In this article, I argue that many women lack the epistemic resources that would allow them to recognise the practice of vaginal examinations during childbirth as violent or as unnecessary and potentially declinable. I address vaginal examinations during childbirth as a special case of obstetric violence, in which women frequently lack the epistemic resources necessary to recognise the practice as violent not only because of the inherent difficulty of recognising violence that happens in an ‘essentially benevolent’ setting such as the (...) medical one, but also, and mainly, due to the pervasive sexual reification of women under patriarchy and the pervasive shame to which women are subjected. My argument is that the practice of vaginal examinations is indeed experienced – bodily apprehended – as violent by many women, but that full epistemic recognition of this violence is frequently obstructed because the experience perfectly coincides with the normal phenomenological situation of women within patriarchy and thus cannot really be framed as violent. A phenomenological analysis presenting the embodied experience of women under patriarchy as always already essentially tied to sexual availability and commodification, and to shame, will explain this epistemological impairment. A phenomenological take on Judith Butler’s distinction between ‘recognition’ and ‘apprehension’ informs my analysis: I deploy it to provide a richer, more nuanced response to the question of why vaginal examinations are not fully recognised and expressed as violent – even when they are, frequently, apprehended as such. Furthermore, Butler’s ideas about the epistemic ‘framings’ through which we make sense of different kinds of lives (grievable versus ungrievable) will help me to explain how the patriarchal sexual reification of women in fact already frames sexual violence as not-violence – which ultimately also prevents labouring women (and obstetrics staff) from recognising vaginal examinations during labour as violence. (shrink)

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. (shrink)

A hallmark of good antenatal care is to respect prospective parent’s choices and provide information in a way that encourages their autonomy and informed decision making. In this paper, we analyse the meaning of autonomous and informed decision making from the theoretical perspective and attempt to show how those concepts are described among prospective parents in early pregnancy and in the public media in a society where NT screening is almost a norm. We use interviews with Icelandic prospective parents in (...) early pregnancy (N = 40) and material covering the discourse around prenatal screening in the media over 5 years period. Our analysis indicates that both prospective parents and the public media include ethical terms in their rhetoric around prenatal screening although those concepts differ in their expression. We conclude that the context in which these decisions are taken does not encourage moral reflection. Prospective parents describe that there is a lack of dialogue with professionals when decisions are made about screening. With routine offer of screening the conceptualization of bioethical concepts finds its own way through a mainstream discourse which has limited connections to the theoretical notions. This has been neglected in the implementation of screening, as limited effort has been subject to audit with reference to explore how the offer of screening and informed choice is experienced among prospective parents. (shrink)

Obstetric violence—violence in the labor room—has been described in terms not only of violence in general but specifically of gender violence. We offer a philosophical analysis of obstetric violence, focused on the central role of gendered shame for construing and perpetuating such violence. Gendered shame in labor derives both from the reifying gaze that transforms women's laboring bodies into dirty, overly sexual, and “not‐feminine‐enough” dysfunctional bodies and from a structural tendency to relate to laboring women mainly as mothers‐to‐be, from whom (...) “good motherhood” is demanded. We show that women who desire a humane birth are thus easily made to feel ashamed of wanting to be respected and cared for as subjects, rather than caring exclusively for the baby's well‐being as a good altruistic mother supposedly should. We explore how obstetric violence is perpetuated and expanded through shaming mechanisms that paralyze women, rendering them passive and barely able to face and fight against this violence. Gendered shame has a crucial role in returning women to “femininity” and construing them as “fit mothers.” To stand against gendered shame, to resist it, on the other hand, is to clearly challenge obstetric violence and its oppressive power. (shrink)

Traditional western conceptions of pain have commonly associated pain with the inability to communicate and with the absence of the self. Thus pain, it seems, must be avoided, since it is to blame for alienating the body from subjectivity and the self from others. Recent work on pain, however, has began to challenge these assumptions, mainly by discerning between different kinds of pain and by pointing out how some forms of pain might even constitute a crucial element in the production (...) of subjectivity. This article deals with the specific form of pain that is labour pain. Pain in labour has been investigated in medicine and lately, copiously, within the social sciences. Analyses from a more philosophical perspective are still very much missing, however, and in developing such analyses, de Beauvoir’s ideas on subjectivity as inherently embodied, as situated, and as profoundly ambiguous when authentically lived, appear to be of significant use. (shrink)

Drawing on sociological and anthropological studies, the aim of this article is to reconstruct how obstetric technologies contribute to a moral conception of pregnancy and motherhood, and to evaluate that conception from a normative point of view. Obstetrics and midwifery, so the assumption, are value-laden, value-producing and value-reproducing practices, values that shape the social perception of what it means to be a “good” pregnant woman and to be a “good” mother. Activities in the medical field of reproduction contribute to “kinning”, (...) that is the making of particular social relationships marked by closeness and special moral obligations. Three technologies, which belong to standard procedures in prenatal care in postmodern societies, are presently investigated: informed consent in prenatal care, obstetric sonogram, and birth plan. Their widespread application issupposed to serve the moral goal of effecting patient autonomy. A reconstruction of the actual moral implications of these technologies, however, reveals that this goal is missed in multiple ways. Informed consent situations are marked by involuntariness and blindness to social dimensions of decision-making; obstetric sonograms construct moral subjectivity and agency in a way that attribute inconsistent and unreasonable moral responsibilities to the pregnant woman; and birth plans obscure the need for a healthcare environment that reflects a shared-decision-making model, rather than a rational-choice-framework. (shrink)

ABSTRACT In recent years, the medical establishment has been speaking in favor of women's autonomy in childbirth by advocating cesarean delivery on maternal request (CDMR). This paper offers to look at the ethical dimension of CDMR through a feminist critique of the medicalization of childbirth and its influence on present‐day medical ethics. I claim that the medicalization of childbirth reflects a sexist bias with regard to conceptions of the body and needs to be used with caution when applied to women's (...) reproductive health. I then use this perspective to critically analyze the position of the American College of Obstetricians and Gynecologists (ACOG) on the ethics of decision‐making in patient‐choice surgery. I claim that informed consent cannot be meaningfully exercised unless women are made aware of the sexist underpinnings of the medical model of childbirth and its influence on the ethical reasoning of the American College of Obstetricians and Gynecologists. I also express concern about the effects of normalizing patient‐choice cesarean sections on the choices available to pregnant women using as examples the institutional rules on mandatory cesarean sections for women with a previous cesarean delivery or breech presentation. I conclude with a call for more research into the real cost of convenience in CDMR, particularly as our increasingly strained publicly funded healthcare system would greatly benefit from the de‐medicalization of normal body functions rather than an increased dependence on costly surgical technology. (shrink)

The medical model of childbearing assumes that a pregnancy always has the potential to turn into a risky procedure. In order to advocate humanized birth in high risk pregnancy, an important step involves the enlightenment of the professional’s preconceptions on humanized birth in such a situation. The goal of this paper is to identify the professionals’ perception of the potential obstacles and facilitating factors for the implementation of humanized care in high risk pregnancies. Twenty-one midwives, obstetricians, and health administrator professionals (...) from the clinical and academic fields were interviewed in nine different sites in Japan from June through August 2008. The interviews were audio taped, and transcribed with the participants’ consent. Data was subsequently analyzed using content analysis qualitative methods. Professionals concurred with the concept that humanized birth is a changing and promising process, and can often bring normality to the midst of a high obstetric risk situation. No practice guidelines can be theoretically defined for humanized birth in a high risk pregnancy, as there is no conflict between humanized birth and medical intervention in such a situation. Barriers encountered in providing humanized birth in a high risk pregnancy include factors such as: the pressure of being responsible for the safety of the mother and the fetus, lack of the women’s active involvement in the decision making process and the heavy burden of responsibility on the physician’s shoulders, potential legal issues, and finally, the lack of midwifery authority in providing care at high risk pregnancy. The factors that facilitate humanized birth in a high risk include: the sharing of decision making and other various responsibilities between the physicians and the women; being caring; stress management, and the fact that the evolution of a better relationship and communication between the health professional and the patient will lead to a stress-free environment for both. Humanized birth in a high risk pregnancy is something that goes beyond just curing women of their illnesses. It can be considered as a token of caring, and continued support, which positively consolidates the doctor-patient relationship. As yet, it has not been described as a practiced guideline, due to its ever-changing complexities. (shrink)