What is feminism? My definition
I’m interested in epistemology – the study of knowledge – so my definition of feminism relates to feminism as a body of knowledge, a way of knowing, and therefore acting, in the world. Feminism is the knowledge that women and girls have been systemically disadvantaged in the world and continue to be disadvantaged. Women and girls are provided with less opportunity to participate fully in all social sphere and encounter more barriers to full participation. My definition of feminism is intersectional, in that it incorporates an understanding that other groups of people also face systemic disadvantage (for example people with disability, people of colour, those who are members of the LGBTQ+ community, and many others), and that when different layers of disadvantage map to the one person, significant forms of oppression co-exist.
With this knowledge comes responsibility. As a feminist, I have a responsibility to examine the social systems I participate in and to consider who the winners and losers are, in order to understand these systems and how they operate. With this knowledge I can (at least in theory) make decisions about how I conduct myself to avoid participating in and reproducing disadvantage for myself and others, including working to change the social world to be more equitable.
Is obstetrics feminist?
Ah, in a word – No. Obstetrics is inherently anti-feminist.
I also define obstetrics a way of knowing the world. We can ask to what degree the processes used to generate obstetric understandings and the knowledges generated from these align with feminist ways of knowing. Looking back at the history of the development of obstetric knowledge makes it clear that women were viewed as a mysterious object, to be examined, dissected, and explored in the pursuit of knowledge for men and by men. Jo Murphy-Lawless’ book Reading Birth and Death (1998) provides an excellent and detailed examination of the development of obstetric knowledge in Ireland if you want to take a deep dive into this idea.
Obstetric knowledge began to be built systematically in the 18th century as “male midwifery” emerged and was publicly sanctioned, while traditional midwifery knowledge and practice (with female practitioners) were increasingly disparaged. Post-mortem examination had become a common practice, used to generate better understandings of how death occurred and what the effect of disease processes was on the internal parts of the body that could not be seen on external examination (Shaw, 2012). In obstetric practice, dismembered women’s bodies and their dead babies were used for students to learn practical skills such as forceps birth or turning the baby to breech and pulling it through the structures of the pelvis. It is not difficult to imagine that the knowledge that was developed in this way did not incorporate understandings of birth as a physiological event, nor of women as active participants in their birth, nor of women as knowledgeable decision-makers who might want to have a say on what happens to their bodies.
The stethoscope was invented and in the 19th century fetal heart rate monitoring began to be used routinely during labour (Gültekin-Zootzmann, 1975). Increasing knowledge of chemistry, microbiology, and radiation during the 19th century set the ground for what we now call modern medicine. It is important to bear in mind that all knowledge exists because there is a knower and each knower occupies a certain social context (Smith, 2005). During the period of rapid expansion of medical knowledge, men where almost exclusively the generators of new knowledge, the teachers of knowledge, and the practitioners of obstetrics. Their knowledge work was undertaken against a background of cultural values that saw women as inferior to men, their primary purpose the keeping of the home, producing and raising children, and meeting the needs of their husbands.
The “facts” that have moved forward into our practice of obstetrics in the present time bring with them the vestiges of these cultural values. These patriarchal values can never be entirely divorced from obstetric knowledge and therefore from obstetric practice. Obstetrics is therefore not feminist.
Can feminisation of the obstetric workforce make obstetrics more feminist?
Over time the number of women gaining entry to the profession of obstetrics has increased, so that (in Australia at least) women now outnumber men. It would be incorrect to assume that being in possession of a female body would automatically undo the history of obstetric knowledge production and mean that women practicing obstetrics would do so in a way that would over turn the antifeminist history and knowledge of obstetrics. To gain entry to the profession, all obstetricians must be successfully oriented to the knowledge of the profession and demonstrate their ability to apply it in clinical settings. This is as true for women and nonbinary people as it is for men. This ensures that all obstetric practitioners, to at least some extent, continue to reproduce antifeminist ways of working. Even me.
Feminisation of the obstetric workforce might help to begin the process of feminising obstetric knowledge, but this isn’t an automatic guarantee that this work will be done.
What would feminist obstetric practice look like?
The answer to this is that I honestly do not know. To get to a point where obstetrics is genuinely feminist would require a radical undoing and remaking of the entire knowledge base on which the obstetric profession is founded. Yes, feminist research approaches should be applied to all future research in obstetrics. However, this alone is not enough to transform obstetric knowledge as it is built on the definitely-not-feminist ways of knowing women that already circulate. Our understandings of anatomy, physiology, and pathology would need to be discarded and built again using approaches that respected women and their bodies. I’m not entirely sure that what we currently know as obstetrics would continue to exist if this work could actually be done.
This does not mitigate our responsibility as feminists who work in obstetrics to do whatever we can to ensure that our practices do not simply reproduce oppression. Given that knowledge sits at the heart of obstetric practice, becoming informed about the histories of how that knowledge came about is the first step along the way to transforming obstetric practice. This is not something that is taught during our training – which is not surprising as it would make it very hard to pass exams once you knew where that knowledge came from!
I’m interested in starting a discussion with other obstetric practitioners about how we go about building a feminist obstetrics. What would it look like for you?
A shout out to Milli Hill
The heading for this blog post was inspired by and reflects the title of Milli Hill’s book, Give Birth Like a Feminist. It’s a great book and a good starting point if you are new to the idea that we need a feminist revolution in maternity care. Go buy a copy!
Gültekin-Zootzmann, B. (1975). The history of monitoring the human fetus. Journal of Perinatal Medicine, 3(3), 135-144.
Murphy-Lawless, J. (1998). Reading birth and death. Cork University Press.
Shaw, J. (2012). The Birth of the Clinic and the Advent of Reproduction: Pregnancy, Pathology and the Medical Gaze in Modernity. Body & Society, 18(2), 110-138. https://doi.org/10.1177/1357034X10394666
Smith, D. E. (2005). Institutional ethnography. A sociology for people. AltaMira Press.