When a Uterus Enters the Room, Reason Goes Out the Window

The philosophical analysis of the history that precedes us adds an illuminating dimension that helps to explain why it is important to deal with unauthorised vaginal examinations during labour: because pregnant women should not so obviously be deprived of their full capacity, because pregnant subjects are still a fully entitled subjects, and because women ought not to lose their citizenship just because they enter the maternity ward.

The chapter explores some of the associations between the use of the brain and the functioning of the uterus that have been in place over the centuries. This association has become so deeply engrained that it seems to be part of our contemporary conceptual furniture. In the face of emerging new medical practice, it remains a desire to hold onto old ways and ideas. However, it is critical that we talk more about what needs to change in relation to our understanding of consent in order to make consent meaningful for pregnant women in labour. At risk here is nothing less than our view on woman’s rationality and citizenship.

I reflect on the conceptual relationship between the notion of reason and the uterus in the history of Western thought, from a philosophical perspective. To understand how certain obstetric and midwifery procedures have survived and how these are directly related to the endurance of a particular view of pregnant women, I untie a critical conceptual knot in the history of patriarchy which was initially examined in my forthcoming article, ‘Reasoning from the Uterus: Casanova, Women’s Agency and Philosophy of Birth’ in Hypatia. I draw particular attention to the link between the uterus and reason at the dawn of obstetrics, during the Enlightenment.

I argue that it is necessary to reconstruct the history of the naturalisation of female rationality in order to understand what is going on in the context of unauthorised vaginal examinations during labour and in other abusive and violent perinatal practices. The philosophical analysis of this conceptual history helps to explain what happens in the maternity ward, and why. For those who are familiar with women’s history and the feminist ideas that help illuminate it, there are too many covertly active associations in contemporary discourses and practices about childbirth not to be noticed. The text refers to the history of these ideas to shed light on three topics worthy of attention when assessing vaginal examinations during labour: the uterine influence on the labouring woman’s capacity, the content/container metaphor, and pain.

Female rationality has always been interrupted by her nature and by naturalising (in excess) her subjectivity. The perfect situation to perform such naturalisation is labour because we do not only have a female body there, but a female body labouring through contractions. The discussion of the above topics then shows why the working of the uterus too often becomes the paradigmatic example of women’s failure to reason. A woman using her uterus is taken to obviously not be able to reason. This suggests that when a uterus enters the door, reason must go out the window.

A developed understanding of the role of rationality explains why harmful behavior continues to occur and it helps to develop better responses to unauthorised vaginal examinations. We need to know why this happens before we can attempt to know how to fix it effectively. For instance, if we accept the above arguments, then we need to consider training to address the underlying discriminatory tendencies. Understanding stereotypical approaches to female rationality will not in itself prevent unconsented interventions. But the long shadow of the naturalisation of female rationality is increasingly foreshortened and this, at least, is a step in the right direction to diminish disrespectful, abusive, or violent practices in childbirth.

I argue that philosophers, lawyers and health personnel must still walk a long path to achieve a conception of the pregnant subject that is truly a human subject (not just a human body). To start with, they need to question the concept of pregnancy, labor, and birth as a non-rational process that is more comfortably placed in the field of nature than in the field of subjectivity and humanity.

Stella Villarmea, Professor of Philosophy, University of Alcalá and a Marie S. Curie Fellow, University of Oxford