Flesh and Steel: Conceiving a Scientific and Literary Praxis of Pregnancy

For those of you unable to make it, I wanted to share my two upcoming conference presentations at MLA (Modern Language Association) in Chicago, Jan. 9-12, 2014. Here’s my first presentation, in draft form. Enjoy!

Flesh and Steel: Conceiving a Scientific and Literary Praxis of Pregnancy

“She was a woman with a young body whose knowledge, biological and intellectual, was defined in clearly marked periods, menstrual, domestic, academic, rounds of flesh, blood, rites, qualifications.  The pregnancy was another such, with its set term.” – A.S. Byatt, Still Life

“I know of no woman […] for whom her body is not a fundamental problem:
 its clouded meaning, its fertility, its desire, its so-called frigidity, its bloody speech,  its silences, its changes and mutilations, its rapes and ripenings.”
~ Adrienne Rich, Of Woman Born

On October 4, 2010, Time magazine chose a provocative cover for an article on fetal origins entitled “How the First Nine Months Shape the Rest of Your Life”: a pregnant woman, naked and sprawling, her legs akimbo, her belly unfurled, her gaze turned away, fixed as a still life for the viewer to inspect and decode (“How the First Nine Months”). This arresting image is important for three main reasons: first, as an apt illustration of the multitude of narratives placed on and around the reproducing female form; second, as a marker of how much Western cultural conditions surrounding birth have changed, rapidly, in the past 30 years; and, third, as an example of how much more the image of the pregnant and birthing woman still needs to develop to achieve full subjectivity in the glaring camera lens of the media-saturated twenty-first century. For, while the pregnant form here is on full display, its curves and recesses celebrated, it is also subjected to extreme normative conditioning: the woman here is thin, white, young, and sexually attractive. Further, her averted gaze brings to mind Iris Marion Young’s argument about growing up as a female: “one will be gazed upon as a mere body, as shape and flesh that presents itself as the potential object of another subject’s intentions and manipulations, rather than as a living manifestation of action and intention” (44). Indeed, the woman here is exhibited as a female work of art, a startling embodiment of shape and form, a testimony to physical beauty even as the body undergoes a shocking metamorphosis many people would concede borders on the grotesque. This picture celebrates this border, and gleefully toes the line between a culturally-acceptable image and an offensive one. It’s up to you, the picture’s audience, to decide if you think the picture performs this tightrope walk successfully, or not.

Using this picture as a jumping-off point for my discussion of the bioethics of birth in today’s wonderful panel, I am going to be showing you a variety of images of the reproductive female body. I ask you to be critical of the subterranean messages that are being conveyed through these images. Because this talk of mine is so invested in the appropriation of the female birthing form, I am especially interested in the way this form is portrayed in popular culture, the arts, and literature. Is birth a process of empowerment? Does the woman achieve full agency, express a voice, as a “becoming-mother” figure? These questions, and many more, should be foremost in our minds when we consider any image of the female body, but especially the image of the female reproductive form.

So, we have our first picture, and our first representation of the border of pregnancy: physical beauty versus the grotesque, empowerment versus subjectification.  However, another set of narratives surrounding this image of reproduction can be read as quite positive. Many critics argue that after the 1980s, a new emphasis was placed on the fetus due to technological developments enabling one to see what was previously unseen—most notably, rapid advances in ultrasound technology and, more recently, 3D imaging that offers to record a video of the baby in the womb. Since the advent of such interior imaging, critics such as Susan Bordo, Rebecca Kukla, Emily Clark, Margrit Schildrick, and Barbara Duden, among others, argue that the pregnant woman consequently became displaced as a mere “fetal container” (in the words of Susan Bordo). The advent of the ultrasound means that the pregnant woman is “simply not a part of anything,” argues Ann Kaplan, specifically referencing pictures portraying the fetus blown up to larger-than-life size, floating in a cosmos seemingly of its own making. Here I am of course referencing the famous fetal photos by Lennart Nilsson which appeared in the 1965 issue of Time, photos which purported to celebrate the miracle of fetal life but in reality, most photos in the collection were taken of dead fetuses.

Leaving the story of the pregnant woman behind, then, the story of the fetus seemed to be the only narrative the public wanted to read. To return to my original picture of the pregnant woman in Time, then, it is significant that this photo is very unlike the fetus-only photos which, as Kaplan claims, work to “write the mother out of the story … or to marginalize and negate her subjectivity.” No, this photo places the woman-in-the-body squarely in the birthing story as the key and central figure, emphasizing her: her body, her subjectivity, her needs, her desires, her decisions. In this regard, the cover can be read as a positive advancement for women’s studies, reproductive studies, and women’s rights, or, in the words of Margrit Schildrick, rather than positing “transcendent disembodiment [as] a condition of agency,” this picture instead “reinscribes the bodies of women.” While this picture symbolizes the myriad ways Western media has progressed when it considers the pregnant woman and the female form (it’s okay to celebrate her! Uncover her! Show her for what she is: a mere human being, not a goddess!), it also conversely emphasizes that women are very much in the same position they were in 100 years ago: fixed, silent, awaiting decoding by the patriarchal gaze. This woman, this body, is not figured as a powerful form with control of its situation and surroundings. Who, then, has the power and control?

I obviously don’t have all the answers, and today I am not going to try to solve a problem that has been brewing since Plato, Aristotle, and, indeed, since Adam and Eve as well. But I think I can offer a stab at a beginning praxis of pregnancy from a bioethical point of view, a praxis that draws on both scientific and literary viewpoints. I will be drawing from the considerable body of research I amassed as I worked on dissertation, which considers female reproduction in the British modernist era, but today, I will consider the specific intersections between literature, science, and the pregnant body. Because these three fields are quite large (to put it mildly), I limit my inquiry to only two Anglophone novels: The Birth Machine by the British Elizabeth Baines (published in 1982), and the more recent “multi-cultural” Cutting for Stone by Abraham Verghese (published in 2009). Verghese was born in Ethiopia to Indian parents, and he now resides in America, and the main character in his novel, Marion, ascribes to this same cultural and ethnic heritage. [As a sidenote, I collect birthing literature, so at the end of the presentation, please let me know if you have any more sources I can add to my library!] Out of all the books—mostly novels, memoirs, critical works, and collections of poetry, and most dating from the early 20th century and beyond—that figure pregnancy and childbirth in any profundity, why choose these two works specifically? Well, simply put, they offer an extremely wide spectrum: one British, the other “transnational,” one by a “white” female author, the other by a multicultural Indian-Ethiopian-American male physician (here the labels we so love to use get a little tricky), one figuring childbirth as an event that must be mapped and planned and must take place employing all the latest and most cutting-edge devices, the other figuring childbirth as a possibly catastrophic event that will “naturally” come to the body whether one is prepared for it or not. Both have specific things to say about the role of the female body versus the role of the doctor, the doctor’s tools, and the role of medicine in birthgiving. Both also feature childbirth as a predominant aspect of the plot: The Birth Machine is completely about birth, and Cutting For Stone narrates the events of a pivotal and catastrophic childbirth scene that lasts, due to interwoven stories and flashbacks, for no less than nine chapters—over 100 pages! For a pregnancy scholar like myself, this is like striking gold. Using these two texts as landmarks of sorts, then, we can attempt to begin to navigate the treacherous landscape that is female reproduction, both reproduction as it exists in “reality” (or “lived, phenomenological experience,” to draw on both Merleau-Ponty and Toril Moi) and as it exists in its fictional counterpart. Finally, I want to leave you today with three main ideas to keep in mind as you go about your lives, lives that will inevitably come up against female reproduction in one form or another, at one point or another.

So, just to reiterate, I am dealing with two bodies: the enfleshed or “lived body” existing in the “real” or the “now,” versus the literary body, a set of codes, a congealing of ink and paper, a cloud of signals operating on several different levels at once, a web of competing discourses jockeying for position yet remaining mostly unseen. I am also grappling with two bodies of critical thought: scientific and literary. In the intersections of these four areas, then, lies my three main ideas surrounding a working praxis of pregnancy, childbirth, and reproduction.

But first: the relevant criticism. Criticism focusing on the technologization of birth in literary texts predominately argues that Western models of control serve to colonize birthing women, rendering them passive, without subjectivity, and at the mercy of, to quote Adrienne Rich, “men and their tools.” (Beyond Rich’s seminal Of Woman Born, see Ann Kaplan, Motherhood and Representation, Helen Sterk, et al., Who’s Having This Baby?, Iris Marion Young, On Female Body Experience and Margrit Schildrick, Leaky Bodies and Boundaries). Further, feminist criticism often calls for the need for holistic new models of birth which are predicated on flux, ambiguity, and change (both/and) rather than upon an either/or model of the body as broken machine (see Emily Martin’s The Woman in the Body: A Cultural Analysis of Reproduction, and Tess Cosslett, Women Writing Childbirth: Modern Discourses of Motherhood). Additionally, Susan Squier offers a foundational argument in Babies in Bottles (1994) that literature is an excellent conduit of bioethical matters, and she interviews scientific, cultural and literary discourses to navigate the waters of “RT,” reproductive technologies, which she signifies in the image of the baby in the bottle (one immediately thinks of Aldous Huxley’s Brave New World and the trauma of “decanting”).

Employing these criticisms, then, I would like to interrogate how the texts by Baines and Verghese configure a bioethics of birth, precariously placed as it is between the steel of masculine science and the flesh of the feminine body.

My first point: Differences in Tools. [Pulling from Verghese, all tools are not the same: the hand is a tool, after all, and used properly, tools are the most meaningful aspect of life, as they are intimately linked to ritual, to passage, and to transformation.] In The Birth Machine, Zelda discovers that her pregnancy and birth have been the subject of research by her husband (a famous doctor). She is admitted to a hospital a week early and subjected to a demoralizing induction process that results in a stalled labor and eventual C‑section. After the horrific process, she finds, scrawled on her chart: “Clinical Trial: Convenience Induction” (116). Yes, she is delivered from the chaos of the birthing process by “men and their tools,” it is true, but the novel makes it clear that it is these men and these improper tools, used improperly, that got her there in the first place.

Verghese’s Cutting for Stone presents the opposite stance. The female body therein is frequently portrayed as being one with the machinery surrounding it, machinery which assists the birthing body in completing its parturition. Hema, a main character in the novel, is an “expert” at using forceps, visualizing the hidden interiority of the female body and then “articulating the two handles and confidently extracting the baby” (58). But the knowledge that Hema carries of the female birthing anatomy and of appropriate tools to employ (and appropriate times in which to employ them) is based on a fundamental respect for the birthing process, and for her role in it. Hema realizes she is an aid—an important aid, it is true, but an aid nonetheless. She is a help-meet, a vital assistant to the birthing process. Her use of tools is judicious and justified in the text: “Hema wielded her scalpel like a woman on fire” (114) — while the indiscriminate, reckless use of tools is again linked to the male physician. In the book, that male physician is epitomized by the odd, somewhat removed Thomas Stone, a renowned surgeon who considers the “Five Fs” of things “better out than in” to be “Flatus, Fluid, Feces, Foreign Body and Fetus” (73). Faced with obstructed labor of his dying love, Sister Mary Joseph Praise, he immediately goes directly to the most sinister tool of all, the “cephalotribe” or “skull crusher” (75). Because he has never performed a C-section, much less an emergency one, he would prefer to kill the infant, or “intruder,” and remove it piece-meal to save his loved one. When Hema bursts in on the scene, “she pointed at the bloody trephine and the open textbook… ‘Books and whatnots?’ She swiped them aside, and they clattered to the floor… She reassured herself that she had no part in the books and whatnots” (99-100).

From these literary snapshots, then, we can see that the problem of parsing out a bioethical birth is most definitely linked to tools and those who wield them, but we must remember that not all tools are the same (consider the hand versus the scalpel versus the trephine and cephalotribe), and not all physicians who employ them are the same as well. The importance, the life and death importance, lies in the difference.

This brings me to my Important Point number two: Information versus Intuition. Verghese, in his 2011 TED Talk (viewable here—highly recommended!: http://www.ted.com/talks/abraham_verghese_a_doctor_s_touch.html) argues for the undeniable and irreplaceable importance of what he figures as “a doctor’s touch,” or, in Cutting for Stone, what is called “Sound Nursing Sense”: sitting and talking to the patient, doing an “old-fashioned” and quite slow and unwieldy physical examination rather than ordering a barrage of disembodied and highly ineffectual tests and scans. His novel quotes a textbook that explains “sound nursing sense” as:

…more important than knowledge, though knowledge only enhances it.
Sound Nursing Sense is a quality that cannot be defined, yet is invaluable when present and noticeable when absent. […] a nurse with book knowledge but without Sound Nursing Sense is like a sailor at sea in a seaworthy vessel but without map, sextant, or compass. (Of course, the nurse without book knowledge has not gone to sea at all!). (41)

There is obviously a significant difference between bodies of knowledge, especially whenever bodies are concerned. There is knowing versus experiencing, seeing versus being, and there is information versus intuition. The physician can know everything in the world about the process of pregnancy, labor and childbirth, but if he or she does not know the woman involved, or if he doesn’t have intuition, the knowledge and science is worthless.

One immediately thinks: okay, to conceive a proper bioethical praxis of birth, then, one needs to ensure that the doctor knows the patient. But it’s not so simple: in Birth Machine, the hapless Zelda is at the mercy of her doctor-husband (arguably the person who knows her best in the world), and in Cutting for Stone, Sister Mary Joseph Praise lies dying at the mercy of the hands of her purported lover. Both these doctors have the required relationship with their patients, but what they lack is the all-important intuition. Intuition is defined as “the ability to understand something immediately, without the need for conscious reasoning,” “a feeling that guides a person to act a certain way without fully understanding why,” going with the gut. As in, not scientific (rational) at all. Intuition can therefore be linked to a feminine modality of knowledge, knowing through the body, versus a traditionally masculine modality, knowing through the mind (to employ problematic divisions). Another way of spinning this knowledge divide is via Plato’s categories of episteme, “pure, or theoretical knowledge, the stuff proper to philosophy which is produced in critical dialogue” over techne, “practical knowledge emanating from skill, art, and practice” (drawing from Mark Cote).

Okay: then we need female doctors who establish ongoing relationships with their clients, a doula-midwife-obstetrician. Perhaps this is close, for it brings me to my Third Important Point: Relationship Yielding Empowerment. Tools, as we have seen, are problematic. Relationship alone doesn’t solve all our problems. But somewhere in the nexus of the two lies the appropriate physician-patient relationship that is rooted in dialectic not dichotomy, founded in becoming not in stasis, and at any given moment, strives to find the middle ground between what is best for the physician (so hampered by the omnipresent threat of litigation) and the patient, whose body lies in the balance.

In The Birth Machine, Zelda finds this fundamental, life-giving relationship with herself at the end, as she escapes the apparatus of the hospital and technologization of birth. She takes the power back by moving her body and making her own decisions; she “names herself: Teacher, Scientist. The words taste. At last they have texture. At last, to acknowledge her own insights, to be her own author” (122). This relationship and fellowship with herself, so long denied by the alienation of medicalization, foreshadows the relationship-to-come with her infant son, who looks at her trustingly as she carries him away from the hospital, away from her husband and towards a new matriarchal life: “He doesn’t cry…his eyes are wide open, waiting for her, waiting for images” (123).  Women, Elizabeth Baines seems to be shouting, take the power, for it will not be given to you. Create your new names, your true names, and, perhaps most importantly, teach your daughters and sons to do the same. We must take back bodily intuition and agency, or, as Margrit Schildrick calls it, “moral agency,” “the sense in which an individual can be said to be in control of and responsible for choices made and acted on within the moral sphere” (6). We must find ways to reacquaint ourselves with the morals and ethics of our body space once more.

Verghese’s Cutting for Stone is a 600-plus love-letter to the art, science, and lifestyle of practicing medicine. The characters in this novel (for the most part) are truly devoted to their craft and devoted to saving and bettering lives. Verghese, in his TED talk, explains that there is no “magic doctor” or “magic treatment,” just a “journey towards wellness.” Physicians need to earn the right to come alongside their patients and lead them towards wellness with such in-depth, personalized, bodily care. He explains that culturally we need to reestablish the ritual of caring for our bodies. “Rituals are all about transformation,” he explains: think of weddings, funerals, they are “terribly important.” The ritual in the patient/doctor relationship, disrobing and allowing touch, is of “exceeding importance, and if you short-change that ritual by not undressing the patient,” it is at the peril of our entire society. With the “explosion of knowledge,” we are “lulled into inattention, forgetting that the ritual is cathartic to the physician, necessary for the patient,” that it has “meaning, and a singular message to convey to the patient… I will always, always, always be there. I will see you through this. I will never abandon you. I will be with you through the end.”

How many of us can say we enjoy this kind of intimate and balanced relationship with our physician? While a relationship like this may border on the hyperbolic, I also think it can offer a useful model when considering a bioethical praxis of a scientific and medicalized pregnancy and childbirth. I propose that a bioethical consideration of the permutations of a woman’s body in gestation and parturition should encompass her complete subjectivity. Marsden Wagner calls this “humanized birth,” or “understanding that the woman giving birth is a human being, not a machine and not just a container for making babies.” In other words, a nuanced understanding of both the benefits and the shortcomings of science in the birthing chamber can lead to a balanced and bioethical birthing process, giving women the critical power over her corporeal, the “principle of personal liberty” (Schildrick 68), the space in which to choose.

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