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‘I Am Not a Patient, and I Am Not a Child’: The Institutionalization and Experience of Pregnancy



In this article the focus is on how the relation between the self and body is formulated in medical/healthcare discourses and how these affect the experiences of pregnant women. I draw on data collected during research on the self-image of young mothers, analyses of booklets and handouts distributed to pregnant women, and interviews conducted both on individual and group bases with young mothers. I argue that the normalizing tendencies identified in the booklets strip women of their agency. However, pregnant women do not always position themselves in terms of maternal normativities. Their accounts of pregnancy and childbirth both support and challenge the knowledge that underpins the practices of medical/healthcare institutions. Their position as agents matters a great deal for them and affects the extent to which they experience pregnancy and childbirth positively or negatively.
Feminism & Psychology
The online version of this article can be found at:
DOI: 10.1177/0959353500010003004
2000 10: 337Feminism & Psychology
Annadís Greta Rúdólfsdóttir
Experience of Pregnancy
'I Am Not a Patient, and I Am Not a Child': The Institutionalization and
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‘I Am Not a Patient, and I Am Not a Child’: The
Institutionalization and Experience of Pregnancy
In this article the focus is on how the relation between the self and body is formulated in
medical/healthcare discourses and how these affect the experiences of pregnant women. I
draw on data collected during research on the self-image of young mothers, analyses of
booklets and handouts distributed to pregnant women, and interviews conducted both on
individual and group bases with young mothers. I argue that the normalizing tendencies
identified in the booklets strip women of their agency. However, pregnant women do not
always position themselves in terms of maternal normativities. Their accounts of preg-
nancy and childbirth both support and challenge the knowledge that underpins the prac-
tices of medical/healthcare institutions. Their position as agents matters a great deal for
them and affects the extent to which they experience pregnancy and childbirth positively
or negatively.
Key Words: discourse analysis, medical model, motherhood, reproduction, young
In this article I focus on the impact of social practices and discourses in med-
ical/healthcare institutions on the experiences of pregnant women and women
giving birth. My concern is how pregnant subjecthood is construed or, more
specifically, what kind of agency pregnant women and women giving birth are
allowed when dealing with these institutions. The material on which I base my
analysis is drawn from a larger study I have conducted on the self-image of young
mothers. To explore this, I draw on Foucault’s (1981) conceptualization of dis-
course as structured ways of knowing as well as institutionalized practices. I also
draw on his emphasis on discourse as productive: we are subjects positioned in
discourses of knowledge and these affect our identities and understanding of the
Feminism & Psychology © 2000 SAGE (London, Thousand Oaks and New Delhi),
Vol. 10(3): 337–350.
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world (Gavey, 1989; Hollway, 1989; Weedon, 1987). When women become
pregnant, they are confronted with and inserted into the ideological and discur-
sive practices surrounding motherhood. Certain images and truths are preferred
over others and serve as strong regulatory ideals or norms which impinge on the
lives of most women, not just those who are mothers (see, for example, Woollett,
1991). In the spirit of Adrienne Rich (1976), these normative ideas could be seen
as examples of the ‘institutionalization of motherhood’:
This institution – the foundation of human society as we know it – allowed me
only certain views, certain expectations, whether embodied in the booklet in
the obstetrician’s waiting room, the novels I had read, my mother-in-law’s
approval, my memories of my own mother, the Sistine Madonna or she of the
Michelangelo Pieta, the floating notion that a woman pregnant is a woman calm
in her fulfilment or, simply, a woman waiting (Rich, 1976: 39).
It is important that feminists analyse how discursive ideas and practices cir-
cumscribe and define the types of agency that women are allowed. However,
women’s experiences do not mirror the images of pregnancy and childbirth with
which they are presented. Because we as subjects have different life stories and
move through different discourses of knowledge in life, our reactions to norm-
ative ideas can never be fixed. Our subjecthood, as Butler (1997) points out, tends
to exceed the power involved in our subjectification, and this can play a part in
our preference for subject positions not suggested by dominant discourses.
Young mothers are a convenient group for exploring how normative ideas
about maternal behaviour are part of the experience of pregnancy and mothering.
As young mothers are often described as a social problem (Phoenix, 1991), they
are frequently the target of normalizing measures. In this article the focus is less
on the young age of women than on what their experiences can tell us about the
way in which women are inserted into the normativities of maternity. But before
I address the construction and experience of pregnancy, it is important to review
the powerful effects of mind/body dualism on western thought and its fusion into
ideas and practices of medicine and health care.
‘The body has been made so problematic for women that it has often seemed eas-
ier to shrug it off and travel as a disembodied spirit’ (Rich, 1976: 40).
Representations of the body in western culture usually construe it ‘as something
apart from the true self (whether conceived as soul, mind, spirit, will, creativity,
freedom . . .) and as undermining the best efforts of that self’ (Bordo, 1993: 5).
The dominant idea is that the truly liberated and disciplined self cultivates ratio-
nal thought, the instrument of the self, on the basis of its freedom from the
impulses of the body. In this regard, popular depictions of mind and body portray
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the two as being in a continual tug of war, where the body constantly threatens to
drag higher mental processes down to the levels of chaotic sentiments and emo-
tions. Since women, as Spelman (1982) argues, have been portrayed as essential-
ly bodily beings, they are considered to be continually swayed by emotions.
Consequently, it is considered harder for women to take reasoned actions and
thereby attain ideal individuality. How can you trust the judgement of a person
who is continually prey to her bodily functions?
The old metaphysics defining mind and body as at odds with each other finds
its way into the medical/healthcare definitions of health. As a number of feminists
have argued, it operates from the implicit assumption that health is ‘a state in
which there is no regular or noticeable change in body condition’ (Young, 1990:
56; see also Tavris, 1992: 104) and that these assumptions mostly apply to the
bodies of young, fit men (Young, 1990). Clearly, the changing bodies of pregnant
women fall outside this criterion of health. As a result, the condition of pregnant
women is rendered abnormal and their bodies problematic.
The regulation of pregnant women is usually defined as health care, and child-
birth is considered to be a medical event. This development is the result of a com-
plex social development to which both physicians and women contribute (see
Riessman, 1992: 123). The medicalization of pregnancy and childbirth has been
a steady but not uncontested process in Iceland. In 1932, the chairwoman of the
Midwife’s Society in Iceland complained that it had become a ‘fashion’ in
Reykjavík to make a doctor attend all childbirths ‘even when there is nothing
wrong and a midwife present’ (Bárardóttir, 1932: 2). In modern Iceland preg-
nant women automatically become part of routine clinical surveillance and most
give birth in high-tech hospitals.
Implicit in the regulation of the health of mothers-to-be are normative ideas or
‘certain expectations’ about proper motherhood, such as, who should be mother,
who should not, who should be given extra care, what qualities new mothers
should have, and so on. In this regard I think it is useful to keep in mind Nikolas
Rose’s comment that normality is not merely an observation but an evaluation.
As he argues: ‘It contains not only a judgement about what is desirable, but an
injunction as to a goal to be achieved. In so doing, the very notion of the “nor-
mal” today awards power to scientific truth and expert authority’ (Rose, 1989:
The gaze, or what Foucault terms ‘the power of the eye’ (1977), plays a vital
part in ensuring that we discipline ourselves according to the norms of society:
there is no need for arms, physical violence, material constraints. Just a gaze. An
inspecting gaze, a gaze which each individual under its weight will end by
interiorising to the point that he is his own overseer, each individual thus
exercising this surveillance over, and against himself (Foucault, 1977: 155).
Feminists have argued that the ‘medical gaze’ has undermined women’s sense
of authority and control over their bodies and that the practices of contemporary
medicine alienate pregnant women from their bodily experiences (Martin, 1987;
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Rich, 1976; Shildrick, 1997; Young, 1990). This is accomplished for instance by
fragmenting the body, making particular body parts matter more than others so
that they almost seem to exist independently from the pregnant woman. Emily
Martin (1987) points out that the conceptualization of reproduction as a form of
production is popular in the medical/healthcare discourse. When giving birth the
woman is the labourer, the body the machine, the baby the product, and the doc-
tor or medical staff the supervisors or foremen of the labour process. In these
accounts, the body does not belong to the woman giving birth, it operates more
or less independently from her will or desires, with the uterus presented as an
involuntary muscle that does the job automatically.
Young (1990) similarly argues that the medical/healthcare discourse has trans-
formed pregnancy into an objective observable process. The privileged relation
that women have had with their bodies through touch and sensation is replaced
with visual information. Medical staff trained in reading ultrasound scans are
considered to have more authority on what ‘matters’ than the pregnant woman.
Moreover, the advances in the technological equipment used to monitor pregnant
women add to the perception of the fetus as independent from the pregnant
woman, and even as a separate subject. The increasing importance assigned to the
fetus goes hand in hand with its increased visibility. Kaplan (1992, 1994) makes
a strong case for this in her analyses of representations of the fetus in North
American visual culture, arguing that ‘[T]he fetus is now given a voice, made to
speak; and it threatens to displace the mother in original ways’ (1994: 122). In
this respect popular images of the fetus do not even include the body of the preg-
nant woman. The fetus floats around like a kind of ‘cosmic entity’, sometimes
complete with voice, character and a mind of its own. Taylor (1998) points out
how the visibility of the fetus in the ultrasound scan mimics birth, thus equating
‘pregnancy with the relationship between a woman and her newborn child’
(1998: 23). In this dyad, the needs of the fetus/child foreshadow the needs of the
pregnant woman who should be guided by unconditional mother love (Bordo,
As I mentioned earlier, young pregnant women are especially likely to be the
target of normalizing measures. Youth is associated with recklessness, immaturi-
ty and dangerous behaviour. But to reach the aims set by health care, the collab-
oration of young women is needed: they have to be willing to act on themselves
and internalize the medical gaze in order to make themselves better, healthier.
This is accomplished by creating desires that attach the young women to specif-
ic identities, hence ensuring their self-discipline. Motherhood is strong in the def-
inition of femininity in Iceland and is marked by the imagery of the person who
attends to everyone’s needs before her own (Rúdólfsdóttir, 1997). Motherhood is
valued as the ultimate accomplishment of mature femininity and as such is con-
sidered to be the natural goal for all women (Marshall, 1991; Woollett, 1991).
The appeal of this imagery to women makes it easy to form an alliance between
expert knowledge and the desires, hopes and fears of the pregnant woman and
new mother. However, discourses of knowledge can accommodate complex and
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often contradictory images and truths. These provide space for resistance and
open up subject positions which may be at odds with the dominant way of inter-
preting medical truths. Bearing this in mind, it is interesting to investigate how
young pregnant women negotiate their position in relation to the knowledge pro-
duced by the medical/healthcare discourse.
In order to investigate how women’s agency is represented in medical/healthcare
practices I looked at how it is framed in the medical vocabulary. Inspired by
Rich’s (1976) description of the booklets she read in the obstetrician’s waiting
room, I chose to analyse booklets and handouts distributed for educational pur-
poses to pregnant women in medical/healthcare institutions. These booklets and
handouts aim to provide answers to possible questions, to give advice and to warn
against dangerous behaviour. These texts are an important vehicle for passing on
institutional views because they are available to all pregnant women. They
include imperatives for behaviour justified with reference to what is ‘right’ and
what is ‘wrong’, and there are numerous references to moral norms.
Nevertheless, as argued earlier, women are not passive receivers of discursive
dictates and I wanted, therefore, to include their perspective as well. I conducted
both individual and group interviews with young women about their experiences
of pregnancy and childbirth. I juxtapose my analysis of the booklets and handouts
with analysis of the interviews with pregnant young women and the group inter-
views with women who had given birth to their first child when they were less
than 20 years old.
Booklets and Handouts
For this study I collected booklets and handouts for mothers-to-be which were in
circulation in 1997. These were widely available in healthcare centres in
Reykjavík, the capital city of Iceland, and ranged from glossy, carefully designed
booklets compiled by institutions such as the Primary Health Care Centre, the
Committee for Equal Rights and the Association Against Smoking, to inexpen-
sive one-page photocopies distributed at the initiative of healthcare staff. Most of
these were distributed free of charge to young pregnant women when they first
visited the healthcare centres, but some were sold at a low cost.
Interviews with Young Pregnant Women and New Mothers
The young women interviewed for this study were approached through one of the
primary healthcare centres in Reykjavík to which I had written explaining how
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the study would be conducted and its purpose. One of the staff gave the letter to
young pregnant women (< 20 years old) and later telephoned them to ask if I
could contact them. Out of 15 women contacted, 10 agreed to take part in the
The young women interviewed were 16 to 19 years old and I conducted two
sets of interviews with each of them. The first was conducted when the women
were at least seven months into their pregnancy; the second at least three months
after they had given birth to their first child. In the first set of interviews, all 10
participants lived in Reykjavík. I could not locate one of the women to re-inter-
view. Another’s child had died and I chose not to interview her again.
The interviews were semi-structured. I used a topic guide, which served as a
framework for the topics I wanted to cover in the interview. This topic guide was
constructed on the basis of informal interviews with professionals dealing with
young mothers and a group interview with young mothers. The guide ensured
that similar topics were covered in each interview and contained various themes.
For this article I will concentrate on discussions concerning relations with
medical/healthcare institutions when pregnant and giving birth. In general, I tried
to keep the interviews conversational and to follow issues raised by the partici-
pants. As a result some topics were discussed in some interviews more than
others and the order of the themes varied. Each participant had a copy of the
transcript from the first interview and these were used as the basis for discussion
in the second interview. The interviews lasted 40–90 minutes.
Interviews with Women who Had Their First Child Young
In the group interviews I talked to women in pairs. Most of them knew one
another before the interview. These women were contacted through youth centres
and clubs organized for mothers run by the churches in Reykjavík. All of them
had given birth to their first child before the age of 20. Apart from this shared
experience they were a heterogeneous group, both in terms of marital status and
342 Feminism & Psychology 10(3)
Characteristics of the data
Perspective Type Quantity
Primary healthcare centre Booklets and handouts 11
Young pregnant women and Two sets of interviews 10 interviewed while
new mothers (< 20 years old) with young women while pregnant; 8 interviewed
pregnant and after they again after giving birth
have given birth
Women who had first child Groups with two Four groups (N= 8)
young (< 20 years old) participants
Key: N= number.
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size of family. Their ages ranged from 19 to 34, and they had given birth to
between one and three children when I interviewed them.
The group interviews were semi-structured and I used a topic guide based on
the individual interviews. However, the group interviews were different in char-
acter from the individual interviews in that the participants actively engaged with
one another. They prompted each other and asked each other questions. As a
result the group interviews tended to be more emotional and more conducive to
raising controversial issues. The group interviews lasted two to three hours.
In line with Sbisà (1996) I systematically focused on two aspects in the analysis
of the booklets and handouts: the first was how the reader was addressed – that
is, the agency of the pregnant woman or woman giving birth. I paid particular
attention to how the body figured in the way in which young women were dis-
cursively positioned. Second, I considered how pregnancy, childbirth and staff
were represented – that is, the focus was on the object being produced and the
way different agents were positioned in relation to the pregnant woman. In addi-
tion, I made a special note of the tone of language used, popular metaphors and
the kind of illustration chosen for different booklets. On the basis of this I iden-
tified several recurrent patterns or discursive themes running through the book-
lets. I related these to the theoretical literature, discussing the way the body fig-
ures in constructions of agency.
All the interviews were transcribed verbatim using the transcription notations
described in Potter and Wetherell (1987: 188–9). As with the booklets, I analysed
discursive themes and their implications for how the young women were posi-
tioned as agents. I present the results from my analysis in two parts. First, I pre-
sent the results from the content analysis of the booklets and handouts; in the
second part I present examples from my analysis of the interviews, where the
young women describe positive and negative experiences of dealing with med-
ical/healthcare institutions.
My analysis of the booklets and handouts broadly confirms what other
researchers have found when analysing handbooks for mothers-to-be (Sbisà,
1996; Treichler, 1990). Childbirth and pregnancy are generally accounted for in
terms of a medical/healthcare discourse. Much of the information is presented as
‘facts’, with frequent reference to the scientific production of those facts.
The medicalization of the pregnant body is achieved partly by not defining
pregnancy as normal until after the birth of the child, thereby rationalizing the
monitoring of healthy bodies. One of the booklets points out how one in three
women can expect complications while giving birth, thus rendering the pregnant
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body as pathological and problematic. In most cases a binary opposition is set up
between the knowledgeable, authoritarian expert and the passive and/or prob-
lematic patient. I identified four strategies for downplaying the agency of preg-
nant women: the detached body, emphasis on emotional instability, pregnant
women and new mothers infantilized and the fetus as subject. These strategies
were more apparent in the glossy, expensive booklets, which seemed to function
as a statement of the institution itself. Each of the strategies will be discussed
The Detached Body
Descriptions of birth generally present it as a process carried on by the body as a
machine functioning of its own accord. In the following description from a book-
let compiled by the Icelandic Equal Status Council (IESC), the pregnant woman
is absent as an agent; instead, the contractions give birth to the baby:
Now there is no resistance from the cervix and the child is pushed out by the
contraction in 1, 2 hours [. . .] During the second stage of labor, or the active
phase, the woman should push and thereby increase the tension in the abdomen
and thereby the uterus. The birth is not finished until the contractions push out
the placenta (1984: 15–17).
This is in line with Martin’s (1987) observation that medical discourse describes
the body as detached from the woman’s will and agency.
Emphasis on Emotional Instability
The booklets and handouts stress that for most women pregnancy is a happy and
positive time, but there is then the qualifying ‘but’. Great emphasis is placed on
the emotional instability of pregnant women: the reader is left with the impres-
sion that the emotions of pregnant women are extremely volatile – they fuss and
worry unnecessarily over petty things – and are capable of overruling rational
thought. More emphasis is placed on the negative rather than potential positive
consequences of this increased emotionality.
Several explanations are offered for this emotional turmoil. Most booklets and
handouts emphasize the changes taking place in women’s lives and bodies, and
the body’s army of uncontrollable hormones. Occasionally these discussions
have a moralistic undertone. One of the less expensive handouts discussing
maternal blues recognizes the enormous demands made on new mothers but still
has this to say:
Employed mothers know that it is difficult to serve two masters. If she is fully
committed to each job it requires her full energy, as a consequence one of the
jobs tends to be done at the expense of the other. Therefore I think the mothers
of infants can experience depression when they realise that you can not have
your cake and eat it (Primary Health Care Centre handout).
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Pregnant Women and New Mothers Infantilized
Pregnant women are infantilized through the way in which they are addressed and
positioned in relation to the experts. Although the main booklet compiled by the
Primary Health Care Centre in Reykjavík, in 1988, stresses that staff are there to
help the pregnant woman and new mother and that she is the one who makes the
decisions, the tone is deeply patronizing. Her concerns are labelled in a negative
and undermining manner as ‘complaints’; in contrast, the experts and staff ‘give
advice’ and have final responsibility for making decisions. Pregnant women are
reminded of things that are already part of the routine of normal adults, such as
that they have to take a bath or shower regularly; they are even encouraged to eat
three to five times a day and to take the time they need and ‘chew the food well’.
At times the advice looks more like something directed to children than respon-
sible adults. The following example illustrates this: ‘Germs that live in the mouth
cause dental decay. They live on sugar that we consume in different forms’ [the
illustration to this text showed a tooth that was crying] (Primary Health Care
Centre handout, 1988: 20).
The Fetus as Subject
Occasionally the booklets place the fetus as the super-subject, thereby transform-
ing the body of the pregnant woman into a mere vessel or incubator: in one of the
illustrations the mother-to-be has been erased. She consists only of the outlines
of her body enclosed around a fetus with adult features enhancing his/her status
as a subject.
Mothers-to-be are expected to engage in activities that make the womb a more
hospitable environment for the fetus. Booklets discussing the dangers of smoking
use this strategy: the harmful effects of smoking are described in detail. In the
main booklet directed against smoking there is, however, neither any mention of
the harm smoking does to the health of the pregnant woman, nor is she given any
advice on how to cut down or stop smoking. This booklet illustrates differences
between mothers-to-be who smoke and those who do not, with a pregnant woman
who smokes portrayed with a vacant expression; she is cross-eyed and her
eyebrows are raised in a gesture of surprise. The fetus is shown curled up inside
her covered in a cloud of smoke with a cigarette in his/her mouth. In contrast,
the woman who does not smoke is presented as a blonde mother who smiles at
the reader, holding a full-term blonde child in her arms.
To sum up, the advice offered in these leaflets is frequently patronizing and the
pregnant woman is not always treated as a fully responsible agent. She either
exceeds the boundaries considered appropriate for mature agency through her
childlike or emotional behaviour, or is not present as agent at all. The old chant
about women’s unreliability, immaturity, dependency and passivity is repeated
yet again.
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The choices and ideas of the young women I interviewed were structured by their
individual histories as well as the discursive context of their lives. Their use of
the information provided by medical institutions was selective and some said that
they preferred consulting friends or their mothers to using booklets and hand-
books. In addition, the dynamics between staff in the medical institutions and
pregnant women sometimes counteracted the institutional regulation of the moth-
ers-to-be, and at times quite explicitly. The young women, for example, told me
that they were encouraged to be assertive about their needs and rights in birthing
classes. However, the ease with which the young women reverted to the medical
vocabulary testifies to its superior status in defining labour and delivery, in line
with Sbisà’s (1996) results from interviews with Italian women. The young
women used descriptions such as ‘stages’, ‘dilation’ and so on to make sense of
the process of giving birth. As Sbisà points out: ‘Such terminology conveys a
mechanical view of what the body will be doing, as well as an idea that what the
woman herself will be doing is something which requires training’ (1996: 371).
The young women I interviewed on an individual basis were more or less sup-
portive of the care that was on offer. Their criticisms were directed towards staff
and I frequently heard the phrase ‘I was “lucky”/“unlucky” with the midwife
attending the birth’. The participants in the group interviews, by contrast, were
more critical and some criticized the medicalization of childbirth explicitly.
Positive Experiences
Although a number of feminists have linked technical innovation in medicine
with alienation, a number of the young women described these technologies as
enabling and beneficial. Seeing the fetus in the sonogram scan was considered to
be one of the strongest experiences of pregnancy and descriptions such as ‘weird’
and ‘strange’ were common. One of the pregnant women compared her experi-
ence of the ultrasound scan to that of watching Aliens. As the young women
described it, this experience made the fetus, or the child as they referred to it,
somehow more real. Although women’s agency and their rights to make choices
for themselves are positioned against the needs and rights of the increasingly vis-
ible fetus, women also use the new visibility of the fetus to serve their own inter-
ests, and for their own empowerment. I found that the young women used this
notion of an ‘other’ with needs separate from their own to encourage boyfriends
to attend the ultrasound scan in the hope that it would make the pregnancy real to
them and elicit behaviour fitting for a father-to-be.
Most of the young women who described giving birth as a positive experience
placed themselves centrally in their accounts. It did not matter whether they had
been given anaesthetics; what mattered was whether they were allowed to feel
that the birth was their achievement:
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Halla (group, describing birth two years ago): But I love talking about what it
was like giving birth, or you know when people ask me, I really enjoyed it, this
is such an explosion, this is such an experience.
Sigrùn (group, describing birth of second child five years ago in Denmark): I
arrived, had a shower, was examined, went into the child birth unit, had the child
and went home. I gave an acute birth, was then at home with the staff I chose
myself. I just took the child put it in the carrycot and walked out.
Positive experiences of pregnancy and childbirth also challenged some of the
knowledge and truth produced by the medical/healthcare discourse. Although the
booklets emphasized the unstable moods accompanying pregnancy and placed
more emphasis on its negative effects, some of the young mothers had experi-
enced mood changes in a positive way:
Sonja (16-year-old, pregnant): I laugh a lot. Many people say to me, you know,
you are always laughing and (.) smiling a lot, very cheerful, then sometimes I
have a tendency to switch off
Annadís: Yes
Sonja: I never sulk or anything like that
Annadís: Yes
Sonja: I am just so happy with life, I find it so weird, especially since you know,
I started to be visibly pregnant. You couldn’t tell in the beginning.
In general, the young women did not view pregnancy as a pathological condi-
tion but as a maturing process where giving birth was a turning point in their own
development as people. This stands in stark contrast to the negative portrayal of
pregnancy frequently presented in the medical/healthcare literature.
Negative Experiences
In their negative descriptions of pregnancy, and especially giving birth, the young
women clearly resisted not being seen as autonomous agents:
Annadís: Is there something you would like to change about how pregnant
women are treated?
María (group, gave birth three years ago): Yes, how they address them, I am not
a patient, and I am not a child. I don’t think they should say ‘shall we get out of
bed now’ or ‘shall we have a drink of water now’, it is just ‘can I offer you some
water’ or ‘do you want me to help you get out of bed’. I want to, you know, I
am a woman capable of thinking for myself even though I am having a baby, do
you know what I mean. If anything I think more because there are two of us
Similarly, the women resented not being consulted about how their bodies were
treated. One woman in the group interviews described how, when she gave birth
to her first child, medical students had been queued up to examine how her cervix
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was dilating. Her memory was of being asked ‘can he try and him and him?’
When she later gave birth to her pre-term child, one of the staff went into the hall-
way and shouted ‘pre-term child’. She then remembered the room cluttered with
‘at least 20 people watching her’. While she concluded that times had changed,
this was a memory that still caused her much pain. This same feeling that the
body was treated as a machine over which the birthing woman had no control was
expressed in descriptions such as feeling like a ‘piece of meat’, ‘like a hen laying
eggs’, ‘like a toy’.
Some of the women complained that they had not been listened to or that they
had been ‘bossed around’ in the hospital. They described this as making them feel
insecure and as if they were not doing anything the right way. In other instances,
technical instruments were trusted more than the women’s own views on what
was happening with their bodies. When I asked the young women whether they
thought this kind of treatment might have been provoked by their youth, they
agreed that this might be a possibility. However, older women in the group inter-
views also reported instances of negative experiences from later pregnancies and
This analysis has a number of implications for feminism. First, it suggests that the
binary opposition between mind and body makes women’s agency in reproduc-
tion problematic and invites those in positions of authority in medical/healthcare
institutions to ignore women’s views and wishes. Women want to be consulted
about how their bodies are treated, not reduced to objects. For example, medical
examinations conducted without the woman’s consent can be experienced as a
humiliating sexual invasion. The cervix and vagina are sexual organs and not just
the birth canal. As such, they are laden with connotations about women’s mod-
esty and sexuality which may be explicitly disregarded during the birth process,
but can never be absent for women. This analysis also portrays the ambiguity and
instability of discourses of knowledge. The young women were both appreciative
and critical of their treatment by medical/healthcare institutions. They valued
technological innovations such as ultrasound scans and the contribution of med-
icine to the control of pain. However, this medicalization became problematic
when they felt that their authority over their own bodies was being removed.
The ambiguity and the unstable nature of discourses open up positions for
resistance. There were a number of examples of resistance to the knowledge and
truths produced by the medical/healthcare discourse such as contesting the views
of medical staff about the progress of labour or refusing to define pregnancy as
an abnormal condition. Indeed, young women’s complaints about the attitudes of
medical institutions and their staff are indicative of resistance to dominant truths.
An important perspective missing in this analysis is the views of the staff
working in medical/healthcare institutions. Interestingly, following a presentation
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of this analysis to the staff at one of the main healthcare centres in Reykjavík, it
was decided to take some of the booklets out of circulation. There is also lively
discussion in the Icelandic media regarding the care of women giving birth. The
concept of ‘choice’ figures prominently, positioning pregnant women as agents,
and views that contrast with the traditional views are filtering into discussions. It
is too early to say whether there will be a discursive shift in institutions which
care for pregnant women, but my experience suggests that feminism can enter the
debate about the meanings of childbirth and pregnancy in the medical/healthcare
institutions themselves.
I thank Anne Woollett, Harriet Gross and an anonymous reviewer for their helpful com-
ments on an earlier draft of this article. A previous version of this article was presented at
the Women and Psychology conference in June 1998 in Birmingham. I am indebted to the
Icelandic Research Council for funding the research reported in this article and to the
Centre for Women’s Research in Iceland for making it possible to conduct this research.
All names of participants are pseudonyms.
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Annadís Greta RÚDÓLFSDÓTTIR completed her PhD at the Department of
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ADDRESS: Department of Social Psychology, London School of Economics
and Political Science, Houghton Street, London WC2 2AE, UK.
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... At the same time, the use of technologies successfully for toxaemia 2 (the presence of albumin in urine) and eclampsia 3 (increasing systolic blood pressure) during the ANC visits can make a pregnant woman an object and the physician a subject. The ability of a pregnant woman to know her own body through experience and exercising self-hygienic techniques to ensure her health is replaced by her new, primary patient status which necessitates technological monitoring, abstracts her body and creates an asymmetric power relationship between the patient and doctor (Barker, 1998;Rudolfsdottir, 2000). 1 The concept of risk management was basically based on an industrial principle. By reviewing major industrial disasters, it discovered what factors had been responsible for these disasters and what should have been done instead. ...
... Motherhood is seen as a job; the mother's work and her body are the resources from which babies are made, the final product is a baby produced by the labour of mothering and obstetricians are the forerunners or mechanics whose job starts when a pregnant mother comes to the clinic for ANC and finishes after her discharge from the maternity centre. It views the female body as a complex entity which warrants medical intervention to repair malfunctioning (Johnson, 2009;Miller et al. 2003;Rothman, 1989;Rothman, 1991;Rudolfsdottir, 2000). 2 Being pregnant is seen as biologically determined by the 'feminine' qualities of women. ...
... It views the female body as a complex entity which warrants medical intervention to repair malfunctioning (Johnson, 2009;Miller et al. 2003;Rothman, 1989;Rothman, 1991;Rudolfsdottir, 2000). 2 Being pregnant is seen as biologically determined by the 'feminine' qualities of women. The role of attendants like midwives or dai is to teach a pregnant mother how to give birth and to take care of a newborn baby (Clarke, 2010;Johnson, 2008;Meyers, 2001;Rothman, 1991;Rudolfsdottir, 2000;Van Teijlingen, 2005) and incentives. Acceptability of their services depends on users' perceptions about their roles. ...
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Because of the increasing nature of the global system, it is safe to say that insecurity anywhere is insecurity everywhere. The emergence of Boko-Haram in 2002 and the subsequent activities of the group have resulted to countless number of damages sustained by the Nigerian nation, the neighboring countries and the world in general especially with regard to loss of lives and properties. With this in mind, the necessity of understanding the group and the sociological factors surrounding their existence and survival becomes pertinent. The presence of Boko-Haram in Nigeria cannot be isolated from the underpinning social circumstances surrounding the understanding and interpretations of the ethno-religious forces that are prevalent in Nigeria and the proliferation of religious ideology from the Middle East. Hence, practical solutions to the problem cannot be realizable without a theoretically informed explanation. The objective of the paper is to trace the identity issue surrounding the emergence of boko haram and their activities using the social identity theory.
... Analyses of obstetric texts show that the bulk of the texts focus on the physical aspects of childbearing, while social and emotional components are either presented in a single separate chapter or are excluded altogether (Hahn, 1987;Martin, 1992). Research shows that self-help pregnancy guides rely primarily on medical discourse to relay information to pregnant women, which constructs the pregnant and birthing body as pathological and detached from any subject; where the emotional aspects of pregnancy and childbirth are addressed, emotional instability and irrationality are emphasized (Marshall & Wollett, 2000;Rudolfsdottir, 2000). The perspective conveyed by both sets of texts conceptualizes pregnancy and childbirth as occurring primarily within the physical realm of the female body. ...
... Research on women's experiences during pregnancy and childbirth suggests that childbearing encompasses more than just the female body, demonstrating that pregnancy and childbirth are also experienced on a social and emotional level. Most of these studies indicate that social and emotional aspects of childbirth have a much greater impact on women's levels of satisfaction with their childbirth experiences than the physical aspects of labor and delivery (Campero et al., 1998;Fowles, 1998;Rudolfsdottir, 2000;Simkin, 1991). ...
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Dominant notions of reproduction perceive childbearing as physical processes that take place within women’s bodies. This perception undermines non-physical components and removes men from the process. This project uses social constructionism to explore the locations women describe pregnancy and childbirth taking place in their childbearing narratives. Based on in-depth interviews with 15 mothers, findings reveal that women conceptualize childbearing as taking place in multiple locations: (1) within the female body, (2) within both the female body and a non-physical realm (e.g., emotional) of one or both partners, (3) detached from any particular location, and (4) within both partners’ bodies. Conceptualizing childbearing as something other than a purely physical event acknowledges non-physical elements of childbearing and allows greater participation among men.
... Contrasting social support perceptions and societal value of pregnant women in Italy, some participants also noted pregnant women were perceived as unable, too fragile, or too ill to complete daily tasks. This nding elaborates on literature suggesting pregnancy affects women's self-identity, positioning them within illness or infantilized narratives (43). Italian pregnancy norms, though mostly positive, may impact women's agency by reducing their identity to only their pregnancy state. ...
... Risk overestimation may result in decision-making that does not re ect women's actual birthing preferences. Fear and risk narratives may relate to lacking understanding of normal birth (13,43), with participants describing birth as too medicalized, while also subscribing to overarching fears about the dangers of pregnancy and birth. Rather than birth observed as a natural and normal process, these prevalent perceptions construct pregnancy as a disease process requiring intervention to avert risk even among low-risk women (13,17,31,46). ...
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Background: Preconception health planning is a recognized resource for optimization of physical and mental-emotional health prior to pregnancy, though few women and providers demonstrate high awareness of preconception health. Furthermore, concerns, fear, and risk perceptions are often absent from the discussion, despite their potential impact on pregnancy and birth decision-making. These themes remain understudied in Italian populations. Methods: Researchers conducted in-depth interviews in 2017 with 43 reproductive-aged women living in or around Florence, Italy, and currently using the Italian health care system. An expanded grounded theory approach was used to explore pregnancy and birth perceptions. HyperRESEARCH facilitated open and axial coding for thematic analyses. Results: Themes emerged in the form of three continuous spectrums across which women view pregnancy and birth decision-making in the preconception period. First, participants identified strong social and healthcare support for pregnancy and birth, which at times was perceived as excessive or limiting (Supported vs. Controlled). Second, participants contrasted Italian preferences for natural and holistic processes with the medical model of prenatal care and birth (Natural vs. Medical). Third, participants constructed pregnancy and birth through risk narratives, placing a high priority on safety (Safe vs. Risky). While women described a culture of social support and natural lifestyle preferences, they also emphasized complications and risk, treatment of pregnant women as sick or fragile, seemingly rigorous prenatal care, and birth choices contingent on as-of-yet unexperienced complications. High levels of social and medical control surrounding pregnancy correlated with high levels of perceived risk. Conclusions: Findings offer opportunities for practitioners to address pregnancy- and birth-related concerns and misinformation through an integrated model demonstrating both the destructive role of risk and control as well as the possibility of a more positive emphasis on safety and support.
... Given the growing ambivalence between women's' positive valuation of technological innovations and the feeling of losing the authority over their bodies (Rudolfsdottir, 2000), we sought to deepen the experience of pregnancy of a group of Portuguese pregnant women and to understand their expectations about childbirth. Essentially, we set out to ascertain what factors are considered most important in the course of the pregnancy and what expectations are developed about the childbirth event. ...
... A semi-structured interview script was prepared to ascertain the experience of pregnancy and expectations about childbirth. This script, with five open-questions, was developed based on a literature review, namely, the works about childbirth expectations (Moore, 2016) and fear of childbirth (Fenwick et al, 2015;Gibson, 2014); and the current medicalization of the birth event (Helman, 2007;Rudolfsdottir, 2000). The first question focused on the representations of the experience of pregnancy and the expectations of the birth ("How do you see the birth to come? ...
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... Nevertheless, this focus expands a medical and riskbased experience of pregnancy and motherhood. These moments of motherhood-as-medicalcondition can be valuable for some mothers and infants (and have even been life saving for an author of this paper), but the expansion can become indiscriminate, so that every moment of every pregnancy becomes scrutinized to the point that the medical ramifications supersede all other aspects of women's lives (Barker, 1998;Rúdólfsdóttir, 2000). ...
The field of science communication is plagued by challenges. Communicators face the difficulty of responding to unjustified public skepticism over issues like climate change and COVID-19 while also acknowledging the fallibility and limitations of scientific knowledge. Our goal in this paper is to suggest a new model for science communication that can help foster more productive, respectful relationships among all those involved in science communication. Inspired by the pragmatist philosophy of John Dewey, we develop an experience model, according to which science communication consists in people’s experiences with science and the meanings they develop from those experiences. Three principles are central to the model: experience is cumulative, context matters, and audiences have agency. We argue that this model has significant implications both for communication research and practice, which we illustrate by applying it to the phenomenon of vaccine hesitancy. We show how science communicators can help to identify and alleviate structural factors that contribute to skepticism as well as fostering opportunities for meaning making around shared experiences.
... Also present in the literature is a tendency to overlook the agency of women who accept medical management of their births, with many researchers failing to explore how and why women are using medical intervention and what benefits they experience in becoming patients (Dillaway & Brubaker, 2006;Fox & Worts, 1999). Generally speaking, existing literature demonstrates that, irrespective of whether women give birth with or without medical intervention, they express the desire to have their embodied agency respected (Chadwick, 2017;Chadwick & Foster, 2012;R ud olfsd ottir, 2000). ...
Childbirth is widely recognized to be among the most painful of experiences, and the most common and effective pain relief for birthing women is known to be the use of epidural analgesia. The increase in the use of epidural analgesia for birthing women has been described by some critics as a by-product of the medicalized model of birth, although there remains a notable dearth of research regarding women’s experiences of epidurals. The present paper seeks to address this research gap by examining how first-time mothers in Iceland discuss their intentions concerning pain relief during birth, along with how they construct childbirth-related pain and the use of epidural analgesia in the context of a midwife-led model of care and an institutionalized preference for “natural” birth. The findings demonstrate that, despite initial intentions, most of the women end up having an epidural, and most describe their epidurals as both wonderful and immensely helpful. The dominant narrative about “natural” childbirth being preferable is not fully refuted by this. Instead, the women either align themselves with the ideology of the capable and knowing body or resist and contest this narrative by constructing their birthing bodies as open to, and in need of, assistance.
... Podobně i Rúdólfsdóttir (2000) poukazuje na to, že materiály určené pro těhotné ženy často pracují s binární opozicí mezi autoritou a věděním experta a pasivní (či dokonce problematickou) klientkou. Agency těhotných žen byla v těchto materiálech systematicky omezována několika způsoby, mezi které patřil například popis těhotného těla jako těla, které žije vlastním životem a je tak mimo ženskou kontrolu. ...
Zkušenost těhotenství v sobě obsahuje zásadní paradox. Na jednu stranu se jedná o vysoce subjektivní prožitek ženy dotýkající se jejího individuálního života a těla, na druhou stranu představuje nutnou podmínku reprodukce společnosti. Tento text se snaží o zachycení této ambivalentnost a představení těhotenství jako sociálního faktu, který přes svou výsostně intimní povahu zároveň představuje prostor pro analýzu otázek konstrukce genderu, norem mateřství, disciplinace ženského těla a kontroly reprodukce. Nahlíží na těhotenství ze dvou úhlů pohledu - jako na zkušenost, která je výlučnou součástí ženské subjektivity a která zakládá specifickou ženskou zkušenost, a zároveň jako na proces, který je hluboce zakotvený v institucionálních rámcích a společenských představách vhodného ženské těla a mateřství.
Pregnancy is a time when many women might be focusing on their health, perhaps to a greater degree than previously. Pregnancy, as every other personal experience, must be viewed holistically. Women and pregnant people often experience increased levels of stress due to fear, partly compounded by medicalized systems of maternity care. These systems can make depersonalize the experience of pregnancy. Wellbeing, although hard to define, incorporates an understanding of the intersections between mind, body and self: mood, emotion, thought and embodied experience are all part of wellbeing and this is particularly relevant during pregnancy. Too often, biomedical approaches to pregnancy care overlook emotional wellbeing and Complementary therapies such as aromatherapy, music and acupuncture offer an adjunct to conventional maternity care and the chance to optimize bio-psycho-social wellbeing throughout pregnancy, and support pregnant people to address the emotional changes and challenges of this period of growth and becoming. This chapter focuses on some ways to use complementary therapies such as aromatherapy, music, and acupuncture to enhance a person’s sense of emotional wellbeing during pregnancy. It touches on some of the psychological, personal, emotional, and physical challenges associated with the pregnancy journey, and considers ways that women and childbearing people can take charge of their own emotional state and enhance their ability to adapt to the changing landscape of body, mind, and personal world during this time of transition.
Conference Paper
Behavior change and improving health literacy based on normative ideals of motherhood is a dominant paradigm to address maternal health challenges. However, these ideals often remove women’s control over their bodies overlooking how the bodily experiences of pregnancy are socially and culturally constructed. We report on 27 interviews with pregnant women and nursing mothers in rural and semi-urban areas of South India, and six focus groups with 23 frontline health workers as secondary data. We explore how the embodied pregnancy experiences are infuenced and negotiated by the socio-cultural context and existing care infrastructures. Our fndings highlight how the ways of seeing, knowing, and caring for a body of a pregnant woman through often conficting norms, beliefs and practices of medicine, nourishment and care actively shape the experiences of pregnancy. We open up a space for novel opportunities for digital health technologies to enhance women’s embodied experiences and pregnancy care infrastructures in the Global South.
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Challenging the norm of silence around miscarriages in Indian society, this paper is my attempt at reflecting, documenting, and sharing the personal experience of living through an early pregnancy loss and subsequent grief. Here, I narrate the story of my “delayed miscarriage” and reflect on the implicit social scripts associated with pregnancy and motherhood in Indian metropolitan context. Additionally, I share the details of my encounters with various healthcare practitioners during the course of my short-lived pregnancy while simultaneously critiquing the healthcare practices adopted for patients of early pregnancy loss at hospitals in metropolitan cities in India. Methodologically, the inquiry adopts an autoethnographic approach wherein the researcher uses personal storytelling, self-reflection, and analysis to illuminate and theorize the cultural experiences and psychosocial meaning-making processes. “Pressures and contradictions of pregnancy scripts,” “silent suffering and discounting of loss,” “mystery of loss and meaning making,” “alienation,” “objectification of the pregnant body,” and “busy business of healthcare” emerged as significant themes for discussion in the autoethnographic account. Through a discussion of these themes, I highlight the ways in which the implicit cultural scripts attached to pregnancy and motherhood take away agency from women. I further argue for the necessity of challenging the prevailing the trend of silent mourning after miscarriages in India to promote mental health and well-being of women. With respect to the healthcare practices in India, I advocate for implementation of an ethically grounded biopsychosocial approach to caring for early pregnancy loss to restore women’s agency. Finally, reaffirming the autoethnographic stance, I discuss the possibility of healing through research and writing in the end.
Full-text available
In this study it is argued that femininity is mediated by historical and cultural factors. I explore how rapid changes in the social structure of Icelandic society have introduced challenges to many cultural constructions. The theoretical framework draws from the work of Michel Foucault, in particular the idea that the individual emerges through the practices and discourses s/he is constituted in, and that these incur power relations. Several entrance points have been selected into the Icelandic culture and its ideas of femininity. One is through a random sample of 209 obituaries, published from 1922 to 1992. The other is through semi-structured interviews with 18 women, aged 16 to 88, conducted in 1992. A discourse analysis reveals two dominant discourses for constituting the "Self', with different implications for men and women respectively. "The discourse of the Chieftain" constructs the "Self' as independent, self-reliant and central. In this discourse, it is argued, the "Self' is a dominantly masculine ideal. In contrast, the "discourse of the Soul" emphasises the individual who puts others before herself, is self-less, obedient, dutiful and loyal. It is argued that these discourses were necessary for maintaining a particular power structure within the pre-modern Icelandic society, and that they portray particular roles as "natural". Changes in modem Icelandic society have caused a rupture in the harmony between these discourses. New discourses have emerged, and women are increasingly putting their own needs and selves before others. The inter and intra-subjective tensions that these changes have incurred are traced. Women's strategies of resistance that have unfolded in response to dominant ideas are outlined. In their different forms of disciplining sons and daughters, women use their position as mothers to encourage societial changes. Implications of these findings for theories of construction of femininity are discussed.