Health

The drive for 'natural motherhood'

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Image caption Are there set ideals about how to be a mother?

The very personal issue of how a woman gives birth and feeds her baby is subject to much public debate.

In this week's Scrubbing Up, Alison Phipps, director of gender studies at Sussex University, suggests women are coming under undue pressure to conform to "natural motherhood", deemed the "ultimate feminine achievement".

This April, Brazilian authorities ordered 29-year-old Adelir Carmen Lemos de Goés to have a Caesarean section because her baby was breech. She was taken to hospital - under a court order - by police officers and had the operation against her wishes.

But when the case reached Western media, it seemed that the C-section itself was the horror, not the fact that it was forced.

Headlines such as 'Inside a War on Natural Birth', preoccupations with the health of the foetus (as if delivering a healthy baby surgically was the real crime), and analyses of global Caesarean rates all betrayed the status of 'natural birth' as paragon of motherhood.

In the 1980s, the World Health Organization (WHO) defined a "normal birth" as one low in intervention, stating that women with "low risk" pregnancies should not be unnecessarily interfered with.

By the 2000s, this term had become common in the UK and elsewhere.

However, during that time protecting women from medicalisation had become pressuring them to give birth "naturally" whether they wanted to or not.

Outcomes were being measured and targets were being set.

Empowered?

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Image caption Bottle-feeding is often criticised

Today, the idea of "normal birth" unites a coalition of governmental and professional bodies, non-governmental organisations, community groups and activists.

It's the apex of "natural motherhood", a package which also includes a glowing, uncomplicated pregnancy and exclusive, extended breastfeeding.

This is the ultimate feminine achievement - women are empowered, we are told, by experiencing labour pains and feeding at the breast.

This needs to be set in context.

In the 1970s, feminists fought against the medicalisation of motherhood, arguing that women had been disempowered by the establishment.

They were right.

However, the pendulum has now swung back again, with women who don't achieve the new "natural" ideals experiencing depression and feelings of failure.

Caricatures

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Image caption Why is a 'natural' birth always seen as the 'right' way?

There are good reasons why "natural motherhood" is hard.

A lot of them are structural - maternity services are stretched and extra support costs money, whether it's a doula or hypno-birthing classes.

Women who don't get much maternity leave often can't breastfeed for long.

There are also a host of medical, psychological and practical reasons why birth interventions or infant formula might be needed.

However, these are often ignored - instead, women who eschew the "natural" are caricatured as immature, ignorant and selfish.

Last year, socially excluded mothers in South Yorkshire and Derbyshire were offered £200 in shop vouchers to breastfeed for six weeks.

Nobody explained how this was going to help babies with tongue-tie to latch on, or persuade bosses to offer pumping facilities.

A lack of support

In our culture - and health service - we revere personal choice.

Except, it seems, when it comes to women's bodies.

In 2011, an outcry followed guidance issued by the National Institute for health and Care Excellence (NICE) which stated that the final decision about whether to have an elective Caesarean section should be the mother's.

Research shows that birth trauma is more often about lack of support than the mode of delivery.

In 2011, a UK Birth Trauma Association survey revealed that many labouring women had been denied the pain relief they requested.

In 2012, Amanda Braithwaite lost her overdue baby girl, something the family believe was due to Amanda being refused a C-section by doctors who had assessed her as 'low risk'.

Is her story any less harrowing than that of Adelir Carmen Lemos de Goés?

The experiences of Adelir Carmen Lemos de Goés and Amanda Braithwaite are horrendous, but even away from these extremes, surely delivering "naturally" or surgically under duress are as bad as each other.

Nowadays, a "natural" birth is the only "right" one. But right for whom?

If it's not a choice, then "natural motherhood" isn't about women's empowerment.

And if it makes a woman miserable, then it's probably not best for her baby either.

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