This feminist narrative inquiry discusses the experiences of two women in a metropolitan city in the Midsouth of the United States who each intended to have a drug- and intervention-free childbirth for the birth of their first child. This data came from a larger study that included narratives from six participants. Using Alecia Y. Jackson and Lisa A. Mazzei's concept of “plugging in,” we read and analyzed the data through three feminist theorists: Sara Ahmed, Gayatri Chakravorty Spivak, and Susan Bordo. This allowed us to push the limits of intelligibility of women and their narratives, challenging the dominant, medicalized discourses prevalent in the current cultural context of the United States.
As I'm standing in line at the grocery store, a woman excitedly asks when I am due. Once I reply, she asks which hospital I plan to use, and I can tell she's eager to share her own childbirth experience. After I tell her I'm planning a homebirth, she stares at me with shock, and then concern, and slowly replies, “Are you sure that's a good idea? I've heard that's really dangerous. I was all gung-ho about a ‘natural’ [uses her hands to make sarcastic air quotes] childbirth too, but it's a joke. Childbirth is the most painful thing you'll ever experience. Be prepared to be disappointed.” I smile bleakly and turn to put my groceries on the register.
While she prepares family dinner, my husband and I tell my mother-in-law our homebirth plans. She is extremely alarmed, and insists I need to ensure the midwife knows how to perform an episiotomy because “every woman has to have one!” Drawing on her own births, she explains how this procedure is mandatory. I smile and listen, shift uneasily in my chair, and finally placate her with my plan of a back-up doctor. I do not mention, though, that the doctor will not be present at our homebirth.
My 73-year-old father, a newly converted proponent of natural childbirth, cannot believe how negative people's reactions are when he tells them of my plans, even people who know and love me. “They all think you're already a terrible mother! It's amazing how much they don't know and how scared people are…” he tells me with shock, and a touch of sadness. I smile my recognition, exhaling audibly into the phone. I tell him that I, too, have heard these words, or read them on people's faces.
We hear countless stories of babies who are “too big” to be born vaginally; stories of women shaking and scared on the operating table before and after their C-sections; stories of women who did not get to hold their baby until an hour after giving birth for, what they are told, medically necessary reasons; stories of women who educated themselves in every possible way about intervention-free childbirth, only to find themselves undergoing non-consensual episiotomies. Women tell us again and again of how they were treated as though they were irrational, unable to think, or make decisions for themselves if they tried to contest or critique any procedure deemed necessary for the supposed safety or well-being of their unborn child. Nearly every day, as visibly pregnant women, we are reminded time and again by these same women, that we live in a country that enacts its inescapable sexism, classism, and scientism1 on women's pregnant and birthing bodies.
As feminist researchers, we are committed to speaking back against the marginalization of women's voices and perspectives in mainstream discourse. Therefore, this feminist narrative inquiry explored women's experiences of childbirth in a metropolitan city in the Midsouth. Specifically, we interviewed six women who each intended to have a natural (drug- and intervention-free) childbirth for the birth of their first child. We were interested in eliciting stories about who or what supported the women in their decision to attempt a natural childbirth, and who or what made this decision difficult or even impossible to enact.
STRUGGLING IN THE CITY: THE INTERSECTIONS OF BIRTH OPTIONS AND SOCIAL STIGMA
In the city in which this study was conducted, it is relatively rare for women to attempt a natural childbirth; women who choose this option are regularly understood and labeled as radical and/or selfish. The city is home to no birthing centers, and only one hospital in the city has a group of regularly rotating nurse-midwives in the labor and birthing ward. We collected data in a large metropolitan city in the Midsouth of the United States. This geographical specificity is particularly significant when considering the differential experiences pregnant and birthing women in the United States can have based on intersecting factors such as access to healthcare and insurance, birthing choices and options, social perceptions and stigma, and class privilege.2
Within the context of this study, women's birthing options are severely limited; even if women from this particular metro area opted for a birth center birth, this would not be possible since the nearest facility is located 300 miles away.3 Despite the birth center's inaccessibility, the state at least has a birth center; 13 states within the United States do not have a single birth or maternity center.4 For women to choose how and where to birth also depends on the availability of birth services and state laws.5 While there is a comprehensive midwifery system with long-standing traditions in place in the United States,6 regulations and state laws as to who can assist in a birth and where (at home, a birth center, a hospital) differs greatly depending on location. To illustrate the conflict, practicing as a certified direct-entry midwife, the only midwife training that specializes in homebirths and birth center births, is illegal or unregulated in 25 states.7
Even when women have the opportunity to choose their birth method, birth place, and attending healthcare professionals, they still have to face the social stigma that surrounds out-of-hospital, non-standard, or “noncompliant” births. As was illustrated in the opening narrative, alternative births are often deemed hazardous, capricious, and selfish, because a cultural assumption exists that non-medicalized births are harmful for the unborn child.8 Amy C. Miller and Thomas E. Shriver explain that, despite a growing involvement of women in choosing how they want to experience their birth, routine obstetric practices in US hospitals still fall within a “medical illness model.”9 Within this model, the pregnant body is conceptualized as inherently pathological and is subjected to standardized prenatal and perinatal medical intervention to predict and minimize risks.10 Robbie Davis-Floyd refers to this conceptualization as the technocratic paradigm of childbirth.11 The narratives of our participants illustrate the ways in which these paradigms of childbirth are enacted through various beliefs, practices, and policies in medical institutions in the Midsouth of the United States.
METHODOLOGY AND METHOD
Although it might seem commonsensical that methodologies exploring a topic such as childbirth would center women's voices and experiences, this is not the case.12 Quantitative data and representations dominate the sociological and medical research surrounding pregnancy and childbirth. As Lynn Clark Callister and Sylvia Bortin et al. suggest, women's voices and experiences need to be re-centered in public and academic discourses surrounding pregnancy and birth.13 In response to this call, we employed narrative inquiry as our methodology because of its focus on the importance of narratives and storytelling within qualitative data collection and analysis.14 Furthermore, narrative inquiry “highlights the ways in which culture and society shape and are shaped by individual lives.”15 Narrative inquiry creates spaces for honoring and recognizing the complexity of women's stories and experiences, and this is especially important during a life transition such as childbirth, as women's stories are often multilayered, complex, contradictory, and heavily influenced by experiential knowledge.16
Conducted in a large metropolitan city in the Midsouth of the United States, the purpose of our study was to elicit narratives from women who planned on having a natural childbirth, paying particular attention to the complexities of their specific contexts. The women were also asked about their social and familial support, and about their experiences navigating the hospital culture if they chose to have a hospital birth. Snowball sampling was used to recruit the six women who participated. In our selection criteria we sought local women who had intended to have a drug- and intervention-free childbirth for the birth of their first child. Since both authors were relatively new to the city at the time of the research, we recruited participants via local midwives and doulas who we found online or by word of mouth. Our participants ranged in age from 30 to 45. One of the women self-identified as Jewish. All of the women were middle class, and there were five white and one black participant, a demographic that reflects the racial disparities in access to birth choices, as described above. Participants engaged in a life-story, semi-structured interview and chose their own pseudonyms. Institutional Review Board permission was obtained and all the women provided written and oral consent.
As feminist qualitative researchers, we understand that our subjectivities inform and influence how we conceptualize research questions, the kinds of data we collect, and how we choose to analyze and represent data.17 Our subjectivities show up in our research in ways that we can acknowledge and analyze, and also in ways that we cannot understand and therefore theorize. While we recognize that our identities are shifting, multiple, and contingent, we offer the following (partial) contextual information so readers can better understand our social locations and how they may or may not influence our research. Alison Happel-Parkins is a white woman from the midwestern United States who grew up in a middle-class family in a relatively progressive college town, although it was not until she moved to San Francisco that she was introduced to critiques of the medicalization of pregnancy and childbirth. While there, she participated in a doula training, which convinced her of the importance of feminist, woman-centered care. At the time of data collection, Alison had nannied for 11 years, and had no biological children. At the time of data analysis, however, she was pregnant, and this pregnancy has inevitably shifted her thinking about pregnancy and childbirth in recognized and un-recognizable ways. Katharina A. Azim is a white woman from Germany who has lived in Russia and the Netherlands, and spends a few months per year in Egypt with her family. She does not have biological children but is supportive of women-centered, unmedicalized childbirth. Until she moved to the United States, she was unaware of the prevalence of routine intervention in US births. After undergoing a doula training through a local doula collective, she has recently assisted a woman during birth and plans to continue in this role for other women. Both authors are involved in a local doula collective. Alison conducted the interviews, and Katharina transcribed them. Both authors worked together to analyze the data.
ANALYSIS IN A POST-CODING WORLD
Heeding the call of many feminist qualitative researchers, we attempted to analyze and represent our data in a post-coding world, with the acknowledgement that our analyses can never be fully explained, understood, or replicated.18 Rather, we use Alecia Y. Jackson and Lisa A. Mazzei's conceptualization of plugging in, which, following Gilles Deleuze and Félix Gauttari, they understand as a rhizomatic process that opens up complex spaces of multiplicity rather than a static concept.19 As opposed to an arborescent and hierarchical structure, the rhizome can be described as a map without a fixed center but with multiple ways of entry and entanglements. Its ways, however, cannot be traced separately and individually. With its entanglement and connecting points, the rhizome “has no beginning or end; it is always in the middle, between things, interbeing, intermezzo.”20 Instead of asking “and/or” of the structure, the rhizome allows for accumulation through “and… and… and…”21 producing ever more lines of flight and the nodes that connect them.
As Jackson and Mazzei articulate, “Plugging in to produce something new is a constant, continuous process of making and unmaking.”22 From a methodological perspective, plugging in involves reading theory through data and vice versa, as well as “working the same data chunks repeatedly” through different theorists.23 It also involves “being deliberate and transparent in what analytical questions are made possible by a specific theoretical concept” and thereby “disrupting the theory/practice binary.”24 This approach rejects the epistemological and methodological assumptions inherent in post-positivist research (e.g., emphasis on data accumulation and theoretical saturation). Instead, it facilitates a rhizomatic interaction with data in a post-analysis space that works “on the verge of intelligibility” by producing different knowledges and by producing knowledge differently.25
As we were immersed in the data, we continually discussed which theorists might bring about “something new.”26 We would discuss what each of our chosen theorists could allow us to see/think/ask, and we discussed how our conceptualizations of the women's childbirth experiences were embedded in larger understandings of the social, political, gendered, material, etc. After verbally plugging in many different theorists and concepts, we settled on three especially provocative feminist theorists who helped us ask interesting, productive, and disrupting questions of our data: Sara Ahmed, Gayatri Chakravorty Spivak, and Susan Bordo.27 Plugging in allowed us to ask questions such as: How is the unhappy pregnant and post-partum mother an embodiment of the feminist killjoy, and how does that affect the ways hospital staff interact with her? How does a woman negotiate simultaneously inhabiting and critiquing a medical environment she cannot not be in? How does a woman's perceived subject-ivity shift when she becomes pregnant and how do these shifts manifest? Rather than creating a priori questions that guided our analysis, this methodology provided us with a way to simultaneously think data and theory. By plugging in these three feminist theorists, new questions led to new explorations, ones we could not have anticipated prior to data analysis. We chose to think with the three theorists presented here because they were the most interesting and productive for us, and because we had not seen their ideas utilized in the extant pregnancy and childbirth literature.
In what follows, we provide an in-depth theoretical exploration of the narratives of two of our participants, Stephanie and Elizabeth. Following Jackson and Mazzei, we do not attempt to represent, in full, all of the women's stories or narratives.28 Nor do we claim to fully represent the two participants on whom we focus in our analyses. We understand data to be always partial, incomplete, contextual, and dynamic. Similarly, “we sought ‘voices’ that, even as partial and incomplete, produced multiplicities and excesses of meaning and subjectivities.”29 While Stephanie and Elizabeth offered powerful narratives that did not substantially differ from those of the other participants, we in no way want to make the case that their stories are interchangeable with those of our other participants. Rather, we use these two narratives due to logistical considerations brought about by the depth of the analyses we created as we plugged in their stories with the three different feminist theorists.
Stephanie is a white woman in her early 40s who is the mother of three children, whose first birth was described in detail during our interview. Her first child was born in the hospital when she was in her mid-20s, and her other two children were born at home. She was talkative and animated throughout the interview, and she is directly connected to the city's natural childbirth community; She had strong opinions about the politics and practice of birth within the United States.
Elizabeth is a white woman in her mid-30s. She lives with her son, who was born in the hospital, and husband in a duplex with her in-laws, who are an important part of her family's life. Elizabeth identified her family as Jewish, and neither she nor her husband grew up in the city or state in which the research was conducted. Both she and her husband attended law school. Elizabeth's anger and frustration about her son's birth was palpable throughout the interview. Through her self-education, she held strong, critical views of how women are treated before, during, and after childbirth in the United States.
THE UNHAPPY FEMINIST KILLJOY
Ahmed's intersectional critique of power in relation to hierarchies based on social positionalities is pertinent to our participants’ narratives. In The Promise of Happiness, she discusses the politico-cultural conceptualizations of happiness, and the social standards, conditions, and performances that are required for certain levels of happiness to be created and maintained. Ahmed argues that “[m]aintaining public comfort requires that certain bodies ‘go along with it,’ to agree to where [they] are placed. To refuse to be placed would mean to be seen as trouble, as causing discomfort for others,”30 and are often either overtly or covertly pressured to conform. When the refusal to “go along with it” relates to intersectional social positionings, such as raced, classed, and gendered expectations, this performance is what Ahmed refers to as a feminist killjoy:
Let us take seriously the figure of the feminist kill-joy. Does the feminist kill other people's joy by pointing out moments of sexism? Or does she expose the bad feelings that get hidden, displaced, or negated under public signs of joy? The feminist is an affect alien: she might even kill joy because she refuses to share an orientation toward certain things as being good because she does not find the objects that promise happiness to be quite so promising.31
We argue that when women voice concern about conventional, popular, or widely accepted US birthing practices, they are the agentic embodiment of the feminist killjoy, making others uncomfortable with their refusal to comply in the creation and/or facilitation of happiness and “good feelings”32 in others. They refuse the expected gendered performance of the docile female patient who listens to and follows the directions of her doctors. Arguably, within the Western medicalized model of pregnancy and childbirth,33 the pregnant body alone is “presumed to be the origin of bad feeling insofar as [it] disturb[s] the promise of happiness”34 through its perceived inherent pathology and unreliability.35 Additionally, if the baby is crassly conceptualized as the “happy object”36 end-product, then the woman and her body are seen as the necessary but inconsequential and objectified vessel, a vessel often understood pathologically, in need of containment and management.
As we read Stephanie and Elizabeth's transcripts through Ahmed's conceptualization of the feminist killjoy, it became apparent that much of their conflict with hospital staff resulted from their embodiment of the feminist killjoy; they were women who were unwilling to play the part of the passive hospital patient for the comfort and convenience of their nurses and doctors.37 In Stephanie's case, she was the feminist killjoy because she introduced unpredictability and potential disorder to the maternity ward upon her arrival. Her agentic desires and demands ruined everyone's positive experience, or the comfort that hinges upon routinized hospital protocol, when she troubled and opposed the normative treatment of her birthing body in the hospital. For example, when she arrived at the hospital and was already in labor, she immediately expressed that she did not want to receive any labor-augmenting medication.38 Stephanie was, therefore, not only within her right to resist these interventions, but she was also attempting to refuse the first step of what is referred to as the “cascade of intervention.”39 As Ahmed describes, Stephanie was “refus[ing] the place in which [she was] placed.”40 Instead of honoring her birth plan, unbeknownst to Stephanie, the nurse put her on a Pitocin drip (contraction-altering synthetic oxytocin).41 She recalled the nurse reminding her, “Honey, you're in a hospital and this is how we do it… you're gonna be in labor for a long time.” After the labor contractions had intensified significantly, as a potential consequence of the Pitocin use,42 the nurse began to pressure Stephanie to reconsider receiving an epidural. Justifying her insistence, the nurse asserted, “I told you, it's gonna get like this, you know, you're not gonna be ready to deliver. You're looking at eight more hours minimum. Minimum!” Stephanie's refusal of the epidural prompted the nurse to point out the ramifications of Stephanie's embodiment of the feminist killjoy. Her veiled threats were a reminder that Stephanie's choice not to go along with everyone else's plans was, in fact, “sabotaging the happiness of others.”43 Regardless of Stephanie's wishes, her body was forced to go along with it—by secretly administering the synthetic oxytocin, the nurse integrated Stephanie's body into the hospital's standardized birthing protocols. This mandatory compliance silenced Stephanie's agency and demands, while prioritizing the agenda (read: comfort and good feelings) of the hospital staff.
Elizabeth's birth narrative was punctuated by anger, frustration, and disappointment. She refused to perform the happy pregnant woman, and the promise of the baby as the happy object was not enough for her. She embodied the feminist killjoy by refusing to silence her own critiques and frustration at the way the country and city she was in delimited her birthing options.44 As Elizabeth stated:
To read all these stories in The Farm [a book on a midwifery collective in rural Tennessee]… I felt so angry that I can't have that because I have a doctor. But, I have no choice, I mean, I either have a homebirth or I have this. And [I] was so bitter. That probably didn't help.
Elizabeth was too nervous to attempt a homebirth. Many women receive information about labor and childbirth from popular culture representations, specifically reality television shows. Unfortunately, media representations of pregnancy and childbirth are often sensationalist—emphasizing pain and terror, they normalize invasive medical interventions.45 Although the infant and maternal mortality statistics from other Western countries utilizing midwives and homebirths point to the safety of non-medicalized births, many people in the United States, as illustrated by Elizabeth's narrative, still view out-of-hospital births as dangerous.46 Health insurance providers contribute to this negative view of alternative birthing methods and places by their reimbursement guidelines and policies.47 Aetna Inc., one of the largest health insurance groups in the United States, does not cover planned homebirths because the company conceptualizes childbirth as inherently “hazardous” for mother and child and “considers planned deliveries at home and associated services not medically appropriate.”48 Cigna, another major health insurer, actively discourages homebirths, and considers them unsafe and potentially hazardous, although they do partially reimburse licensed physicians and nurse-midwives for their homebirth services. They do not, however, pay for services of certified midwives, homebirth related supplies, or homebirth related prenatal evaluation.49
When out-of-hospital births are framed as hazardous and selfish, it becomes easier to understand how hospitals become the default site for births. As pregnant and birthing women (even those with pregnancies that the medical industry defines as low-risk) undergo increasingly routinized medical interventions, the discourse shifts from preventing harm to the child to treating childbirth pathologically.50 This reflects how pregnancy and childbirth have been pathologized within the US context, and how interventions have become routine rather than infrequent procedures to be used sparingly in rare and medically necessary circumstances.51 As Miller and Shriver explain, the United States is a special case concerning labor and birth since there is a “reliance on obstetricians for even routine deliveries,”52 while countries such as the Netherlands, Canada, and Australia explicitly commit to midwifery and doula support and natural childbirth.53 Since Elizabeth had discourses purporting that homebirth is dangerous and ultimately selfish, she felt forced into seeing a doctor and birthing in the hospital, which she knew put her at greater risk of medical intervention.
As we found throughout our interviews, and reflected in the literature, many people use the fact that the baby was born (seemingly) healthy to justify and/or ignore mistreatment of the birthing woman.54 The idea is that even if a woman's birth plan is not respected, or even if she feels bullied or coerced into an unwanted medical intervention, when/if the baby is born healthy, the woman (and her partner and healthcare providers) often look past these negative experiences because the happy object end-product was a baby.55 Elizabeth does not conform to this expectation. After her baby was born, she felt ignored, and she was resentful that her comfort was not taken into consideration. Based on the archetypical feminine, nurturing mother-figure, Elizabeth's anger and resentfulness represent the ultimate feminist killjoy.56 For her, it was not enough that she was a new mother and that her baby was born healthy. She felt disrespected, she was angry at how her birth progressed, and she could not believe that for the hour following the birth her “hands [were] still bloody from where [she] briefly held him.” She was not ecstatic, happy, and relieved after her son's birth. Instead, she dared to give credence to her own emotional and physical needs, an act of a feminist killjoy refusing to embody the archetypal mother. She recalled: “And so, I didn't feel happy after somebody said, ‘Okay. It's over.’ There was no excitement, no ‘Oh wow!’” Throughout the interview, Elizabeth refused to re-story her experience in order to incorporate a happy ending to justify and/or rationalize her birth trauma. Rather, as the feminist killjoy, she vehemently expressed her disappointment and anger at the series of injustices she endured while pregnant and in labor.
INHABITING THE IMPOSSIBLE NO
In her writing, Spivak describes that, as a postcolonial scholar from a country formerly colonized by the British Empire, she has access to imperial culture and can communicate within it.57 However, while she involuntarily inhabits, and potentially benefits from, this cultural space, she also critiques it from within. It is a positionality of the “impossible no,” a space she cannot not want to inhabit because it affords her the opportunity and privileges to speak from within the structure while simultaneously deconstructing it through her critique. Although participation in this space may be construed as complicit, Spivak phrases it as “negotiating with enabling violence.”58 The person negotiates her own positionality as an inhabitant and critic; she critiques the forces of the space, and her relation to and with these forces, while also benefitting from existing and speaking from within them. The result, Spivak argues, is that “[p]ersistently to critique a structure that one cannot not (wish to) inhabit is the deconstructive stance.”59
We suggest that Elizabeth's narrative contained multiple examples of Spivak's delineation of the impossible no. Recognizing the limitations inherent in applying a postcolonial concept to spaces and contexts outside of postcoloniality, we still find productive value in using Spivak's concept to think through our participants’ birthing narratives. The first instance in which we understand Elizabeth as existing within a space of the impossible no is when she participated in childbirth classes while pregnant. While in the actual classes, she was highly critical of the information presented to her; however, she stated that she could not not attend the meetings because of the explicit expectations from family and friends. In a sense, the social pressure to attend was too strong for Elizabeth to resist. Abstaining from childbirth classes may have made her susceptible to the “selfish mother” stigma that is so prevalent within her current cultural context.60 Also, she did not have a choice in childbirth classes; women in her city either do not attend childbirth classes, or they attend the classes covered by their health insurance company at the hospital where they intend to give birth. Since self-education was immensely important to Elizabeth, she found herself in a space she could not not inhabit, and that left her with only one option: attend the childbirth classes provided by her hospital. The frustration she felt about inhabiting the space of the impossible no was palpable during this part of the interview, and she described how the nurse emphasized that childbirth was painful and dangerous.61 As Elizabeth recounted, “She had a long thing, how you change a diaper, how you, let's frighten you… all the terrible things that can go wrong if you do x, or y, or z.” Because of her self-education, Elizabeth knew these narratives were unnecessarily sensationalist and potentially harmful. Nonetheless, because of familial and social pressure and her own desire to exhaust all potential means of self-education, she felt forced to inhabit a space that she inherently disagreed with, a space that represented what she did not believe to be true about pregnancy and birth.
Similarly, Elizabeth felt forced into birthing her baby in a hospital because of societal pressure and the lack of available birthing options. Even though the hospital represented the medical model of pregnancy and birth, of which she was critical and suspicious, she could not just abandon this space. Although homebirth was technically an option, Elizabeth would not consider it because she wanted what she perceived to be the “safest” way of birthing her child.62 She was put in the position of having to inhabit the impossible no; she could not not want to inhabit the space of the hospital because it was the only “choice” she felt she had as a good mother. And yet, she entered this space with trepidation and apprehension; her understanding of routine procedures during hospital births had been shaped by her attempts at self-education and by conversations with her health professionals. During her interview, Elizabeth was able to simultaneously speak about her experiences from within the structure of the hospital and deconstruct it through her critiques.
As she neared her due date, Elizabeth's doctor explained that if she did not naturally go into labor within the next week, they would induce her, regardless of her objections. The doctor declared this assertively, despite their history of varying (and conflicting) calculations of the actual due date. The doctor used Elizabeth's fear of a C-section to coerce her into agreeing to an induction date. Experiencing, in her words, “mortal terror,” Elizabeth succumbed to being induced, leading her into inhabiting the medicalized space of the impossible no once again.
There are also multiple instances of Spivak's impossible no in Stephanie's birth narrative. When the nurses asked Stephanie numerous times if she was ready for an epidural, to which she repeatedly answered “no,” what made her ultimate agreement an impossibility to resist were 1) her Pitocin-induced contractions were unnaturally painful; 2) she was constantly reminded that she chose a painful birth; 3) she was constantly reminded that sedation would relieve her of her pain and her struggles with her nurses. Since she inhabited a doubled space where she was both dominated and dominating, Stephanie's impossible no was the moment she could no longer resist medicalization and felt broken and defeated. On the one hand, she was an advocate for unmedicalized childbirth as an alternative birth form and had her partner's support; on the other, she was the involuntary recipient of Pitocin, and felt the constant pressure from the medicalized birthing environment. The repetition of the question “Are you ready for that epidural now?” implies that “no” is never an appropriate or acceptable response.
The ultimate feelings of defeat do not appear to stem from Stephanie's final agreement to an epidural, but from her marginalized space in the hospital, where alternative childbirth was systematically undermined by dominant discourses of medicalization that refused to accept alternative conceptualizations of childbirth.63 And yet, while the “no” to the hospitalized labor process is impossible, Stephanie troubles this dominant space by expressing feelings of brokenness in a place that supposedly “fixes” people.64 Exposing the contradictory and violent nature of the medicalized system and the discrepancies between the hospital's purpose and its codified practices actualizes the deconstructive force that Spivak ascribes to the critique from within.65
In “Are Mothers Persons?” Bordo delineates national conversations and court cases related to the rights of pregnant and birthing women, and the rights often bestowed upon fetuses.66 Part of her thesis is that women's “subject-ivity” is compromised as the rights of the fetus are elevated: “Very simply put, that construction [the ontological argument used by fetal-rights activists] is one in which pregnant women are not subjects at all (neither under the law nor in the zeitgeist) while fetuses are super-subjects.”67 Paying particular attention to how the US legal system treats pregnant women, she argues:
In practice, our legal tradition divides the human world as Descartes divided all of reality: into conscious subjects and mere bodies (res extensa). And in the social expression of that duality, some groups have clearly been accorded subject-status and its protections, while others have regularly been denied those protections, becoming for all medical and legal purposes pure res extensa, bodies stripped of their animating, dignifying, and humanizing “subject-ivity.”68
Pushing this point further, Bordo explains how, when women's bodies are understood as res extensa, they are inevitably treated as “fetal incubators,” existing for no other purpose than to carry, feed, protect, and nurture the fetus.69 When we read Stephanie and Elizabeth's transcripts through Bordo's theoretical arguments surrounding subject-ivity, motherhood, and the increased emphasis on fetal rights, a number of provocative illuminations emerged.
First, and most obviously, both Stephanie and Elizabeth were stripped of their subject-ivity and treated as fetal incubators, albeit in different ways. While there are numerous subtle incidents of this sprinkled throughout Stephanie's interview transcript, the glaringly apparent example is the fact that she was stripped of her right to informed consent. As discussed earlier, Stephanie was, without her consent, administered Pitocin upon her arrival at the hospital. Stephanie had been confident in her birth plan, in which she explicitly stated, “I do not want Pitocin, I do not want a C-section… I do not want an epidural.” Informed consent is the most basic of human rights for individuals in hospital settings;70 yet Stephanie, arguably because she was pregnant and understood as merely a fetal incubator, was stripped of this basic right. She explained that there was “no option to ask them” to take her off the drip, which made her, in her own words, immediately insecure: “My brain is not thinking normally anyway cause I'm in kinda fight or flight.” This is why Stephanie prepared her birth plan in advance and discussed it with her physician. The presentation of false choices and the violation of informed consent was a recurring theme throughout the narratives of all our participants, and is similarly reflected in the literature.71 Bordo argues that this act, the denial of informed consent, strips a person of his/her subject-ivity:
The doctrine of informed consent is, in a very real sense, a protection of the subjectivity of the person involved—that is, it is an acknowledgement that the body can never be regarded merely as a site of quantifiable processes that can be assessed objectively, but must be treated as invested with personal meaning, history, and value that are ultimately determinable only by the subject who lives “within” it. According to the doctrine of informed consent, even when it is “for the good” of the patient, no one else—neither relative nor expert—may determine for the embodied subject what medical risks are worth taking, what procedures are minimally or excessively invasive, what pain is minor.72
Again, Stephanie's experience illustrates how the subect-ivity of pregnant women can be revoked, often as the personhood and rights of their fetus are seemingly elevated.
Similarly, Elizabeth was also treated as res extensa, or a body stripped of its humanizing subject-ivity. For example, even though her due date had been changed by various doctors throughout her pregnancy, she was forced to choose an induction date rather than choose whether or not to be induced at all. This false dilemma created a substantial amount of fear for Elizabeth, and during the week prior to her baby's birth, she was extremely anxious, fearful, and increasingly angry.73 Elizabeth, or rather Elizabeth's body, was understood as merely a fetal incubator, existing to uphold the subect-ivity of the fetus. The most dramatic and striking example of this was captured in Elizabeth's narration of the moments immediately following her son's birth.
[I] delivered him and then. … In the US they take the baby away to clean them up. I tried to hold on a little bit, but they were just like all of a sudden he was gone. … And I felt bloody, and vulnerable, and open, and exposed, and not in a position to say something assertively, and for all I knew there was a problem and no one really said anything. … I still felt you're lying on a bed in a sterile room that's cold with a cold IV fluid in you and there are bright headlights it feels like shining on your nether regions and people you don't know have just had their hands all over and in you.
The baby was moved from one incubator (her womb) and wheeled away in another, without further explanation to the mother. While the once-fetus-now-baby was being tended to, Elizabeth, the new mother, was left alone, uncovered, and vulnerable; no one attended to her needs because her work as fetal incubator had been completed. The personhood of the now-autonomous baby had been secured. Elizabeth recounted the moments after her son was taken and she found herself alone in the delivery room:
Your hands are still bloody from where you briefly held him because no one's thought to bring you something to wash your hands off because you just did the part they have to take care of which is the disease. … They know how to fix you, but I had red, blood-dried hands for about an hour before someone thought [that] I could go to the bathroom to wash myself.
Using it ironically, Elizabeth mirrors the language of health providers and insurance companies described previously; by referring to the pregnancy as the “disease” that is taken care of by the doctors and hospital staff, she uses a similar pathologizing metaphor.74 While the lack of “respect for the autonomy of the mother”75 was a prenatal and perinatal issue, now Elizabeth's postnatal body is treated as an object no longer required for the immediate survival or well-being of the fetus/baby. Thus, as the dependent fetus is promoted to independent neonate, the mother's body is further degraded from incubator lacking autonomy to incubator of no further relevance. In short, the Cartesian res extensa as human incubator becomes apparatus vacuus, the empty vessel.
THINKING BIRTH STORIES DIFFERENTLY
There are some stories and narratives that defy reduction, which is an essential component of traditional qualitative data analysis.76 This narrative inquiry elicited stories that, for us, required a commitment to making different kinds of sense from the data and being open to “thinking data differently.”77 We found, as Elizabeth A. St. Pierre and Alecia Y. Jackson suggest, “analysis occurs everywhere and all the time,”78 first unconsciously when we were drawn to feminist theorists while discussing the narratives, then deliberately when we plugged in these same theorists during our analyses. We also found multiple lines of flight.79 These are context-specific; different lines would emerge for participants in, for example, different countries or even regions within the United States. Sometimes the three concepts—feminist killjoy, impossible no, and subject-ivity—smoothly map onto each other, while at other times their contradictions become explicit and dissonant. For example, the way we use Spivak's impossible no challenges the sometimes overly simplistic feminist resistance narrative that can be created by Ahmed's feminist killjoy. As Michel Foucault writes, there is no pure space of resistance,80 and the impossible no illustrates how even those with the best of feminist killjoy intentions can get swept up into the institutional culture of the medicalization of pregnancy and childbirth.
Although we celebrated when our participants described how they refused to go along with what was expected of them, in many instances, the overdetermined space of the impossible no foreclosed potential feminist killjoy resistance. Women often have limited control over how they are being created as subjects, and the sorts of medical discourses within and through which they become subjects. Depending on the context, there can be serious repercussions for women who refuse, or who are not able, to go along with medicalized practices that are codified by institutional policies and procedures. Farah Diaz-Tello lists the many ways women who rejected medicalization or overmedicalized ways of giving birth were punished, including threats of court-ordered C-sections, calls to Child Protective Services, or forcible discharge from the hospital.81 In our participants’ stories, this manifested as ridicule and non-consensual medical interventions.
The space of the impossible no is predicated upon and enabled by understanding women's subject-ivity as delineated by Bordo. There would not be the dissonance between what women want and what they are subjected to at the hospital if the female body were not conceptualized as the fetal incubator and the birthing woman were not deemed pathologically unfit to make “rational” decisions.82 The entanglements of ideas and practices—including but not limited to, gendered understandings of rationality, codified interventionist medical procedures, discourses about the dangers of homebirth, and entrenched medical hierarchies within hospitals—serve to create spaces of the impossible no; these spaces are inevitably occupied by women who have been stripped of their subject-ivity.
Individual acts of resistance by the feminist killjoy are not sufficient; the female birthing body must be reconceptualized on the institutional and policy level. Further, it is unfair to expect women to be solely responsible for enacting feminist resistance, especially when they are the ones doing the physical and emotional work of pregnancy and childbirth within a system that continuously tells them to doubt themselves, give up control of their bodies to medical institutions, and understand their own needs and health as secondary to the needs and health of their baby. We need allies and advocates who listen to women and encourage them to make informed choices about themselves and their families,83 who challenge the stripping away of subject-ivity, and who call out spaces of the impossible no. In short, we need feminist killjoys at every institutional level to refuse to go along with the current normalized medicalization of pregnancy and childbirth.
Just as there is always “and… and… and…”84 in the rhizome of pregnancy and childbirth, there remain different, yet unexplored, nodes that add to the complexity of institutional and structural inequities that women experience. For example, the intersections of race, ethnicity, class, and age in relation to access to healthcare, health insurance, homebirth culture, etc. are vital considerations that beg further examination in the larger context of US women's experiences of pregnancy and childbirth.85 For example, within the United States, infant mortality rates for black babies are 2.4 times higher than for white babies.86 In order to shift our analytical focus onto different intersectional understandings of women's lives and experiences, other theoretical concepts could be plugged into the data, creating diverse entry points into the rhizome. In some epistemological and methodological frameworks, the context-specific nature of our work, and/or the theoretical specificity of our analyses, would be understood as a limitation of our study. Rather than a deficit or restriction, we understand these aspects of our analyses as a productive and useful layer of contribution to the existing literature about women's experiences of pregnancy and childbirth. As is true for all deconstructive projects, discussing and engaging with dominant discourses inevitably contributes to them, potentially (and unintentionally) strengthening them.87 However, as discussed, and as Kamala Visweswaran and Elizabeth A. St. Pierre and Wanda S. Pillow remind us, there are no pure spaces of resistance, and we are always working within and against the limits inherent in the decision-making required throughout qualitative data collection and analysis.88
Women's narratives deserve a more multi-perspectival feminist analysis. Currently, pregnancy and childbirth are framed within the medical model, which understands pregnancy as a dis-ease, and seeks to control and contain women during childbirth. Using multiple feminist theorists to read with and through our data allows us to think “on the verge of intelligibility” with our participants’ narratives.89 By doing so, we are working within Spivak's impossible no. We are simultaneously (inevitably) inhabiting our current contextual spaces—within which discourses of the medical model of pregnancy and childbirth dominate—while insisting on a deconstructive critique intent on troubling that same discourse.
During the writing and editing of this essay, the feminist killjoys in our city have been organizing. They have been refusing to go along with practices and policies considered typical. These women—many of whom are affiliated with the city's only local, independent, women's health clinic—have been providing free doula services to low-income women in hospitals around the city (despite pushback from some doctors and nurses), have been agitating for change with local politicians, and have actively sought to highlight the alarming statistics around infant and maternal mortality in the city's lowest-income zip codes. Additionally, they have been working towards creating a third space, outside of the hospital and not in the home, for women to birth their babies. At the time of the study, no birth centers existed in the city. Now, two years later, the clinic, which serves economically disadvantaged women and families, has raised enough money to start construction on a freestanding birthing center.
Throughout the process of garnering support and attention, we have witnessed feminist killjoys in action—activists who have forged alliances over the mutual recognition of institutionalized sexism, racism, and classism that curtails women's reproductive options and choices. Abortion and birth doulas, midwives, nurses, physicians, and regular citizens have come together to provide women with healthcare choices that women in other cities in the United States have come to expect, utilize, and rely upon. Their organizing has made some uncomfortable—by insisting that women have choices for childbirth outside of the hospital, they are necessarily pointing out the inadequacies of the medical model of childbirth. Nevertheless, their organizing has worked. The city is one step closer to providing alternative spaces that recognize and value women's subject-ivity by facilitating choice and agency.