Measuring Mothering

Author(s): Rebecca Kukla

Reviewed work(s):
Source: International Journal of Feminist Approaches to Bioethics, Vol. 1, No. 1, Doing
Feminist Bioethics (Spring, 2008), pp. 67-90
Published by: Indiana University Press
Stable URL: http://www.jstor.org/stable/40339213 .
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MEASURING MOTHERING
Rebecca Kukla

Abstract
As a culture,
wehavea tendency to measuremotherhood in termsofa setofsig-
nal moments thathavebecomethefocusofspecialsocialattention and anxiety;
we interprettheseas emblematic summations ofwomen'smothering abilities.
Women'sperformances during these moments can seem to exhaustthe story
ofmothering, and mothers thesemeasuresand evaluatetheir
ofteninternalize
ownmothering in termsofthem."Good"mothersarethosewho pass a series
oftests-theybondproperly duringtheirroutineultrasound screening,theydo
notleta sipofalcoholcrosstheirlipsduringpregnancy, theygivebirthvaginally
without painmedication, theydo notoffertheirchildan artificial
nippleduring
thefirstsix months,theyfeedtheirchildrenmaximally nutritiousmealswith
every and
bite, so on. Thisreductiveunderstandingmothering had coun-
of has
effects
terproductive upon healthcarepracticeandpolicy,encouragingmeasures
thatpenalizemothers who do notliveup to culturalnormsduringsignalmo-
ments,whilefailingto promoteextendednarratives ofhealthymothering.

"Asmartwomanwholovesherunbornchildwillavoid havinga
c-sectionifat all possible.Onlya self-absorbed
wimpwouldchoose
toput herbabyin harm'swayso thatshe doesn'thave toalterher

THE INTERNATIONALJOURNALOKFEMINIST APPROACHES TO BIOETHICS Vol. 1,No. 1 (SPRING2008).© 2008

68 TO <^&W*^L<
j7nte**™U*&*t€*£&*€*****£QRFEMINISTAPPROACHES 1:1

don tgetany
scheduleorfeelanypain. Thesewomendefinitely
fromme"
respect
ASHLEY, 2006

"Manymotherswhohave difficult birthslovetheirbabies.Love is not

forme.A veryslowopening."
It's theopposite,
a contraction.
LAUREN, 2004

mothergavebirthto me at theendof 1969,aftera difficult pregnancy

duringwhichhergraduate-student healthinsuranceallowedheronly
minimalprenatal care.1A hippywithdegreesinliterature, drama,andeducation,
shewasan idealmother foran infantanda preschooler: Shenourished myevery
sparkofcreativity,
delighted in mypersonalityquirks,fedmehealthy food,and
taughtmetoreadbythetimeI wastwo.Firmbelievers thatgoodparenting did
notrequirea hiatusfromlifeandadventure, sheandmyfather becameintimately
familiarwiththeplaygrounds, zoos, and ponyridesofEuropeand northern
Africa.However, she was a problematicmotherofan olderchild.Shewas con-
trollingandfearfulwhenI showedsignsofindependence andderidedmydesires
tofitinwithmypeergroups.Myparentspulledmeoutofschoolrepeatedly for
monthsata timeandmovedmetoa newneighborhood andschoolalmostevery
year,so thattheycouldtravelfreely without theresponsibilities ofhomeowner-
ship.SeeingthatI excelledacademically despitethesedisruptions, mymother
showedlittlesensitivitytotheireffectsuponmy emotional and sociallife.Later,
oncemyindependence and myfailureto accepthervisionoflifeat facevalue
becameundeniable, shemoreorlessrelinquished responsibility forme,leaving
metosupportmyself frommymid-teens on.Yetshehasturnedouttobe a won-
derfulmotherofan adultchild.Afterwe each settledintoacceptanceofour
mutualindependence, shebecamea staunchsupporter ofmychoicesanda care-
fuland appreciative audienceformyaccomplishments, as wellas a devoted,
playful,creative
grandmother. Thejuryis outonwhatkindofelderly mother she
willbecomelater,aftershebecomesdependent upon her children in turn.
So wasmymothera "goodmother"? Aristotlesaidthata man'shappiness
couldbe measuredonlyoncehe was dead;happinessand unhappinessreside
in hislifenarrativeonlytakenas a whole(1941,BookI, Chapter10).Similarly,
goodmothering be constituted
can onlythrough an entireparenting narrative.
My mother's narrativeis not yetcomplete, norwill itever be univocal.
 REBECCA KUKLA 69

Yetas a society wehavea tendency tomeasuremotherhood, notinextended

but
narratives, by a setof signal moments thatwe interpret as emblematic testsand
summations ofwomen's mothering abilities.Women's performances duringthese
moments can seemtoexhaustthestoryofmothering. Mothersofteninternalize
thesemeasures andevaluatetheirownmothering intermsofthem.These"defin-
ingmoments" tend to come veryearly in themothering narrative - indeed,several
ofthemcomeduringpregnancy orevenbeforeconception.
Considerhowthephrasereproductive ethics hascometorefer almostexclu-
to
sively ethical analyses of discrete choices faced during pregnancy evenearlier.
or
in
Keytopics reproductive ethics include abortion, pre-implantation geneticdi-
agnosis,andfertility medicine. Thisoughttostrike us as strange. Reproduction is
theprocessofcreating newpeopleandbuildingfamiliesand communities. Re-
productive ethicsoughttorefer totheethicsofcreating andcaringfornewgenera-
tions.Thisis a processthatextendsacrossthelifespan.Ifwerestrict ourunder-
standing ofreproduction totheprocessesofconception andpregnancy, notonly
willweignoremuchofthematerial andsociallaborthatconstitutes thecreation
andsustenance ofnewpeople,butwesurely riskdistorting thesocialandethical
of
meaningoftheseearlystages reproduction. is, That itwould be odd to think
thatwecan understand theethicsorsocialsignificance ofpregnancy orconcep-
tionwithout understanding them as firstand foremost the beginningsoflonger
narratives.Yetmainstream bioethicists consistently lose interest in mothers once
thebeginning of their narrative is over. We give littleor no bioethical attention to
theethicsofmothering childrenafterinfancy, notto mentionolderchildren. I
claimthatthisreductive of
understandingmothering has had counterproductive
effectsuponhealthcarepracticeandpolicy, encouraging measuresthatpenalize
mothers whodo notliveup to cultural norms duringsignalmoments whilefailing
toencourage extended narratives ofhealthy mothering.2
I believethatone oftheimportant tasksforfeminist bioethicsis to turn
thebioethicalspotlightupon thefactthatreproduction notonlyhappensin
women'sbodies,butthroughwomen'songoing,richlytexturedlabor- labor
that,afterall,does notescapea complicated relationship withmedicalinstitu-
tionsandspacesafter pregnancy ends. From pediatrician's officesandlate-night
emergency rooms to the
negotiating increasing medicalization ofchildren's
behaviorandbodies,womenmother in and through their complicated relation-
shipsto medicalauthority, judgment, and possibilities, evenwhentheyresist
doing so. Whether or not it should be thisway, even in our currentage ofin-
creasingly shared parenting duties, mothers bear a disproportionate responsibil-
70 ^,t^rnt*/^+i**/ <Z**+in*t/W FEMINISTAPPROACHES
TO 6&;*><*//*i<±i
1:1

ityformanagingtheirchildren's contactwithprofessional healthinstitutions,

maintaining their healthat thedomestic level(throughfeedingand hygiene
practicesand thelike),and trainingthemin safetyand self-care.Correspond-
ingly,mothers arehelddisproportionatelyresponsiblefortheirchildren's
physi-
cal andmentalhealthimperfections.3 Justas bioethicsmisrepresentspregnancy
and conceptionwhenitseversthemfromtherestofmothering, likewiseac-
countsoftheethicsoffamilyrelationships missa pressingdimensionofmoth-
eringiftheyfailtobringthetoolsofmedicalethicsto bear.

In thefollowing,I explorethreeexamplesofsignalmomentsthatwe interpret

as displaysand testsofwomen'smaternaladequacy;I thenturnto thelarger
culturaland ethicalimpactofmeasuringmothering in theseways.

Respondingproperlyto ultrasoundimages
Althoughtheritualsand theaccompanying ritualsvaryfromcountry to
country Mitchell
(cf., and Georges 1997), ultrasound screening forfetal
abnor-
malitiesduringapparently healthypregnancies hasbecomecompletely routine
in manycountries. In Canada and theUnitedStates,forinstance,itis standard
tohavesuchan ultrasound screening aroundtheeighteenth weekofpregnancy.
The eighteenth-week ultrasoundindeedhas becomeso routinethatcouples
oftenwaituntiltheyhavehadittoannouncethepregnancy tofriendsandfam-
ily(Mitchell2001;Weir1998).Theprocedurerequiresno informed consent,is
rarelyrefusedbywomen,and is generally precededbylittleorno discussionof
themedicalpurposesofthetest,itsprovenrisksorbenefits, ortheoptionsthat
willbe availableifan anomalyis detected.(In fact,therehasbeenno persuasive
datashowingimproved outcomesforindividual mothers orbabiesfromroutine
ultrasound and an
screening, although atypical ultrasound mayleadtoa recom-
mendationformoretesting, thereare almostno conditionsdetectableon the
ultrasound screenthatcan be treated ormanagedinutero.Reported reductions
in neonatalmorbidity and mortality due to routineultrasoundscreeningare
basedon termination rates,andtermination canhardlybe countedas an option
thatimproves thehealthofa fetus.)
Although themedicalexpectations surrounding thetestmaybe vague,the
webofnormative andsocialexpectations inwhichitis embeddedis not."Good"
mothers areexpectednotonlytohavetheultrasound, buttobutlookforward to
itas a keymoment on thepathtomotherhood. Theprimary purpose ofthe test,
as itis representedin ourculture,is notdiagnostic butsocial.Pregnant women
 REBECCA KUKLA 71

areencouraged totreattheeventas a treasuredmomentduringwhichtheywill

"meetthebaby"forthefirst time.Whenconfronted withtheimageoftheirfetus,
"good"mothers manifestloveandamazement andreaffirmthatthetesthashelped
themunderstand ofthebaby.Goodmothers
the"reality" areaccompanied tothe
ultrasound bysupportive heterosexualhusbands and The
fathers-to-be. jointat-
tention oftheexpectant motherand father, to theinscrutable
directed screenas
theultrasoundtechnicianrattlesoffthefeatures and propertiesofthe"baby,"
servestoaffirm andforeshadow thenormative nuclearfamilyunit.Attheendof
thescreening, thecoupleusuallyreceivesa photototakehomewiththem,which,
as medicalethnographer LisaMitchell(2001)hasshown,servessociallyas "babys
first
picture."Indeed,themedicalpurposesoftheultrasound havetakena back
seatto itssocialpurposesto suchan extentthatmanywomenfindthemselves
completely unpreparedfortheemotional impactofproblematic ultrasound results
(cf.,Yaqub2005).
Lestweremainunconvinced thattheprimary purposeoftheultrasound is
socialratherthanmedical, weneedonlyturntothecommercial ultrasound clinics
thathavesprungup in mallsacrossthecontinent in thepastdecade.Fora fee,
theseclinicswillperform an ultrasound andprovide a photoofyourbabyina cute
baby-themed frame. Theyalso sellvariousothertypesofmerchandise decorated
withyourultrasound image.Whatis significant, formypurposes, istheextent to
whichthesecommercial clinicsadvertise theirservicesthroughrhetoric thatsug-
gestsa normative expectation thatgoodmothers willwanttopreserve theirultra-
soundexperience. "FetalMoments: AnUltrasound toRemember," an aptlynamed
clinicin a suburbanAtlantamall,recommends purchasing "customkeepsake
jewelry"featuring yourbaby'sultrasound photo(see fig.1).Accordingto their
Website,"Fetal Moments is heretoprovide youandyourfamily witha wonderful
bondingexperience through a uniqueultrasound thatyoucantreasure foryears
tocome."4 Whiletheclinicexplicitly declinestooffer medicaladviceordiagnoses,
alltheirpackagesincludea DVD andphotos, "gender determination,ifrequested,"
to
and"room bringyourfamily and friends."
Theultrasound ritualservestoputwomen'smaternal bonafidestothetest.
We can seethismostclearly, perhaps, bylookingatwhathappenswhenwomen
"fail"thistest.For example,Lisa MitchellfoundthatCanadian ultrasound
technicians andobstetricians corrected expectant mothers whoreferred towhat
theysawon thescreenas a fetusinsteadofa baby.Whenwomendidnotmani-
festthe"proper"levelofemotionorthe"proper"formofengagement withthe
ultrasoundimage,techniciansweresuspiciousoftheirfitness to motherand
72 ,J^rf^i#««/^^^/^#>#«^/()I FEMINISTAPPROACHES
TO ^#/^*5<^L* 1:1

Figure1. Advertisement
for"FetalMoments"ultrasoundstudio(www.fetalmoments.com)

theircommitment tothepregnancy. Technicians also weresuspiciousofwomen

whoshowedtoo muchor notenoughinterest in thehealthofthefetusor too
muchornotenoughinterest initssex.Theyweresometimes directly judgmental
towardexpectant parentswhowere"too"interested inthesex,tellingthemthat
"findingoutthesexisn'timportant. Themostimportant thingis thatthebaby
is healthy." in
Occasionally, such cases and when
particularly thewomanwas
notCaucasian,thetechnicians wouldevenlie abouttheirabilityto detectthe
sexofthefetus(Mitchell2001,381).
Thustheultrasoundtestisculturallyframed notonlyas a socialritualduring
whichyoumeetyourbaby,butalso as an earlymomentat whichan expectant
mothersabilityto engageand bondwithherbabyand to arrangeforitsproper
socialreception
is measured.One ofMitchell's intervieweestoldherthestoryof
howherownultrasound had goneand thenasked,"Howdid I do?"(ibid.,epi-
graph).On thepopulartelevision
sitcomFriends, RachelGreene-oneofthemain
whois alreadymarkedas a nonstandard
characters, motherwhenshebecomes
 REBECCA KUKLA 73

pregnant whilesingleafterspendinga drunkennightwithherex-boyfriend-

burstsintotearsduringherultrasound, wailing"I'ma terrible mother!" because
the on
shecannotsee fetus thescreen when thetechnician pointsitout.5Although
theritualssurrounding theultrasound areculturally variantandrelatively recent,
ourexpectations forhowwomenwillactandfeelduringtheseritualsarealready
quiterigidandwell-entrenched in ourfolkculture.6 Itis acceptablefora woman
to refuseorto seekinformation the
about sexofthebaby,forexample,butonly
fortherightreasons:shecan refuse theinformation becauseshewantsthesexto
be a wonderful surprise,but not because she isjustuninterested; shecanfindout
thesexbecauseshewantstostartcontentedly purchasing gender-coded babygear,
butnotbecauseshewouldgreatly prefera childofonesex(although, interestingly,
suchpreferences seemtobe moresociallyacceptable forfathers). One can refuse
theultrasound altogether on the grounds that onewillwant to carrythebabyto
termregardless ofanyanomaliesand"loveitthesamewayno matter what,"but
in
notbecauseoneis simplyuninterested thetestand unconvinced thatthereis
anymedicalbenefit totheprocedure.
In thefaceofthedearthofmedicalevidenceforconcretebenefits forul-
trasoundscreening, thestandard justification for
itsroutinization has been that
ithelpswomenbondwiththeirunbornchildren(cf.,Sedgmenetal. 2006).This
is so despitethefactthatsuchan effect is scientificallydubiousat best (cf.,
Lapaire et al. 2007). Byimplication, a woman who failsto havethenormative
reactionsto theultrasoundeventis maternally deficient. whywe
Interestingly,
carewhether or notpregnant womenbondwiththeirfetuseshas gonemostly
unquestioned. It is a major empirical assumption-and one forwhichI have
foundno scientific evidencewhatsoever -that bondingwithone'sfetusmakes
one anymorelikelyto bondwithone'sactualbaby.Indeed,we mightimagine
thatbondingwithsomething completely portablethatwe havemetonlyvia an
image will make the of
reality a spitting, screaming infantthatmuchmoreofa
shock.Mostpregnant womenarealreadygoingto extreme lengthsto monitor
and discipline their behavior to minimize risk;pregnant women obsessively
controltheirdiets,exerciseregimes,emotionalstates,haircareproductuse,
andjustabouteveryotheraspectofdailylife.We hardlyneeda toolsuchas the
ultrasoundto heighten thisalreadyexcessivephenomenon. Meanwhile,preg-
nant women who in
engage seriouslyrisky behaviors such as drugabuse are
unlikely tostopwithout someintervention morehelpful thana suggestive image
and a sternwarning.It seemsto me thatourvaluationofthematernal-fetal
bondstemsfromourdesiretostartturning motherhood intoa normative affair
74 j£*2WW£»**<*/^«**#wf OF FEMINISTAPPROACHES
TO {J&dvttf&o*1:1

as earlyas possibleand likewiseto startmeasuringa woman'smaternalade-

quacyas earlyas possible.

Birthas a maternalachievementtest
Laborand delivery typically takelessthana day;somewomenlaborforas
longas a fewdays.Mothering, however, typically lastsformanydecades.Within
mostmothering narratives, birthmakesupa tinyspeck.Adoptive mothers do not
give birthtotheir children. Yet we have elevated the symbolic importance birth
of
tothepointwhereitappearstoserveas a make-or-break testofa woman'smother-
ingabilities.Ifshemanagesherbirth"successfully," makingproper, risk-adverse,
self-sacrificing choices,and maintaining bothproperdeference to doctorsand
controloverherownbody,thensheproveshermaternal bonafidesandinitiates
a lifetime
ofpropermothering. If,ontheotherhand,shefailsatthesetasksduring
labor,sherevealsherself as selfishorundisciplined andrisksdeforming herbaby's
character,health, andemotional whileputting
well-being, herbondwithherchild
inpermanent jeopardy.
According toourculturalmythos, "good"mothers delivervaginally with-
outpainmedication, after advanceplanningandappropriate prenatal education.
Second-best mothers submitregretfully butdocilelytowhatever medicalinter-
ventionsthedoctorsrecommendto correctand controltheirunrulybodies.
"Bad"mothers makeother, "selfish"choices,suchas givingbirthathome,seek-
ingoutan epiduralor a cesareansection,or attempting a vaginalbirthaftera
previousc-section.Alternatively, "bad" mothersmayjustfailto demonstrate
sufficient
control overtheirbirths. Theymaylabor"unproductively" andthereby
"failto progress"or otherwisefailto proceedin a timelyfashiontowardan
uncomplicated birth.7 In somehospitals, womenthatendup receiving cesarean
sectionsresulting in healthy babiesareroutinely givenunsolicited on
literature
to
grieving help them through their feelings of failureand loss at nothaving
successfully achieveda normative birth.8
Whenwomenwerefirst encouragedtodrawup birthplansin whichthey
specifiedtheirpreferences concerning painmedication, whowouldbe allowed
in theirroomsduringlabor,and otherbasicaspectsoftheircare,thelaudable
ideawastohelpwomenbecomeatleastpartialagentsoftheirownbirths, rather
thanpassively submitting tomedicalmanagement. However, overtime,formu-
latinga birthplanhas movedfroman empowering optionto a socialduty.In
theadvice column,"AskAmy,"a recentletter-writer was appalledthather
pregnant friend was not attending childbirth classes:"She saidthatsheandher
 REBECCA KUKLA 75

husbandweregoingto"wingit"andthatthenursesknewwhattheyweredoing.
I was a bitstunnedthatthiswell-educated womanwouldhavesucha casual
attitude This expectant mom also said thattheyweregoingto flipa cointo
decidewhetherto havean epidural.I thinkthisis veryirresponsible. These
do
procedures carry a levelof risk/'9
Contemporary North American pregnant
womenare expectedto plan outtheirbirthswiththeelaborateprecisionand
careofa traditional brideplanningherweddingday,and theyareexpectedto
do itearly.One Web siteperversely recommends: "In thehappyhaze ofearly
pregnancy ... the realityoflabor and birth may seem extremely faroff-which
makesthistheperfect timeto startplanningforthearrivalofyourbabywith
a birthplanthatdetailsyourwishes."10 One fairly typical"interactive birthplan"
thatcan be downloadedfromchildbirth.org is a seven-pageformthatasks
mothers to detailtheirchoicesin eighteen different categories and severalsub-
categories, coveringeverything from the lighting in the room, to thespecific
instruments thatmaybe usedin caseofcomplications, tothelaboringpositions
thattheywill adopt.We can pushtheanalogybetweenbirthplanningand
weddingplanningfarther: as womenarecalleduponto planand designtheir
births, they are invitedtothink ofbirth,notprimarily as thefirstdayoftherest
oftheirchildren's lives,butas their"specialday,"during which theirtenureas
mothers willbe symbolically foreshadowed andputon display, justas weddings
areoftenframedas thebride'sspecialdayandas thesymbolic moment atwhich
theperfection (orimperfection) ofthe is as
marriage performed spectacle.a
Such elaboratebirthplans set up completelyunrealisticexpectations
concerning howmuchcontrolone can possiblyhaveoverthelaboringprocess,
thereby setting womenup forfeelings offailure, lackofconfidence, disappoint-
ment, and maternal inadequacy when things do not go according plan,even
to
whenmotherand babyend up healthy. Theyalso givewomentheimpression
thatiftheydo nothavestrongopinionssevenmonthsin advanceconcerning
howtheywouldliketheirlaborroomlitand whether theywishto availthem-
selvesof foot pedalsduringlabor, then they are not sufficientlyengaged,con-
cernedmothers-to-be. Furthermore, although the entire phenomenonofthe
"birthplan"is pervadedbytherhetoricofchoiceand autonomy, all women
knowthatgoodmothers makesomechoicesbutnotothers.Forinstance,indi-
catingthatonewantspainmedication attheearliestmedically possiblemoment
is nota sociallyacceptablechoice,eventhough it is a choice availableon the
form.LaurenSlater(2004) writes,"Our [prenatal]teacherbelievedthatbirth
was fullofchoices.'You shouldwritea birthplanand giveittothenurses,'she
76 TO {jSd&ttf&c* 1:1
<7,tJeirva/t'o,*a/ &*€*****£OK FEMINISTAPPROACHES

said. 'You shouldrefuseall pain medication.Refusea heartmonitor.Refuse

'
Pitocin Our instructor also informed us thatbirthinterrupted bytechnol-
ogyequalsa motherlessableto bondwithherbaby."
Theideathatwomenhadbetter managetheirbirthssuccessfully orriskfail-
ing to bond withtheir babies- and thereby risk a narrative of motherhood cor-
ruptedirreparably from the firstmoment- is tenacious. Beginning with the at-
tachment parentingmovement spearheaded byJohn Bowlby (1969,1983,and1988)
andWilliamandMarthaSears(1993)inthe1970sand 1980s,alarmists fromboth
thenaturalchildbirth movement and thetraditional medicalcommunity have
for
argued, instance, that mothers who do not breast-feed in the hour
first willnot
bondwiththeirbabies,thatmothers whoarenotfully lucidatthemoment ofbirth
duetopainmedication willnotbondwiththeirbabies,andso forth.11 Typically,
thenominalconcernofthosewhoraisesuchworries istoprotect mothers against
losing these opportunitiesto bond becauseof overzealous medical interventions.
However, infact,suchclaimsredoundagainstmothers who,forwhatever reason,
do notmanagetoorchestrate thesefirst
moments correctly, putting theirmaternal
successintoquestionfromthestart.Forexample,notedbirthanthropologist
Brigitte Jordanclaims,"Asemi-conscious motherwhodoes nothearherbaby's
firstcryanda narcotized infant whosereactions areweakareofftoa badinterac-
tionalstart"(1992,79).Shethentellsthestoryofwitnessing a birthinwhichthe
mother, purportedly terrorizedby too much medical intervention, stoppedbeing
"courageous" and instead"gaveup"duringlabor.Hercontractions stopped,her
laborwasartificiallyrestimulated, andherbabywasbornwiththehelpofforceps.
Jordan endsthedramatic talebycommenting "I hopeshestilllovesherbaby"(ibid.
112-13).Thepassageis supposedtobe an indictment ofmedicalizedbirthprac-
ticesin theUnitedStates,butthenormative languageoffailureaimedat the
motheris clear,as is Jordan'sbeliefthatthiswoman'sfailedperformance during
themoment ofbirth- however muchitcanbe blamedonherdoctorsandthein-
stitutionalizedritualsofthehospital-portends a lifetime ofdeficient maternity.
In popularculture,thedistasteformotherswhodo notbehaveproperly
duringtheirbirthsisstrong andexplicit,as istheimplication thatthisbadbehav-
iorreflectsupontheentirety oftheirmothering. Women'schoicestohaveornot
tohavecesareansectionshaveparticularly mobilizedthisdiscourse. Notoriously
labeled"tooposhtopush,"mothers whochooseelective cesareans fornon-medical
reasonsarevilified bythemediaand in onlinediscussions. In an articleentitled
"TooPoshtoPushMomsSetBadExampleforSociety," theVancouver Sunedito-
rializes,"PitypoorSeanPrestonSpearsFederline His momcouldn'tevenbe
 REBECCA KUKLA 77

bothered to suffera littlepainfora lotofgainon thedayofhiscelebrated birth.

Yes,giving birththe old-fashioned way hurts. Welcome to motherhood" (Fralic
2005).Here,Britney Spearsselective c-section-which, giventhewaysofabdomi-
nalsurgery, probably didinvolvemorethan"a littlepain"- is takenas reflecting
upon
directly herentire relationship tomotherhood, whereaspropermaternity is
associatedwithself-sacrifice and a willingness to bearpain.Meanwhile,on a
babycenter.com bulletinboarddiscussionconcerning theethicalacceptability of
elective
c-sections,typical entries expresssentiments similar toAshley, whowrites,
"I amtotally againstelective c-sections A smartwomanwholovesherunborn
childwillavoidhavinga c-sectionifat all possible.Onlya self-absorbed wimp
wouldchooseto putherbabyin harm'swayso thatshedoesn'thaveto alterher
schedule orfeelanypain.Thesewomendefinitely don'tgetanyrespect fromme."12
Hereagain,non-normative choicesconcerning birtharetakentoindicate a global
deficiency ofmaternal love and competence.
Partofwhatinterests meaboutcomments liketheseis thecomplete vague-
nessconcerning whatsortsofgainsandharmsareatstake.Whatexactly would
Britney a
gainbyattemptingvaginal birth,and exactly how aremothers who elect
c-sections puttingtheir babies "in harms Of
way"? course, thisis a complexsci-
question,andthereis plenty
entific ofongoingresearch aimedatpinningdown
theexactadvantages anddisadvantages formothers andbabiesofdifferent modes
ofdelivery.Whatwedo knowisthat,incomparison witha hostofothermundane
andincomparison
activities, toallprevious moments inhistory,allofthestandard
optionsforbirthin developednations(cesareansections, vaginalbirthsafterce-
sarean,homebirths, waterbirths)areextremely safeformotherandbabyalike.
Britney surelytakesfewer chanceswithherbabybyscheduling a c-sectionthan
doesa mother whochoosesa preschool thatis a car ride ratherthan a walkaway
fromherhome.13
In fact,whether we castcesareansectionsorvaginalbirthsas therisky,
selfishoptionvariesin accordancewithcontext,notin accordancewiththe
actualrisksinvolved.Not onlyhavesome(mostlyindigent) womenwhohave
resistedmedicallyrecommended cesareansectionsoccasionallybeen served
withcourtorders(orin thecase ofMelissaRowlandin SaltLakeCityin 2004,
withhomicidecharges), butevenwomenwhowishtoattempt an elective vaginal
are
birthaftera previouscesareansection increasingly faced withdraconian
hospitalrestrictions (Schneider2005; Grady2004) and thesame chargesof
selfishness and risk-taking thattheirpeerswhoseekelectivecesareansections
face.The standard justification forpreventing womenfromattempting vaginal
78 TO (J&iottf&c* 1:1
iW FEMINISTAPPROACHES
<y,tJ&i+t<*&o,t<*/<7*>t***t<*/

birthsaftera cesareanis based on theriskofcatastrophicoutcomesdue to

uterine rupture.Notonlyis theriskofuterine rupture
tiny,but- ironically-this
riskturnsout to be roughlyequivalentto theriskofuterineruptureduring
primary vaginaldelivery (Smithetal. 2002).Meanwhile,repeatcesareansare,
ofcourse,no saferthanprimary cesareans;indeed,quitetheopposite.In other
words, whether a scheduled cesarean or an attemptedvaginalbirthis theso-
ciallysanctioned,"properly maternal"choicedependson whetheror notthe
motherhada previouscesareanornot.Butthefactofa previouscesareanin no
wayreversestherelativeriskofthesetwooptions.Therefore, hereour social
attitudestowardpropermaternalchoiceare cutfreeofanybasisin objective
relativerisks.14
Butinanycase,therealrisksandtheirsizesdo notseemtobe ofinterest to
thelaycriticsofmothers' birthchoices, whoappearquitecontent withhand-wav-
ingreferences to gainsand harms.Especially becausethesecritiquesarenotre-
sponsive toanyspecific, sizablerisks,itishardnottoconcludethatthemainnor-
mativestandards atplayareideological, notmedical:Ourculturalinsistence that
womenmake"proper" birthchoicesandmaintaincontrol overtheirbirthnarra-
tivesis notaboutminimizing realrisks;rather, ourdesiretomeasure
itsupports
mothering in termsofwomen'spersonalchoicesand ofself-discipline exercised
duringsignal moments. What is at stakeis notthehealth
of babies butan image
ofpropermotherhood, combinedwiththeideathatbirthshouldfunction as a
symbolic spectacleofsuch motherhood.
Wemustremember thatmothering isnotdennedbyitsfirst moments. Even
thebestbondbetween a mother andhertwenty-minute-old babyis a meaningless
shadow of a genuine mother-childbond of the sort that sustains good
mothering.

You are whatyourchild eats

Providinghigh-quality earlynutrition to childrenand eatingwellduring
pregnancy areundeniably important components ofgoodmothering. Children's
nutritional
statusdependson eatinghabitsthatareestablished overtime.How-
ever,our cultureis repletewithimagesoffeedingmoments thatpurportedly
corruptboth children and mothers in some permanent way.
Thelogicofthesinglecorrupting biteshowsvividlyin a recentarticleby
JodiKantorin theNewYorkTimesentitled "MemotoNanny:No JuiceBoxes."
Kantorwrites,apparently withoutirony, "Thecurrent nutritionalwisdomsays
thatwhatchildreneatmaysettheirtastesin placepermanently. In thisview,a
 REBECCA KUKLA 79

hotdog is neverjust a singletubeofmeat,becauseitwilllead to thousandsof

salty,processed,who-knows-what-filled lunchesto come."Heretheseemingly
singlehotdog is picturedas extending beyonditself, determining and encap-
sulatinga lifetime ofpooreatinghabitsratherthanremaining singular.Byal-
lowinga hotdogto slipintoherchildin a momentofweakness,a mothercan
pervert thechild'stastesand eatingpracticesforever, thereby undoingmonths
oryearsofdevotionto purchasing organicfood,avoidingtransfats,and plan-
ning and preparing balanced meals forherchildoutoffreshingredients.
Ultrasound testsandbirthareidiosyncratic events, andI havearguedthat
mothersare measuredbytheirperformance during these events.Thelogicof
feedingis slightly different:one mustfeedone'schildoverand overagain,and
thereis no discretemomentat whichone can proveone'spropermaternality
through feeding. On theotherhand,atanymoment a mother mayproveherself
an improper mother through an actof feeding.Hence this is a testthatone can
neverpassbutis alwaysatriskoffailing. Kantor's articlereceived hundreds ofon-
linecomments immediately from mothers, many of them arguing infavor of more
maternal surveillance anddiscipline and stricter eating rules. One mother com-
mented,"Thisarticleis frightening. How can parentsgivesuchdiscretion to a
babysitter?"Commentators described quitting theirjobsrather thanrelying upon
nanniesandgrandparents whocouldn't be trusted toavoidhotdogs,refined flour,
orproducts withtracesofpeanuts.One mother whoadmitted in hercomments
to owning at least one bottle of infant formula was immediately flamedby
others.15
Indeed,one can failthefeeding testveryearlyon. Manyparenting guides
suggest or claim that her
outright allowing baby single one suck on an artificial
nipplemaywelldestroy a mother's chancesfora successful breast-feeding relation-
shipforever (andinturn,thata babywhoisnotbreast-fed isathighriskforfailure
tobondwithitsmother, lowIQ, andmultiple behavioral andhealthproblems).16
NorthAmericanbreast-feeding promotional materials consistently emphasize
exclusive breast-feeding,as opposedtothemoreproductive messagethatthemore
breastmilkbabiesreceive, thebetter."Doesonebottleofformula makethatmuch
difference? We wishwe couldsaythatitdoesn't," statesLa LecheLeague,rather
disingenuously, intheirbreast-feeding guide,"butwecan't"(1997,90).According
tothisguide,a singlebottle of formula can trigger life-threatening allergies,and
anycontact withartificialnipples(bottlesorpacifiers) cancausenippleconfusion,
wherein thebabyisnolonger willingor able tolatch onto a breast. In fact,although
itistruethata babywhois regularly fedfroma bottlemayrejectthebreastorlose
80 ^t^trt^/t^ri^/ ^etrri^/ TO (£irx<>//ii<*1:1
AW FEMINISTAPPROACHES

theskilloflatchingontoit,thereisnoevidence fornippleconfusion resultingfrom

theoccasionaluseofartificialnipples(cf.Fisher and Inch 1996 and Neifert,Law-
rence,and Seacat1995).A 1992studyfoundno difference inbreast-feeding out-
comesbetweennewborninfants whowereexclusively andthosewho
breast-fed
received onebottledaily(Cronenwett, Stukel,and Kearney1992).Thepervasive
fearofinstantnippleconfusion amongnewmothers, bythemedical
cultivated
establishment/the WorldHealthOrganization (WHO) and the UnitedNations
Children'sFund(UNICEF),amongothers, is itself
indicativeofthepowerofthe
logicofthe singlecorruptingmoment.17
Artificial
nipplesareportrayed as corrupting morethanjustan infant's
feedingpractices;theirstaincan infectmothering as a whole.In WhattoExpect:
TheFirstYear(thesequelto theubiquitousand unforgiving queen ofguide-
books, Whatto ExpectWhenYou'reExpecting),we findout how,despitea
mother's bestintentions,thatfirst ofan artificial
offer nipplecan initiatea pro-
cessthatcorrodesnearlyall aspectsofmothering:
Be awarethatpacifier use easilyslipsintopacifier abuse.Whatstartsoutas
thebaby'scrutchcan easilybecomethemother s. Thereis theever-present
temptation to use thepacifieras a convenient substitutefortheattention
sheherselfshouldbe providing to herchild.Thewell-meaning motherwho
offersthepacifier. . . maysoon findherselfpoppingin a pacifierthemo-
ment[herbaby]becomesfussy, insteadof trying to determine thereason
forthefussingor iftheremaybe otherwaysofplacatinghim.She mayuse
itto getthebabyoffto sleepinsteadofreadinghima story, to ensurequiet
whileshe'son thephoneinsteadofpickinghimup and consolinghimwhile
to buyhis silencewhileshe'spickingouta pairofnewshoes
she'schatting,
insteadofinvolving himintheinteraction. Theresultis oftena babywhocan
be
only happy with something in his mouth,and who is unableto comfort
himself,entertain or
himself, get himselfto sleep.(Murkoff, Hathaway, and
Eisenberg 2003,117)

Afterherinitialofferof thepacifier, themotherin thispassageis sweptpas-

sivelydowna current ofbad mothering overwhichshehas littleor no control;
led intotemptation, shesoon findsherself thepacifier
substituting forherown
activities
ofmothering. Shereplacespropermotheringactivities
withmarkedly
gendered, on thephoneand shoeshopping.
trivialtasks:chatting Although the
firstsuckmaybe bothtempting andfleeting,
itsconsequenceis an orallyfixated,
emotionally crippled child.18
 REBECCA KUKLA 81

Theideathateachfeedingmomentpresents a pivotalchoicebetweenrisk
andmaternal extends
responsibility backwards into pregnancy.WhattoExpect
WhenYoureExpecting warns,"Every bitecounts:Before you closeyourmouth
on a forkfuloffood,consider, 'Is thisthebestbiteI can givemybaby?'Ifitwill
benefityour baby, chew away. Ifit'llonlybenefit yoursweettoothor appease
yourappetite, putyour fork down" (Murkoff, Eisenberg, and Hathaway2002,
80).Thispassage - which regularly incurs thewrath ofpregnant womenin chat
roomsand on bulletinboards- demandsthatmothersdisciplinetheireating
withliterally everybiteoffood,avoidingthecorrupting, selfishbitethatis not
baby-directed. Here,eatingsimply because one is ("to
hungry appeaseyour
appetite")is akinto maternal betrayal.
Therisksandbenefits thatarisefrommothers' economic
ongoinglifestyle,
security,and accessto high-quality foods faroutweigh therisks and benefits
thatattachtoanysingleforkful orsuck.Ourfocuson theimportance offeeding
momentsratherthanon long-term eatingpatternsbetraysour entrapment
withinan ideologicalpictureofnormative maternalperformance, ratherthan
a reasonableconcernwithchildren's well-being.

ofmeasuring
Theeffects in moments
mothering
I havedescribed threematernal activities-undergoing a routine ultrasound,
and
givingbirth, feeding one's baby(or or
fetus child)- that I have arguedserve
as cultural testsduringwhich women's maternal bonafides are measured. In each
case,medicalinstitutions, themedia,andmothers themselves colludeinassessing
howmothers perform duringheavily, normatively-regulated signalmoments. The
rhetoric surrounding these moments suggests,on theone hand, that they de-
will
termine thesuccessofthefuture mothering narrative (whether motherwill
the
bondproperly withherbaby;whether thebabywilldevelopa lifetime ofsecure
and
relationships healthy eating habits)and on theother hand, thatthey revealthe
truthabouta woman'sfitness tomother (whether sheis sufficiently engaged, self-
sacrificing, risk-adverse, etc.).
disciplined,
Ourculturalimagesofpropermaternal behaviorduringthesetestsarenot
politically neutral.Rather, a woman's to
ability perform "properly" withrespect
toprenatal and
care,birth, feeding aremarked by socioeconomic status andethnic
identity.Consider:
(1)LisaMitchell foundthatimmigrant womeninCanadawere,notsurpris-
less
ingly, likely to followthe scriptduringtheirultrasounds. Nothavingbeen
trainedon thecontingent culturalritualssurrounding event,oftencoming
the
82 ,7, t/*i,,«/<«,i« /</„„<, i«/ <>\FEMINIST TO(/i<«<>//t«^1:1
APPROACHES

fromcountries wherethereis no routinescreening duringhealthy pregnancy, or

fromcountries wherethescreening is treatedas a clinicalratherthana social
event,theywerelessinclinedto personify theimageon thescreen,bringalong
theirspouses,expectkeepsakephotos,and so forth.Accordingly, ultrasound
technicianstendedto offer thesewomenless medicalinformation thantheir
counterparts who followedultrasound etiquette, and the technicians socialized
lesswiththesefetalimages.Later,theyreported thatthe women seemed insuffi-
cientlyconcerned withandexcitedabouttheirbabies(Mitchell 2001,185).
(2) An unmedicated vaginal birth that goesaccording a predetermined
to
birthplanistakenas thematernal goldstandard, I argued.Buta woman'schances
ofhavingsucha birthdependheavilyuponherownhealth,heraccessto high-
quality,continuous healthcarewitha provider whois familiar withherprefer-
ences,herabilityto articulateherwishesin a waythathealthprofessionals will
her of an
understand, mastery English(in Anglophone hospital orbirth center),
herabilitytohirean advocatesuchas a doulaormidwife, andherlevelofsupport
fromfamilymembersand otherswhocan speakforherduringthebirth.The
toinsistthata birthplanbe respected
ability bythehospital staff,evenwhenmedi-
callypossible,
normally a of
requires highdegree education, confidence, andper-
ceivedsocialauthority.Everyoneofthesefactors variesbysocioeconomic position.
Womenwhomanageto havea "natural"birthmayfeelthattheyaresomehow
communing withtheirmythical pre-industrial sisters,butinfact,theynormally
drawheavilyupontheirsocialprivilege and theirimmediate accessto state-of-
the-arttechnological interventionsinenacting theirbirthnarratives.
(3) Poorwomenhavelessaccesstohigh-quality, diversefoods,andlesstime
to preparemealsforthemselves and theirchildren.Poorand minority women
havelowerratesofbreast-feeding thanfinancially securewhitewomen.19 Weknow
thatthisis notbecauseofdifferences in women'sknowledgeofthebenefits of
breast-feeding(Guttman and Zimmerman 2000). Among other determining fac-
tors,poorand minority womenarelesslikelyto havejobs thatprovideenough
maternity leave to establish
breast-feeding or privatespacesin whichto nurse.
Theyaremorelikelytobe singleparentsandtoworklonghours.20
Thustotheextent thatwetake"proper" maternal performance duringthese
key moments as a measure ofmothering as a whole, we will re-inscribesocial
privilege.We will reada deficientmaternal character into the bodies and actions
ofunderprivileged andsociallymarginalized women,whereasprivileged women
withsociallynormative homeandworkliveswilltendto serveas ourmodelsof
propermaternal character.
Yetitis likelythatwomenpassthesemothering tests
 REBECCA KUKLA 83

lessbydintoftheirinherently maternal character andtheirresponsible commit-

menttotheirchildren thanbecausetheyhavetheright kindofeducation, financial
resources, healthinsurance plans,family and
structure, jobs.
Our focuson howmothersperform at signalmomentsis partofa larger
culturalsensibility: inNorth America andBritain, atleast,publicethicaldiscourse
tendstofocusheavilyon personalresponsibility andwill-power as itis displayed
(or fails
to be displayed) at discrete choice-points,rather than on thestructural
conditions thatenableorundermine peoples abilityto makegoodchoicesover
thelongterm.It is difficult to turnpublicattention to theenvironmental, eco-
nomic,andsocialconditions thatcanmakevariouschoicesandbehaviors difficult
oreasy;insteadwe tendtoemploya conceptualrepertoire- madeup ofnotions
suchas character, will-power,choice,andresponsibility- thatinherently isolates
individuals as ethicalagentsandoccludessuchcontextual determinants.
Thisindividualist logicencourages policiesandinitiatives thatfocuson in-
fluencing thechoicesthatmothers makeatparticular moments, ratherthanon
creating structural conditions thatfosterextended narratives ofhealthy mother-
For the
ing. example, public service announcements forthe United States Depart-
mentofHealthandHumanServicesbreast-feeding campaign, "Babieswereborn
tobe breast-fed," launchedin 2005,showpregnant womenengaging in absurdly
riskyone-time suchas log-rolling
activities andbull-riding, followed bythetext,
"Youwouldn't takerisksbefore yourbaby'sborn. Why start Breast-feed
after? ex-
clusively for sixmonths."21 Here,anysingledeparture from exclusive breast-feed-
ingis equatedwitha dramatically self-indulgent
risky, choice.Elsewhere, I have
pointedoutthatthiscampaignfocusesentirely on mothers' choices,usingthe
rhetoric ofpersonalresponsibility andblame,without anyattempt toadvocatefor
tolerance forbreast-feeding amongemployers, family members, members
or of
thepublic,orforstructural changesinworkplace rules,maternity leave,orurban
planning that would make such exclusive
breast-feeding viable formorewomen
(Kukla2006).
Consideralso our emphasison zero-tolerance whenitcomesto alcohol
consumption duringpregnancy. Womenare repeatedly toldthatthatthereis
"noprovensafelevel"ofalcoholconsumption duringpregnancy; indeed,inthe
UnitedStates,theofficialpositionof the Surgeon General is thatanyalcohol
consumption is
duringpregnancy unacceptable, and a growing number ofother
countriesare adoptingsimilarpositions.22 Althoughextensiveresearchhas
failedtoturnup anyevidenceofnegative effectson fetusesfromwomen'slight
tomoderatedrinking as partofa healthy theideathata singledrink
lifestyle,23
84 ,j£««fe*««/l«««/^«i#*«/<>K FKMINISTAPPROACHES
TO (£;<><>//ti<yl
1:1

SPECIALTY SECTION: Critical Care

One DrinkCan Last a

Lifetime
Womenwhoconsumealcohol duringpregnancy
puttheirbabiesat riskfora
multitude
of lifelongproblems

ByCarolNelkeDimbar,
APRN
April11,2005

Figure2. FromNurseWeek,April11,2005

bothrevealsmaternalirresponsibility and can havea lifelong

corruptinginflu-
enceis pervasive.In a publicserviceannouncement producedby theAd Coun-
a hipyoungblackwomantellsheraudience,"Ifyoudrinkalcoholwhile
cil,24
you'repregnant, youmaybe ruining yourbaby'schancesofeverhavinga normal
In figure2, a headlesspregnantbellyappearsto be gearingup to suck
life!"25
backa giantglassofwinedirectly intothewomb.Thearticleheaderemploys
thelanguageofriskand blame("women. . . puttheirbabiesat risk"),while
reinforcing thescientifically
inaccurateideathata singledrinkcan undermine
an entiremothering narrative(onedrinkcan "lasta lifetime").
 RKBKCCA KIKLA 85

Ourdetermination toprevent
womenfromeverdrinking duringpregnancy,
andourdemonization ofthosewhodo,hascomeatthecostofeducating pregnant
womenaboutthedifference betweenhealthy andabusiverelationships toalcohol
and thedifferencebetweentheoretically riskybehaviors.
and substantially The
publichealthemphasisuponcomplete avoidanceofalcoholhasnotbeenaccom-
paniedbysubstanceabuseprograms forpregnant women.Theimplicit assump-
tionwouldappearto be thatgood motherswillfollowtheno-safe-level, zero-
tolerancerule,whereaswomenwhoviolatethisrulealreadyhaveproventhem-
selvesto be bad motherswhoarebeyondsaving.Epidemiologically speaking,
poverty,social and
stress, smoking aremuch biggerriskfactorsforhavinga baby
withFetalAlcoholSyndrome thanis occasionaldrinking(Armstrong 2003),but
ourfocuson momentsofmaternalchoiceoccludesthesesocialdeterminants.
Scaretacticsunderscored bythelanguageofchoice,maternal character,andper-
sonalresponsibility convince
pointlessly many women who are notat riskfor
having babieswithFetal Alcohol to the
Syndrome forgo pleasure ofan occasional
glassofwine,whilesurelyinducinglittleotherthanguiltin alcoholicwomen
whosebabiesareatseriousrisk.

As a culture,then,we privilegeearly,discretemomentsofchoiceas the

measuresofmothers, as opposedto ongoingpatterns and developing relation-
- if in
ships as we can bond a moment, destroy or secureour child'schances at
well-being ina moment, orfailatmothering ina moment. Andyet,whilethereis
the that
always possibility poor a will
decision turnout tohave tragicconsequences
(suchas KateandGerry McCann'smuch-discussed decisiontoleavethreetoddlers
alonein a hotelroomwhiletheywentoutfordinner - a decisionthathas been
universallycastbythemediaas Katesrather thanthecouple's),singleeventsrarely
a
play large rolein determininghow a childwillturn out,orhow healthy andsuc-
cessfula mothering narrativewillbe. My suggestionis thatwe need to view
mothering as a workinprogress untiltheveryend.Whenitcomestohealthpro-
motionandpolicy, weshouldshiftourattention awayfrommothers' performances
at keymoments, and ontoproviding familieswiththesystematic supportthat
wouldenablewomento engagein ongoingnarratives ofgoodmothering. Such
supportwouldincludefoodandjob security; decent maternity leave;fullaccess
to familyplanning;a cleanerenvironment; universalaccesstodecenteducation
andhealthcare;workplaces andlaborlawsthatarestructured aroundtheassump-
tionthatmanyworkers willhavesubstantial parental commitments, including
86 ^£x*t*a****€*lj&>*4*n**lw FEMINIST TO(/^/^/At'^i 1:1
APPROACHES

commitments to breast-feeding and to fathering; accessibleinterventions for

womenstruggling withaddiction, mentalillness,or othersocialstresses; and a
safe,competent, junk-food-free publicschoolsystem forall children.
Ifwe takeseriously theideathatreproduction is typicallya decades-long
socialand materiallaboroflove,and nevermerely a biologicaleventinvolving
eggs,sperm,andwombs;thentheseareall reproductive rights,andthebioethical
consideration oftheircontours and limitsis reproductive Hencethereori-
ethics.
entation ofattention thatI havebeenurging woulddramatically changethescope
and methodsofreproductive ethics.In thefirstinstance,reproductive ethics
wouldnolongerconcernparticular medicalchoicesmadebefore conceptionand
duringpregnancy. Itsprimary subjectmatter wouldbe largerquestionsofsocial,
economic,and environmental justice,and inevitably- ratherthanjustas an af-
terthought-gender equity.Contemporary reproductive ethicsgenerallytreats
mothersas fleeting sourcesofgeneticmaterialand gestational environments,
whoseethicalroleinreproduction is summedupbyandconfined toa handfulof
choicesmadeatorbeforethestartofourchildren's lives.As feminists,we must
insistthatbioethicists takemothers tobe whole,sociallysituated peoplewithen-
tirelifenarratives,typicallyincluding several decades of mothering.

Notes
1.Earlyversions ofthispaperwerepresented attheAmericanSocietyforBioethics
and theHumanitiesannual meetingin Denver,Colorado in October2006 and as a
keynoteaddressat the"Monitoring Parents:Childrearing in theAgeofIntensivePar-
enting" conference at the University of Kent in June, 2007. Forwonderful supportand
helpfulconversations, I am grateful to Sonya Charles, Colleen Fulton,Ellie Lee,Mere-
dithMichaels,TriciaShivas,an anonymousreviewer, and especiallythemembersof
theObstetricsand Gynecology RiskResearchGroup:ElizabethM. Armstrong, Lisa
Harris,Miriam Kuppermann, Margaret Anne
Little, DrapkinLyerly, and Lisa Mitchell.
Thisresearch wassupported bya grantfromtheSocialScienceandHumanities Research
CouncilofCanada.
2. As an anonymous refereerightly pointedout,1do notmakeanyseriousattempt
to definegoodorhealthy mothering in thispaper.Surelywomencan be betterorworse
mothers. However, my here
interest is in gainingcriticaldistancefrom(whatI seeas) one
problematic, hegemonic wayofmeasuring mothering, ratherthanwithforging and de-
fending alternative
a specific picture of the ethicsofmothering. Mothering is moral
serious
work, and hence we do need to consider what ittakes to mother well;
hopefully, however,
wecan transcend theideathatmothering canbe measuredinanyuniform way.
3. 1 elaborateand defendtheclaimthatmothersplaysucha crucialrolein the
healthcaresystemin Kukla2006.
4. www.fetalmoments.com (accessedSeptember 15,2007).
 REBECCAKUKLA 87

5. "TheOne WhereRachelTells.. .",first airedOctober11,2001.

6. 1 cannot,in anyformalsense,provideempiricalevidencethattheseattitudes
are entrenched in our folkculture;itis oftenin thenatureoffolkattitudesnotto be
formally documented or articulated.
7. Severalfeminist scholarshavepointedouthowthelanguageoffailingand de-
fectivewomen'sbodiespervadesourdiscussions ofbirth.Cf.Harrison1982;Davis-Floyd
1994;and Lyerly 2006.
8. ThiswasthepracticeatOttawaCivicHospital,whereI gavebirthtomyperfectly
healthy sonbycesareansection.I do notknowhowmanyhospitalsdo this,however itis
easytofindpamphlets designedforthispurposeonline.See forinstancewww.birthrites.
org/Bookletlndex.html (accessedNovember12,2007). See www.plus-size-pregnancy.
org/CSANDVBAC/csemotionalrecov.htm#References (accessedNovember12,2007)for
a largeclearinghouseofliterature designedto aid emotionalrecoveryaftercesarean
section.
9."AskAmy," August29,2007,accessedatwww.chicagotribune.com. A recentNew
YorkTimesarticle,"TheEndofChildbirth 101?",underscores theconcernaboutwomen
whodo nottakechildbirth classesexpressedbythisletter-writer, worrying thatsuch
womenwillnotbe ableto"reapthedividends ofhavinghada teacher whoexplainedeach
possibleintervention."
10.www.kidshealth.org.
11.Bowlby's programspawnedvarioussympathetic studies(e.g.,Kennel,
scientific
Trause,and Klaus 1975),as wellas a scientific backlashattempting to debunkhim(in-
cluding Lozoff 1983).
12.www.babycenter.com. PostedSeptember 28,2006.
13. 1 could notpossiblydocumentor compareall thepossiblerisksofroutine
driving andofbeingbornbyscheduledcesareansection.Butforpurposesofillustration,
considerthataccordingtotheNationalCenterforStatistics, the2003rateofautomobile
accident-related in theUnitedStateswas 8.34/1000population,whereasthe
fatalities
rateofperinataldeathassociatedwithscheduledcesareansectionsin theUnitedStates
is 1.3/1000 population(Landonetal. 2004).
14.Theargumentofthisparagraph,differently worded,appearedpreviously in
Lyerly et al. 2007.
15.News.blogs.nytimes.com/2006/09/28/memo-to-nanny-no-juice-boxes.
16.Cf.,e.g.,La Leche1997andTamaro1998,as wellas thestandard lactationnursing
textbook, Lawrence1994,whichrecommends givingnewmothers thisadvice.
17.Cf.,e.g.,AmericanAcademyofFamilyPhysicians2000. UNICEF and the
WHO jointlysponsortheBabyFriendly whichexplicitly
HospitalsInitiative, promotes
thetotalavoidanceofartificial nipplesin orderto prevent nippleconfusion.Cf.www.
babyfriendlyusa.org (accessedNovember13,2007).
18.In Kukla2005,Chapter5, 1 documentthislogicofthecorrupting suck,as it
appearsin popularmedia,guidebooks,and scientific journalarticles,in quitea bitof
detail.
19.www.cdc.gov/MMWR/preview/mmwrhtml/mm5512a3.htm, accessedNovem-
ber13,2007.
88 j£**S^Wi»##«/^*4*Wr0F FEMINIST 1:1
TO(/><«<>//t«,i
APPROACHES

20. Fordetaileddiscussionsofwhypoorand minority womenbreast-feed atlower

rates,cf.Blum2000,and Kukla2006.
21. PSAs available at www.4women.gov/breastfeeding/index. cfm?page=
adcouncil.
22. AustraliaandNewZealandareintheprocessofimplementing lawsthatwould
requirezero-tolerance labelssimilarto thoseused in theUnitedStates(www.amavic.
com.au,accessedNovemberl3, 2007),and New Zealand has recently strengthened its
Ministry ofHealth guidelines,which havegone from recommending avoidance ofal-
coholduringpregnancyto urging"totalabstinence"duringpregnancy(www.otago.
ac.nz/news/news/2006/13-07-06_press_release.html, accessedNovember13,2007).
SomeCanadianprovincesrequirewarningsstatingthatpregnant womenshouldavoid
all alcoholto be postedin licensedestablishments. In May 2007,thegovernment of
Britainand theRoyalCollegeofObstetricians and Gynecologists"strengthened"their
warningsconcerning alcoholconsumption duringpregnancy. Whereastheformer of-
ficialBritish recommendation wasthatpregnant womenlimittheirconsumption toone
to twodrinksperweek,thenewguidelinesadvisethatwomenshould"stopdrinking
altogether" duringpregnancy (Bennett2007).
23. Foran exhaustivereviewoftheevidence,cf.Armstrong 2003.
24. Inventors ofMcGruff theCrimeDog, SmokeytheBear,and the Babieswere
Bornto be Breastfed" campaign,amongothersocialmarketing materials.
25. PSA availableatwww.nofas.org/MediaFiles/PSA/PSA.wmv.

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Armstrong, E. M. 2003.Conceiving Fetalalcoholsyndrome
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Bennett,R. 2007.Zero- Thenewalcohollimitin pregnancy. TheTimes.May25.
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