Justine van der Leun’s recent piece in The Guardian has received a fair amount of attention in the childbirth community. It’s ‘I felt I was being punished for pushing back’: pregnancy and #MeToo and subtitled ‘Pregnant women are still being patronised, blamed for our bodies’ failings, and made to feel guilty about our choices.’
Van der Leun experienced a very complicated pregnancy a few years ago:
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Why have midwives replaced the factual ‘vaginal birth’ with “normal birth’ and replaced the factual ‘pain relief’ with ‘intervention’? [/pullquote]
I spent one third of 2015 – about 120 days – on bed rest. I moved only to visit a hospital or doctor’s office, where I was scrutinised and presented with a list of concrete and potential deficiencies. There was certainly something wrong with my cervix, likely something wrong with my hormone levels, probably something wrong with my placenta, and possibly something wrong with my baby’s heart. Every time I was examined – which was constantly – a new potential problem surfaced. Having already lost two pregnancies, I was overcome by the looming possibility of catastrophe. I refused to prepare for anything more than a week in advance, as if hope were interchangeable with hubris and therefore deserving of punishment.
The outcome was a healthy baby girl:
That panic ended two years ago, replaced by the more welcome panic of how to care for a baby. After so much dread, not a single could-go-wrong went wrong. I will never know if the precautions helped, or if everything was fine all along. My daughter, born healthy at full term …
Now Van der Leun is pregnant again and this is also a high risk pregnancy. But this time she is whining:
At my 20-week check, the ultrasound technician informed me that, while my baby was in perfect condition, my cervix – the portion of the uterus that stands between the baby and the world – was shortening prematurely, the condition that had caused me much grief two years earlier. The official diagnosis is “incompetent cervix”. In a “competent” female body, the cervix stays long and closed until full term, and then dilates. But in an “incompetent” female body, the buffoonish cervix can shorten and open early, allowing a baby to tumble out. The “incompetent cervix” joins a number of curious obstetric diagnoses: the “inhospitable uterus”, “hostile uterus”, “hostile cervical mucus”, “blighted ovum”. Meanwhile, men experience “premature ejaculation” and not “inadequate testicles”; “erectile dysfunction”, but never a “futile penis”. They exhibit problems, but their anatomy is not defined as lacking. Pregnant women over 35 are of “advanced maternal age”, just a slight improvement over the previous term, only recently defunct: “elderly”. Those who have suffered more than two miscarriages are known as “habitual aborters”. We experience “spontaneous abortions”. A bad habit, that impetuous self-aborting: if only we had the self‑control to stop.
Oh, grow up! It’s hard to imagine anything more immature than facing a life and death situation and whining about the language that doctors used to describe it. Van der Leun seems to believe that this both patronizing and misogynistic:
The expectations placed upon women by the obstetric establishment – especially if our pregnancies don’t follow a perfect course, and often even when they do – are presented as normal. The field of obstetrics requires women to enter into an absurd realm, or perhaps to simply remain within the absurd realm in which we already exist. We’re subjected to methods that verge on Victorian: to remain prone, and in extreme cases tilted on a hospital bed at an angle for months at a time; to forgo work, pleasure, money; to allow painful interventions and invasive procedures; to agree to major abdominal surgery. We’re told it’s for baby’s sake; anything other than blind acceptance is selfish at best, murderous at worst.
I take that back, it’s even more immature to be so self-absorbed with pregnancy as to forget about the many non-pregnant people who struggle with kidney failure, heart failure, liver failure, and other failures of vital organs such as the pancreas in diabetes. No doubt they’d trade a lifetime of death defying struggles — dialysis, insulin, transplant surgery or heart surgery — for a few months of lying in a hospital bed forgoing work, pleasure and money and ending up cured. Sadly for them, their struggles are often permanent, lasting until an early death.
Where did Van der Leun get the idea that pregnant women are uniquely patronized by medical language? From midwives, of course:
Decades ago, a group of midwives, frustrated that pregnancy was treated as a condition and women as incapable children, created an empowering birth ideology, encouraging women to be confident about their bodies’ life-giving abilities…
Van der Leun doesn’t stop to ask herself why it was providers of care who insisted that the existing language was patronizing, and why it was these same providers whose concern for patronizing language did not extend to non pregnant women; they weren’t equally upset about devastating language like premature ovarian failure. If she had, she might have concluded that complaints about language were midwifery marketing tools, crafted to claw back patients from obstetricians, not to improve patient care.
Had Van der Leun really thought about it, she might have wondered why those same midwives proceeded to exchange purportedly patrionizing obstetric language for equally patronizing midwifery language like replacing the factual ‘vaginal birth’ with “normal birth’, or replacing the factual ‘pain relief’ with ‘intervention’. She might have realized that while obstetricians used what she considered objectionable language to promote the best possible outcome for mother and baby, midwives deploy patronizing language to leverage guilt and shame in an effort to increase their employment prospects.
In the ultimate irony, Van der Leun resorted to patronizing, misogynistic claims about female obstetricians, dismissing them with:
Women now make up more than half of obstetrician-gynaecologists, but the field was designed and dominated by men for centuries.
Architecture was designed and dominated by men for centuries but no one accuses female architects of knuckling under to men when they employ the exact same principles of structural engineering. The ministry was designed and dominated by men for centuries but no one implies female ministers are knuckling under to men when they preach about the exact same God. So why should female obstetricians be cavalierly dismissed as incapable of making their own decisions? Because there is no equivalent in those professionals to midwives who want their clientele for themselves.
Is the language of medicine patronizing?
I suppose it is if you think your self-worth resides in your organs. Fortunately, no one thinks their self-worth should be based on the function of their kidneys, liver or even their heart, yet women like Van der Leun think it ought to reside in their uterus and vagina.
That’s misogyny not on the part of doctors, but on the part of midwives and others like Van der Leun who reduce women to the function of their reproductive organs.
