Book report: The Woman in the Body

Martin, Emily (2001).  The Woman in the Body: A Cultural Analysis of Reproduction.  Beacon Press, 1987, revised 2001.

My score
7/10

My review
The Woman in the Body was recommended to me by one of my committee members.  Emily Martin attempts to find truth with a capital T in how women perceive themselves and their life changes, and how pervasive medical explanations are in our society.  She investigates women's experiences with menstruation, childbirth, and menopause (not reviewed here), starting with the medical model and working through interviews with women of different ages and socioeconomic classes.  As this was the first real anthropological text I have ever read, and as I have never really discussed any of these issues (other than childbirth) with other women, I was fascinated, cover to cover.  The book and its accounts describe a culture similar to my own, with women's experiences that, when averaged, are like mine.  How weird is that?

Расцвела сирень, акация...

В мире нет счастливее меня!

У меня сегодня менструация:

Значит, не беременная я!

(Loose translation: Lilacs and acacias are in bloom / There is none in the world happier than me / Today I have menstruation / Meaning I am not pregnant!)

First, Martin attacks menstruation.  The medical texts describe the monthly flow in overtly negative medical terms, which Martin dubs the failed production model: it is when the egg fails to be fertilized; the tissue dies; the outer uterine layer is shed and expelled.  But many women come to anticipate menstruation gladly as a sign both of fertility and of the lack of a pregnancy.  Interviewing women on their own feelings, she finds two different mental models.  Unsurprisingly, given sex education in school and the bombardment with the all-too-familiar medical model in popular media, middle-class women recite the failed production model as their understanding of menstruation.  But working-class women instead explain the logistical implications, saying that menstruation is when your body changes, that it lasts this many days and requires these modifications in routine and these tools to help you deal with it.  Working-class women were unable to regurgitate the failed production model entirely.

Next, Martin attacks PMS, or premenstrual syndrome, the term associated with the days just before a woman's period during which she may act out, be angry, be clumsy, and be moody.  Women report feeling more sensitive and unhappy with their lives, which makes them lash out at their children and spouses, the latter of which complain of an imperfect wife but brush it off as PMS.  Martin examines the cause of this anger and contrasts American standards (basically, that we all work like robots without regard to our natural ebbs and flows of creativity and productivity) with certain indigenous African cultures, in which menstruating women are considered "unclean" and are given a week off from their usual duties.  In this week, women enter a menstruation hut with other menstruating women, and they relax in making a slow-cooking meal for each other and focus on --- I don't know, I guess becoming cleaner people.  Of course, the menstruation hut is an impossibility in our society given our norms, but the idea is poignant: shedding endometrial tissue is taxing on the body, it affects the mind, and we need a break --- especially in a world that fails to value the work women do in the home.

The failed production model carries over from menstruation to childbirth (and these sentiments are echoed in Pushed (see my review).  Birth is the expelling of a perfect fetus from an imperfect incubator (i.e., the mother).  The mother is producing the fetus, and medicine focuses on this production  There is a timeline for what is considered "normal" (and, for statistical purposes, "normal" is fairly well defined) and any birth deviating from around normal is augmented.  From the moment a pregnant woman in labor enters the hospital, the clock is ticking, and the production of the fetus must happen in the appropriate time.  Martin points out Barbara Rothman's research showing that the time women labor in a hospital has been decreasing linearly since the 1940s [1].  The increasing prevalence of fetal monitors, both internal and external, wireless and wired, transmitting information to the nurses' station, means that medical personnel no longer need to attend to the woman in labor, but to the machine that monitors her.  The woman is becoming an annoying afterthought in the process of expelling the fetus.  Meanwhile, the leading obstetrical text, Williams Obstetrics, fails to mention the mother in the paragraphs about labor and childbirth altogether until the small section on "intra-abdominal pressure," and instead encourages doctors to ally with the fetus, small and innocent, rather than the mother, capable of introducing great harms to the fetus due to the pathological condition which is natural labor.  It is no wonder women in America are striking against the hospital, striking against institutionalized medicine, to take back birth and take back their rights to their bodies!

Then there is the matter of interventions, and especially C-sections.  It is no mystery that our national c-section rate is around 33%.  Is there a difference when you control for race and class?  Of course there is.  Martin poses two theories.

1. Higher C-section rates for middle-class white women because these women can pay for the privilege of the commodity which is higher health standards.
2. Higher C-section rates for working-class black women because these women are used as "guinea pigs" in medicine; where new procedures are tested, refined, and perfected.

Martin found both theories supported.  Middle-class white women received C-sections for real medical emergencies, such as prolapsed cord, bleeding, and high blood pressure.  Meanwhile, black working-class women received C-sections for the catch-all phrase "dystocia," which includes and is derived directly from running up against a time limit in labor.  On top of this, black working-class women are mistreated by the hospital staff, being denied pain medication, comfort techniques, and presence of their loved ones.  Martin summarizes how these two groups of women can and, those that feel they must, must resist the hospital environment, to strike and protect their bodies and their rights, in their own ways: 

For a white middle-class woman, the salient issue may be to stall going to the hospital so the clock cannot be started or to organize and demand that all hospitals in the region install birthing rooms; for a white working-class woman, stalling may be an issue, but behind it lurks the larger issue of finding a way to pay for prenatal, obstetrical, or infant care; for a black working-class woman, the issues of stalling and paying may be crucial, but even if she contends with them, she still may have to find a way to avoid downright mistreatment or to manage to have matters explained to her at all.

Conclusion

What is my interpretation of the result of this critical look at women's perception of their own menstruation and childbirth?  Women's experiences with, understanding of, and ways of communicating the details of menstruation and childbirth varies by socioeconomic class and race.  As women progress up the socioeconomic ladder, they become unquestioningly accepting of the medical models from textbooks, by which doctors abide.  As they accept, they are indoctrinated into the system and become part of it, even despite significant research showing the system to be flawed.  There is a silent war between working class and middle-class women: between women that fight the flawed system and are fought by it, and women that have become part of the system, contributing to its flaws.

References

[1] Barbara Katz Rothman (1983).  Midwives in Transition: The Structure of a Clinical Revolution.  Social Problems, Vol. 30, No. 3, Thematic Issue: Technique and the Conduct of Life (Feb., 1983), pp. 262-271.  University of California Press on behalf of the Society for the Study of Social Problems.

Stable URL: http://www.jstor.org/stable/800352