Motherhood and nurturing in the age of obesity

Keenan, Julia and Stapleton, Helen, 2010,  Bonny babies? Motherhood and nurturing in the age of obesity, Health, Risk and Society, Vol. 12, No. 4, 369-383

 This article grabbed my attention as I am very interested in issues of feeding and nurturing as core activities of motherhood practice, as well as in body image issues. In this article, Keenan and Stapleton draw on women’s accounts of their interactions with health professional and families to see how the prevalent and powerful biomedical discourse around obesity plays out in practice. The authors describe the importance of this discourse for this study as involving the medicalisation and moralisation of large bodies in pregnancy as ‘obese’ and thus the creation of subjects ‘at risk’ to themselves and their foetus/infant.

This paper is based on findings from a qualitative research project, conducted from 2006-2008 in a city in the north of England, and this paper draws mainly on accounts and experiences told by  participants with large bodies.

First they discuss the World Health Organisation’s definition of obesity as ‘excessive fat accumulation that may impair health’. This definition is operationalised many times through the use of Body Mass Index (BMI), based on a height to weight relationship, which is a simple and cheap tool. A BMI of over 30 is most commonly seen as obese. For children, categories are based on the percentile position on ‘normal’ growth scales. Obese children are considered those which surpass the 95^th or 98^th percentile.

The authors discuss the different problems that the use of BMI to figure out risks brings, and show how critical studies of obesity question the link between BMI and health, which often are translated into policy in oversimplified ways that create definitions of certain bodies as fat and problematic.

The authors show how biomedical research links appropriate pre-pregnancy weight, weigh gain and nutrition in pregnancy with satisfactory foetal outcomes, and more and more with infant health over the life-course.

In the biomedical literature, a BMI over 30 is linked with

‘increased risks of miscarriage, gestational diabetes,  high blood pressure and pre-eclampsia,  blood clots, haemorrhage following birth, increased risk of induction and instrumental delivery, post-caesarean wound infection, genital and urine infections, giving birth to an infant with an abnormally high birth weight and problems with breastfeeding; obesity is significantly implicated in maternal deaths (CEMACH 2007). Babies born to ‘obese’ mothers are at increased risk from premature birth, still birth and birth abnormalities and are more susceptible to health problems, including obesity and diabetes in later life.’

However, as the authors point out, there is still debate about how much of an increased risk obesity brings, and these risks are not exclusive to women with BMI over 30. And there are contestations to the notion that adult health is predetermined by infant body size.

But this discourse comes strongly through social and cultural norms concerning the right way to prepare for pregnancy, and is framed in the media in this terms. This authors point out how health has increasingly moral connotations, and how being obese, this ‘risky’ bodily state is seen as an individual and moral failure.

However, given this atmosphere, the authors were surprised to find that women in antenatal interviews reported that health workers did not discuss ‘obesity’ with them. Very few were under consultant care due to their weight, and most of them were not aware of any of the risks listed above, apart from those few who were self-informed. In the UK, maternal weight in pregnancy is not monitored. So apart from a one-off measurement of weight and height at the beginning, weight is only informally monitored by midwives.  Women with a family history of diabetes, or with a BMI over 30, where tested for gestational diabetes, and monitored if the results were positive.

The authors argue that it is understandable that health workers were reluctant to broach the subject, as despite the urgency of the obesity debates, there are still no clear policy guidelines, support or resources, and health workers do not want to make women feel guilty, uncomfortable, or encourage them into weight regulation. Although the authors do not go into this in detail, they highlight that negative comments were always given by family, their social circle or the media.

In this way, weight was not made an issue during pregnancy by health workers, and while attempts at discussing this issue by participants were met with reassurance, some women found this helpful, while others found it frustrating, as they would have liked some support and discussion. This was especially the case for women in terms of birth plans. Most of them were led to believe that they could just plan whatever birth they wanted, but they were unaware of the regulations that prohibit certain options for women with BMI over 30, and they felt that, at the last minute, they were snatched of their choices.

Furthermore, the lack of dialogue about the risks for women and their babies meant that when health professionals, especially higher rank ones, mentioned weight as the cause of ‘poor outcomes’, these were dismissed by women. The approaches that higher ranking health professionals used were crude, induced blame and were insensitive, and did not work in terms of the goals of these professionals – raising awareness about the risk of excess adiposity – but made women, quite rightly, discredit their comments.

In terms of infant size, the authors note that across their data as a whole, underweight or premature babies generated much more anxiety around their weight than a baby deemed to be ‘big’. The authors show that the much like the more traditional understandings of ‘bonny’ babies, bigness and a good appetite were seen positively, and not as a problem. The only exception to this unproblematised view of weight gain was done by women who managed diabetes through pregnancy.

The authors end up concluding that while they do not want to contest the studies that relate excess adiposity with increased risks for women and infants, they want to identify the problems that using a measure such as BMI can bring in terms of policy, or in its translation in the treatment of individual women to improve birth outcomes and health. This article shows the disparity between discourses and practices. At the moment, health workers do not encourage women to manage biomedical risks, within pregnancy, but there are many policy and guidelines in the pipeline that are probably going to change this. Moreover, this article underlines how it is not possible to understand the medicalisation and moralisation through the work of one type of actor, such as health workers, but other social actors need to be included.

I liked this article because it tackles a sticky issue: how to understand in a measured way the risks that ‘obesity’ might bring, while problematising deterministic studies and the individualisation and moralisation of this problem. At least I find it tricky. I am worried about what these studies are showing, and scared, frankly, but at the same time, am wary about how this might be translated. If I had to bet, I would say it will probably end up in blaming the mum, and not only for a difficult pregnancy and or birth, but for the health of their children now and forever. Which is not the outcome I would like to see, but it is one that is taking shape in the media for instance. But just because it is sticky does not mean we can ignore it, or act as if nothing happened….It is the same with women’s bodies and fat shaming. We don’t need more of that, and we do not need more women who are not happy in their bodies. In this case, how could there be support for women, without it being medicalising, moralising and individualising the problem? As I say, tricky.

Lucila

Is it good to have more public births?

Robyn Longhurst, 2009, You Tube: a new space for birth?, Feminist review, 93, 46-64

Robyn Longhurst analyses in this article the rise of a different space for birth, a more ‘public’ one at that: birth videos uploaded on You Tube. As she points out, women have long been expected to birth in particular ways, and in particular contexts. In the western contemporary world, birth is mainly done in private spaces, with only a few close members of family present, and it takes place in the hospital or (in a lesser number) in the home.  But now, there is also You Tube, where millions can watch videos of women giving birth at the click of a button. For this study, Longhurst analysed hundreds of videos and its comments, and concluded that while You Tube has the potential to open up new windows on birth, at the moment this is not realised. As she states,

‘You tube does not overcome or render insignificant material expressions of power, instead it typically privileges US centric view of births, reiterates discourses of ‘good’ mothering, and censors particular (mainly vaginal) representations of birth.’

I was interested in this article because I am curious about the spatiality of motherhood, that is, the spaces in which motherhood is performed.  And I am ever amazed at birth, love reading about it, and hearing birth stories. I am one of those people who can listen to your detailed birth story, without getting bored… yes, I know, weird. Reading this article was interesting as it figured a different space where motherhood, and in this case birth is done, which is complex, as it is at the same time, material but virtual, intimate but public, raw but edited. And of course, I had to go and have a look (hmmm, ‘interesting’ to see it from the other side…).

Coming back to the article, the author argues that bodies are always located, and what this means in this case, is that You Tube is not just a backdrop, but constitutes these birthing bodies too, as much as these bodies constitute You Tube. She shows how all the videos represented the birthing subjects as ‘good mothers’ –selfless, loving, kind, adoring – through words, images and music. Furthermore, a particular normativity of birth comes through, a particular way of ‘doing it right’, which includes feelings but also technologies (natural, induced and C-sections), positions, rituals (for example who cuts the cord) and places (hospital, birthing centre or home) of birth, and type of families too (hetero-normativity). This also reflects where the videos are being posted from, mainly, it seems, from the US. And who is posting these videos – people who obviously have enough resources (material and skills) to own a video camera, edit the video, and put it online. As much as You Tube is a technology that can be used to share videos globally, US users predominates and create a certain sense of what is normal, or expected. As the author points out, though there are examples of ‘other’ types of birth, most viewers will only see a narrow range of birthing experiences represented.

Finally, Longhurst analyses how certain types of videos are censored, especially vaginal births, and how also many are deemed inappropriate for minors, even though this is not the case for animal births, or even very graphic representation of c-sections. Objections to these videos do not come only because they cause abjection (as many comments make explicit) but she analyses how this has to do with vaginas being ‘eroticised orifices’. When women show their birthing bodies in public, instead of keeping them, modestly, in private, they are partly contesting mainstream notions of good mothers, even though at other times, it confirms these, as I described above.

Longhurst concludes this article with a cautious note. She shows how important it could be for birth videos to be more widely available, but also reminds us of the exclusivity of these virtual geographies, and of the ways that most of these videos reinforced normative western reproductive views of birth.

While this article had at the times the feel of being still a bit raw, it worked to give me tools to think about motherhood in more spatial ways as well as to remind me of the different ways in which images, spaces and bodies are co-constituted. The author ends with an interesting comment on the importance also of thinking about how these images will be seen, digested, used, which will probably depened on gender, on experience, on sexuality, class, culture and so on.

I remember midwives in the NHS prenatal day course were happy about being able to see some more real labours online, because before they only had some not so good 1970s videos only. I also think that visibility of birth practices, especially if it allows for difference, as Longhurst argues, can be beneficial. However, I was left wondering who would these videos benefit. Not that there is a need for beneficial outputs, I guess. But what I mean here is that I am not really sure if it is really that good for mums to be. Or more precisely, I am not sure it would have been so beneficial to watch these videos before ever having  a baby. Because now I know how it feels, looking at women giving  birth gives me less of a feeling of ‘otherness’. In other words, it would have probably been too far removed from my experience to be able to understand it (and not freak out). Also, because I was the person giving birth, the images I have are totally different from those that can be seen from a camera, and that were many times the object of these videos.

But obviously, it is not the same for every person. And I do think that health workers, midwives, and mums probably get more out of these, and well, it could do some good for men to look, in order to get a bit more appreaciation here 😉  (though there was a story within this article about using videos of labour for a pornographic film – it seems pregnant women are already a hit…how about that?? I am suggesting here another type of appreciation…).

What do you think? Have you watched videos of birth? Were they useful? Would you film your own birth?

Lucila

ps: I edited it again after I published it, sorry, it felt a bit incomplete!

The materials of mothering

Boyer, Kate and Boswell-Penc-, Maia, 2010, Breast pumps. A feminist technology, or (yet) “More Work for Mother”? In Layne, Linda, Vostral, Sharra and Boyer, Kate (eds.) Feminist Technology, University of Ilinois Press, 119-135. (Women, Gender, and Technology)

Boyer and Boswell-Penc enquire in this chapter whether breast pumps can be considered a feminist technology. I find this article interesting in that it focuses on one example of the stuff, that is,  the materiality, which makes up modern motherhood and examines what roles this technology play, what does it enable, and what are the risks that it brings, through analysing  the cultural context of its emergence but also by analysing its use in practice.

Their work focuses on the use of breast pumps in the waged workforce in the US, one of the countries where women have less maternity leave in the world. One of the questions which frames this study is understanding if the breast pump is a feminist technology or if it is it another device which, as Ruth Schwartz Cowan (1983) argues, creates ‘more work for mother’, as many other so-called labour-saving devices.

In this chapter they look at the cultural context in which the breast pump emerged – a time (60s-70s) where there was growing awareness and advocacy for the benefits of breast milk over formula, and a moment when higher number of women were returning to the waged workforce. The latter practice was due to different reasons ranging from economic restructuring, the need for double wages, and the fact that women were occupying better managerial positions. They describe how, in the 1990s, the technology evolved to be lighter, portable and cheaper, and jumped from being mainly hospital-based, to being available for retail.  

The argument for it being a feminist technology stems from the way that using this technology allows more mobility, more temporal and spatial freedom to the mother. The breast pump can bring a much needed break for mothers and it allows for mothers to break the cyclic time loop that new mothers who breastfeed are in – the two hour window to do things!- as well as the necessary proximity to the child. It also expands the choices that women have in terms of infant nutrition, as well as serve other important purposes, such as relieve engorgement in mothers who choose not to breastfeed, and help initiate breastfeeding for mothers who adopted an infant. Moreover, its use in waged workplaces could help push the boundaries of the private/public, by bringing to work an activity normally done in the privacy of the home.

However, these authors point out that much of its liberatory potential in terms of waged work is constrained by attitudes about pumping (and general lactation), issues about the technology, workplace design and the politics around actual pumping. Breast pumps, thus, have to be understood within its actual use, which is something that these authors delve into. They show how attitudes to pumping at work make women who pump, as well as the breast milk itself, feel ‘out of place’. The strong feelings that breast milk brings out is seen, for example,  in the case where women were fired for leaving their breast milk stored in the communal fridge. For women who pumped at work, the search for privacy and the sense of embarrassment around pumping, made them look for different strategies that would allow them not to be seen or heard (electric breasts pumps can be very noisy!), such as going to feed to the car, in the medical centre, in an unused office/conference room. Other constrains also include finding the time for it, as often employers do not structure extra breaks for this. What this shows is that the responsibility of finding a place and a time for this activity is down to the individual. Moreover, it highlights the reasons for the uneven distribution of its use, in terms of class especially, as the possibility of having this extra space and time is most likely to be in middle income jobs, rather than low income ones.

Furthermore, these authors also highlight some of the risks that this technology can bring to feminist struggles. By providing a technical and individualised fix to the question of how to combine lactation with work, it might keep employers off the hook in terms of providing other, and maybe better, alternatives. In addition, as these authors show, this technology has something in common with other technologies, such as communication technologies, in that they give more mobility, more spatial and temporal freedom, but it also raises the expectations of what can be done. The authors show that as much as this technology increases choices and provides flexibility, there is a risk that it could be used against efforts for longer maternity leave or on-site care, for instance.

What I found fascinating is that this article makes me think about the different things that make up the practices of mothering, and how each of these things are performative in more than their utilitarian sense. They work to highlight questions of race and class, as it has been shown in this article. I would say that things and technologies also play a role in identity formation, as they act as markers of inclusion in certain groups. In a sense, I think that they are also part of the ways of evaluating a mother’s performance – I am thinking here of the pressure I felt the first times I tried to put up or down the buggy in public, for instance!

We are surrounded by stuff in our practices as mothers: buggies, breasts pads, sterilisers, cots, nappies, dummies, bottles, special clothes for breastfeeding, high chairs, car seats. And the list can go on and on. Leaving out the stuff of motherhood would impoverish our understanding of the politics of motherhood/parenthood, which is why I find what these authors do, that is, questioning the theoretical possibilities but also the complexities that seeing and thinking these technologies and things in practice bring about, is a crucial exercise.

Measuring mothering

Rebecca Kukla “Measuring Mothering” The International Journal of Feminist Approaches to Bioethics, Vol. 1, No 1, 2008, pp. 68-90.

In this article  Rebecca Kukla examines how mothering is measured according to certain standard points in time at which mothering is considered to be of paramount importance: for instance, at the first ultrasound test and when making choices about the birth and about feeding the baby. Kukla argues that mothering is a lifelong process and that mothers cannot be judged according to how they behave at certain moments that are culturally and socially constructed to measure their emotions and reactions to their babies. As Kukla points out, measuring mothers’ behaviour at certain given moments can hardly evaluate their behaviour as future mothers.

Although I agree with Kukla’s analysis up to a point , I feel that certain matters need to be disentangled. First, the question of measuring in relation to judging; second, the question of bounding v. controlling; and third, the cultural construction of the ‘good mother’.

Concerning the first point, Kukla rightly uses the term measuring rather than judging when she refers to mothers. According to the Oxford Dictionary, measuring means assessing the importance, effect or value of something, whereas judging refers to forming an opinion or a conclusion. Although I sympathise with the effort to remove judgement from the debate, the fact is that women are judged rather than measured when it comes to their mothering. 

When talking about mothering performance, the issue is still much around forming an opinion rather than giving a value, as Kukla shows when referring to “good mothers”. For this reason I believe that the whole discussion would more appropriate if it considered why mothers should be measured or judged at all rather than whether good mothers can be measured by their behaviour at certain given moments. The problem is that mothers are measured/judged by social and cultural constructions that are later endorsed not to empower women but to make them feel insecure and dependent.

Second, the question of bonding v. controlling: according to Kukla, the first ultrasound in pregnancy has moved from a being required medical protocol to being a social and cultural activity where future mothers’ reactions to this first picture of their baby are observed and measured. Although I agree with this statement, I also think that the first ultrasound event is very much the result of paranoid Western control of every single aspect of nature and birth. As Douglas and Michaels shown in The Mommy Myth, the industry of controlling, protecting and providing all types of safety gadget for babies and toddlers grew dramatically in the 1980s, forcing parents to endlessly evaluate their children’s activities, almost exclusively according to safety criteria. This paranoia places mothers as the only experts responsible for the health and safety of their children. Admittedly, the first ultrasound screening poses a question of measuring v. bounding, but also one of control, increased paranoia and fear of life.

Finally, I must confess that I was surprised to see how Kukla refers to good mothers as mothers who give birth naturally without any sort of pain relief. This is definitely a cultural and class construction belonging to the Anglo-American middle class experience. In Spain, the country I come from, people considered my option to have a natural birth “stupid” (really!) and “masochist”, and I was not in the least considered a better mother than my friends and family members who had epidurals and bottle-fed their babies. In fact in Spain natural birth options (especially home births) are seen as dangerous, and those who choose them, freaks. In sum, the narrative of a good mother is a social and cultural one in which women are subject to fashion and dominant opinions at a given place and time.

This brings me back to the question of why mothers should be measured/judged at all, and most of all to how and when the battle to make the personal political turned into a blaming and scrutinizing game in which my personal becomes public. I feel that there is a need to go back to basics and revise the feminist slogan that the personal is political, because somewhere and somehow our beliefs that were stolen,. Bringing problems and issues that were considered private (reproduction, mothering) into the public arena suddenly became bringing public judgement on our private lives. In my view, the question remains very much why there is so much measuring and judgement of mothering.

Natalia