Lies They Told My Mother: Dr. Amy Tuteur on the Moralization of Childbirth

May 9, 2016

Dr. Amy Tuteur is an obstetrician-gynecologist and writer, returning to Point of Inquiry to discuss her new book, Push Back: Guilt in the Age of Natural Parenting. Known from her popular blog as The Skeptical OB, she has appeared in several publications and news outlets over the years educating the public about the facts of birthing healthy babies, and more importantly correcting the misinformation surrounding birth and mothering, such as breast feeding, nipple confusion, attachment theory, and “birth warriors.”

Her book takes a closer look at the factual misconceptions surrounding childbirth, as well as the history behind these unscientific ideas. Dr Tuteur and host Lindsay Beyerstein discuss the history of natural parenting and how it affects mothers today, particularly the ways myths about childbirth can make life miserable for mothers, and how the natural childbirth industry can profit from their worries.

This is point of inquiry for Monday, May nine, 2016. 

Hello and welcome to inquiry. A production of the Center for Inquiry. I’m your host, Lindsay Beyerstein. 

Mother’s Day is just around the corner and I’m here today with daughter Amy to her. Amy is a retired obstetrician gynecologist and the author of the new book Pushback Guilt in the Age of Natural Parenting. She blogs at the skeptical O.B.. A mother’s path has never been easy, but these days the road has turned into an obstacle course to hear some people talk. If you don’t have a drug free vaginal birth, followed by an extended period of breastfeeding, baby wearing and co sleeping, you’re basically a child abuser. So tell me, Amy Weiss, why is mothering such a nexus of guilt in our society these days? 

I could it guilt comes naturally to mothers. There’s absolutely no way to avoid guilt, both feeling it and using it to control your children. 

But we have added reasons for guilt and we’ve pressured mothers with it when it doesn’t really have any basis in science to feel guilty over how your baby is born or whether your baby was breastfed. 

What is attachment parenting or attachment parenting and natural parenting? One and the same or of a distinct phenomena? 

Well, attachment parenting is a philosophy that was popularized by doctors brilliant by Dr. William Sears and his wife, nurse Martha Sears. And it argues that there are serious issues that infant mother attachment is contingent week has to be supported, won’t happen naturally. And mothers need to do a variety of specific things in order to get their newborns to attach to them. And essentially 180 degrees opposite from what we know about infant attachment, which is that it occurs spontaneously, naturally. It’s almost impossible to stop and has nothing to do with specific behaviors around birth or feeding, but merely just meeting her baby’s needs. The natural the attachment theorists of the 40s and 50s who elucidated infant attachment. Actually said that children don’t need perfect mothers. They need what they call the good enough mother, a mother that they can count on to meet their basic needs. 

Whereas all this societal anxiety coming from about the idea that your baby won’t love you. 

Well, that’s a really good question. As Charlotte Faircloth has written about this, she’s from the University of Kent. They have a Center for Parenting Culture Studies, which I think is really interesting, the idea that there’s a parenting culture, because I think we tend to look at parenting culture as immutable. 

You know, however, parents, that’s the way everybody. But it’s not. And that the idea that your baby will love you unless you do certain things was basically fabricated by the people who wanted you to do those things. 

Amazing how that works. 

Yes. Yeah. You got to give them a lot of credit for their marketing. It really was brilliant. They really hit women where they live in their love for their children. 

Do you think it has something to do with women feeling conflicted about or guilty about working outside the home or other things? That their anxiety has been heightened by the idea that maybe their babies won’t love them because they’re not living up to some traditional ideal? 

I think that that’s what people who are creating the guilt are open. Yes, the idea is to make women doubt themselves. And the idea really and truly is to make women believe that their needs don’t count. Their need for pain medication doesn’t count the need to feed a baby in a way that isn’t painful or inconvenient. Doesn’t count the need for some privacy or to sleep in the bed with your partner without your baby being in, it doesn’t count. Women’s needs are totally, totally invisible. And women have been convinced to forgo their needs by a group of people insisting that their children’s needs are greater. And there’s very few mothers who wouldn’t give up an awful lot if they thought it was going to help their child. The real problem here is that most of that stuff isn’t true. So they’re giving up an awful lot in order to conform to somebodies idea of what a mother should do without any actual benefit to their children. 

I mean, it’s it’s funny when you sort of think about the history of Harry Harlow as monkey dummies, where they meet. You’ve got infant monkeys that are falling in love with a piece of carpet wrapped around a piece of metal because that’s that’s the best monkey surrogate that it can get. Not exactly the standard of breastfeeding cost sleeping maternal perfection. That Bill Seares baby book says you have to meet in order for your baby to love you. 

Yeah, that’s one of their earliest books. And in that book, they reveal that they believe that attachment parenting was transmitted to them by God. They they learned about through prayer. And it’s God’s way of organizing the family with the father as the head. The mother is subservient and completely occupied by taking care of the children. 

Why is attachment parenting gotten so much traction in secular circles? I mean, it seems like the people that I know, they’re into attachment parenting are extremely secular and often a very feminist. 

Well, I think partly it’s good marketing. It’s been presented as feminist. It’s been presented as warping the conventional parenting tropes. But actually, it’s remarkably retrograde. It’s really parenting from the 1950s. 

And one of the things that I thought a lot about in writing the book and I thought about over the last decade is if you wanted to get women to give up their political and economic rights, what better way to do it than to moralize motherhood and accuse them of being bad mothers if they went out to work or if they wanted more out of life than simply taking care of their children. 

And just to be clear, you’re not saying that any of the individual components of attachment parenting are bad practices in themselves, like breastfeeding or cuddling your baby or carrying your baby around in this thing, rather, during a bad right there. 

They’re not saying that they’re bad. And for some people, they’re the right thing to do. I mean, I, I have a confession, which is that my children are grown now, but I had four imaginal births, two with epidurals too, without I breastfed all four of my children. And although the terminology didn’t exist at the time, I was essentially an attachment parent. But that was because that’s what worked for me and for my children. I would never imagine that that made me a better mother than somebody who chose differently for herself and her children. 

And I think that’s really the biggest problem with attachment parenting, is it makes the personal preferences of privileged white women normative. 

Is there any evidence that any of these practices are kanfer objective benefits compared to not doing them? 

Well, the only one that potentially confers objective benefits is breastfeeding. And in countries with clean water, industrialized countries, those benefits are actually very small. They are limited to a few less colds and a few less episodes of diarrhea on this across an entire population of infants in the first year. And when you think about it, that is really not that surprising. You know, for most of human existence, one hundred percent of babies who are breastfed and babies died in droves. And if you look at mortality, international mortality data, you’ll find that the countries with the highest infant mortality rates have the highest breastfeeding rates, essentially one hundred percent. And that shows you that, you know, while breastfeeding may be a good thing, it’s ability to ward off disease and prevent problems can prevent death is really quite limited. 

So what we’re looking at is kind of a confound were the least developed list least. You know, hygenic systems are also the ones where people are breastfeeding out of necessity while yet they are breastfeeding out of necessity. 

But, you know, for example, The Lancet ran a series recently that said if all women everywhere breastfed, hundred thousand lives could be saved a year. But almost all babies die in countries where most of the babies Huckabee breastfed. So who exactly is going to be saved by breastfeeding babies in countries with low breastfeeding rates? Like First World countries. 

Is it the same? Some activists claim that every woman who bears a child can physically breastfeed is not actually true. Like if they just try hard enough to do enough was hopefully true. 

And when you think about human reproduction or really any animal reproduction, it would it would be bizarre. Were true. I mean, one thing about reproduction, whether it’s animals or plants. There’s a tremendous amount of wastage. So, you know, we’ve all seen those documentaries where the mother turtles haul themselves out of the ocean and bury one hundred eggs a piece in the sand. And then on one moonlit night, they all hatch it. Once in a million, baby turtles scramble across the sand for the safety of the water. 

And that’s the happy part. Wow. 

But then the Eagles come and pick them off and the crabs come and eat them. And there’s so many because only a few are going to survive. Wastage is built into reproduction. It’s built into human reproduction, too. You know, you think women are born with about four million eggs, most of which they will never ovulate. And even of the ones they ambulate, most of them will never be fertilized in. Men make billions of sperm that will never get anywhere near an egg to fertilize it. And even when conception does occur, we know that for established pregnancies, pregnancies are diagnosed by a positive pregnancy test, 20 percent of those will end in miscarriage. So death is really very common in reproduction. So the idea that breastfeeding somehow would magically be perfect wouldn’t. Pregnancy is imperfect and childbirth is imperfect. It’s really kind of ludicrous on its face. 

What are the health risks of continuing to push if you’re if you’re trying to breastfeed and it looks like the baby’s not getting enough nourishment? What are the health risks of continuing to persevere without supplementing with other kinds of calories? 

Well, we don’t know exactly because we haven’t really looked at that. But we have noticed over the last few years the rise in the incidence of neonatal dehydration. So babies are getting profoundly dehydrated and that raises the sodium in their bloodstreams and can lead to seizures and brain damage and even deaths. And even if a baby doesn’t get so profoundly dille that suffers brain damage or death, a baby that’s not getting adequate milk is a baby who is being starved of nutrients. And that cannot possibly be good for a baby’s brain. 

And they feel hunger and that sort of thing, just like any other human right. 

Well, they scream. They scream at the hungry. In fact, hunger for them is an elemental drive, probably even more powerful than for adults. So one of the most ironic things about attachment parenting is that the same people who would tell you that letting your baby cry him or herself to sleep will lead to brain damage, which it doesn’t. By the way. But they, you know, CIO are crying it out in the attachment parenting circles that’s thought to lead to permanent harm to babies. They’re the same people that will let your starving babies cry it out because, you know, wait till your milk comes in or don’t supplement because you’ll sabotage the breastfeeding relationship as if what we’re trying to optimize is the breastfeeding relationship and not into doubt. 

Is nipple confusion a real thing like some people wore on that if you have a bottle and you give her baby that’s trying to breastfeed a bottle occasionally, that that will undermine the whole process. So it’s actually true that babies are less likely to continue to brow. They have options there. 

There really isn’t much evidence for that. But I think it’s worth taking a step back and looking at what has happened to breastfeeding promotion over the last few decades. 

You know, the benefits of breastfeeding are no bigger than they ever were. You know, they’re no better than they were in 1976. But the angst around it is much greater in 2016. And why is that? I believe that the moralization of breastfeeding has paralleled the monetization of breastfeeding, that with the rise of a lactation industry, breastfeeding has taken on an urgency that far outstrips its actual benefits. And I don’t mean to imply that lactation consultants don’t believe what they say. This is not a cynical effort to manipulate women. They do believe it, but it’s just not true. And so you have something like the quote unquote baby friendly hospital initiative, which isn’t even friendly to babies because it’s based on tenets that have no scientific support, like the idea that supplementing a little bit in the first few days will ruin the breastfeeding relationship. I mean, the evidence that we have is exactly the opposite. And it’s the same thing with nipple confusion. I imagine that there are some baby somewhere who may get confused, but it doesn’t really seem to be the problem that activists insist that it is. So there’s a tremendous amount of guilt and a tremendous overexaggeration of benefits. And who exactly is having their life improved by this? It’s certainly not babies. And it’s definitely not mothers. 

Is there any evidence that breastfeeding helps mothers lose weight after childbirth? 

It’s a completely individual thing. Some women will lose weight. Some women won’t be able to lose weight. And some women could even gain weight because those calories have to come from somewhere. So it’s possible they could come from burning them off. And they do for some women. But other women won’t make enough milk unless they’re constantly eating to replenish the calories that they’re pouring out of their body every day. So it could be harmful, but it might not be helpful. But the idea that women need to be tricked into breastfeeding by telling them, oh, it’s good for you, you’ll lose weight is part of a larger problem, which is that we’re promoting breastfeeding by not being completely honest about its benefits, by not being completely honest about its risks, and by being fundamentally dishonest about how hard it is for women. 

It’s like so many of these junctures in terms of the whole reproductive through Dec. three are just kind of a genetic lottery, like how big your pelvis is and how much breast tissue you have and all these things that are really not under anybody’s control. There’s a whole industry dedicated to telling women that if they just follow the right, the right pattern, the right formula, that they can control these outcomes. 

Well, Keith, you know, I think it goes back to what has happened in midwifery with natural childbirth. Midwifery existed for most of human existence, and it went into eclipse in the early nineteen hundreds because of the rise of obstetrics and obstetrics had two humongous advantages. Over midwifery, it was safer. And it offered women pain relief. And it also had a smaller advantage, which doesn’t really get much play when we discuss it. But for the women of the time, it was important, which was for many of these women. It was a vacation going to the hospital. 

And so hospitals the popularity of hospitals soared in the early 20th century. And midwifery went into eclipse. And the way midwives sold the story is because obstetricians drove them out of business. And I’m sure no obstetricians were worried about the financial health of midwives. But it wasn’t the obstetricians that go them out of business. It was what the obstetricians offered. They offered safety and they offered pain relief. 

Is there any truth to the idea that physicians restricted operative delivery that they didn’t want midwives wanted to learn, or at least some? Mittness wanted to learn how to use forceps and that the obstetrical establishment kept them away from technology. They could have embraced on their own. 

I haven’t seen much evidence of that. I think something different happened that midwives made a comeback by declaring that what obstetricians offered wasn’t any good. 

So if obstetricians could offer safer deliveries and midwives would say that childbirth was inherently safe and obstetricians didn’t do anything to improve it. If obstetricians could offer effective painfully and midwives turn around and said, well, you know what? The pain is good for women and it’s bad to remove the pain. 

If obstetricians could offer pediatric care at the time the baby was born, Midwestern rather said no. 

What’s important is skin to skin contact not being seen by a pediatrician. It’s pretty much, you know, for for the natural childbirth world. Every day is opposite day. Whatever the obstetrician says, they say the opposite. The essence of childbirth is that childbirth is dangerous in the essence of natural childbirth. Is the conviction completely unmoored from reality that childbirth is safe? So that’s why there’s this belief that you can control things, because if you couldn’t control things, you might need a doctor to help you. That’s where it comes from. I mean, we know every hour about the rest of the human body. 

You don’t have control over how wide your feet are. So why we you have control over how large your pelvis is or how big your baby grows. 

Can you tell us about how the Mars was literally a communist plot? 

Is this just alternating in terms of how that caught on? 

Yes. Well, that was a story told by. Paula McDonald, I think, is her name and her book about the history of Lamya is vetted or originated in the Soviet Union because the Soviet Union couldn’t afford in the wake of the Second World War, couldn’t afford pain relief for anybody, really, but certainly not for laboring women. So they decided that they could have a little V and condition women to forget or manage the pain of childbirth. And what’s interesting is that it was a complete failure in the Soviet is never really caught off. And they came to France by way of the communist hospital that existed in France. And it was promoted as superior to pharmacologic pain relief because pharmacologic pain relief costs money, but realized, you know, no matter where you were in the proletariat, you could afford it to decide how it could even work in theory. 

It was the idea that you would have Pavlovian condition. She would condition breathing while you were not in pain. And then the response would be if you were breathing, then you would no longer be in pain. 

Yes, that was supposed to be the idea. 

Would that work if. If. I mean, people living conditions would talk about reflexes not being in pain. Isn’t that reflex? 

Oh, it could never work. There was never any theoretical basis for why it would work. It was you know, it was a response to a terrible situation and an effort to compete with the the bourgeoisie west to say, well, we have we can’t afford pain medication, but we went one better. We we have this completely socialist form of pain relief that anybody can access. And you don’t need any money. 

Sounds like a really great idea. If it were true. Yes. But it wasn’t true. It wasn’t true. 

Does it confer any benefits, any of those kind of conscious relaxation and breathing techniques? Do they at least help women cope with the stress of labor? 

I’m sure they help some people. But what really interests me is how we don’t teach it to men to help them cope with the stress of painful events. Nobody suggests that a man should deal with a kidney stone by breathing in a certain way. So why is it that women don’t get adequate pain relief when men always get it? 

I feel like it’s spreading, though, this idea of mindfulness as there’s this huge backlash against opioid pain relief. You know, not entirely unjustified, considering that there have been, you know, excesses, but I mean, seeing more and more doctors writing op ed saying, oh, I want all my patients learn mindfulness meditation to deal with the rheumatoid arthritis, and that’s slipped disks and all this, you know, across the gender spine. Wow. 

I think opioid addiction is a serious problem, but it’s not in any way related to pain relief for labor. 

No, definitely not for labor. 

Right. So, you know, the idea that women are somehow benefiting from the pain of labor. I mean, that’s like the most misogynist thing I could possibly think of. 

And it’s interesting that men were some of the leading ideologues in spreading the idea that pain in labor was ennobling. 

Well, it’s it’s not a coincidence. I mean, you know, natural childbirth, which was started by grandly decreed while Major League, which is started by a Catholic fundamentalist group, an attachment parenting, which was popularized by this year, as I described earlier. They were all explicitly stated as a way to push women back into the home. So it’s not really that surprising that white men were behind most of it. And if you think of the heroes of the natural childbirth movement, you know, Bradley did read for non L’Amour’s Michelle O’Doul, Marsden Wagner, Robert Bradley, they were all white men’s work best Grantly Dick Reed’s philosophy. 

Well, he was a eugenicist and he was, as were many eugenicist in the 1930s. He was obsessed with what he considered the problem of race suicide in that the white race was going to die out because of primitive women. We, the women of color, were reproducing faster. So he drew from the racist and sexist beliefs of Victorian and Edwardian physicians that black women were closer to nature. They believed that black women were hypersexual ised and that they accepted their role in bearing children and gladly did read fabricated out of thin air. The idea that because they were such authentic women and understood what their job was, that they had painless labor. 

Interestingly, nobody ever asked those men because they didn’t have painless labor. 

So it’s incredibly. Is that a movement that some people say is a feminist movement was started by a racist, sexist guy to convince women that their job was to stay home and have babies? 

Who is behind the idea that orgasmic birth is some kind of common phenomenon that you can achieve? Oh, really? 

That’s you know, I need to make Asten in the far left of the natural childbirth movement. You know, orgasmic birth was not described until 1992. And it had, to my knowledge, had never been described in anybody except wealthy white women who have read the natural childbirth literature. 

Is it possible that it really is happening through the power of suggestion? I mean, it seems like retail something somebody that something’s got to be incredibly sexually arousing, that it might, in fact, happen. 

If I told you it’s going to be incredibly sexually arousing to punch you in the stomach, it wouldn’t happen. 

Know that. 

And this idea that although there are some people that pale, some guys that pay a lot of money to get kicked in the crotch, you know, captains of industry have a friend who’s a dominatrix who makes a very good living. 

Oh, they’re putting a certain subset of the population. 

Well, that’s, you know, masochism. And that’s a different thing altogether. 

But this idea that that childbirth is sexual and that you can get sexual pleasure from it. It’s really the logical extension of trying to make Askins fully. And it but it doesn’t have any bearing in anything. I mean, if if it were a real thing, it would be described as nonwhite cultures fit among non wealthy women and among women who had never been exposed to the natural childbirth literature. But as far as I know, that hasn’t happened, which suggests to me that it’s basically like the emperor’s new clothes. 

You know, if you want to prove that it used to be that, you know, if you want to prove you were a childbirth warrior, you avoided medication. And then somebody came along and said, oh, yeah, well, I’ll go you one better. I’ll have my baby at home. And then somebody else came along and said, well, I’ll have my baby at home unassisted. And then somebody else came along and said, I’ll have my baby at home to have an orgasm while I’m doing it. 

Yeah, it does seem like kind of a showstopper. Yeah. You going to top that, right? Well, that was that dolphin birth lady in Hawaii. 

Yeah, well, there’s all sorts of things. You know, I wouldn’t I want to see is why in birth you now have your baby in front of a lion. 

Let’s see how brave you are. This idea that, you know, birth is a piece of performance art, that’s a brand new thing, because for most of human existence, women were their only concern was to survive without being named cannibalized baby. And we are so incredibly privileged that we don’t even realize that what we’ve done is make it into performance art and put babies at risk while billions. 

I feel like the performative aspect of birth is kind of cool in some ways that, you know, we have a safe enough process that people can then bring creative expression to it. As long as they’re not making bad decisions medically, it would be. 

Except that, you know, one of the things that I worry about is this notion of empowerment through childbirth and empowerment to breastfeeding. I mean, if you wanted to take away power, real power for women, what better way to do it than to tell them that they are power could be risk, that they could be powerful through childbirth. They could relinquish their role in the wider world. And the only power they really need is the power of a birth performance. And the only power they really need is the power of extended breastfeeding. Now, if that were a spontaneous thing and women felt that way about it, that would be awesome. But when you have an organized movement and telling women that, you know, power is to be found in the function of their reproductive organs, then that’s a throwback. That’s what they told women 500 years ago in a thousand years ago. In 10000 years ago. You know, don’t worry about using your mind or your talents. Don’t worry about your character. Just worry about reproducing. 

And it’s funny how many people feel like a failure on a deep personal level. How many women feel like that there’s something that they’re bad as human beings. They fail because they can’t deliver vaginally or because they want anesthetic or rather really basic things like that. 

Well, that’s a testament to the brilliance of the marketing efforts of the natural childbirth industry. 

I was find that hard to wrap my mind around, because when I grew up, I grew up thinking that babies, blob human babies were born by C-section because that’s just what happened to the women in my family. 

They almost died giving birth. Yeah. Even in the 1940s when my dad was behind, he was born by C-section before it was popular because that’s just, you know, otherwise he would have never really occurred to me that it was like some kind of some kind of contest. But it just astonishes me. 

How much competitiveness there is about something that’s so outside of anyone’s actual abilities or control. 

Oh, yeah. But the natural childbirth industry, it’s to say, is within your ability to control it and they’ll help you control. You know, I wrote my book for two reasons. First, the primary reason is to just help women feel better. And, you know, there’s nothing to feel guilty about as a mother that we don’t have to make up new things. But the other is that I wanted to ask the social question, why have we as a society done this to women and who is benefiting? It’s certainly not women and it’s not babies. 

Why do we keep talking, hearing about how maternal mortality rate in the United States has risen? What’s what’s behind that? 

Well, first of all, much of the purported rise is due to the fact that over the last 20 years, we’ve changed death certificates twice in order to capture more maternal deaths. And if you actually grasp maternal deaths by year, you’ll notice that in 1999 and 2003, they took a big jump, not because they were more maternal deaths, but because questions were asked to death certificates to capture whether or not somebody was pregnant at the time that they died. The other thing is that when women in the United States die during pregnancy, they die from lack of technology. They don’t die because of technology. If you look at who dies, it is disproportionately women of color and poor women. And they often die because they have preexisting medical conditions or because they develop serious medical complications and they can’t access the high tech care that would save their lives in the same way that wealthier white women can access it. 

So these are people who are growing without care for prenatal diabetes and high blood pressure and that kind of stuff and dying as a result. 

Well, absolutely. You know, the preexisting the fact that women are older and more obese is definitely contributing to the death rate. But I think what’s really ironic about the way that natural childbirth is point to maternal mortality. Well, there’s two ironies. First, they’re doing nothing about it. You know, they point to it. But it’s not like natural childbirth is for poor women of color. It isn’t. So it’s not like they’re doing anything about it. The other thing is that when they compare the United States to other countries, for reasons that we don’t understand, there’s a much greater incidence of prematurity and medical complications and pregnancies of women of African descent. And when you look at maternal mortality across industrialized countries, it’s almost perfectly proportional to the amount of women of African descent in the populations. So when they chastise the United States for having high maternal mortality, really we have a higher risk population. 

Now, that’s not doing much probably to address the people in greatest need that we’re not we don’t have his right. Public health infrastructure assets. 

Absolutely. But if you take a look at who’s dying, they’re not dying because they had a C-section and dying because they didn’t have the NICU. So it seems particularly cruel to use their tragedies to promote something that would never have benefited them. You know, we really need to work on maternal mortality. But what it will take to lower more maternal mortality has nothing to do with natural childbirth. I mean, if you look at the ways that we one of the ways that we’ve lowered neonatal mortality is that we created different levels of newborn nurseries. 

So you could have, you know, your basic well, baby nursery was level one and some regional hospitals had level two nurseries. But the big academic medical centers had level three nurseries and made sure that all the sickest newborns get transferred to level three nurseries. We don’t have anything comparable for pregnant women in the critical care needs of a very sick pregnant woman. It can differ substantially from a man who is in the ICU or a nonpregnant woman who is in the ICU. We would be much better served if we wanted to lower maternal mortality, as people claim they do. To looking into making these kinds of services more accessible to the women who are dying for lack of them. 

That’s all the time we have. Amy, thank you so much for coming on the show. 

Thank you for having me.