“Reproductive freedom” is being defined as a person, not just a womb

Motherhood can be life-changing, but women shouldn’t have to consider it some kind of “destiny”.

Motherhood: it’s a complicated, difficult, but presumably rewarding journey that propels you headfirst into public property faster than a stint on the X Factor. Suddenly, it seems everyone knows what’s best for you – what you should (or shouldn’t) be eating, drinking, and, most importantly in K-Middy’s case, wearing (a recent headline asked whether or not she’d be “frumpy like Diana”). For those who carry their offspring in their womb, this first taste of motherhood usually comes from someone in the frozen foods aisle boldly placing his or her hand across their swollen uterus and enquiring about the due date - and repeat, for every other day for the next long few months, until, like a woman of our acquaintance, she explodes, and finds herself yelling “GET OFF ME AND FUCK OFF” at a perfect stranger.

Others have less irritating initial experiences: epiphanies during ultrasounds or when they first see their newborn’s face, for instance, in the brief period of relief in between the lasting effects of an epidural and the government’s next announcement that they’re raising tuition fees again. Undoubtedly, becoming a parent has the power to change a huge amount on a personal level. But for women, one other thing is also for certain: whether it’s a panel on This Morning discussing whether “breast is best” for the hundredth time, speculation in the latest tabloid over whether Beyoncé was wearing a “false stomach” during her pregnancy (really), or the patronising assumption at a dinner party that you’ll “just grow out of” deciding not to have children, the choices that an individual woman makes about motherhood are almost always assumed to be free topics of public discussion.

Perhaps nothing demonstrates this more than the fall-out from Hilary Mantel’s fairly uncontroversial essay on perceptions of royalty in the media, extensively quoted out of context and then reimagined as a “catfight” between her and Kate Middleton by the Daily Mail and the Telegraph. The Mail heavily implied that Mantel’s criticism was in some way connected to her inability to have children: a jealous rant at the demonstrably pregnant Duchess, because women’s words – even in academia – must only be prompted by deep-seated Freudian emotions linked to their biological “destinies”, especially when babies are involved. Like the evil barren stepmother from folklore, Mantel is cast as the older women jealous at the Princess’ youth and fertility. So obvious was the fairytale connection (for what are celebrity stories if not fairy tales?) that these archetypes even manifested themselves in cartoon form, showing the double Booker Prize-winner gazing into a magic mirror too divine the fairest of them all and seeing, of course, Kate.

While it got its teeth firmly set into Mantel and her supposed infertility, it was sharpening its claws for the next victim: Heather Frost, a mother-of-eleven on benefits, who was receiving a six bedroom council house – or, as the right wing press would have it, a “mansion”, as opposed to a fairly economical – two kids per bedroom at least – use of social housing. Frost had piqued the media’s ire by supposedly buying one of her children a horse (although in fairness every mother who has served up Findus lasagne in the last ten years is probably guilty of that crime). Apparently, a mother in receipt of state welfare should expect that the nation scrutinise the nuances of her parenting decisions in return. It’s only fair, after all, since Frost had rudely “chosen” to have eleven children she couldn’t afford, and would probably have had more were it not for the small matter of cervical cancer. And yet, her children, who have presumably already had a fairly tough time of it watching their mum fall prey to a life-threatening disease, are expected to receive punishment for her reproductive choices. Never mind the wee ones and their entitlement to warmth and shelter, it’s more important to the bitter mob in the comments section that the mother learn her lesson for daring to reproduce to such a great extent.

Of course, little is said of how Frost, might have had a reasonable expectation of some child support from the childrens’ fathers. Fathers, particularly absent ones, are afforded some societal judgement themselves - but all too often, “motherhood” is equated with “parenting”, while “fatherhood” is extracurricular, and women are held to much higher standards in this arena than their male counterparts. Which brings us to the other news story this week – the IVF reforms, including the raising of the upper age limit to 40. Cue much commentating on irresponsible and selfish women leaving it too late to get pregnant, and how the state shouldn’t be expected to fund such an endeavour. Their male counterparts, however, (you can call them “career men” if you like) are never berated for their bachelor lifestyles that delay parenthood. Women dawdle and dilly-dally, while men euphemistically sow their wild oats and enjoy their freedom. Such stereotypes save anyone having to think about things in too much depth – throw a woman who couldn’t care less whether she has kids or not, or isn’t that invested in the whole shebang, and it all gets rather too nuanced and complicated to make simplistic headline-grabbing value judgments.

In media land, while middle class women are spunking up £3,000 a cycle on IVF, working class women breed indiscriminately, producing children they can’t afford to keep. In fact, neither “group” has anything approaching true reproductive freedom. While one lot is wrestling with a lack of information regarding contraception, not to mention the expectation that giving birth is all they are good for, the other is trying desperately to assert their independence from all of that, only to find it difficult to conceive later in life. Of course, most women fit into neither group, because they are both, largely, media confections, but the point about reproductive freedom stands. Who, truly, can be said to possess it? You might say the aristocracy, unhindered as they are by financial or career related concerns, but then the Waity Katy/Royal Womb narrative would beg to differ.

Having a baby (or not) is a personal choice that is different for every single woman, and one that occurs for a myriad of reasons. It often also involves a man. And yet, there seems to be very little empathy regarding any of those choices viewed as being within the woman’s remit. It’s always a case of doing it wrong. Thus there is no sympathy for the woman devastated by her inability to conceive, nor for she who is unable to cope with her many children. Less so for she who does not desire children at all. She must have a screw loose, or rather, something missing in the biological nuts and bolts make up the various components of “womanhood”.  “Being a mum” is still seen by many as our natural state; so much so that women who choose not to breed (especially feminists) are widely seen as “cutting their nose off to spite their face”. Men are often taught that women will ask for the standard package – marriage and babies – as soon as a certain amount of time has passed. Women’s media feeds us back the idea that that is a woman’s place and natural aspiration: flick through any celebrity magazine and witness a female public figure who has recently popped out a child instantly transformed from human of interest into “yummy mummy” or “tiger mother” or “momtrepreneur” (anything, as long as it’s not “tax-wasting benefit scrounger”). Such archetypes are used to divide us, when what we need most is to have empathy for one another and an understanding that motherhood can be life-changing, but that it does not come to define us. In other words, the true meaning of “reproductive freedom” is being able to define yourself, first and foremost, as a person.

 

Women can't be divided into "yummy mummies" and "tax-wasting benefit scroungers". Photograph: Getty Images

Rhiannon Lucy Cosslett and Holly Baxter are co-founders and editors of online magazine, The Vagenda.

Getty
Show Hide image

The surprising truth about ingrowing toenails (and other medical myths)

Medicine is littered with myths. For years we doled out antibiotics for minor infections, thinking we were speeding recovery.

From time to time, I remove patients’ ingrowing toenails. This is done to help – the condition can be intractably painful – but it would be barbaric were it not for anaesthesia. A toe or finger can be rendered completely numb by a ring block – local anaesthetic injected either side of the base of the digit, knocking out the nerves that supply sensation.

The local anaesthetic I use for most surgical procedures is ready-mixed with adrenalin, which constricts the arteries and thereby reduces bleeding in the surgical field, but ever since medical school I’ve had it drummed into me that using adrenalin is a complete no-no when it comes to ring blocks. The adrenalin cuts off the blood supply to the end of the digit (so the story goes), resulting in tissue death and gangrene.

So, before performing any ring block, my practice nurse and I go through an elaborate double-check procedure to ensure that the injection I’m about to use is “plain” local anaesthetic with no adrenalin. This same ritual is observed in hospitals and doctors’ surgeries around the world.

So, imagine my surprise to learn recently that this is a myth. The idea dates back at least a century, to when doctors frequently found digits turning gangrenous after ring blocks. The obvious conclusion – that artery-constricting adrenalin was responsible – dictates practice to this day. In recent years, however, the dogma has been questioned. The effect of adrenalin is partial and short-lived; could it really be causing such catastrophic outcomes?

Retrospective studies of digital gangrene after ring block identified that adrenalin was actually used in less than half of the cases. Rather, other factors, including the drastic measures employed to try to prevent infection in the pre-antibiotic era, seem likely to have been the culprits. Emboldened by these findings, surgeons in America undertook cautious trials to investigate using adrenalin in ring blocks. They found that it caused no tissue damage, and made surgery technically easier.

Those trials date back 15 years yet they’ve only just filtered through, which illustrates how long it takes for new thinking to become disseminated. So far, a few doctors, mainly those in the field of plastic surgery, have changed their practice, but most of us continue to eschew adrenalin.

Medicine is littered with such myths. For years we doled out antibiotics for minor infections, thinking we were speeding recovery. Until the mid-1970s, breast cancer was routinely treated with radical mastectomy, a disfiguring operation that removed huge quantities of tissue, in the belief that this produced the greatest chance of cure. These days, we know that conservative surgery is at least as effective, and causes far less psychological trauma. Seizures can happen in young children with feverish illnesses, so for decades we placed great emphasis on keeping the patient’s temperature down. We now know that controlling fever makes no difference: the fits are caused by other chemicals released during an infection.

Myths arise when something appears to make sense according to the best understanding we have at the time. In all cases, practice has run far ahead of objective, repeatable science. It is only years after a myth has taken hold that scientific evaluation shows us to have charged off down a blind alley.

Myths are powerful and hard to uproot, even once the science is established. I operated on a toenail just the other week and still baulked at using adrenalin – partly my own superstition, and partly to save my practice nurse from a heart attack. What would it have been like as a pioneering surgeon in the 1970s, treating breast cancer with a simple lumpectomy while most of your colleagues believed you were being reckless with your patients’ future health? Decades of dire warnings create a hefty weight to overturn.

Only once a good proportion of the medical herd has changed course do most of us feel confident to follow suit. 

This article first appeared in the 20 April 2017 issue of the New Statesman, May's gamble

0800 7318496