Hello and welcome to FAB Gab. This is the podcast for the International Journal of feminist approaches to bioethics brought to you by fab Network. My name is Kathryn MacKay and today I'm joined by Kiera Keglowitsch and Michelle Meagher to discuss their paper 'making room for births that are not good: lessons from cesarean shame, shame'. And Kiera and Michelle are both joining me from University of Alberta. Hi, Kiera. Hi, Michelle. Hello. Hi. Hi. Thanks
for having us today.
Thanks for joining me. I think right off the top. I wanted to just clarify that this is cesarian Shame, shame. Shame about feeling cesaerian Shame.
Keira jump in on that one.
Yeah, Michelle and I were chatting about this earlier, but our word processing was really unhappy with us. ourselves. Thanks, shame, shame. We've got constant reminders. And you share this is what you're saying. But we felt it was important to differentiate cesarean Shame. So the shame over having experienced an emergency C section and to cesarean Shame, shame. Or as you you already pointed out, Kathryn that kind of shame over feeling shame. Yeah.
Yeah. It's really interesting. I just wanted to clarify that at the top for our listeners that, yeah, shame, about shame, which is fascinating. So let's get into it. I wonder if Michelle or Kiera you could give us a kind of summary of the paper.
Sure. I'm happy to start we'll probably jump in and, and do this back and forth. But the first thing that I would say is that this is a paper that began from our interest in understanding how new moms used baby blogs to describe their birth experiences. And we are especially interested in stories from women who describe this feeling of shame and what we came to call Shame, shame, shame when their plans to deliver babies naturally vaginally, were disrupted by emergency C section. And it's extremely common, of course, right. But it is often felt as as a disruption. Some of them felt like some of the women who are writing in baby blogs felt like they had failed in this first and very important step in mothering and step into motherhood. And that got us to thinking about the social pressures that expectant mothers feel around, curating or creating a good pregnancy and curating or creating a good birth.
Yeah, and I can jump in and add that. We were really inspired by one of our colleagues, Cressida Hayes, who is a feminist philosopher. And we were drawn to a term she uses curating, it was quite evocative for us. She uses curating to describe how modern subjectivity, and our kind of contemporary ways of being subjects is really connected to the choices that we make. And putting that in the context of birth, that women who had emergency C sections felt as though their capacity to make choices and to be in charge of birth were taken away. So their ability to curate a final experience of birth was taken from them through having an emergency C section, and that reflected a failure of their ability to sort of control the curatorial process. Yeah,
and I would just follow that up by saying that, you know, we argued that women's women's shame was expressed in the stories of disappointment. And that that the stories are really suggest that there are different ways to narrate, there could be different ways to narrate, or think about births that puts put less pressure on pregnant women and birthing women.
Yeah. And I think you point out in your paper, and you've just sort of said here, as well, Michelle, that these are super common, I think you say that. It's the most common cesarean sections are the most common surgery in the United States and in Canada. And in the United States, almost 1/3 of women deliver by cesarean section. So it's like a lot of people. So where does the shame come
from? Great question. And that's the question about the papers. You know, I think it is a lot of people and it's not unexpected to end up with an emergency scenario. And if I can speak out of turn, you know, right after we we submitted this paper, one of us had an emergency cesarean so not a surprise, not a surprise and yet always a surprise to People who go through it so often a surprise and certainly not, not, not part of the plan, nobody plans to have a an emergency says, Eric, it's emergency. It's not yet. But you know, what, what we wanted to think about is, is what does it mean to have a plan to have a birth plan? What are the implications of that having a birth plan? We're not the first people to write about birth plans and to think about them critically from a feminist perspective. But I think that, you know, what, what we do is we're in this paper is we're exploring feelings of shame, shame, about shame, that is associated with these these plans gone awry, right. And ultimately, we we want to think of ways in which we together, not just me, and Kiera, but you know, medical providers, theorists, thinkers, people who are interested in reproduction can can really imagine birth as an unfolding experience, not as a script to be written and followed. So. So if we think about it as something that's we don't know, in advance, then we can't have failed at it. Right? If it's not, if there's not a right way to do it, there's not a wrong way to do it.
Yeah, so there are some things that I'm very keen to talk about towards the end of your paper, where you're sort of talking about where the neoliberal logic of self actualization comes into the picture here, but I don't want to preempt too much. So first, maybe it will be helpful for the listeners to give a kind of like, what are some of the main points in the argument that you'd want people to kind of have in their minds?
Well, I think the first thing is this definition of cesarean shame, shame. Maybe is there more we want to say about that definition? Kara?
No, I was gonna say the same thing that I think we've sort of talked about cesarean Shame, shame already. But that was a really important contribution that I think we made in a really important term that we feel describes this very particular experience. And I think we were also quite drawn to what Quill Kukula describes as the signal moments, or kind of concrete instances through motherhood that that we use to judge people's ability and capability of mothering. And we look particularly at birth and pregnancy, and what we determine about people's ability to mother when they have a bad birth, when they have a C section that was not planned when their birth plan fails to driving home the significance of a C section in the long term kind of understanding of how a person is going to be as a mother, based on these very kind of concrete instances.
It made me think about Quill Kukla's work and the the other literature on breastfeeding also has that kind of signal moment of failure or success as a as a mother.
Yeah, totally. Absolutely. It's a great comparison. And I think we could have we could have written a paper exploring breastfeeding, shame, shame. I think that the concept of is quite mobile. You know, we're absolutely riding buses, Aryan Shame, shame, but on a broader level, and I think this is one of the contributions of the paper. On a broader level, we are, you know, employing feminist affect theory to understand cesarean Shame, shame, but also like, just the feelings that are associated with our reproductive experiences of our bodies, right? So, feminist affect theory tells us that all of our feelings are our social artifacts. They're not just personal experiences, or personal problems or quirks. They're really, they're not individual feelings, they really tell us something about the world that that we live in. So we wanted to think about shame and shame, shame as a cultural phenomena that we really should be exploring, in order to understand women's experiences of birth in general, and emergency or unplanned cesarean, more specifically, I think that's another big takeaway of the paper.
Maybe you can explain that a little bit more. What does it mean, when we talk about shame as being kind of social artifact?
Hmm. Well, there's a couple of really good scholars who are working on this in feminist ethic theory, one would one would be Sara Ahmed, who writes a little bit um, she writes about all kinds of feelings. but one would be shame. Another person who does this work is Elspeth proben. But, you know, they, they really tell us that shame gets at shame is shame is the ultimate social effect, right? Shame is, is, is a feeling that's like all feelings, is experienced individually, but is a social, social construct. What makes us feel shame, changes over time, it's different in different cultures, it's different different parts of your life, it's different for different people, right? It different people in different contexts. So I think that I think that, that it's, we saw evidence of shame in the baby blogs, and it's a very specific form, form of shame. You know, Proben and Ahmed tells us that shame is, is an effect or a feeling that has to do with how we relate to other people and how we understand people seeing us and knowing who we are. So it's very much it's, it's a, it's an aspect or a feeling that's really about who we understand ourselves to be, and how we understand our subjectivity,
what really drove the idea of shame home to me was comparing it to the idea of guilt, and differentiating shame from guilt, which in the early forms of this paper we spent some time working on. But that guilt is more about sort of breaking a rule, going against a social norm, doing something that we think is wrong, and as Michelle has already outlined, shame really is about our ideas of who we think we are, and how we relate to other people, and how we're going to be seen by those around us and understood by those around us. So the the relationality of shame, I think is really important.
So now I want to ask you about sort of like the shame shame set up, because I think it seemed in the paper, that the way that this comes to be is that so first of all, there's this, there's this area and shame, which is where a woman feels ashamed that she has failed in this sort of natural birthing process that she had expected to have, and that she was told by physicians and midwives and sort of broader society that she ought to have. So she should have, she should be aiming for this natural vaginal birth. And then that can't happen. And she has had an emergency C section. So this is clearly non optional. This is a an emergency operation. But she's ashamed in the first place that that has happened, like her body has failed her. And she has failed in some sense to, and so who she is being reflected as like, not a good enough woman, something like this. But then she's also a kind of liberal feminist. And or I think as you put it, in the paper, you talked about popular feminists, and so she's taking in what I like to think of as liberal feminism or boss lady feminism, where she's absorbed a story that to be a strong feminist woman means to be very self actualizing making your own choices, taking control of your narrative, like all of this stuff. So then she feels ashamed for feeling ashamed, because she knows that she shouldn't feel ashamed for having an emergency C section. But she can't sort of like let go of that, that shame. So it's this compounding situation that is kind of that I and I love this about your paper because a critique of this like really distilled sloganeering version of feminism that we see on Instagram, paired with patriarchy. It's like a problem that's coming out of this version of feminism that is itself a kind of a version of it that is responsive to maintaining control of the current systems, but kind of neoliberalism in a way basically, it kind of like compounds to make her just feel extra bad.
Yes. I mean, I think you've described it really well. I'm and I really appreciate hearing you talk about what we've talked about here. a clearer way, that is what we're getting at, you know, and we're interested in sitting with that shame rather than pushing it away. interested in sitting with that shame because, because, and again, this is coming from feminist affect theories, our feelings matter, feelings, shoving them away, you know, replacing shame with pride, which is one way we could go. It doesn't it doesn't get at the root root of these problems.
Right. So that was one of the options that you said kind of like One way that people are told to take back their story is to is to feel proud about, like just the fact that they have, you know, a healthy living child. So like, one of the things, one of the responses from people to cesarean shame is to say, well, at least you're both healthier, like, that kind of thing. And you and you say like, that's not going to work. Yeah.
Yeah, I think I think in fact, it's beyond not going to work. It's sort of undermines the experience. And, and the the feelings that have resulted from this emergency C section. And tries to one of the terms that we will use is embrace away, but to embrace away any negativity that you're feeling, which isn't always possible. And I think that the idea to just feel pride relies quite heavily on the rationalization, as you've mentioned, Kathryn, of it is what we both needed to come out of this healthy and alive. And yet, I have these tremendous feelings of shame and disappointment, that pride can't get rid of, can't embrace away.
And I would also say that, that embracing away or if we're thinking about the advice that's given to caregivers, you know, encouraging pride or good feelings, replace those bad feelings with good feelings. Again, it's that deeply individualizing rhetoric here, just think about it differently. Just put a smile on your face, just don't think about your sadness, you've got this beautiful baby. Yeah, you've you've got the baby, the baby, the baby is what the goal was, but but to to think those feelings as being simply your own, rather than an effect of the deep social pressures that are placed upon women to to make the right choice to be autonomous actors who who are working on their own own self rather than rather than them recognize that, that there are these shared ideas that shape how we can be who we are. And I think that those, those are the issues that we wanted to get at as well.
So were there any particular challenges or objections that you had to overcome when you were writing the paper, one that
we grappled with a bit was the specificity of our topic. That the kind of group of people we are, we're reading about and, and thinking about are, presumably heterosexual cisgendered, there's a lot of middle class kind of tone in the blogs that we referenced, I mean, obviously, they, these people needed to be able to access the internet to be literate, to have time to write on blogs, all of these these features. There were things on the blogs that made it seem that they were aimed at white women. So we did ask ourselves, you know, are we perpetuating a kind of focus on these voices? Do these voices need to be amplified? And what are we are we taking you know airspace away from other voices and doing this work. But we kind of acknowledge that this is a popular, this is a common problem, I should say. And I think in in analyzing these voices, and working with what the women on these blogs have said, we felt that we were able to kind of contribute and enter into a small piece of what we acknowledge is a much broader conversation. And also knowing that that more work needs to be done and that this is not by any means. The end of the conversation, Michelle and I have started to contribute our thoughts to an already ongoing conversation in a small way, acknowledging that it is limited. So we went back and forth a lot of times on how we wanted to address this, but I'm hopeful that recognizing the limitations and understanding where we can go to begin to address them with future work.
I'm wondering if there's anything that you wanted to give our listeners as kind of takeaway messages from from this work?
You know, we end the paper with some strategies, managing or although that's kind of a neoliberal term, maybe living living with births, births that don't unfold according to our carefully laid out plans or to the expectations that we that are set for us so Oh, we we call these births that are not good. So the title is making room for births that are not good. We didn't want to say bad births. But we didn't want to, you know, pretend that they were good, either, you know, so that births births that are not good, how do we how do we, how do we live with them. So there's a couple of things that we think about as, as strategies. One is really making a room for making room for a range of feelings, including shame that we have, in the process of giving birth, and paying attention to them, recognizing that they're all important, they're not hormonal, they're not individual, they really tell us something about the social experience of birth. So that will be one of the strategies.
Another strategy, we suggest is a reorientation of the idea of a birth plan. It's a pretty common term. In my medical training, I've encountered it already only three short years into the very long process. But reimagining the birth plan, not as something that kind of rules in or out certain procedures that says, I will be okay with an epidural, if I reach this point, and this has not changed, or that has not changed, but instead focuses on understanding each other to be able to form relationships in the birthing team between the laboring mother and those who are supporting her. And on really having an understanding of the diverse outcomes. And this to me, there's a little bit of irony in this, but maybe being able to anticipate that birth is unpredictable. And that part of planning is planning for that unpredictability, while also accepting that you don't know how it's going to go and being okay with that.
Yeah, that seems like a really important point. And maybe it seems like another part of this too, is like, not just leaving room for feeling shame, but also acknowledging that it's okay for women to feel disappointed when her birth doesn't go the way that she thought that it would, and, you know, according to her plan, or according to what she'd really hoped would be true, but that it's okay to be disappointed. Even though you're happy with this infant that you have that's alive.
There's some terminology that we really love from, Anne Lyerly, who describes the utterly out of control nature of childbirth, found those words, just encapsulate childbirth wonderfully, and were really powerful in what we wanted to convey the utterly control
which I feel Yes. Which again, brings me back to this idea of the kind of neoliberal world that we live in not just neoliberal feminism at all, but just this neoliberal world where everything is choice based, and everything under that rubric is controlled. So to think of birth, as this process is utterly out of control, I think really challenges the way that we tend to think about our world like what does it mean, to be autonomous, it means to have control over
these things. I think that gets me really excited for thinking about the way that pregnant embodiment and and childbirth can provide new models for subjectivity. You know, sometimes there's, there's feminist theories that say, the pregnant body really challenges our idea of autonomy, because you have a body that is neither one nor two bodies, right. But here, we've also we've got this example of this, this thing that has a beginning and an end, but it's also completely and utterly out of control. And there's something there's something super exciting about that, about entering into an experience and letting the experience happen without being in control of it. And how could that sort of shape how we do other things in the world?
Yeah, this is a great point. And I'm, I don't often do this, but I'm going to draw a parallel between this episode of the podcast and the episode of the podcast that came out just before this one, which was actually about eating so it's not gonna sound like it's very similar. But the author contrasts. clock time with stomach time. And the idea of stomach time is time according to things like seasons and harvests. And you could imagine that something like seasons, harvests reproduction, it all actually goes together and there's a certain sense in which pregnancy has well pregnancy has its own Time. Yeah, it's not one that we can put on a clock. It's not something that we can, you know, fungible units that we can move around and spend because we like the labor time is the labor time. It's the time that it takes
time that it takes in the same way that the growing season is the time that it takes. Absolutely. And I think that you're talking about Megan Dean's work, right. The connection here is that I know Megan Dean, she was a student of Cressida Heyes' at the University of Alberta. So it's neat to hear that you're that you've made the connection to Megan. That's excellent.
Yep. Yeah. Cool. Well, Cressida's having a massive impact on the world. I can tell.
Oh, yes, yeah.
Well, thank you so much for speaking with me. It's been really a pleasure.
Thank you so much for having us. This was great. Thank you.
My pleasure. And thank you very much for listening to this episode of FAB gab. You can find the paper we've discussed Linked in this episode's notes along with a transcript of our discussion. Fab gab is hosted and produced by me Kathryn MacKay. You can find our other episodes on Spotify, Apple podcasts, radio public or wherever you get your podcasts of quality. Thanks again for listening. Bye
