Handcuffed by a cannula, strapped to a cardiotocograph that monitors my baby’s heartbeat, I writhe with pain. The hospital bed physically and mentally shackles me. The aching pierces beyond the body like intense waves crashing through me. This was the prison in which I feared birthing my son.
Throughout my pregnancy, in every medical consultation, I defended my right for freedom of movement during labour. I was marked as a ‘high risk’ pregnancy, a category frequently debated and often conflated with race within medicine and obstetrics. Though he had not been born, the irony of birthing my black mixed-race son in a hospital, which to me mirrored a prison, was eerie. I felt restrained, not by steel bars, handcuffs or chains, but instead by the insertion of medical authority that often viewed women – especially black women – as bodies, fragmented and detached from humanising notions of spirituality, cultural memories and past experiences that may influence how, where and with whom we choose to give birth.
Midwives and obstetricians during my antenatal care assured me that measures would be in place to support my request for freedom of movement in labour. I knew my body and what I needed to cope with pain. I needed water. I needed to move, to bend, to flex, to stretch and to breathe; after all, my body had done this before.
Instead, I was strapped to a bed, on my back, with bright lights beating against me. My husband, a soft-spoken man, reminded the midwife present during labour of what I wanted – only to use highly technical measures if my glucose readings were above target, no continuous monitoring if it restricted movement – and her reply felt scripted from a policy manual. ‘This is our protocol for women with gestational diabetes…’, as she continued to connect me to various machines. With clipped sentences, I spoke to my husband, between the ever-growing waves of contractions, ‘Let them do what they want. I’m in so much pain.’
The hospital is a prison
Ultimately, my baby was born. He was healthy and has gone on to meet many developmental milestones that assure parents of their child’s overall well-being. I wish I could say that was enough or that it is all that matters. But it is not. The politics of birth resemble state control and violence akin to the prison industrial complex. Women’s bodies, in particular those deemed risky due to race, class, immigration status, elevated age or ability, are subjected to a kind of obstetric carcerality where medical procedures trump a woman’s embodied knowledge and experience of pregnancy.
In my case, I was also diagnosed with gestational diabetes – a type of diabetes that develops during pregnancy that carries risks, including a large baby (which could lead to shoulder dystocia during birth), preterm labour, stillbirth or an increased risk of developing type II diabetes.
The diagnosis infiltrated my pregnancy and experiences of motherhood anew. My body was considered dangerous and a threat to the baby: it required close monitoring and surveillance. In every appointment my experience as a person herself who was carrying a baby was rarely considered. Instead, the message was: think of the baby.
As the mother, I was arguably the most invested in the health and safety of the baby. But in the eyes of some health professionals I encountered, being a ‘risky body’ removed my capacity to make decisions – they knew better than I did. Like many women, I value medical advice, but too often we are not listened to, and for black women, our voices are exponentially silenced as medical knowledge is deemed superior to somatic and lived experiences. Medical expertise could have been used to work in harmony with my own embodied knowledge and needs. Instead, it felt like a hospital prison system bore down on my birth experience.
Centring the concern on the unborn, rather than also listening to the woman sitting before them is also a glaringly anti-feminist and conservative understanding of a woman’s personhood – she is reduced to being a vessel. If she does not comply, she is constructed as a bad mother. I was once threatened with the possibility of a ‘dead baby’ from a nurse who wanted me to fall in line with her treatment plan.
The carcerality of bodies in childbirth
Birth politics matter, from the retraction of rights to abortion care in the US to marches across the UK raising awareness of the working conditions of midwives. Birth politics are a microcosm of wider society, upholding and perpetuating systems of oppression and violence against women, gender minorities and racialised peoples and other marginalised groups.
Black women in the UK face an increased risk of stillbirth, preterm birth, maternal and infant mortality. Similar statistics are also prevalent in the US, France, Canada and the Netherlands. Considering the similar and shared histories of slavery and empire, in many contexts, the experiences of surveillance and control within obstetric care (and medical care more broadly) parallel issues of human right violations, policing, borders and migration.
Throughout my pregnancy I couldn’t help but wonder how being a black woman was linked to how I was perceived during my care. Did medical staff take control over my body because my blackness was pathologised and seen as a risk factor? After I raised a question derived from a research article that didn’t match the obstetric nurse’s treatment recommendations, an intense conversation ensued where she listed her qualifications and years of experience in the field, a power tactic to put me in my place.
She later asked me, ‘Where are you from?’ The hairs on the back of my neck stood at end; it’s a tormenting way that racism works. It could have been a question she asked to lighten the mood, but I felt she wanted to culturally place my dissent to her authority as a medical expert.
Many of the women that I saw in the diabetes clinic were also women of colour. I thought often of how the experience of gestational diabetes is racialised, one where our biology, cultural foods, body shapes and sizes are blamed and berated through the practice of treating our bodies as sites of intervention rather than also addressing wider contexts that influence health.
It felt like a hospital prison system bore down on my birth experience
Liberating strategies of care
The systemic issues of maternity care are complex. The NHS is massively underfunded and understaffed. Birth is increasingly overmedicalised. Medical interventions, of course, save lives. But an industrial approach to medical interventions is intended to speed up birth, leading to shorter hospital stays and a greater ‘efficiency’ of services – which speaks to the governance of public services in the UK today.
The NHS maternity services are facing the most challenging times yet. Despite this, many service users, midwives, doulas, obstetricians, academics, policy makers and community organisers are working to advocate, deliver and embed personalised, culturally-safe care in pregnancy, childbirth and the postnatal period.
Good maternity care is the bedrock of society; its implications are far-reaching, impacting individuals, families and communities at large. It is time we take seriously the politics of birth, its impact on women and birthing people, and the ways in which we mobilise liberating strategies of care.