Natural childbirth, a philosophy of privilege

Natural childbirth is the project of Western, white women from first world countries who are relatively well off. It does not have much resonance among women of other cultures, nor among women of color within first world countries. In other words, “natural” is about and absolutely depends upon social privilege.

It’s been that way from the very beginning. Grantly Dick-Read, widely considered to be the father of the natural childbirth movement, viewed natural childbirth as a way for white women of the “better” classes to avoid “race suicide.” Ornella Moscucci explains the thinking of Dick-Read and his eugenicist peers:

[T]hese health reformers were concerned about the differential birth rate—the tendency of poorer, less healthy sections of society to have larger families than their “betters”. Thus, as well as endorsing plans for the sterilisation and detention of “degenerates”, they also sought to encourage the middle classes to have more children… Female education and employment were seen as a particular evil, insofar as they led women to regard motherhood a burden and to neglect hearth and home…

… Dick-Read … claimed that primitives experienced easy, painless labours. This was because in primitive societies the survival value of childbirth was fully appreciated and labour was regarded as nothing more than “hard work” in the struggle for existence. In civilised societies on the other hand a number of cultural factors conspired to distort woman’s natural capacity for painless birth, producing in woman a fear of childbirth that hindered normal parturition…

In other words, “natural” childbirth was created as a philosophy for privileged women, and it remains so to this very day.

Political scientist Candace Johnson explores the role of “natural” childbirth as a philosophy of privilege in contemporary society (The Political “Nature” of Pregnancy and Childbirth, 2008). She starts by framing the question:

… [W]hy do some women (mostly privileged and in developed countries) demand less medical intervention in pregnancy and childbirth, while others (mostly vulnerable women in both developed and developing countries) demand more …? Why do the former, privileged women, tend to express their resistance to medical intervention in the language of “nature,” “tradition,” and “normalcy”? …

The answer?

The evidence seems to suggest that arguments about the negative impact of medical intervention in the lives of women, “medicalization,” seem to resonate only among privileged populations. As indicated by Laura Purdy, medical intervention in pregnancy and childbirth is evaluated very differently in different contexts, and the expression resistance among privileged women in developed countries often appeals to “nature”:

“When we learn that African-American women in the United States die more often in childbirth than white women, and that horrifying numbers of Third World women are dying as we speak, nobody concludes that preventive action would be morally intrusive. Yet we tend to be bewitched by the claim that menstruation or pregnancy are natural processes and thus inappropriately dealt with in the medical realm.”

In poor countries, communities or under-serviced areas, medical care is a necessity, upon which exercise of agency and autonomy is contingent. But the refusal of pharmaceuticals and clinical care among affluent or well accommodated (by a universal health system, for example) women is at once a form of political resistance and an assertion of identity.

It is precisely for this reason — that rejection of medicalization is an assertion of identity — that explains its restriction to privileged women. Only women of privilege, with enough to eat, easy access to medical care, and the leisure to contemplate their “identity” are attracted to “natural” childbirth.

In developing countries, appeals are continually made for more medical intervention in pregnancy and childbirth, not less… [I]n the United States, higher rates of maternal mortality among African American women serve as evidence for the need for better access to medical care … However, the preference expressed by many privileged women in affluent countries, such as Canada and the United States, for midwifery care and home births, is curiously at odds with public health data and ethical arguments.

As Johnson explains:

It is a rejection of privilege that simultaneously confirms it. Therefore, the problem of medicalization seems to apply disproportionately to privileged women. In fact, some of the most serious pronouncements of medical interference in pregnancy and childbirth as a “natural, normal, woman-centered event” come from women of considerable privilege and authority.

It is not surprising then that “natural” childbirth, a philosophy of privilege is rejected by women who lack social privilege, women of color and women from non first world countries. But there is a further reason for rejection, the romanticization of the experience of non-privileged women:

… Third World women’s experiences with traditional or natural birthing practices have been appropriated and romanticized by first world women, often to the detriment of the subaltern women. Sheryl Nestel claims that “conceptually, images of Third World women have served to define middle-class white women’s midwifery identities through both negative comparison and fantasized idealization”

To put it bluntly, privileged women construct a view of childbirth that explicitly ignores the vast suffering endured by real women forced to experience childbirth “naturally.”

… The fantasy of Third World women’s natural experiences of childbirth has become iconic among first world women, even if these experiences are more imagined than real. This creates multiple opportunities for exploitation, as the experiences of Third World women are used as a means for first world women to acquire knowledge, experience and perspective on ‘natural’ or ‘traditional’ birthing practices, while denying the importance of medical services that privileged women take for granted.

Natural childbirth is rejected by women of color and by women from countries outside the first world. Natural childbirth is a philosophy that presumes economic security, ready access to medical technology, and the leisure to construct an “identity.” It does not merely ignore the suffering that childbirth entails for many non-privileged women, it actively erases their suffering by pretending that it does not exist and never existed.