knots and nuchal cords are not the terror they are made out to be because of cord coiling and Wharton’s jelly. In a healthy cord with a normal amount of jelly, the vessels are protected by cord coiling (which adds turgor to the cord), and the jelly, which is gelatinous and thixotropic, meaning that it becomes more liquid under pressure, and you can’t compress a liquid, so the vessels remain protected even if there’s a knot. In our big placenta books, it says that the only time you need to worry about a knot or a nuchal cord is if there is a very skinny cord with minimal Wharton’s jelly (which happens in growth restricted babies); if the knot developed really early on and the presence of the knot prevented the normal amount of jelly developing at that site meaning you end up with stenosis of the cord; or if the cord is flat and uncoiled, which makes it more flaccid. We would only diagnose a cord knot as being responsible for poor outcome if there is evidence of obstruction to flow-so if there is a colour change on either side of the knot with part of the cord being congested and the other very pale, and usually the part of the cord that is congested is also swollen because of obstruction. We always take a slice through the knot and if you see a proper organising thrombus in the vessels then obviously you’ve got problems.

    The article doesn’t mention anything much about the defensive anatomy of the cord and I thought it was a little misleading, but that’s looking at it from a pathology point of view. So how often do you obstetricians and midwives see nuchal cords and knots that have caused problems, and have I been labouring under a misapprehension all these years? It’s not that I’ve ever refused to diagnose it-I’ve certainly had mid-trimester miscarriages where the fetus has a cord that is far too long for his gestation and has ended up getting tied in knots around it, but its not that common from my point of view.

    • mabelcruet

      Edit-the first reference in the article is a link to Bob Bendon’s obstetric pathology page. The man is the king of placenta pathologists-his obstetric pathology site is amazing and well worth bookmarking!

    • attitude devant

      This OB finds it rather hilariously awful. Nuchal cords are common; problems with them are not.

      What I find specifically hilarious is that her concern about cords is limited to when to clamp and cut them. She is correct that neonatal hypovolemia can occur if the venous return to the baby is occluded but the arterial outflow to the placenta is not, but this is NOT the cause of most poor transitions. What about all those hours and hours of labor with intermittent cord compression of a vulnerably located cord? She doesn’t know about that….because she doesn’t monitor adequately.

      So the floppy blue baby comes out, and she blames it on hypovolemia from cord compression (and what is that weird claim about the vagina acting like a pair of MAST trousers during the second stage???), and says the main thing is to let the placenta re-perfuse the baby. Well that’s not a bad thing, but in practice that means that proper resus gets discounted and that blue baby who is also acidotic and hypoxic doesn’t get the prompt help needed. God, these idiots make me want to shriek.

      • mabelcruet

        Yes, the impression I got was that she considered delayed cord clamping to be more important than anything else, so she spun the article in order to promote that.

    • Anna

      I’m not a medical professional but I am a loss Mum and we do have a few ‘true knot’ Mums in my support group – its a large group 10K members though. I think you are right – nuchal cords causing problems are rare but if you’re that one parent – and you see your baby born with a cord round their neck you’re gonna blame that – whether that was the cause or not. My guess is the OBs are far more scared of it than other HPs and midwives (who also opine that nuchal cords are necklaces) because an OB is the one that takes direct responsibility. The OB is gonna want to have something to blame too – if there happens to be a tight knot then I suppose its a bit like “phew” – Its not something I did or didn’t do? As far as nacheral midwives go – yep, all that matters is that the clamping is delayed and baby has skin to skin. I was on one of the shitty maternity consumer groups I torture myself by following recently and they had some crap about how we should have bedside resus cribs or babies should be resussed on the Mum and a midwife commented “wouldn’t that be really difficult to do with IVs and intubation etc” and in they flew squawking with their “studies”. Apparently no babies would ever die if those awful terrible Drs didn’t cut the cords. So I have watched a full on resus (failed) and a medium level assistance (succeeded but baby went to SCN and NICU) and theres no way in the world it could or should be done in a bedside cot, on the hospital bed or on the Mothers chest and again I’m not a medical professional but time wasted seeing if baby pinks up or doing a few puffs on the Mum (which is probably enough in the vast majority of cases) equals brain cells in the few that aren’t going to come round fine without further assistance. I understand why OBs wanna cut now and ask questions later – even though a lot of the time it probably would have been fine, even beneficial for the baby to have left it longer. Like so much of obstetrics its a high stakes guessing game and its very easy for midwives and academics to say “oh thats so rare, and almost never causes problems” – not having a go at you Mabelcrust – I love your posts and have learnt so much from them. I didn’t get to meet the path that worked on my baby but it was clear the head of Obstetrics learnt from him – and the explanations given were very helpful. I think for laypeople its very easy to see things as black and white but what the experts know is that there is sooooo much in between.

      • mabelcruet

        I’m sorry that you’ve lost a baby, and I hope I didn’t trigger any unhappy memories. You’re so right about wanting answers, but seeing things in black and white comes with its own problems. Very often, my autopsy reports and placenta reports don’t have a final conclusion-I list all the issues I’ve found, and then the obstretrician and midwives put it together with their findings. It’s common to have a stillborn baby who is a little bit small for his age, with a placenta that’s a little bit small, and the placenta might look a bit ischaemic and have an area of infarction, and then there might be an early inflammatory reaction. So it’s hard to say what was the cause of death, or was it everything acting together. Maybe the infection was the final straw and it wouldn’t have killed a healthy well grown babe, but in a baby who was a bit small with a suboptimal placenta, maybe the infection was just enough to tip him over the edge. But that’s hard to deal with, because if it was just infection, it’s easier to manage the next pregnancy, but if we don’t know exactly what the cause was, it’s harder to give the likelihood of recurrence. And not knowing means the parents will be frightened the whole way through.

        So if I find a cord knot, I always mention it, and then do a discussion about why I don’t think it had occluded blood flow (from a pathology aspect), but it’s up to the clinicians to make the final conclusions and decisions-maybe they are more confident in saying it was or wasnt a cord issue based on their clinical findings. It’s not uncommon to have this ‘discrepancy’ -placental abruption is a common cause of stillbirth, but the placenta take a couple days at least to show the typical features of abruption, and if delivery is expedited, there may not have been time for the typical features to evolve. So clinically, the obstetrician is happy it was an abruption on clinical grounds, but the pathology can’t confirm it.

        • Back in the “bad old days” when C/Ss were avoided as much as possible, and CFM and ultrasound were yet to be invented, I had a patient who was fully dilated and pushing, when we noticed [using a doppler] that the FHR dropped with each contraction and was slower and slower to come back up. The patient’s doctor was urging her to ever stronger efforts, and as soon as was feasible, delivered the baby with forceps. It was dead; had died literally in the last few minutes. There had been a true knot in the very short cord, and it was the mother’s pushing that tightened the knot. Today, a patient like that would have been noticed, via CFM, to have the decels typical for cord problems, and most probably would have had a C/S much sooner and the baby would have been saved.

          • mabelcruet

            Cord length is something that I always comment on, with the proviso that I may not have the full length of it, because usually the midwife clamps it, then trims it closer to the umbilicus. But anything shorter than 30cm is a worry. As far as I know, we still haven’t worked out properly why there’s so much variation in length. I more commonly see very long cords (anything over 70cm is excessively long). Short cords are associated with babies who have neuromuscular issues and don’t move in utero, so you’d think long cords would go with babies who move a lot-I kind of envisage it like homemade pizza dough-the more you work it, the more it stretches, but I have no idea if that’s true or not. And cord coiling-why are some cords coiled up as tight as those old fashioned telephone wires and others not? We know long and over coiled cords are a risk for stillbirth, but we don’t know what causes it, we can’t test for it in utero, and even if we could test for it, we don’t know how to un-coil it. My obstetric colleagues tell me that sometimes you can see a very coiled cord on scan, but there’s nothing they can do except keep checking on fetal well being and having a low threshold for intervening.

            My other bug bear is fat placentas. Instead of a dinnerplate shaped placenta, we occasionally see ones that are more of a side plate size diameter, but 5+cm thick. These are generally related to babies who are sub optimally grown, but why? The placental weight and volume is the same as a normal dinnerplate size one, so why does it not grow the baby as well? I have a vague idea it comes down to surface area-if the maternal vessels are evenly distributed throughout the endometrial cavity, then a small but very fat placenta isn’t going to cover as much area and so can’t access as many maternal vessels, so it’s poorly perfused. But I don’t actually know this. That’s another thing I comment on that I am not sure is significant, just odd.

    • CanDoc

      This OB agrees with attitude deviant.
      1) Vast, vast majority of nuchal cords and true knots are totally benign.
      2) The vein is not as well protected as the muscular arteries and I do believe is vulnerable to compression in labour (recall “variable decelerations” that are by definition related to cord compression?), especially in the second stage. Again, usually benign, but sometimes with more prolonged compression as fetus descends (complicated variable decelerations seen in heart rate tracing as a result). Most emergent deliveries (forceps/emergency CS) I perform are for complicated variables, sometimes I find a nuchal cord, sometimes not, but I assume there’s a cord getting squeezed somewhere there – but this is during labour, not prelabour.

      3) The “flat” baby is in her photo is anything but: note the scrunched up eyebrows and flexed fingers. That corded baby is just fine.
      4) I’ve never seen a bad outcome where I thought a true knot in the cord was the culprit. I’m sure it can happen if the knot is tight and happens at a very early gestation resulting in stenosis as you’ve pointed out, but so much wharton’s jelly… it’s like putting a pool noodle around your garden hose then trying to tie it in a knot to stop the blood flow.
      5) Author of this blog is a quack. Delayed cord clamping generally good, but not if it prevents resuscitation of a baby, especially a baby with a low heart rate who is now getting rather limited oxygen from the detaching placenta. Not a pancea.
      6) But I also agree very much with Anna – everybody (including Obs) wants to have an explanation for a grieving mother and family. And preferably an explanation that is highly unlikely to recur in a future pregnancy. Not knowing a reason is torture, and frankly, if when I say, “We’re not sure of the cause, but one possibility is that baby was tangled in her cord”, my loss moms hear “It was a cord problem and unlikely to happen again”, then I’m okay with that. I’m still going to watch like a hawk and deliver early next time.

  • mabelcruet
    • My youngest granddaughter has just discovered that the word “Bibi” [as in Israel’s PM Netanyahu] doesn’t mean “peepee”. We have return elections here in September, so there’s a great deal of political talk, and she always chimes in with a vigorous “No!” when Bibi’s name is mentioned, thinking she’s being asked if she needs the loo.

  • fiftyfifty1

    “What would it look like if women were truly empowered in their mothering choices?
    Both … AND..[…]…etc.”

    Naw. Mothering choices aren’t empowering any more than fathering choices are empowering. Both are just a part of your family life. They may confer enjoyment and meaning to life, but don’t confer power (unless you are part of a monarchy or something.)

  • EllenL

    Just when you think lactivists can’t go any further in the oppression of mothers, they do exactly that. Now they tell us that pumped breast milk is inferior to milk taken at the breast.

    Pumped milk has more bacteria, or different bacteria, we don’t know exactly what, but it must be bad.

    Sure, pumping milk is the only way a working mother can hold down a job outside the home and still provide breast milk for her baby. Too bad! Quit your job and stay home where you belong.

    And don’t think dad or grandmother can feed the baby while you catch up on sleep, or leave the house to have fun or just have a life. Baby needs to be latched onto YOUR BREAST. Any deviation makes you a bad mother.

    • Cartman36

      It’s like the vaginal seeding craze. C-section babies have different bacteria so let’s swab their nose and mouth with gauze mom just stuck up her vajayjay. I was interviewing a post partum doula and she suggested I do this after my planned RCS. She did not get hired.

    • EmbraceYourInnerCrone

      All this kinda makes me glad I decided I didn’t want to breastfeed. I was under way too much stress and thinking about learning how to breastfeed on top of it was too much. It also meant my husband could take the newborn night feeds a lot which he loved.

      • So did my husband. He’s a real Jewish Mother

        • EmbraceYourInnerCrone

          Mine would take the fussy baby and walk around the living room describing the pictures on the wall or if she was really grizzling he would stand in front of the open freezer door and tell her what they could make with all the ingredients, we think the sudden blast of cool air startled her into quiet for a few minutes, or maybe she was always a foodie 🙂

    • mabelcruet

      In the hierachy of feeding a baby, the ranking goes:

      Best: Exclusive breast feeding
      Not so bad, but not great: Pumping and breast feeding
      Donor milk from milk banks
      Donor milk sourced privately from strangers
      Inducing lactation in other family members (feeding dad lots of drugs to get him producing)
      SNS whilst breast feeding-SNS should use expressed breast milk from milk banks or strangers

      And way, way down at the bottom-

      Formula feeding

      • The Computer Ate My Nym

        Donor milk from strangers whose health status (in particular their viral status) and trustworthiness you don’t know? Um…no. It’s probably actually formula that they claim is breast milk anyway. I hope. Also why is SNS so low on the list? Seems odd that it would be lower than straight up milk from strangers, presumably in a bottle.

        • mabelcruet

          Sorry, it was a sarcastic post! It’s not my list, it’s my conclusion of what lactivists seem to prefer

          • The Computer Ate My Nym

            I understood that you were being sarcastic, just puzzled by the lactivist hierarchy.

          • StephanieJR

            I don’t think we can apply logic to these people.

        • Cristina B

          I always thought SNS was using formula in that instance. Therefore, it makes lactivist sense that pretending to breastfeed (via SNS) is higher up than formula in a bottle.

    • Who?

      It was only a matter of time.

      If the thesis is that breastmilk is made by your body perfectly matched to the baby’s state right now, then holding the breastmilk and giving it later is necessarily inferior. Of course, by the same argument, donor breastmilk is a pure waste of time.

  • The Bofa on the Sofa

    Someone very wise once said, “Empowerment is manifested in the ability to make choices, not in the choices that one makes.”

    And I stand by it, damnit!

  • Cartman36

    I remember the first time I came across the womanly art of breastfeeding book was in a thrift store. i thought gross, this must be some outdated book from the 50’s. Nope, its LLL book that they keep updating and publishing.

    Thankfully as my kids get older it happens less and less but I can’t tell you how many times over the years I have had people make unkind comments about my working full time. I love my job and I am better mom because I work and I refuse to apologize for it.

    • attitude devant

      Not to mention that having a roof over their heads and clothes to wear, etc, etc, etc, are things that are kinda important!

      • Cartman36

        That and being able to support them even if something happens to my husband. The last thing I would want to deal with if my husband died is trying to find a job when I hadn’t worked in years.

        • Griffin

          Me too. What a terrifying position to be in.