Anna Fielder, Going Into Labour: Childbirth in Capitalism, Pluto Press, 2024. Pbk £18.99.
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Debates have proliferated over recent years in the broad area of 'social reproduction' in capitalism. From a Marxist perspective, the issues can be addressed in terms of the formulation found in the German Ideology, in which Marx and Engels describe the focus of their historical materialism as the ‘production of life, both of one’s own in labour and of fresh life in procreation’, or in relation to the distinction between the reproduction of the working class from day to day on the one hand, and from generation to generation on the other. There is room for debate over how much or how little attention Marx himself devoted specifically to the production of fresh life in procreation - Fielder evaluates his legacy and some subsequent developments effectively in Chapter 2, wittily entitled 'Stretch Marx'. Marx noted, as did Engels, the appalling rates of maternal and infant mortality in early industrial Manchester, the inevitable neglect of those infants that did survive as a consequence of the need for men and women alike to work long hours in order to procure the means of subsistence, and the common practice of leaving infants from their earliest days in the care of wet nurses who routinely used concoctions of opiates and treacle such as Godfrey's Cordial (no longer available, I'm afraid) to keep their charges quiet. But these are passing references. Anna Fielder can justifiably say, therefore, that 'For all that Marx is known for, his name is not readily associated with the labour of childbirth' (2). More surprisingly, perhaps, for all their attention to other issues, Marxist feminists and contemporary theorists of social reproduction have not paid much attention either to the 'fleshy and messy' aspects of childbearing, or to the changing social and institutional contexts in which it takes place. Fielder sets out to put that right, starting from the premise that 'analyses of childbearing must grapple with the role of capitalism [as understood by Marx], if they are to account for why calls for change in relation to childbirth often go apparently unheeded' (4). Broadly speaking, she is concerned with the adverse consequences of neoliberal policy and practice, and the means to reversing them. She brings to the task a solid understanding of Marx, a good grounding in critical international political economy, and her experience as a practising midwife prior to a return to academia: the result is an original and pathbreaking book that should place childbearing at the centre of work on social reproduction.
Fielder spells out the broader background succinctly in the opening pages:
'Over recent decades, academics and activists have attributed responsibility for many of the problems which developed in relation to childbirth to a range of social forces. The rise in caesarean sections and use of heavily routinised care with iatrogenic effects [illness or disease caused by the treatment itself] have been seen as a product of industrialism or industrial society. Patriarchal power structures have also been held to account. It is now widely documented that prior to the eighteenth century, women in Europe as well as North America had given birth largely in their homes supported by other women, friends, relatives and midwives. By various mechanisms, which differed between countries and localities, the influence of males doctors grew. Women were largely excluded from becoming physicians and were prohibited by tradition or other means from wielding instruments such as forceps which doctors increasingly deployed. By the mid-to-late twentieth century, and earlier in many places, childbirth had been constituted as a medical event and was taking place primarily in hospitals: in other words, on the terrain of "medical men". Childbearing has been described as undergoing a process of appropriation by men even well beyond the mid-twentieth century. Yet over recent years, there has been growing acknowledgement that much feminist research carried out on people's experiences of childbearing has centred the experiences of white, often middle-class, cis women. In highlighting the patriarchal character of birth-care-institutions - of their staffing structures and prevalent clinical practices - social and historical forces and determinants of health such as racism and colonisation have often been overlooked' (7).
Rightly, then, Fielder does not derive her analysis of childbirth exclusively or mechanically from Marx, but first addresses childbearing in contemporary societies (Aotearoa-New Zealand, US, and UK) first in terms of its own history and social logic, and then explores the contribution Marx can make to our understanding of it. She rejects the idea that Marx 'developed an overarching theoretical schema for application in any situation', into which childbirth might be squeezed, drawing instead on his observation that aspects of life that appear immutable or "natural" often do so as an effect of the consolidation of intensely social forces, relations and elements. From this perspective, applied by Marx by way of illustration to the idea of the population, 'the concrete is concrete because it is the concentration of many determinations, hence unity of the diverse.' So too with childbirth. The trick is to identify the 'determinations' that are most significant: Fielder identifies four, and for three reasons they turn out to be very well chosen indeed. They are obstetric technology, risk, evidence and choice, addressed successively in chapters 3-6. First, they are central aspects of contemporary childbirth. Second, they all dynamic categories that reflect change over time. And third, the change that they reflect is above all shaped by evolving neoliberal policy and practice. The application of tools to childbirth dates back the invention of forceps (17th century) and Pinard Horn, or ear trumpet (19th century), but 'contemporary birthing units are filled with a vast array of equipment and technologies: electronic foetal monitors, ultrasound scanners, surgical instruments, syringes, drips, drip-stands, a growing range of pharmaceuticals, electronically adjustable beds, surgical tables, and far more' (16). The first commercial electrical foetal monitor dates from 1968 (Hewlett-Packard); ultrasound dates from 1958 (pioneered in Glasgow, from technology originally used to detect weaknesses in the hulls of ships), but made huge advances in the 1980s that have continued to the present. Science and technology saves lives (though the evidence on behalf of continuous foetal monitoring is weak - but it reaps vast profits for HP, Philips and others, enables whole squads of birthing people to be monitored from one desk, and, apparently, fascinates male partners in particular). But the manner and extent to which it is used, and over-used, reflects a range of pressures and practices not directly concerned with the well-being of the birthing person or the baby. Prominent among these - along with the power and influence of profit-oriented corporations and the need to reassure consumers that you have the latest kit - is the understanding and management of risk. Childbirth is framed as risky, on a sliding scale from low to high, and risk is assessed through evidence derived from scientific clinical and/or epidemiological research, with the large-scale Randomised Controlled Trial (RCT) emerging as the 'gold standard' from the 1990s on. In turn, these three parameters - technology, risk, and evidence - limit and shape choice in childbirth: 'Be it consumer choice, patient choice, informed choice, women's choice, or other varieties of choice, renditions of choice (and the absence thereof) have become pivotal in defining the quality and character of contemporary birthing care' (16).
As Fielder maps out the journeys that pregnant people take through the 'apparently neutral features of the birthing landscape', a clear problematic emerges - accepting that children are not conceived and born in order to serve the needs of capital, how is it that from their birth and as they grow, capital stakes its claim on them? Or, put differently, what can an analysis of childbirth tell us about the tensions between communities, families and households on the one hand, and the long term needs of capital on the other? Within it, one common feature and one sharp contrast emerge between the different trajectories in the three principal countries on which she focuses: in the United States, the virtual disappearance of the community midwife as large private institutions dominate, in the UK, despite similar trends, the continuing role of midwives, albeit increasingly under threat, and in Aotearoa/NZ; and in all three, there are persistent markedly worse outcomes for black and indigenous populations respectively.
90, Ferguson. Children are not produced by capitalist methods. Childbirth subsumed less than domestic labour i.e. daily renewal of labour power. How to turn children into a healthy, educated workforce. 95 risk of abnormality. CGT - machines replace workers 97. cf C-section for 'efficient' use of staff.
Natural birth 12-14
References and Further Reading
Brown, Jenny. 2019. Birth Strike: The Hidden Fight over Women's Work, PM Press, Oakland.
Federici, Silvia. 2004. Caliban and the Witch, Autonomedia, New York.
Firestone, Shulamith. 1971. The Dialectic of Sex: The Case for Feminist Revolution, Bantam.
Fraser, Gertrude J. 1995. ‘Modern Bodies, Modern Minds: Midwifery and Reproductive Change in an African American Community', in Faye Ginsburg and Rayna Rapp, eds, Conceiving the New World Order: The Global Politics of Reproduction, University of California Press, 1995, pp. 42-58.
Gardiner, Jean. 1997. Gender, Care and Economics, Macmillan.
Heagerty, Brooke Victoria. 1990. Class, gender and professionalisation: the struggle for British midwifery 1900-1936, Ph.D, Michigan State University, permalink https://doi.org/doi:10.25335/e3ed-sf19.
Heagerty, Brooke Victoria. 1996. 'Reassessing the Guilty: The Midwives Act and the Control of English Midwives in the Early 20th Century', in Mavis Kirkham, ed, Supervision of Midwives, Books for Midwives Press, Hale, pp. 13-27.
Heagerty, Brooke Victoria. 1997. 'Willing Handmaidens of Science? The Struggle over the New Midwife in Early Twentieth-Century England', in Mavis Kirkham and Elizabeth Perkins, eds, Reflections on Midwifery, Books for Midwives Press, Baillière Tindall, London, pp. 70-95.
Oakley, Ann. 1976. Wisewoman and Medicine Man: Changes in the Management of Childbirth, in Juliet Mitchell and Ann Oakley, eds, The Rights and Wrongs of Women, Pelican, London, pp. 17-58.
O'Brien, Mary. 1981. The Politics of Reproduction, Routledge & Kegan Paul, Boston, London and Henley.
Rothman, Barbara Katz. 1989. Recreating Motherhood: Ideology and Technology in a Patriarchal Society, W.W. Norton and Company, London and New York.
Fielder spells out the broader background succinctly in the opening pages:
'Over recent decades, academics and activists have attributed responsibility for many of the problems which developed in relation to childbirth to a range of social forces. The rise in caesarean sections and use of heavily routinised care with iatrogenic effects [illness or disease caused by the treatment itself] have been seen as a product of industrialism or industrial society. Patriarchal power structures have also been held to account. It is now widely documented that prior to the eighteenth century, women in Europe as well as North America had given birth largely in their homes supported by other women, friends, relatives and midwives. By various mechanisms, which differed between countries and localities, the influence of males doctors grew. Women were largely excluded from becoming physicians and were prohibited by tradition or other means from wielding instruments such as forceps which doctors increasingly deployed. By the mid-to-late twentieth century, and earlier in many places, childbirth had been constituted as a medical event and was taking place primarily in hospitals: in other words, on the terrain of "medical men". Childbearing has been described as undergoing a process of appropriation by men even well beyond the mid-twentieth century. Yet over recent years, there has been growing acknowledgement that much feminist research carried out on people's experiences of childbearing has centred the experiences of white, often middle-class, cis women. In highlighting the patriarchal character of birth-care-institutions - of their staffing structures and prevalent clinical practices - social and historical forces and determinants of health such as racism and colonisation have often been overlooked' (7).
Rightly, then, Fielder does not derive her analysis of childbirth exclusively or mechanically from Marx, but first addresses childbearing in contemporary societies (Aotearoa-New Zealand, US, and UK) first in terms of its own history and social logic, and then explores the contribution Marx can make to our understanding of it. She rejects the idea that Marx 'developed an overarching theoretical schema for application in any situation', into which childbirth might be squeezed, drawing instead on his observation that aspects of life that appear immutable or "natural" often do so as an effect of the consolidation of intensely social forces, relations and elements. From this perspective, applied by Marx by way of illustration to the idea of the population, 'the concrete is concrete because it is the concentration of many determinations, hence unity of the diverse.' So too with childbirth. The trick is to identify the 'determinations' that are most significant: Fielder identifies four, and for three reasons they turn out to be very well chosen indeed. They are obstetric technology, risk, evidence and choice, addressed successively in chapters 3-6. First, they are central aspects of contemporary childbirth. Second, they all dynamic categories that reflect change over time. And third, the change that they reflect is above all shaped by evolving neoliberal policy and practice. The application of tools to childbirth dates back the invention of forceps (17th century) and Pinard Horn, or ear trumpet (19th century), but 'contemporary birthing units are filled with a vast array of equipment and technologies: electronic foetal monitors, ultrasound scanners, surgical instruments, syringes, drips, drip-stands, a growing range of pharmaceuticals, electronically adjustable beds, surgical tables, and far more' (16). The first commercial electrical foetal monitor dates from 1968 (Hewlett-Packard); ultrasound dates from 1958 (pioneered in Glasgow, from technology originally used to detect weaknesses in the hulls of ships), but made huge advances in the 1980s that have continued to the present. Science and technology saves lives (though the evidence on behalf of continuous foetal monitoring is weak - but it reaps vast profits for HP, Philips and others, enables whole squads of birthing people to be monitored from one desk, and, apparently, fascinates male partners in particular). But the manner and extent to which it is used, and over-used, reflects a range of pressures and practices not directly concerned with the well-being of the birthing person or the baby. Prominent among these - along with the power and influence of profit-oriented corporations and the need to reassure consumers that you have the latest kit - is the understanding and management of risk. Childbirth is framed as risky, on a sliding scale from low to high, and risk is assessed through evidence derived from scientific clinical and/or epidemiological research, with the large-scale Randomised Controlled Trial (RCT) emerging as the 'gold standard' from the 1990s on. In turn, these three parameters - technology, risk, and evidence - limit and shape choice in childbirth: 'Be it consumer choice, patient choice, informed choice, women's choice, or other varieties of choice, renditions of choice (and the absence thereof) have become pivotal in defining the quality and character of contemporary birthing care' (16).
As Fielder maps out the journeys that pregnant people take through the 'apparently neutral features of the birthing landscape', a clear problematic emerges - accepting that children are not conceived and born in order to serve the needs of capital, how is it that from their birth and as they grow, capital stakes its claim on them? Or, put differently, what can an analysis of childbirth tell us about the tensions between communities, families and households on the one hand, and the long term needs of capital on the other? Within it, one common feature and one sharp contrast emerge between the different trajectories in the three principal countries on which she focuses: in the United States, the virtual disappearance of the community midwife as large private institutions dominate, in the UK, despite similar trends, the continuing role of midwives, albeit increasingly under threat, and in Aotearoa/NZ; and in all three, there are persistent markedly worse outcomes for black and indigenous populations respectively.
90, Ferguson. Children are not produced by capitalist methods. Childbirth subsumed less than domestic labour i.e. daily renewal of labour power. How to turn children into a healthy, educated workforce. 95 risk of abnormality. CGT - machines replace workers 97. cf C-section for 'efficient' use of staff.
Natural birth 12-14
References and Further Reading
Brown, Jenny. 2019. Birth Strike: The Hidden Fight over Women's Work, PM Press, Oakland.
Federici, Silvia. 2004. Caliban and the Witch, Autonomedia, New York.
Firestone, Shulamith. 1971. The Dialectic of Sex: The Case for Feminist Revolution, Bantam.
Fraser, Gertrude J. 1995. ‘Modern Bodies, Modern Minds: Midwifery and Reproductive Change in an African American Community', in Faye Ginsburg and Rayna Rapp, eds, Conceiving the New World Order: The Global Politics of Reproduction, University of California Press, 1995, pp. 42-58.
Gardiner, Jean. 1997. Gender, Care and Economics, Macmillan.
Heagerty, Brooke Victoria. 1990. Class, gender and professionalisation: the struggle for British midwifery 1900-1936, Ph.D, Michigan State University, permalink https://doi.org/doi:10.25335/e3ed-sf19.
Heagerty, Brooke Victoria. 1996. 'Reassessing the Guilty: The Midwives Act and the Control of English Midwives in the Early 20th Century', in Mavis Kirkham, ed, Supervision of Midwives, Books for Midwives Press, Hale, pp. 13-27.
Heagerty, Brooke Victoria. 1997. 'Willing Handmaidens of Science? The Struggle over the New Midwife in Early Twentieth-Century England', in Mavis Kirkham and Elizabeth Perkins, eds, Reflections on Midwifery, Books for Midwives Press, Baillière Tindall, London, pp. 70-95.
Oakley, Ann. 1976. Wisewoman and Medicine Man: Changes in the Management of Childbirth, in Juliet Mitchell and Ann Oakley, eds, The Rights and Wrongs of Women, Pelican, London, pp. 17-58.
O'Brien, Mary. 1981. The Politics of Reproduction, Routledge & Kegan Paul, Boston, London and Henley.
Rothman, Barbara Katz. 1989. Recreating Motherhood: Ideology and Technology in a Patriarchal Society, W.W. Norton and Company, London and New York.