Childbirth, parenting and the subversion of expertise

“Trust yourself, you know more than you think you do.”

This is the first line of Dr. Spock’s revolutionary advice book for parents. It was revolutionary in its time because it counseled a new way of looking at parenthood. Prior to Dr. Spock’s emergence on the scene, the prevailing view of “good” parenting involved following the views of parenting experts. For example, mothers were advised to feed infants according to a schedule, not on demand, and to feed them scientifically superior infant “formula” not breastmilk.

Dr. Spock’s views represent a rejection of radical reliance on experts and suggested that parents had their own, equally valid, sources of knowledge: their personal experiences and their understanding of their own infants. In the intervening decades, Dr. Spock’s advice has been taken to its own radical extreme. Indeed, the entire concept of “expertise” has been deliberately subverted. Now, particularly in natural childbirth and vaccine rejectionist circles, parents are not merely encouraged to substitute their knowledge for that of experts; they are encouraged to believe that they are experts. In other words, rather than supplementing expert advice with parental knowledge, some mothers insist that parental knowledge is expert advice.

Subverting “expertise” in this way serves several important functions. By insisting that they are “experts,” natural childbirth advocates, vaccine rejectionists and others can simultaneously embrace the esteem in which science is viewed and reject the actual scientific evidence. Second, they can use their “expertise” to validate their own parenting choices. Third, they can enhance their own self-esteem by elevating mothering to be an expert, albeit unpaid, occupation.

Charlotte Faircloth argues that this new approach to parental expertise reflects contemporary liberal political philosophy:

In contemporary liberalism the responsible moral actor is not one who conforms blindly to expert or even popular recommendations. Rather, as Murphy notes in The Sociological Review (51[4]), “she is expected to subject such recommendations to evaluation and questioning, operating as an informed consumer.” Those who are not reflexive, informed consumers are deemed irresponsible or in need of education.

If that sounds familiar it’s probably because it is one of the mantras of both natural childbirth and vaccine rejectionists movements. The “best” mother is not the one who accepts expert advice, but the mother who “educates” herself by imbibing the beliefs of those who reject expert advice.

But what is laudatory in the political sphere is not necessary valuable in the scientific sphere. The responsible citizen should subject political information to evaluation and questioning and should vote based on her own beliefs, not the recommendations of politicians. When it comes to determining which political candidate best represents her beliefs, the individual is the expert. That’s not the case with science. Determining the whether vaccines are effective requires consulting the literature, not communing with one’s personal intuitions.

The assault on scientific expertise is hardly a secret in natural childbirth advocacy. Robbie Davis-Floyd has devoted her sociology career to demeaning authorative knowledge and replacing it with “embodied knowledge.” In a chapter in Davis-Floyd’s book Childbirth and Authoritative Knowledge, Browner and Press write (Chapter 4):

Recent attention has focused on strategies by the institution of biomedicine to attain medical hegemony in U.S. society… Drawing on Jordan’s concept of authoritative knowledge (AK), this account examines the circumstances under which a group of pregnant women in the U.S. facilitated biomedical expansion by accepting the advice offered by their prenatal care providers. We consider the significance of competing forms of knowledge, particularly” embodied knowledge …”

We define embodied knowledge as subjective knowledge derived from a woman’s perceptions of her body and its natural processes as these change throughout a pregnancy’s course. Jordan’s pioneering work documented how a group of California laywomen used embodied knowledge to accurately diagnose their own pregnant state prior to biomedical confirmation. The women employed a variety of phenomenological indicators as diagnostic criteria including breast enlargement or soreness, nipple tenderness, feelings of extreme “heaviness” or bloating, food cravings, and intolerance to particular foods or smells. Other research found that women in the Colombian city of Cali used these same phenomenological indicators as well as other more idiosyncratic ones such as skin discolorations and pubic itching to diagnose their pregnancies.

Jordan’s conceptualization of AK frames our discussion. She defines AK as rules that carry more weight than others “either because they explain the state of the world better for the purposes at hand (‘efficacy’) or because they are associated with a stronger power base (‘structural superiority’), and usually both.” … In situations of structural inequality, however, one set of rules or form of knowledge often gains authority, devaluing and delegitimating others in doing so…

This account is overtly political, misrepresents medical knowledge, and is downright bizarre. “Embodied knowledge” is nothing more than personal symptoms. Medicine does not deny the validity of symptoms, merely their specificity. A urine HCG pregnancy test represents authoritative knowledge in this setting; embodied knowledge includes “skin discolorations and pubic itching.” There is no doubt that the authoritative knowledge represented by a pregnancy test is far more reliable than any particular symptoms of pregnancy.

If this is their best example, the entire concept of “embodied” knowledge is hardly more than a joke. Physically experiencing symptoms does not constitute “expertise,” does not accurately reflect reality (a woman can experience pregnancy symptoms without being pregnant) and is utterly unreliable. Experiencing pregnancy symptoms does not turn a woman into an expert on pregnancy. If that were the case, we could all be experts on architecture by living in houses.

This subversion of both expertise and knowledge may boost the self esteem of its promoters, but it does nothing to improve the lives of children. Dr. Spock was right; trust yourself, you know more than you think you know. But there’s a caveat: What you know does not represent the sum total of all knowledge on the subject. It’s worth consulting experts and paying attention to expertise. And if you want to be “educated,” you can’t take a short cut by pretending that what you already know is enough. You have to do the hard work of learning science, statistics and the actual subject under discussion, whether it is obstetrics or immunology.