Women can’t reclaim their agency from doctors by ceding it to midwives and lactation consultants


How did the natural childbirth and breastfeeding industries go so wrong?

Why do I receive emails and Facebook messages from desperate women nearly every day detailing their guilt, self-abnegation and torment over “failing” to give birth vaginally or to breastfeed?

Why, when I talk about my writing with friends and acquaintances, do women years removed from childbearing burst into tears about their struggles?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Doctors shouldn’t pressure or shame you … and neither should midwives or lactation consultants.[/pullquote]

The philosophies of both natural childbirth and lactivism were created as ways to re-domesticate women, so they would not seek legal and economic equality. Their retrograde beginnings were hidden when they reached the mainstream and their the goal of reclaiming women’s agency from paternalistic doctors resonated widely. Instead of doctors deciding that women should be asleep during birth, deprived of emotional support from partners and subject to unnecessary procedures like shaving and enemas, women insisted that it was their right to be conscious, to be accompanied by partners and to accept or reject procedures based on informed consent. Instead of being convinced to forgo breastfeeding or forced to give up breastfeeding due to lack of breastfeeding support, women insisted that it was their right to receive encouragement and support in nourishing their infants in the way they thought best.

What went wrong?

Both natural childbirth and lactivism went off the rails when they insisted that the only way women could reclaim their agency from paternalistic doctors was to hand it over to paternalistic midwives and lactation consultants.

What would childbirth and lactivism look like if women themselves were in charge of the decision making? It would look very different than it does today.

  • All possible choices would be represented because women have a broad spectrum of needs and desires.
  • Birth plans would just as readily include maternal request C-sections as unmedicated vaginal births.
  • Pain relief would have a prominent place in birth plans since most women find they need pain relief.
  • Women would choose how to feed their infants based on what worked for them, and they would NEVER be shamed for bottlefeeding.
  • Free formula gifts would be available to those who want them.

In other words, every safe childbirth or feeding decision made by mothers would be respected by professionals and by other mothers. Decision making would be bottom up: women would make the decisions and inform providers of their choices.

Instead, in the process of women reclaiming their agency from doctors, midwives and lactation consultants swooped in to steal it from them. Within natural childbirth and lactivism, decision making is top down. Midwives, doulas and childbirth educators decide what a “good” or “normal” birth should look like and they force that decision down women’s throats. How? By hectoring and shaming dressed up with the twin lies of being “better for baby” and “evidence based.” Lactation consultants decide how babies should be fed and force that decision down women’s throats. How? By hectoring and shaming dressed up with the twin lies of being “better for baby” and evidence based.”

The Baby Friendly Hospital Initiative (BFHI) is the paradigmatic example of how natural childbirth and lactivism reflect top down decision making and deprive women of their own agency.

The name itself — Baby Friendly Hospital Initiative — is a deliberate slap in the face to women, implying that women who can’t or don’t wish to breastfeed don’t care about their babies. It reflects the professional lactivists’ beliefs that they know better than women what is best for them and their babies, and it is the apogee of mother shaming.

It’s appalling that any hospital allows such an organization anywhere near emotionally fragile new mothers. The medical community has regrettably empowered a group of zealots — lactation professionals — with top down decision making authority over infant feeding. They’ve allowed these zealots to frame the issue of breastfeeding as “baby friendly” when it may be anything but. They’ve allowed them to ignore the needs of mothers. And they’ve allowed them to promote shaming woman as an acceptable tactic for manipulating them.

These zealots deprive women of agency. The assumptions behind the BFHI are that women cannot be trusted to make decisions for their infants, must be hectored into breastfeeding, any alternative must be made as inconvenient as possible, and that bottlefeeding or combo feeding mothers can and should be deprived of valuable infant formula gifts.

Similarly, national health systems that rely on midwives as gatekeepers to care have done the same thing. In the case of childbirth, it’s about saving money. Midwives cost less because they are less educated, less trained and provide less care. But many are zealots, promoting an ideology of “normal birth” above the needs and desires of women. In the UK, for example, these zealots have been empowered to deny desired pain relief, desired and (sometime necessary) C-sections and to shame women who won’t abide by their ideological dictates.

These midwifery zealots deprive women of agency. The assumptions behind contemporary midwifery ideology is that women can’t be trusted to make decisions about birth. They must be hectored or even tricked into giving birth the way that midwives prefer.

Lactivists rationalize their abysmal and disrespectful treatment of new mothers as “better” for babies, just as midwives justify their insistence on unmedicated birth as a standard by claiming that is is “better” for babies and mothers … just as doctors justified shaving and enemas as “better.”

But women can’t reclaim their agency from doctors by ceding it to midwives and lactation consultants.

It’s YOUR baby and YOUR body. You are entitled to YOUR choices in birth and infant feeding.

Doctors shouldn’t pressure you or shame you … and neither should midwives or lactation consultants.