Natural childbirth advocacy depends on privilege

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Last week I reviewed why natural childbirth philosophy is fundamentally and ineradicably racist. I quoted Rachelle Chadwick (Bodies that Birth: Vitalizing Birth Politics) in exploring an imagined racial dichotomy in birth where indigenous women of color are fantasized as “primitive and animal-like and thus primed to give birth (and breastfeed) easily and without pain or the need for medical assistance …”

The philosophy of natural childbirth is also deeply classist. It reflects the cultural preoccupations of privileged Western white women and entirely ignores the ugly, deadly realities of maternity care for poor women.

Privileged women worry they will be subjected to the “medical gaze”: poor women worry they will be invisible.

Chadwick has a lot to say on this topic, too, and I’m impressed with her framing of this issue, too. Despite being immersed in obstetrics for the past 35 years, this framing is new to me, though it provides an explanation for a widely known phenomenon — the terrible infant and maternal mortality rates of poor women.

Simply put, while the privileged white women of the natural childbirth movement have been obsessing over being subjected to the “medical gaze” of increased monitoring and risk mitigation, poor women (particularly poor women of color) have been suffering from their “invisibility” under the medical gaze.

That’s because, as Chadwick notes:

Problematically, studies of risk and birth have been overwhelmingly based on the perspectives of privileged women … There has been little examination of risk and birth from the perspectives of marginalized women …

Chadwick directly addresses this serious oversight.

Far from being subject to increased monitoring and surveillance, low-income women were often subject to biomedical invisibilization during labor/birth in which they disappeared, were forgotten and disregarded, and fell outside of the medical gaze. Monitoring, machines and interventions were often missing and many women were left to labor alone with no medical assistance or pain relief.

As a result:

…[W]hile the biomedical definition of birth as a risky event requiring medical care/intervention framed women’s experiences and narratives of birth across diverse sociomaterialities, biomedical risk was enacted differently according to positions of privilege/marginalization.

Privileged women worry about “medicalization” of birth, though even those who choose homebirth and freebirth assume that their choice to forgo medicalization is made safe by their easy access to high tech care should they need it.


The enactment of largely middle-class notions of ‘natural birth’ or planned homebirth are thus founded on privileged access to resources and the ready availability of medical care and technocratic interventions on demand.

Poor women — in both high resource as well as low resource settings — have a very different experience of risk.

While privileged women were concerned with the risk of ‘losing control’ and made birth choices accordingly, worries about ‘control’ did not appear in the stories of low-income women… For [low-income] women, entangled within a different set of risk politics, a key concern in relation to birth was not loss of control but lack of care.

Chadwick is writing about South Africa but her observations apply to most industrialized countries:

In public sector [maternity facilities] however, the biomedical risk economy is structured very differently and in some settings is marked by the absence of technological monitoring and machinery, indifferent care and a lack of surveillance. In these contexts, women’s laboring bodies are often rendered invisible and fall outside of biomedical optics.

Privileged women and poor women have very different experiences of maternity care:

While women utilizing the private medical sector are usually highly monitored throughout their pregnancies, poor pregnant women are generally not subject to the same degree of high-tech monitoring and risk management.

It is not surprising then that poor women suffer much higher rates of infant and maternal mortality. They and their babies are dying from a lack of the very technology that privileged women disdain.

For privileged, Western white women:

…[P]regnancy and birth often became an identity-making process in which a range of technologies and practices (3D sonograms, sonograms, acupuncture, pregnancy yoga, amniocentesis, hypno-birthing) were used as ‘technologies of the self’ to craft selves and identities.

Poor women, in contrast, are desperately hoping they and their babies survive.

Natural childbirth advocacy ignores these women. Indeed, to the extent that most midwives, doulas and natural childbirth advocates acknowledge the high infant and maternal mortality rates of poor women, it is purely instrumental. They mobilize these tragedies to argue — grotesquely — that poor women need more midwives and doulas when they really need more perinatologists and ICUs.

Processes whereby black and poor laboring bodies are rendered invisible and left to fall outside of normative modes of biomedical risk management (in some public sector contexts) speak to wider forms of societal power in which some lives are valued (and must be protected) and others are not.

As Chadwick notes:

Both the panoptical [medical] gaze and the absence or withholding of the gaze thus function as potential technologies of power and are embedded in sociomaterial relations of oppression, privilege and marginalization.