Push Back: Guilt in the Age of Natural Parenting

Obstetrician Amy Tuteur, M.D. is on a no-holds-barred mission “to help women escape the feelings of guilt [attendant to] the currently popular philosophies of natural childbirth, lactivism, and attachment parenting.” Though Tuteur readily admits that aspects of these movements have value (e.g., “There is a considerable body of scientific evidence suggesting that the presence of a doula can improve the childbirth experience”) and that those who embrace them mostly mean well, she takes each phenomenon to task for using falsehoods and pseudoscience to disempower women while claiming to do the opposite.

It can be difficult to swallow Tuteur’s unflinching assessment. “You or I might imagine that dead babies would cause midwives to reassess their aversion to technology,” she writes: “Instead it has caused them to reassess their aversion to dead babies.” But Tuteur makes a convincing case that her bitter medicine needs to be taken, and I found it manageable in small doses over the course of a week or two. Any attempt at a cover-to-cover read, a bolus, in the language of medical analogy she so adeptly employs throughout, is sure to end in frustration, however. That’s because the repetition and long-windedness of Push Back are as annoying as they are reinforcing. 

I struggled throughout to decide whether I wanted Tuteur to tone it down a notch, to lay off the vitriolic gas and not flog quite so many dead horses. “Many midwives, doulas, and childbirth educators have an inappropriate level of confidence despite their own lack of knowledge, and a significant proportion of lay advocates suffer from the delusion of believing themselves ‘knowledgeable’ after having done ‘their research,’” she writes in an emblematic passage, concluding that “[t]he world of celebrity natural childbirth and homebirth advocates is filled with … ‘confident idiots.’” On the one hand, oof. On the other, she ain’t wrong.

In fact, she’s right about a lot of things. Labor is dangerous. The idea that it’s not has caused many women to internalize the message that an unmedicated vaginal delivery is both possible and ideal in all but the rarest cases. From this “glorification” of one birth method, we get the disappointment and shame that come with unmet expectations.

No one claims that if you eat with a spoon you ought to feel guilty because you aren’t eating “as nature intended.” Similarly, if you faint every time you stand up, no one claims that it wouldn’t happen if you just “trusted hearts.” So why should birth be approached so differently” with women being instructed to just “trust birth”?

As for inductions and c-sections, Tuteur writes: 

The natural childbirth literature is filled with stories of women who ignored medical advice to induce labor and their babies survived. That’s because induction is recommended when the risk rises; doctors don’t wait until that risk is 100 percent or even close to 100 percent. The same reasoning applies to putting babies in car seats.

Her defense of the medical establishment extends to formula: “The existing scientific evidence shows that breastfeeding has real benefits, but in industrialized countries, those benefits are trivial.” Nursing has nonetheless “been aggressively promoted in public health campaigns.” As a result, breastfeeding has become a moral issue in recent years, she writes, lending a little personal perspective: “Back when I was nursing my babies, breastfeeding was recognized as one of two excellent ways to nourish an infant. Breastfeeding was considered marginally better, but not so much so that it was worth hounding women.”

She keeps race and class in mind as she analyzes each of these trends: 

The dominant mothering ideology in the United States today is attachment parenting, also known, revealingly, as intensive mothering. It’s the dominant ideology not because it is the way that most people parent, but because it is the ideal held by middle- and upper-middle-class mothers who are often highly vocal on the Internet and social media.

There’s certainly a case to be made that Tuteur acts as an apologist for modern obstetrics which isn’t without its flaws. But she acknowledges some of them, and her thoughts undoubtedly add value, one-sided though they may be:  

Among middle school girls, there is probably no insult more devastating than “no one likes you….” Among new mothers, there is probably no insult more devastating than “your baby hasn’t bonded to you.” That’s why lactivist and natural childbirth bullies wield it so promiscuously among new mothers. There is no evidence that bottle-fed babies are less bonded to their mothers than breastfed babies; there is no evidence that C-section babies are less bonded to their mothers than babies born by vaginal delivery. That hasn’t stopped activists from repeatedly invoking bonding to force new mothers into compliance with the ethos of the group.

And Tuteur’s bottom line is difficult to argue with: When it comes to birth, feeding, and parenting, several methods are reasonable, and it should be up to individuals to decide, unencumbered by pressure to conform to ideals of dubious origin and validity.

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