When a uterus enters the room, reason goes out the window

Feminist Theory

In this article, I argue that many women lack the epistemic resources that would allow them to recognise the practice of vaginal examinations during childbirth as violent or as unnecessary and potentially declinable. I address vaginal examinations during childbirth as a special case of obstetric violence, in which women frequently lack the epistemic resources necessary to recognise the practice as violent not only because of the inherent difficulty of recognising violence that happens in an ‘essentially benevolent’ setting such as the medical one, but also, and mainly, due to the pervasive sexual reification of women under patriarchy and the pervasive shame to which women are subjected. My argument is that the practice of vaginal examinations is indeed experienced – bodily apprehended – as violent by many women, but that full epistemic recognition of this violence is frequently obstructed because the experience perfectly coincides with the normal phenomenological situation of women ...

European Journal of Women's Studies, 2010

The issue of abortion has been the topic of heated and frequent debate in post-Communist Poland. Parliamentary debate in 1998–9 centred around a legislative attempt to restrict prenatal testing, specifically amniocentesis, in order to further reduce the numbers of abortions carried out, as it was argued to inevitably result in the termination of pregnancy. Medical professionals are rarely visible as subjects of and authorities on the abortion debate in the Polish context. However, in this debate around prenatal testing, the medical community appear as key commentators and meaning-makers. This article asks the following questions: What role do the medical profession and biomedical knowledge play in the debate around prenatal testing, when abortion is highly politicized? Second, what social meanings and consequences are attributed to prenatal testing? How do these construct the relationship between foetus, pregnant woman and doctor, and what agency and 'rights' are attributed to women in the process of prenatal testing?

Midwifery

Objective: to investigate the personal, social, cultural and institutional influences on women making decisions about using epidural analgesia in labour. In this article we discuss the findings that describe practices around the gaining of consent for an epidural in labour, which we juxtapose with similar processes relating to use of water for labour and/or birth. Design: ethnography. Setting: tertiary hospital in Australian city. Participants: sequential interviews were conducted with 16 women; hospital staff (primarily midwives and doctors) participated during six months of participatory observation fieldwork. Findings: women were not given full disclosure of either practice and midwives tailored the information they gave according to the institutional policies rather than evidence. Key conclusions: informed consent is an oft-cited human right in health care, yet in maternity care the micropolitics of how informed consent is gained is difficult to ascertain, leading to a situation whereby the concept of informed consent is more robust than the reality of practice; an illusion of informed consent exists, yet information is often biased towards medicalised birth practices. Implications for practice: as primary maternity care-givers, midwives have a role in providing unbiased information to women; however it appears that hospital culture and policy affect the way that this information is presented. It is arguable whether women in such instances are giving true informed consent, and for this reason, the ethics of these hidden practices are questioned.

Human Studies, 2021

This paper addresses epistemic aspects of the phenomenon of obstetric violencewhich has been described as a kind of gender violence-mainly from the perspective of recent theories on epistemic injustice. I argue that what is behind the dismissal of women's voices in labor is mainly how the birthing subject, in general, is conceived. Thus, I develop a link between the phenomenon of testimonial injustice in labor and the marked irrationality that is seen as a core characteristic of birthing subjects: an irrationality that appears to be always at odds with the kind of knowledge that is, wrongly, privileged within medicalized childbirth. I use Miranda Fricker's analysis to argue that a central part of obstetric violence involves laboring women being "wrongfully undermined specifically in their capacity as knowers" (2007: 9): they are disbelieved in the labor room because of a double prejudice, one deriving simply from their condition as women, the second involving the kind of knowledge that many women find useful in the process of birthing. Women in labor thus suffer from both systematic and incidental kinds of testimonial injustice.

Nursing Ethics

The bioethical principle of respect for a person’s bodily autonomy is central to biomedical and healthcare ethics. In this article, we argue that this concept of autonomy is often annulled in the maternity field, due to the maternal two-in-one body (and the obstetric focus on the foetus over the woman) and the history of medical paternalism in Western medicine and obstetrics. The principle of respect for autonomy has therefore become largely rhetorical, yet can hide all manner of unethical practice. We propose that large institutions that prioritize a midwife–institution relationship over a midwife–woman relationship are in themselves unethical and inimical to the midwifery philosophy of care. We suggest that a focus on care ethics has the potential to remedy these problems, by making power relationships visible and by prioritizing the relationship above abstract ethical principles.

Journal of Medicine and Philosophy, 2014

This paper demonstrates how the problematic kinds of epistemic power that physicians have can diminish the epistemic privilege that pregnant women have over their bodies and can put them in a state of epistemic powerlessness. This result, I argue, constitutes an epistemic injustice for many pregnant women. A reconsideration of how we understand and care for pregnant women and of the physician-patient relationship can provide us with a valuable context and starting point for helping to alleviate the knowledge/power problems that are symptomatic of the current system and structure of medicine. I suggest that we can begin to confront this kind of injustice if medicine adopts a more phenomenological understanding of bodies and if physicians and patients – in this case, pregnant women – become what I call “epistemic peers.”

American Journal of Bioethics, 2012

Yale JL & Human., 1995

Competing historical and cultural understandings of the human body make clear that medicine and the law construe bodily truths from differing knowledge bases. Jurists rely virtually entirely on medical testimony to analyze biological data, and medical professionals are not usually conversant with the legal ramifications of their diagnoses. In early modern Europe, both physicians and jurists recognized that their respective professions were governed by different epistemological standards, a view articulated by F6lix Vicq d'Azyr (1748-1794), anatomist and secretary to the Royal Society of Medicine in France from 1776. Vicq d'Azyr noted that while lawyers were required to make unyielding decisions based on conflicting laws, customs, and decrees, physicians were permitted more latitude for uncertainty.' In the late twentieth century, Western medicine and law have become inextricably entwined as technologies have produced new ethical dilemmas facing medicolegal jurisprudence. The authority of women to voice and explain their experiences of pregnancy and childbirth before and during the eighteenth century contrasts powerfully with the twentieth century's reliance on medicolegal decisions to define these experiences. In early modern Europe, women controlled information, experience, and beliefs concerning reproduction, and women held authority over it. A woman only became officially and publicly pregnant when she felt her * The author would like to thank Robert Kieft, Reference Librarian at Haverford College, and the librarians at the Historical Collections of the College of Physicians of Philadelphia for research assistance.

2013

Competing historical and cultural understandings of the human body make clear that medicine and the law construe bodily truths from differing knowledge bases. Jurists rely virtually entirely on medical testimony to analyze biological data, and medical professionals are not usually conversant with the legal ramifications of their diagnoses. In early modern Europe, both physicians and jurists recognized that their respective professions were governed by different epistemological standards, a view articulated by F6lix Vicq d\u27Azyr (1748-1794), anatomist and secretary to the Royal Society of Medicine in France from 1776. Vicq d\u27Azyr noted that while lawyers were required to make unyielding decisions based on conflicting laws, customs, and decrees, physicians were permitted more latitude for uncertainty. In the late twentieth century, Western medicine and law have become inextricably entwined as technologies have produced new ethical dilemmas facing medicolegal jurisprudence. The au...

Nexus: Newsletter of The Australian Sociological …, 2006