Abstract
Obstetric violence has been analyzed from various perspectives. Its psychological effects have been evaluated, and there have been several recent sociological and anthropological studies on the subject. But what I offer in this paper is a philosophical analysis of obstetric violence, particularly focused on how this violence is lived and experienced by women and why it is frequently described not only in terms of violence in general but specifically in terms of gender violence: as violence directed at women because they are women. For this purpose, I find feminist phenomenology most useful as a way to explain and account for the feelings that many victims of this violence experience and report, including feelings of embodied oppression, of the diminishment of self, of physical and emotional infantilization. I believe that the insights to be found in feminist phenomenology are crucial for explaining how and why this phenomenon is different in kind from other types of medical violence, objectification, and reification. Iris Marion Young’s description of feminine existence under patriarchy, as conformed by a perpetual oppressive “I cannot,” is at the center of my analysis. I argue that laboring bodies are at least potentially perceived as antithetical to the myth of femininity, undermining the feminine mode of bodily comportment under patriarchy and thereby seriously threatening the hegemonic powers. Violence, then, appears to be necessary in order to domesticate these bodies, to make them “feminine” again.
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Notes
I deal with the phenomenon of obstetric violence mainly as experienced by white, Western, middle-class women, who are more exposed to the effects of medicalization and technology in labor, though recent research shows that obstetric violence is also rampant in semi-developed countries (see my later discussion of Venezuela), where childbirth is becoming more medicalized but a strong tradition of caring for human, especially women's, rights, is still largely missing (see, for instance, Béhague et al. 2002; Bruekens 2001; Potter et al. 2001). The history of medicalized childbirth is interestingly complex in feminist terms: attempts to find medical relief for childbirth pain originated in desperate calls from women and feminist opposition to the suffering and pain of childbirth that it had always been considered "natural" and "moral" for women to undergo. For countless women who decide to challenge women's "natural destiny," numbing labor pain was and still is an empowering act (Baker 2010; Smeenk and ten Have 2003; Wolf 2012). Nevertheless, as childbirth became increasingly medicalized, many women started to feel disempowered by the technologization of labor. Extreme numbing practices (like the "twilight sleep" used in America from the nineteen fifties through the nineteen seventies, during which women almost completely lost consciousness) became common, diminishing women's self-image and their perception of control and agency during labor (Behruzi et al. 2013; Smeenk and ten Have 2003; Wolf 2012). But women in societies lacking technology and basic medical attention still suffer in childbirth from that lack. Johnson explains medicalization as, paradoxically, mainly a problem for the privileged: "the preference expressed by many privileged women in affluent countries… for midwifery care and home births, is curiously at odds with public health data and ethical arguments. 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" (2013: 200, my emphasis).
Merleau-Ponty writes: "Our body is not in space like things; it inhabits or haunts space. It applies itself to space like a hand to an instrument, and when we wish to move about we do not move the body as we move an object. We transport it without instruments as if by magic, since it is ours and because through it we have direct access to space. For us the body is much more than an instrument or a means; it is our expression in the world, the visible form of our intentions" (1964: 5). This ignores the situation of women under patriarchy, in which they are inherently banned from owning their own bodies in the way that Merleau-Ponty asserts we "all" do.
The tension between being submissive and docile because of having internalized patriarchal models of femininity and being able to perceive and recognize violence as such arises in connection with not only obstetric violence but also violence in general against disempowered groups that have internalized oppression. Here the recognition of violence has to do with how the body in labor frequently behaves, forcing women to step outside their passive femininity. This glimpse of an authentic, ambiguous, embodied subjectivity enables women to recognize patriarchal objectifying violence against their powerful embodied selves.
Women can also be disempowered within the non-medicalized, midwifery model of childbirth, even though that disempowerment may not be a consequence of violence. Charles (2013) reflects on the deep feelings of incompetence, frustration, and shame many women experience after "failing" to give birth without medical intervention: for some women, the "midwifery model" may be as disappointing as the medicalized one (see also Baker 2010). I do not analyze this kind of disempowerment here, nor do I deal with the consequences of obstetric violence for the babies being born. Recent studies show benefits for babies delivered in a quiet environment and allowed to spend the first hours of life close to their mothers and undisturbed (Bodner et al. 2011; Salgado et al. 2013; Vieira et al. 2010; Wagner 2001), but since these studies mainly show that babies benefit in the long run from "good attachment," which mostly has to do with how the main caregiver interacts with the baby, what probably benefits a baby most is having a satisfied mother (whether or not her labor was medicalized).
It might be argued that because this is not perceived as violence by the obstetricians (who may consider it doing their best for the woman and baby), we cannot call it violence, since violence must be intentional to be counted as such. Landau (2010: 70), for instance, argues that explicit intention is a constitutive element of violence. Without attempting any philosophical reflection here on the ontological possibility of unintended violence, I justify my analysis, which is exclusively phenomenological, by the fact that the concept of (intentional or unintentional) obstetric violence has been recognized by law and, more importantly, experienced and reported as such by a great number of women. However, Allison Wolf's illuminating analysis (2013) of medicalized childbirth as essentially violent, from which I will quote, is based on Žižek's concept of metaphysical violence, contending that violence must be intentional to be considered real violence.
This, per Beauvoir, is precisely how the oppression of women has functioned: men have projected immanence onto women, falsely believing that they (men) are absolute transcendence while women are absolute Others, pure immanence, pure flesh. Men project their abject parts onto women and consequently deprive themselves of freedom, wrongly believing that they themselves are absolute freedom. By forbidding women to enter the dialectical subject-to-subject process, men deny themselves, paradoxically, their own freedom. By reducing women to their bodies, to pure immanence, pure facticity, while considering themselves as constituted by pure transcendence, a distilled freedom that is not mingled with embodiment nor intertwined with flesh, men deny women the possibility of developing themselves as moral subjects with moral freedom (see Scarth 2004: 99–121; Arp 2001: 138–40).
The assertion that obstetric violence is a form of gender violence and must be understood as structural rather than behavioral violence is central to my argument. This means that the medical staff is not necessarily aware of performing this kind of violence, often functioning as an unconscious perpetrator of an existing violent structure (and even in some cases attempting to resist that structure). Bellón Sánchez, for instance, in her compelling study of obstetric violence in Spain, uses Foucault's concepts of "biopower" and "authoritative knowledge" to insert the phenomenon of obstetric violence into the wider phenomenon of medical violence resulting from medicine's excessive power over bodies within contemporary Western societies and from the unquestioned authority that has been given to medical staff (2014: 27–29). This wider phenomenon of medical violence, however, is also clearly gendered: Bellón Sánchez shows that women, and especially their reproductive processes, have been particularly vulnerable to it. Modern medicine—deeply androcentric from its beginnings and to this day—endorses and reproduces male values and is particularly occupied in controlling female bodies (especially their reproductive processes and sexuality) while safeguarding male hegemony, as many feminist critiques of medicine argue (Bellón Sánchez mentions Haraway, Harding, and Schiebinger in this context (2014: 25)). Obstetrics, with its intimate relation with human reproduction and female sexuality, Bellón Sánchez asserts, is especially prone to chauvinism and controlling practices (2014: 37). She goes on to discuss obstetric violence as representing another facet of the strict control exercised over women's bodies through "biopower" and medical "authoritative knowledge": women, barely considered to be "epistemic agents," have been largely excluded from the production of knowledge in medicine, including obstetrics. Within those systems of knowledge women are construed as passive objects awaiting instructions regarding their condition (healthy/unhealthy or able/unable). Bellón Sánchez reviews literature showing many birthing women who do not trust their bodily experiences until the doctor confirms them as "real" and several cases in which the consent of the doctor and the medical staff—not of the woman—is needed for the delivery to "officially" start or for the woman to begin pushing (2014: 30). Medical violence towards women, and obstetric violence in particular, must be recognized as part of pervasive violence towards women in general. Obstetric violence may be seen as a consequence of both the excessive power of hegemonic, androcentric medical authority and the ubiquity of violence against women.
Argentina and Mexico followed (in 2009 and 2014, respectively). The term was introduced in Venezuela following social campaigns during the nineteen eighties to improve sexual health and reproductive rights; the actual legal phrase "obstetric violence" was used for the first time in the 2007 document, as one of nineteen different types of punishable violence against women (Bellón Sánchez 2014: 54). Bellón Sánchez's discussion (2014: 50–62) suggests that the coinage of this term in developing Latin American countries probably has to do with the omnipresent chauvinism and the resulting violations of women's rights in these societies, along with a greater awareness of that sexism and gender inequality in those societies in recent decades and a willingness to contend with them.
Before I discuss the idea of "birth rape" I want to add an important disclaimer: I do not argue that obstetric violence is rape. It is not necessary to equate the two ontologically or insist that every case of obstetric violence is a form of rape to acknowledge the many reports from women (including women who previously experienced sexual violence) recognizing their own experience of obstetric violence as one of "birth rape". The phenomenological analysis of these experiences, which their victims compare to rape, is essential and could be highly productive in political and philosophical terms: the voices of women who experience their labor as a form of rape need to be heard and explored, rather than silenced in an attempt to keep the category of rape untouched. I am aware that using the category of rape in this context might seem problematic and scandalous, especially regarding its implications for the medical staff's intentions. Dealing with these reports phenomenologically, however, thus avoiding the question of the medical staff's "real intentions," will allow us to listen seriously to these voices and reflect on them, without censoring them for "inaccurately" borrowing the concept of rape.
Another recent report on birth rape can be found in Reed (2008).
I should note, however, that emergency Caesarean sections involving no genital manipulation are also frequently reported by women as rape. Childbirth appears to have a sexual dimension even when it turns into a Caesarean section; the feeling of being tamed, sometimes almost coerced, into the procedure and of being cut by the doctor's knife might be enough to make women feel raped. This complicates the assumption that the involvement of genitals and genital manipulations is the main reason for women's perception of these coerced births as rape.
Young draws again here on Beauvoir's theory of feminine existence in patriarchal society.
Countless labor stories describe labor in these terms (Gaskin 2003, 2011; Powers 2009): as an integrative experience, compounding a strong sense of crude, raw, uncontrollable embodiment with a clear sense of agency, power, and self-sufficiency. Lundgren's phenomenologically informed study of the "meaning of giving birth" (2011) includes a number of reports reflecting this position, defined by Lundgren as that of "women being subjects" in the process of labor:
Well, it was so powerful. It was unlike anything else. As in very bad weather, such as a very heavy thunderstorm, a snowstorm or something. You can’t control it. Something was happening regardless of what you do. I must say it’s very, very groovy.
A second report says:
You get concentrated when the pain comes and feel that the pain is developing something… to follow and see the connection in relation to the opening. During my last delivery, it was more like… no I don’t want this. But now I was no longer a victim. Instead, I was more in control of myself, you may say. (Quoted in Lundgren 2011: 122f.)
In the following, I take this body to be a clear threat to patriarchal power, which therefore needs to violently domesticate it.
This is how we gain authentic subjectivity, according to Beauvoir, who writes that "every existent is at once immanence and transcendence" (1989: 255). In order to recognize this ambiguity as pertaining to all subjects, she argues, it is first necessary to recognize ourselves as ambiguous: not only as free, transcendent subjectivities projected into the future but also as embedded in otherness. The task is to identify ourselves as freedom at the same time as we recognize the otherness within us, fleshing out our own immanence, our own fleshed corporeality (Beauvoir 1948: 102f.). Recognizing ourselves as ambiguous embodied subjects, both rooted in materiality and immersed in transcendence, is the first step in identifying the other as ambiguity, both freedom and immanence. Denying the other—through physical, economic, and political oppression—the possibility of developing moral freedom means failing to recognize the subject’s ambiguity and reducing it to pure immanence, a condition where the subject turns into pure flesh, a body lacking all transcendent meaning, with no project, no future. This immanent subject cannot recognize its own ambiguity or freedom: it is a subject deprived of subjectivity who in turn cannot recognize my own freedom. Confronting it, I am myself turned into an object. This is where oppression resides. Regarding how tyranny represents for Beauvoir this cancellation of the subject’s ambiguity, and the implications for the condition of the tyrant himself, see Arp (2001: 120–132), Bergoffen (1997: 30f.), and Scarth (2004: 81–84).
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Acknowledgments
This research was supported by the Israel Science Foundation (Grant No. 162151/).
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I am deeply indebted to the two blind reviewers of this paper, whose constructive advice and comments helped me to transform a narrow reading of Obstetric Violence into a much broader and careful project.
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Cohen Shabot, S. Making Loud Bodies “Feminine”: A Feminist-Phenomenological Analysis of Obstetric Violence. Hum Stud 39, 231–247 (2016). https://doi.org/10.1007/s10746-015-9369-x
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DOI: https://doi.org/10.1007/s10746-015-9369-x