FAB Gab Episode 10: Kate Mason on Early Motherhood Bioethics
4:51AM Jul 14, +0000
Speakers:
Kathryn MacKay
Kate Mason
Keywords:
baby
mother
birth
people
tether
care
maternal
foetus
paper
laughs
postpartum
china
kate
fab
bioethics
breastfeeding
write
women
biological
programmes
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 Kate Mason from Brown University to discuss her paper 'Postpartum, Maternal Tethering: The Bioethics of Early motherhood'. Hi, Kate.
Hi, how are you?
I'm good. How are you doing?
Fine, thanks.
Good. Thanks for joining me.
Thanks for having me.
Oh, it's a pleasure. I think the first question to ask you, Kate is if you could give a kind of overview of your paper and your argument about postpartum maternal tethering.
Sure, so the the basic premise of the paper is that the maternal foetal conflict that bioethicists have written about for decades does not end at birth. So I argue that it obviously it morphs into a different form. And I'm not suggesting in any way that the foetus and the baby are the same thing. But what I am suggesting is that while the ethical status of the foetus transforms at birth, the ethical status of the mother's relationship with that foetus slash baby does not change nearly as much as we make it out to be, due to what I refer to as the postpartum maternal tether. And I talk about that basically, as a continuation of both the biological and social connection that ties a woman to her baby. And starting in pregnancy, you tie in a pregnant body to a baby that puts ethical constraints on her ability to act in her own interest and participate in in her social context the way that she might want to. And so while this tie again lengthens and stretches, it doesn't break when the foetus exits the body, because of the way in which babies are dependent, totally dependent on a caregiver. And that caregiver, in almost every context in the world tends to be assumed to be the mother. And there's sort of biological connections, but also very, very strong social connections. And so I give examples of how this works. And I suggest at the end, that it's actually mothers to... due to illness, and I take the example of mental illness, which is the most common complication of childbirth worldwide. Women who, because of illness are not able to act in that function and that role, that they... even though that, you know, there's a lot of suffering in there that it sort of ends up opening up the space for thinking about how to de-naturalise and kind of de-sanctify the mother-baby relationship specifically, in ways I think could be productive for families more broadly. So that's sort of the two minute overview.
Yeah, that's really helpful. And I think so this paper is based on some research that you did in the field. Is that right?
Yeah, so I'm an anthropologist. And so our way of gathering data is to do ethnographic fieldwork, which involves a lot of participation, observation, we call participant observation, in things that the community is in groups of people we're studying are doing. So I did this kind of work in both the US and in China, working with mothers, with clinicians with researchers who are working on postpartum mental health issues, and also conducted a lot of interviews with clinicians, as well as with moms, with other members of the family. And with other folks who are just working in this area.
I was wondering how you chose your locations. I guess choosing the US is kind of an obvious one, because that's where you live and work. But...
Yeah.
How did you choose China?
Yeah, so I've been doing research in China for about two decades now. So my previous work, which has sort of come back to the surface with COVID, was focused on infectious disease and Infectious Disease Control. And so I wrote a book about the SARS epidemic in China in 2003, which obviously has become rather relevant.
(laughs).
So I've gotten pulled back into that world. So it's nice to take this time to talk about my my work on the postpartum period. So it was a natural fit. And I went specifically to an area of southwestern China in Sichuan Province, a city called Luzhou, which is sort of a... it's referred to as a third tier city in China. A third tier city in China being a city that has about a million people (laughs).
Oh wow.
So the scale is very different there than in you know, Australia, for example. But in that, in that city, people continue to live in kind of relatively traditional family structures. So usually, the grandmother will be very involved in taking care of a baby and will live with the family and care for the mother and baby. And so I was interested in that contrast between that family structure and how it usually turns out in the States. So that was the source of the desire to compare. And what I found was that it is very different. But interestingly, the outcome is really similar. So, so at least middle class mothers - because in both locations I was working with, let's say, with middle class mothers who were partnered in some way, and you know have sort of this traditional family structure in the context where they are. In both cases, they were struggling with similar things, but the specifics were different. So in the States, a lot of it had to do with not having enough support, or being alone. And in China, it often had to do with too much support. So the grandmother being very intrusive, often, traditionally, it's the mother in law, and that relationship can be very fraught. And so there are kind of different triggering factors to the mental health issues that women are having. But the way in which it presented and was experienced was actually sort of surprisingly similar.
Mm hmm. Yeah, that was interesting. I wonder if you could, for the listener, sort of take us through what the main points of argument are in your paper.
Sure, so. So the first point is, I just try to establish that there is an ethical issue here, that are... is related to but somewhat different from the ethical challenges of the prenatal period. And I spend some time establishing this because there's very, very little written in the bioethics literature about the postpartum period. And there's so much about pregnancy. And I just felt like this is a really neglected area of thought and research. And so I try to establish that this is an important ethical question. And I described, you know, this tether that I was talking about earlier that I see as, as happening and kind of talk about both the biological and social nature of that tether. So, you know, certainly biologically for mothers who are breastfeeding in particular, but really all mothers when they've just given birth, and I am talking about birth mothers in the papers, I want to clarify, it's all cisgender women who gave birth to their babies that they're caring for. So obviously, there might be some different kinds of issues for other other folks who are mothering. But for these... for these people who have given birth, there's obviously this biological connection. So there's the breastfeeding and if you're breastfeeding, but also hormonal changes that occur right after, right after you give birth that are affected by holding the baby on your skin, for example, that causes oxytocin to rise, there are various physical connections. But, you know, really, most importantly, there's this social concept, that women who have just given birth are naturally the best caregivers for their newborn babies, and that they naturally should want to care for that baby, to the exclusion of absolutely everything else. And then, and there's a degree to which this holds on, you know, long after the newborn period. But I argue that there's, there's a special nature to this assumption in the newborn period, where if a woman for example, does not want to be caring for her week-old baby, we think there's something very terribly wrong with her. Right? And that's, that's pathologised and stigmatised so much that, as I put it in the article, it's it's thought about as being unthinkable, like what kind of mother would not, not love and want to care for all the time, her baby who just came out of her body, right? So there's a certain particular kind of stigma attached to mothers who don't behave as we expect them to really early on, and then later, it becomes sort of more acceptable to maybe, maybe you don't want to spend all day with your baby and you want to go back to work and that's okay. But that's later. So it's early on, it's really not seen as as a possibility for something you would want. And if if a mother does not interact with the baby and the way that you... that they're expected to, or does not display this instinctual maternal know-how, or does not bond with them in a way that that that they're expected to socially, then that's that's very much pathologised. And so I argue that that pathologisation... but I mean it there's a vicious cycle there because women who are for example, if they're feeling depressed, they often have trouble bonding with the baby in the expected ways, they might not want to, they might not feel capable of doing certain care for the baby and even if there's somebody else, like a father or a grandmother or somebody else who's more than willing to step up, it's still seen as this really big problem that needs to be solved. And then the woman feels so terrible about this, that that tends to make the depression worse, and it becomes this sort of vicious cycle. So that's, that's one piece of it. And then I get into talking about relational autonomy and dependencies, I talk a lot about Eva Kittay's work, if I'm pronouncing her last name, right. And her work on dependency as being a sort of important part of relational autonomy and relational autonomy, as I talked about it, meaning basically that you're no one acts entirely buyer for themselves, right. So self determination, and choice only ever happens in the context of relationships. And so I very much subscribe to that idea. And to effect his idea about dependency that we all at some point in life are dependent on others, and most of us have someone dependent on us at some point. And that's a normal part of the way we exist that should be celebrated and not stigmatised. So I have no, I take no issue with that argument. But the problem that as I see it, is that very often, we act as if babies are uniquely vulnerable to its mother, and I quote Roberts here, so the idea that they're dependent is fine, but the idea that they're uniquely vulnerable to their biological mothers after birth, so that they have to be dependent on her specifically is kind of where I see the problem. And so Kittay argues that, you know, we can deal with this problem by providing more support from others, right, so the problem is more support. And if you can support them, and they're not feeling overwhelmed, and they can take care of their baby, without you know bad effects on themselves. But I argue that that still, that still assumes that mothers have special obligations to their babies that other people do not, for example, a father or another family member. And, and so that restricts their autonomy in ways that is really particular to to this kind of position. And I think that that's problematic. So where I kind of come with this is that, maybe it's okay, if sometimes the mother is not necessarily the one taking care even of a newborn. Maybe we need to de-pathologise that experience, and maybe, you know, if you're exhausted and you're not sleeping, and your body is battered, and you're scared, and you don't know what you're doing, and you're depressed, maybe you're not the best person to be caring for your baby at that time. And maybe that's okay, maybe we shouldn't like think that's an emergency, maybe we should encourage others to feel as much responsibility for taking care of that baby who does need round the clock care and you know, I'm not quarrelling with the fact that babies need an adult to take care of them at all times, it just shouldn't have to always be the mother. So that's kind of where I come to.
And I had a question about the baby-friendly requirements. So because I thought this was so interesting to read about, you know, to your point that brand new mothers who've just given birth are exhausted and their bodies have been battered and whatever, they're tired, of course and in pain. And so there was... you provide some of the conditions that a baby friendly designation would require. So I guess if a hospital wants to have baby-friendly designation, it's actually... it struck me that that the requirements are baby-friendly, but mother unfriendly. Like have the baby in the room at all times, offer no alternatives except for breastfeeding unless it's proactively demanded. That sounded like maybe that is really good for the baby to have the adult there all the time, but maybe not great for the new mothers at all.
Yeah, I think you've hit the nail on the head. And actually, interestingly, some advocates for for women struggling with postpartum mental health challenges are trying to push for mum-friendly hospitals for exactly that reason, right? Because it's, it's so oriented around the baby. And this is really what I take most issue with in my article, and I feel really strongly about this but... that when a mother has just given birth, she suddenly doesn't matter, right? Like her needs or desires are completely inconsequential, because it's all about the baby. And again, that changes over time but at the beginning, you know, nobody cares about what's going on with the mother - you want her to recover and everything but it's it's all about optimising around the baby and there... to even suggest that 'well, maybe we we might be willing to make some compromises on what is absolutely 100% best for the baby to help the mother' that's like not something anyone's willing to entertain, you can only really make that argument if you can show that the baby is the same either way, like if there's any possible negative side to the baby, even if it's minor, it's like, you can't even suggest it, because it's, it's so taboo to think about. Maybe the baby might be at 95% instead of 100% optimisation for what's good for them, so that you can help the... the mother, right. And that's the part I think, is really just troubling.
And it's interesting how it, I guess this is the this is really the other point that you're making that this tether exists still between the mother and the baby, but between the baby and other parent and grandparents and siblings, and so it kind of fails to see the baby in the family group. It just sort of selects the baby out and kind of isolates them and says, like, sort of what's best here instead of what's best for the whole family, because surely, the mother's recovery thriving, is really crucial to the whole group, as well.
Yeah, I mean, and, and a lot of the treatment for postpartum mental illness is... revolves around the mother, baby dyad. So Australia has these two, these Mother, Mother, baby, impatient or personal impatient programmes in which you come with your baby. And idea is that it's, it's terrible to take a baby away from it's mother, again, assuming this is like universally, just something that nobody would want to do. And so you bring the baby with you. And a big part of the, I've sat in on on a programme like this, in Providence, a big part of the therapy is teaching the mom how to interact with a baby in a way that's seen as healthy and to bond with the baby. And so the sort of treatment for her is really bound up with this idea of what's good for the baby, which is something else I find troubling and as you point out, doesn't always make a lot of sense. Because, you know, a lot of families even in the States, and I would venture to say in Australia are not necessarily these traditional 'mother cares for baby' and it's all about the mother-baby relationship. Right? There are a lot of other people involved. And presumably we want these other people involved, right, especially there's a lot of emphasis now on trying to get fathers or other partners involved. But by framing it around, it's the mother-baby dyad, you're really missing out on an opportunity, I think, to more broadly about about the family, as you point out.
Yeah. And I thought, I really liked the line that you even italicised, which was that 'bonding with her baby should not be equated with healing herself'.
Yes.
I as like yes! True.
Exactly. And that that's one of the things that really bothered me in doing these observations. And it was all extremely well intentioned, of course, but you know, especially some other mothers who showed up to these mother-baby programmes, like, they don't want to be with their baby right now (laughs). They want to focus on themselves, and they're tired of dealing with the baby, and they might have someone at home who can take care of the baby, you know, it's great to have as an option if you don't have anyone else who can care for the baby. But it's actually a requirement in a lot of these places, you have to come with a baby and you know, that it doesn't make sense for everybody and it shouldn't be... your own well-being should not be assumed to be wrapped up with that of your baby, you should focus on yourself, especially during a crisis. So...
Did you face any challenges when you were either collecting the data for this paper and writing up the paper?
So I mean, the the data has been a very long process. I actually became certified as a postpartum doula and I took a course in maternal mental health and did a lot of different things, as well as doing the interviews in two different countries. So you know, a big I would say, a big challenge was getting anyone to fund or care about this.
Oh really?
I had a lot of trouble getting funding for this project, because I don't know I can't help but thinking it's a little bit it's a little bit of a sexist sort of undertone to it, because people just don't they just didn't see this as being that important to study. You know, people study pregnancy and people study parenting and and why are you focusing on this one particular period, at least among social scientists, you know, clinically, there's a lot more attention to this. And I should say there's, there are a lot of people working very hard on these issues and among among clinical researchers, but in the social sciences, much less so. So that was a challenge. And then the other challenge, I guess about this particular paper is just that it is so fraught, and I did feel so strongly about it that it was very hard to write it (laughs)... it took a lot of years, I mean of sort of writing a little bit and coming... leaving it for a while, and then coming back and reading some more and then erasing it all and starting over. And that's kind of part of my process, anyway, whenever I write something. This was... this took a long time. I think I started writing this about three years before it actually got published, because I just started and stopped and trashed it and started over again (laughs). It just took a long time to get to where I felt worried about it.
Yeah. Yeah, that's interesting. It's, it's interesting to me how sometimes those things that we are most passionate about are the most difficult things to write in a scholarly way about?
Yeah, exactly. Because you want to get it right, because you care, you know?
Absolutely. Well, I guess we're coming towards the end of our time here. So I'll just ask you a final question. And that is, what kind of takeaway message do you hope that people will gain from your paper? What do you want people to leave with?
I would say to just give mums a break (laughs). And I mean, this is maybe not a terribly innovative idea. But you know, becoming a mother shouldn't involve becoming a sacrificial lamb to your child, like it... you can, you can be a good mother without making yourself miserable. And I think a lot of people, especially when they first have a baby really don't know how to do that. And they don't get a lot of support for how to do that. And the other part of that is just, you know, at the beginning of a newborns life is when they are the most vulnerable, but it's also often when their mother is the most vulnerable. And so we need to be thinking about how to how to help two different vulnerable people here at the same time, and we're not really doing a good job of that in most places.
Thank you so much for that.
Thank you. Thanks for having me.
Oh, it was great. And thanks, everyone, for listening to this episode of FAB Gab. You can find Kate's paper that we've discussed linked in this episode's notes along with the transcript. FAB Gab is hosted by me Kathryn MacKay and produced by Madeline Goldberger. You can find our other episodes on Spotify, Radio Public, Anchor or wherever you get your podcasts of quality. Thanks so much for listening. Bye.