From conception to new parenthood, women experience many different stages of childbearing which can be difficult to navigate. Here, Dr Susan Hogan, Professor of Arts and Health at the University of Derby, examines how art-making can provide a means for women to express and understand their changed sense of self-identity and sexuality as a result of pregnancy and motherhood.
Different cultures treat pregnant women differently. Here in the UK, women report having their enlarged stomach touched more and some new mothers feel they are fair game for conversations about their new babies from a selection of strangers with whom they’d not previously spoken.
In this way body privacy and the negotiation of public space is altered for women who are pregnant or new mothers. Indeed, a new mother can find simple tasks, such as getting on a bus and shopping, have become extremely difficult. I found it impossible to get my buggy on a bus in London, I recall, as I was simply elbowed out of the way by determined commuters. No concession was made to the fact that I was encumbered.
In contrast, in many parts of France, people with babies or young children may find themselves ushered to the front of queues and given preferential boarding on forms of transport.
Relationships and financial
In many relationships, where there has been relative equality between partners, inequality can start to develop when the first baby is born. Women often lose or reduce their paid employment and become semi-dependent on their partners, possibly for the first time in their relationships. Loss of employment at this time can result in late-in-life poverty for many women who make insufficient pension contributions throughout their careers.
These decisions around early parenting have lifetime consequences. The Economist magazine put it like this: ‘Having children lowers women’s lifetime earnings, an outcome known as the child penalty’. Women having time out of paid employment, or reducing their employment, then puts men at the forefront of the career/wage-earning stakes within relationships, and subsequently, it is often the man’s career that is prioritised, even resulting in possible geographical relocations to seize new opportunities, which can further dislocate wives and partners from their support networks.
Women who stay on at work are likely to be subject to an array of discriminatory behaviours and lack of career progression. It doesn’t have to be like this, and the more we move to genuine co-parenting the better it will be for women and men alike.
The way women give birth varies, but in many cultures, there has been a strong move towards hospital births as customary. Until the 1960s, the British Medical Journal was advocating that for normal pregnancies the best place to give birth was in the home. The British Medical Journal in 1954 was still willing to ‘arbitrate decisively’ that ‘the proper place for the confinement is the patient’s own home’.
Today, the overwhelming majority of births take place in hospitals. Once in the medical environment, women are more likely to be subject to ‘routine’ medical procedures, which would be less likely to be implemented in the home. For example, so-called ‘routine induction’ is common, to precipitate and speed-up childbirth. It is justified to prevent ‘bed blocking’, an insidious dehumanising euphemism that prioritises hospital timetables over letting the labour take its natural time – women vary and so do the length of our labours.
Routine induction is presented as a normal procedure and its risks and benefits are rarely properly articulated and discussed with the labouring woman. Induction is linked to the likelihood of further medical procedures and higher levels of pain. Furthermore, women can be made to feel unreasonable if they decline. However, induction is linked to an increased rate of episiotomy and Caesarean Section, which is a serious and life-threatening surgical procedure.
A national survey carried out in Italy between 2003-2017 found that episiotomy had been performed ‘by deceit’ on 1.6 million women: 61% of whom declared they had not given informed consent. Of these women, 15% considered it to be ‘a form of genital mutilation’ and 13% regarded it as a ‘betrayal of trust’.
The same survey revealed that four out of 10 women (41%) were subjected to practices ‘that violated their dignity and psychological integrity’. This survey was useful in revealing a level of obstetric intervention that was seen of clear concern. Indeed 21% of the women in Italy considered themselves to have been subject to ‘obstetric violence’ whilst giving birth. The proportion of these women to be diagnosed as being depressed in new motherhood is not reported.
The World Health Organisation (WHO) has also reported on disrespectful and abusive treatment experienced during childbirth globally, highlighting particular situations including:
- Failure to get informed consent for procedures
- Lack of confidentiality
- Gross violations of privacy
- Coercion to undergo medical procedures (including sterilisation)
- Outright physical abuse
- Profound humiliation and verbal abuse
- Refusal to give pain relief
- Neglect of women during childbirth (with the consequence of women suffering life-threatening, avoidable complications)
- Refusal to admit women to health facilities
- Detention of women and their infants after childbirth due to their inability to pay
The WHO has produced the following statement on the prevention and elimination of disrespect and abuse during facility-based childbirth: ‘Every woman has the right to the highest attainable standard of health, which includes the right to dignified, respectful care’.
To dismiss women’s reactions to pregnancy, childbirth and new motherhood as merely neurotic is unacceptable and compounds abuses of power and discriminatory cultural norms. In previous work, I have explored the ‘mother blaming’ aspects of various psychological theories, as women are positioned as ‘the problem’. – Whether it’s being perceived as deficient if we don’t bounce back immediately from traumatic births and destabilising circumstances, or being held responsible for our children’s attachment anxieties should we dare to venture out without our infants – women are condemned in much of the published psychological theorising which is fundamentally oppressive; examples of criticism even include “too good” mothering.
Mother blaming is endemic and Caplan sardonically sums it up. I paraphrase: sit too close to your child and you are smothering and invasive; sit too far away and you are narcissistic, remote and rejecting, or possibly ‘castrating’. Of her clinical experience she wrote: ‘We found that mothers were blamed for virtually every kind of psychological or emotional problem that ever brought any patient to see a therapist’.
Many of the discourses around new motherhood are orientated towards characterisations of deficient and failing-to-cope women, rather than looking at the terrain of birth itself, which is both intensely ideological, contested and destabilising. I have argued that it is a combination of a myriad of factors, which renders childbirth and new motherhood as uniquely disorientating and potentially distressing.
Childbirth and childrearing are complex and women experience often unprecedented pressures and constraints in their lives during pregnancy and after birth. Even those wishing to support new mothers often use language which unwittingly blames the mother.
Some women may be more at risk of psychological distress during pregnancy, or after birth, (such as those subject to emotional or physical violence throughout their pregnancies from their partners, or women who have been coerced into proceeding with an unwanted pregnancy, or who have experienced rape, for example).
To blandly put forward the diagnosis of post-natal depression, with no real attempt to deconstruct what this really means, runs the risk of compounding abuses of power, which are manifold. Talwar suggests that art therapists must be prepared to challenge ‘power hierarchies’ as part of their work.
In my view, this should include an explicit acknowledgement of social constraints, pressures and institutional abuses to which women are subject when experiencing pregnancy, birth and new parenthood.
Art making offers a means for women to express and understand their changed sense of self-identity and sexuality as a result of pregnancy and motherhood. The aim of my latest book is to introduce readers to the various ways in which art is being used with women who are experiencing different stages of childbearing – who may be unable to conceive and are struggling with infertility treatment, experience miscarriage and loss, or are facing other issues of adjustment.
This work can include a myriad of factors: ambivalence, prenatal anxiety, unhappiness and disorientation, or even dread, as well as re-kindled feelings of grief for lost parents, unresolved feelings towards mothers and others, feelings of abandonment where the progenitor has fled, birth trauma, or the grief of the loss of a baby. Art can also be of help in exploring and supporting family relationships with partners involved and in supporting new families.
It is admittedly hard to shake off the rhetoric of post-natal ‘illness’ as the existing literature illustrates, but it is important that those institutional practices and norms, that are illness inducing, are acknowledged. I am keen to ‘de-pathologise’ women’s experiences, whilst also acknowledging real distress, rather than add to a dominant rhetoric of women’s instability and inadequacy. I hope this volume is a useful step in this direction.