Beyond the Metanarrative?

A few months ago, Thomas Beatie wrote a first person narrative for "The Advocate" recounting some of his experiences being a pregnant trans-man.  While he is not the first man to ever be pregnant, he and his wife made a decision to take their story to the mainstream public.  "The Advocate" is a widely read LGBT magazine that is both in print and online, and Beatie even had an interview with Oprah (which I did not see).  

Beatie's stories of dealing with medical professionals echoes the experiences trans folks have had with access to health care more broadly, for example, doctors turning him away, refusing to use male pronouns, etc.  These accounts are similar to the accounts of Robert Eads in the film "Southern Comfort" and his struggles with ovarian cancer.  The sex/gender binary can block access to healthcare and this block can often be life-threatening for trans people.    

What is interesting in relation to Beatie's account of his pregnancy are the reactions from people, absolutely unwilling and unable to see Beatie as a man because pregnancy is seen to be the defining characteristics of being a woman/femininity.  One doctor states, "As a licensed medical doctor I can assure you that this "man" is in reality a female who simply had their breasts removed and are taking male hormones.  This in turn could disturb the child's normal neo-natal growth in her body" (Kravitz).  This doctor in fact is referring to Beatie's possession of female reproductive organs and condescendingly puts "man" in quotations implying falsity, an imposter.  Also, he does not find it necessary to say what "normal" neo-natal growth is for a fetus.  It seems to me that if Beatie's body can menstruate and get pregnant, the fetus has a chance of growing just fine.  Meyerowitz, in the telling of a history of transgendered people and medical professionals says, 

the conflicts involved issues of knowledge and power...the doctors had the cultural authority, whether or not they had ever encountered, studied, or thought about transsexuality...doctors also had the power to determine exactly who would qualify for treatment (375).  

Kravitz, the "licensed medical doctor" took it upon himself to "assure" the public of the reality of Beatie's situation.  Meyerowitz tells of how the medical gaze got turned back on itself during the early struggles of transgendered people demanding access to healthcare.  

One might think that Beatie's story in the mainstream public could disrupt people's expectations of the gender binary and the authority of the medical gaze, but I argue that despite Beatie's pregnancy, he has fallen into using tropes of masculinity v. femininity in defending his position.  Beatie says, "I am stable and confident being the man that I am...I will be my daughter's father, and Nancy will be her mother.  We will be a family" (Beatie).  As Sandy Stone so succinctly puts it, "who is telling the story for whom, and how do the storytellers differentiate between the story they tell and the story they hear" (295)?  

works cited: Beatie, Thomas. "Labor of Love." The Advocate. 26 March 2008. 18 May 2008 http://www.advocate.com/exclusive_detail_ektid52947.asp?page=2.

Kravitz, Abner. Online comment. "Transgendered man claims he's pregnant with a girl." 26 March 2008. 18 May 2008 http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20080326/pregnant_man_080326/20080326?hub=Health.

Meyerowitz, Joanne. "A "Fierce and Demanding" Drive." The Transgender Studies Reader. Ed. Susan Stryker and Stephen Whittle. New York: Routledge, 2006. 

Stone, Sandy. "The Empire Strikes Back." The Visible Woman: Imaging Technologies, Gender, and Science." Ed. Paula A. Treichler, Lisa Cartwright, and Constance Penley. New York: New York University Press, 1998. 285-309. 

Visual Imaging Technologies

http://4dbaby.com/

If you look under the "Samples" section of the website you will see side by side shots of the face of the fetus using this technology and the face of the newborn baby.  This comparison of visual images encourages a viewing of the unborn fetus as a life that is viable outside of the mother's womb.  The quote on the site says, "clarity in 4d ultrasound images provides a true First Look at infants facial features" (First Look Sonogram).  This kind of visual imaging has discursive repercussions around reproductive freedoms and furthers to individualize fetuses while marginalizing the status and health of the mother.  

Carol Stabile's article, "Shooting the Mother: Fetal Photography and the Politics of Disappearance," looks at how visual technologies have played a role in the erasure of women's bodies.  She argues that, "representations of "fetal personhood" depend upon the erasure of female bodies and the reduction of women to passive, reproductive machines" (172).  While this erasure has a panoply of causes, fetal representations are particularly powerful in a society that is saturated in and highly influenced by visual imagery.  

Similar to the argument made below in the discussion of "The Onion" article, visual imaging can create a dangerous situation where the fetus is given personhood over the mother and in turn threaten reproductive freedoms (see below).

works cited: "First Look Sonogram." 12 May 2008 http://4dbaby.com/

Stabile, Carol. "Shooting the Mother: Fetal Photography and the Politics of Disappearance." The Visible Woman: Imaging Technologies, Gender, and Science. Ed. Paula A. Treichler, Lisa Cartwright, and Constance Penley. New York: New York University Press, 1998. 171-197. 

Friend #2 Answers to Questionnaire

1. I worked with a system called Hypno-Birthing. Every night I would do exercises based in imagery and self-hypnosis (deep relaxation). The exercises originated with different breathing techniques. Also the general idea is to envision an easy painless birth and not to listen to or read about stories that created any fear or tension. So I avoided listening to other people’s birth stories. I also did some work with the Pink Book – which is a series of exercises and birth positions put together by some Australian midwives. It was particularly helpful in finding better positions during labor and finding ones that were best for me even if they were really simple like lying on my side.

2. Once a month during most of the pregnancy and then once a week towards the end. At the very end I went in every three days or so for non-stress tests because I was considered late.

3. I started off with a regular ObGyn and then after I had all of my pre-natal tests complete (I did amnio) then I worked with a midwife for the remainder of my pregnancy.

4. I always knew I wanted a mid-wife. Because of my family history (mainly my mom’s and my twin sister’s) with birthing I knew that I needed more time and less intervention if I was going to have a vaginal birth.

5. I went into labor at home. I self-induced with castor oil – yuck. I wish that I had the patience to wait a few more days, but my baby was already 3 weeks + past my due date.

6. I gave birth at Alta-Bates birthing center and it was fantastic.

7. I had a vaginal birth. But came very close to having a c-section. William was almost 101bs with a big head and I was in labor for 2 days. But it worked out. My doula was amazing. Well worth every cent we paid her. I would not birth without a doula! And my midwife was patient and had great delivery techniques. Lots of oil and great timing.

8. We (myself and my midwife and doula) agreed that an epidural would have increased my chance of having a c-section. So I waited long enough and went through transition and then it was time to push.

9. Yes I did have a birthing plan, but the work with hypno-birthing really teaches you to give yourself over to the birth and not to have too many expectations. I left it open and trusted that the birth was going to go the way it was going to go, rather than putting any absolutes on anything. I was born c-section and had no issue giving birth c-section if that was going to happen. I really worked on positive energy and openness to what was going to happen.

10. No not really other than it took a very long time and I had little relief between contractions. I would say it was more mentally taxing then I had anticipated. But I never felt over-run by the labor. I felt very in the moment and experienced a kind of trance state. I wish it had gone faster but in hind sight my fear is what kept it from progressing faster. So it just took me a while to let myself give over to the birth and to really listen to William. I think he wanted to take his time transitioning into the world as well. So – I am ok that it took so long.

11. I keep thinking about how when I was home I didn’t want to lie on my side because it felt like it really opened me up so much to the birth. I realize now that sitting was my way to control the birthing. If I have another child I will know what to expect more and will give over to the feeling much sooner because it really was about a deep opening and I didn’t need to worry so much about that feeling. Also my training as a dancer is the opposite for birthing. It felt out of control to let myself release. Now that I have done it once I know that my body and my baby would not go against me, that my mind could have taken a back seat sooner. But it all worked out in the end. That is the way it was supposed to be. The pushing was great because then I was able to have some power again and I felt William working with me. The more we worked together the better the pushing went. I actually look back at that moment in the labor and smile because it was so wonderful and it was at the end of two days! I really felt him wanting to come into the world. Oh that is an exciting time. I absolutely was amazed to see William enter the world. I remember deeply the feeling of great accomplishment and exaltation – well worth 10 months of pregnancy.

Friend #1 Answers to Questionnaire

1. i have been a professional dancer all my life, which has prepared me for any kind of bodily experience...from exercise to trauma to birthing. i figured: when (the shit hit the fan or) things got intense, i would breathe!!! i also figured: women have been doing this for years, so how bad could it be?!

2. about once a month

3. female ob-gyn

4. i spoke with friends who had been pregnant and did some research and took abirthing class (just one day)
-then i got a doula (early on) and talked through some options.
-i am very decisive, but knew that birthing can bring forth unexpected circumstances, so i wanted to do what would be best for my baby. thus, i had decided that if i were to be induced with pitocin that i would request an epidural. i've heard that pitocin makes contractions much more painful than "natural" birthing pain, and i also became aware that dosages of epidurals are minimal these days, allowing you to labor and feel the contractions, which i found to be true. i was overdue and had to be induced (first with a balloon-type device overnight, then with pitocin in the morning). i requested the epidural, and everything went so smoothly that i would do it again in a heartbeat.

5. hospital: alta bates, berkeley

6. hospital: alta bates, berkeley

7. vaginally

8. yes

9. the plan was: don't overplan. i mean, would you plan your death? exactly. i knew that if i were to get pitocin that i would also request an epidural. i also knew that before it got unbearable i might also request an epidural. in the event of an emergency c-section, it is good to already have anepidural in place to avoid general anaesthesia. also, those trippy paindrugs (not the epidurals but the ones that make you loopy) remove some of your capacity to act rationally---they make you "out of it"---so i prefer the localization of the epidural, which numbs (only partially) your body, but not your brain.

10. not exactly, but there was one (only one) irregular heartbeat during my check up the day before i was supposed to be induced (planned), so they induced that night instead to avoid any future irregular heartbeats during contractions. this was probably extra precautionary, but it was fine with me to be "better safe than sorry."

11. i am someone who knows my body well, and i really trusted both my instincts and medical knowledge. in other words, i did not buy into the myth that a"completely natural" birth (without drugs) is the best way to go. i loved my epidural and still had a completely involved birthing experience, pushing with each contraction and all! it was easy as pie and very straightforward. i used a combination of prior/existing bodily knowledge, doula's advice(and coaching during labor; plus husband coaching/soothing with her), and advice from my friends/books with medical knowledge.
-i found the second trimester the most energetic, and even performed in and choreographed a dance duet for myself and another 7-month pregnant dancer. nevertheless, i was not at all obsessed about working out, dancing, or exercising during pregnancy, and i find this to be an asset. pregnancy is not olympic training, and it's most important to listen to one's body, cravings, rest impulses, etc. i took prenatal vitamins. i also engaged in a fairly strenuous academic schedule, but then rested a lot the last month. and slept a lot throughout. and ate a ton. i gained 40 pounds, and was comfortable with it. i think that it's important to find a great source of advice during one's first pregnancy, such as a doula or best friend.

Pregnancy and Birthing Questionnaire

1. What kind of physical preparations did you make for giving birth, if any? For example, breathing exercises, mediation, etc.

2. How often would you go in for check-ups while pregnant?

3. Was this with an obstetrician or a midwife or both?

4. How did you decide which type of assistance during the birthing process you wanted?

5. Where did you go into labor?

6. Where did you give birth?

7. Did you give birth vaginally or by cesarean section?

8. Did you have an epidural?

9. Did you have a birthing plan?

10. Did you encounter any "complications" during your pregnancy or labor?

11. Briefly describe any details about your pregnancy, laboring, and/or birthing process that you find interesting.

Fetus or Parasite?

http://www.theonion.com/content/news/woman_overjoyed_by_giant_uterine

This (rather hilarious) article is a critique of the trend toward individualizing fetuses and, through satire and humor, puts a focus back on the woman's pregnant body.  This is a dangerous thing to do because so much work of the Women's Health Movement was to remove the medical gaze from women's bodies.  In fact, I would not go so far as to call this article a feminist critique, there are quite a number of problematic comments, but it takes a useful stance for a feminist critique of the effects of looking at fetuses as autonomous beings, as beings somehow separate from the bodies within which they reside.  Treichler et. al. arue that "in acknowledging what is seen, and newly seen, we need to be equally vigilant about what is not seen, or no longer seen" (3).  I am not arguing for a simple shift of the gaze, but rather that the significance of what is (not) being spoken about has ramifications beyond linguistics.  

The Onion article says, "Immediately following a physician's examination for her menstrual cessation, 37-year-old events planner Janice Crowley told reporters Tuesday that she is "ecstatic" with her diagnosis of a rapidly growing intrauterine parasite" ("Woman Overjoyed by Giant Uterine Parasite").  By calling what the reader can assume to be a fetus a "parasite" the article emphasizes the fact that the creature cannot live outside of the woman's body.  The fetus is dependent on the mother for survival and can possibly pose a risk to the mother's health.  The parasite is called a " golf ball-sized, nutrient-sapping organism" ("Woman Overjoyed...").  Within this framework, the focus of health is the woman, not the fetus.  

There are implications for reproductive freedoms by positing a fetus as an autonomous being, which is often done in discourse and imagery around abortion rights.  "The speech that would render women speechless must be interrupted and this entails...interrupting "the visual discourse of fetal autonomy"--reembodying the disembodied fetal form or resituating the gestating fetus in a uterus and the uterus in a body, thereby re-membering what is otherwise dis-membered" (Hartouni 213).  This article does just that.  The focus is on how the fetus affects the body and health of the mother, situating it within her body, dependent upon her body.

works cited: Hartouni, Valerie. "Fetal Exposures: Abortion Politics and Optics of Allusion." The Visible Woman: Imaging Technologies, Gender, and Science. Ed. Paula A. Treichler, Lisa Cartwright, and Constance Penley.  New York: New York University Press, 1998. 198-216.

Treichler, Paula, Lisa Cartwright, and Constance Penley. "Introduction: Paradoxes of Visibility." The Visible Woman: Imagiing Technologies, Gender, and Science. Ed. Paula A. Treichler, Lisa Cartwright, and Constance Penley. New York: New York University Press, 1998. 1-17. 

"Woman Overjoyed by Giant Uterine Parasite."  The Onion. 27 August 2007. 6 March 2008 http://www.theonion.com/content/news/woman_overjoyed_by_giant_uterine.

bump watch?!

http://omg.yahoo.com/baby-bumps/hot-topics/21

I know I'm not always up-to-date on pop culture, but bump watch!? The watching is not just about "the bump" either. There's also reporting on the medical side of things- like vaginal vs. cesarean section births, doctor check-ups, leaked ultra-sound photos, etc. Well, I made up the idea of ultra-sound paparazzi, but one could imagine...

Ricki Lake and False Binaries

Check out this documentary: http://www.thebusinessofbeingborn.com/

This film, produced by Ricki Lake, is an example of some contemporary political work being done around the medicalization of pregnancy and childbirth. The film aims to disprove many culturally popular beliefs in the U.S. about the safety of giving birth in hospitals with doctors versus having a more "natural" birth with a midwife. Its main argument seems to be a call to de-medicalize pregnancy and birthing.

One of the main issues at hand is the notion of choice. In this regard, pregnancy and birthing discourse is closely tied to discourse around abortion rights. The idea of making a choice based on informed consent and personal desires is often juxtaposed to the processes of normalization that are continually acting upon us. This juxtaposition creates a false binary and leads political arguments in directions where differing opinions will inevitably never find common ground. Instead it is useful to think about personal choice and processes of normalization as both constantly at work. Then, the work to be done (aided through the theoretical work of Judith Butler) is to expand the realm of the norms to provide broader accepted opportunities to exert informed personal choices. The work that this documentary does is to present birthing with a midwife as a viable popular option for women to choose. It's downfall is in demonizing the majority of obstetricians and births that occur in hospitals which may alienate some women's "desires" and experiences and thus make them closed-off to the films political project.

It’s All Connected- In the Fertility Clinic

The article, “Biomedicalization: Technoscientific Transformations of Health, Illness, and U.S. Biomedicine” by Adele Clarke, et. al. describes the elements of biomedicalization occurring in contemporary United Statesian medicine. A key focus of the differences between medicalization and biomedicalization is on a shift from “control over” bodies and practices to “transformations of” them. The authors of this article coin the term “ Biomedical TechnoService Complex, Inc.” as a way to situate biomedicalization both politico-economically and socioculturally, with a focus on the proliferation of technoscientific innovations into the medical realm (162).

An obvious site of the entrance of technology and the furthering of the medical gaze into pregnancy and childbirth is in the Assisted Reproductive Technologies (ARTs) clinic. Charis Thompson’s book, Making Parents: The Ontological Choreography of Reproductive Technologies, looks to disprove the nature-versus-culture duality and to show how the social constitutes our understanding of the natural by empirically doing work inside a fertility clinic. If the “Biomedical TechnoService Complex, Inc.” shows how biomedicalization has entered politics, economics, society, and culture, the fertility clinic is a place where one can see intersections and a co-constitutive nature of all of these at work.

In terms of the (bio)medicalization of pregnancy and birthing, Thompson’s work helps us to realize the materiality of constructions. As is mentioned in the previous posting, obstetricians socially constructed a new framework for understanding pregnancy and childbirth. This does not mean that this new construction did not lead to a very real reality. Thompson says, “what I have found is that the metaphor of construction leads people not to discount reality but to attribute reality and causal power to many ontologically different kinds of things and to many different kinds of agents” (33). This means that our understandings of women’s bodies and the biological processes of pregnancy and birthing are made from an interplay of constructed beliefs about nature and culture yet are nevertheless grounded in reality.

works cited:
Clarke, Adele et al. "Biomedicalization: Technoscientific Transformation of Health, Illness and U.S. Biomedicine." American Sociological Review. 68:2, 2003. 161-194.

Thompson, Charis. Making Parents: The Ontological Choreography of Reproductive Technologies. Cambridge: MIT Press, 2005.

Introduction to the "Disease"

The notion of pregnancy and childbirth as diseases begins with medicalization. Catherine Riessman’s article, “Women and Medicalization: A New Perspective,” documents a history of the medicalization of pregnancy and childbirth, geographically focused in the United States.

Prior to the entrance of obstetricians into the realm of pregnancy and childbirth midwives attended to births. These were women who, “assisted by a network of female relatives and friends, provided emotional support and practical assistance to the pregnant woman both during the actual birth and in the weeks that followed” (Riessman 51). Beginning in the early 20th century the field of obstetrics arose as an option for monitoring pregnancy and birthing. “Obstetricians were successful in persuading both their physician colleagues and the general public of the “fallacy of normal pregnancy,” and therefore of the need for a “science” of obstetrical practice” (51). This move from midwives to obstetricians was a process intertwined with race, class, and gender.

The work to demonize midwives was a racial and class project, in that “obstetricians were from the dominant class, whereas midwives were mostly immigrant and Black women” (51). Note that Riessman herself doesn’t have a clear notion of whether to mention race or class—she conveniently relates the obstetricians with a higher class (while not mentioning Whiteness) and the midwives with race and ethnicity (while not mentioning poverty). Riessman’s article continues to lack in a radically critical raced or classed analysis of the history of the medicalization of pregnancy and birthing, but her conflation of different types of subjugated positionalities shows how complicatedly embedded medicalization is in all arenas of life.

works cited: Riessman, Catherine Kohler. "Women and Medicalization: A New Perspective." Politics of Women's Bodies. Ed. Rose Weitz. Oxford University Press, 2003. 46-63.

Personal Motivations

Although there is plenty written on the (bio)medicalization of pregnancy and birthing, and I would have liked to choose a topic on which less is written, I have chosen this topic for my “disease” journal because of personal interests. I have a plan of one day becoming a midwife and have already begun training to be a post-partum doula. More recently, a good friend of mine nearly died in the hospital after giving birth by cesarean section to a healthy little baby. The majority of women in my life over 30 are either pregnant or have just given birth. I have a personal investment in understanding these processes of biomedicalization better for both my close friends and my future career.