The following article, written by former OBOS staff member Robbie Pfeufer Kahn, was originally published as a chapter in the 1988 book Changing Education: Women as Radicals and Conservators. The book was published by the State University of New York Press, edited by Joyce Antler and Sari Knopp Biklen, and posted here with permission from SUNY Press.
Taking Our Maternal Bodies Back: Our Bodies, Ourselves and the Boston Women’s Health Book Collective
By Robbie Pfeufer Kahn1
Almost twenty years ago, some early members of the women’s movement in the United States produced a book on women’s health which has achieved world-wide recognition for educating women about our bodies and for contributing to a national and even international women’s health movement. In what follows I discuss the history and development of Our Bodies, Ourselves by looking at successive editions of the text. Following this more comprehensive history I direct my attention to the development of the childbearing material and, finally, speak about the text’s contribution to women and educational change.
The women’s health classic, Our Bodies, Ourselves (hereafter referred to as OBOS) grew like a pearl in the shell of Boston, one of the foremost medical centers of the world. Out of the irritant of experiences as patients in the medical system, the founding women in the Boston Women’s Health Book Collective (hereafter called the Collective) created something of value for the women’s movement and for all women. Originally the book began as a course. Calling themselves the Boston Women’s Health Collective, or the Boston Women’s Health Course Collective, the women who first convened to discuss women and health issues produced a series of papers called Women and Their Bodies: A Course.2 They had come together at a “women’s liberation” gathering sponsored by the organization Bread and Roses (an early women’s liberation movement group in the Boston area) to discuss their experiences as patients; some had in mind their obstetrical experience, which often is the first sustained contact a woman has with the medical care system. Respecting subjectivity—a respect found throughout the women’s movement, reflected in the early slogan “the personal is political,” and in the proliferation of “consciousness raising” groups (where women get together to share stories)—the “bodies’ groups” as they came to be called, were organized so that women could share feelings, experiences, and ideas with one another. A photo in the first edition (1970:3) was used to show women sitting together in a circle—the circle long having stood for unity and wholeness—engaged in the act of helping each other restore a sense of integrity which their medical (and in some cases social) experiences had eroded. The cover photo of the book used in all the editions shows women of different ages holding a placard which reads “Women Unite.”
Initially, the women simply wanted to share stories and draw up a list of “good” doctors; but, as one woman put it, for every good story about a doctor someone else had a counter “horror” story. Soon the women decided to teach themselves information about their own bodies. People divided up subject matter according to interest, set about doing research, and made presentations to the group. Conducted at places like Harvard Medical School Library, the research uncovered misogyny as well as information about women and their bodies; the disclosure of medicine’s attitudes toward women became part of the project.
Transmitting information through the written word initially came about, according to one member of the group, because there was “so much energy in the room” when the bodies’ groups got together that no one wanted to be stifled by listening to a presentation; women wanted to talk freely. So they began to xerox and distribute their papers. Distributing the papers in time for meetings became a problem and the idea arose of printing them up. Initially, then, writing was subordinate to life process, by which I mean that fixing something on paper was less important than the living relationships among people.
Printed by The New England Free Press, an alternative publisher, the first edition of the working papers, Women and Their Bodies: A Course (1970) sold 250,000 copies by word of mouth alone, attracting the attention of large publishers. The first Simon and Schuster edition (1973), entitled Our Bodies, Ourselves: A Book By and For Women was written with the same attention to group process as the first edition.3 To make the book accessible to all women, the price was kept low; clinic groups were and still are entitled to a seventy percent discount. The Collective urged women to write them with ideas for revisions; many of these suggestions were used in successive editions. When the Collective gave the book to a mainstream publisher, the women active in the project at that time closed the group and incorporated; however, the Collective continued to collaborate with women from the outside.
Having achieved the status of a textbook, OBOS has been revised four times since 1970, about the rate of revision for a standard medical text; in each case the changes have been bold and self-reflexive compared to a traditional medical text, such as Williams Obstetrics, which revises cautiously, and certainly does not question its central premises.4 Besides the U.S. edition of OBOS, which was a bestseller for many years (it sold over two million copies), the book has been translated into fifteen languages. Collaborating with others, members of the Collective have written three other books—for parents, Ourselves and Our Children, for teenagers (male and female), Changing Bodies, Changing Lives, and for older women, Ourselves, Growing Older. With MASSCOSH the Collective published an expanded version of a chapter in the latest edition of OBOS, called Our Jobs, Our Health for blue and white collar workers; and with ISIS, an international women’s health organization, the Collective published the International Women’s Health and Resource Guide.5 In addition to many other projects, the Collective founded the Women’s Health Information Center, which has become one of the best libraries of women’s health material, and is visited by women from all over the world.6 This book, then, which went from a 294-page publication with a newsprint cover graced by a somewhat muddy photograph, to a 647-page book which was a national bestseller for many years, began out of the subjective experience of a relatively small group of women, out of the group process called consciousness-raising and, not to be forgotten, out of the then burgeoning second wave of feminism.
The women describe (1973:1) how over time the title of the book shifted from Women and Their Bodies, to Women and Our Bodies, to Our Bodies, Ourselves (the 1985 edition is called The New Our Bodies, Ourselves [NOBOS]);7 the changing title reflects the journey away from so-called objective acquisition of knowledge, a style which initially influenced the group despite their novel approach to learning and teaching.
The book’s wide reach never could have been matched by sticking to oral presentation rather than publication. The power of the written word is symbolized by the diminishing size of the cover picture. The photo which in word and image signifies women uniting becomes smaller with successive editions. In the first Simon and Schuster edition it fills three quarters of the cover area, with the name of the book modestly on the bottom; in the next edition it takes up one quarter of the cover with the title large and at the top; in the latest edition the name fills two thirds of the cover area with the picture the size of a small snapshot. The increasing tendency to abstraction shows how the name of the book, which by now is a code for the book on women’s health, has become sufficient without referents. Many women who read and use the book are not active in the women’s health movement at all, and each edition of the book has reached women of more and more diverse national, class, racial, and ethnic backgrounds. Feminists may mistrust the domain of the written word, having been excluded from it historically; but OBOS is a testimony to how this domain can be used to advance feminist interests.
Social Context for Our Bodies and Ourselves
Over the years the text of OBOS became conceptually stronger as it increasingly defined a social context for our bodies and ourselves. An example can be seen in the changing title of the chapter on lesbianism. Originally called “Homosexuality” (1970: 31) (both an androgynous and somewhat scientific title), in the second edition the text, taking a defiant stance, called lesbians by the denigrating name society has given, attempting to transcend the slang term by embracing it: “In Amerika they call us Dykes” (1973:56). In the latest edition, however, the authors step away from the facts of the social order and name lesbianism themselves by the title: “Loving Women: Lesbian Life and Relationships” (1985:141).
The feminist theologian Carol Christ makes a distinction between what she calls a “social quest” and a “spiritual quest.8 In a social quest a woman seeks to gain a place in the world as given; it represents “women’s struggle to gain respect, equality, and freedom in society—in work, in politics, and in relationships with women, men and children” (p. 8). A spiritual quest has to do with our recognition of being grounded in “‘deeper forces or currents of energy/ to use Doris Lessing’s terms, which operate in all natural and social processes. These forces are the energies of life, death, and regeneration and being, non-being and transformation, which are most obvious in nature, but which also operate in the social world” (p. 10).
The latest title of the lesbian chapter proposes a social reality free from distortions, a title which does not come out of thin air since the social infrastructure of the women’s movement is much more developed now than it was ten years ago. Nevertheless, the title bespeaks a social quest, something beyond the world as we know it, which such things as the naming of the chapter can help bring into being. In the earlier editions you feel the women turning and twisting within the constraints of society as it is—in its patriarchal character. The social quest in these earlier efforts at times was awkward, prone for example to rhetoric such as “Childbirth preparation for all! Power to women!” (1970:154) because there was as yet so little social reality to sustain it. As the editions progress they become more comfortably self-defining, like the title of the lesbian chapter, owing to the life course of the writers themselves and, very importantly, to the social changes brought about by the women’s movement. These inner and outer changes allow the book to become stronger conceptually; its structure and content affirm or suggest new principles of social organization. By saying “Loving Women: Lesbian Life and Relationships,” the text frees itself from the social onus upon lesbianism; by pairing the lesbian chapter with a chapter on men, the text suggests that lesbian culture to some extent is distinct from life among men. These latter relationships have their own difficulties, as the title “Working Toward Mutuality; Our Relationships with Men,” (1985:123) implies. The conceptual or contextual strength of the latest edition comes, then, from two things. First, the text is responsive to the world—a characteristic not shared by traditional medical texts—permeable both to the lives of the authors and to society. Second, as the social matrix of the women’s movement has developed, the text increasingly has clarified its social quest, and some of what it makes real in words on paper still remains to become an established part of the social order. As the text is “intertextual” with the social order and with women’s lives, it itself helps bring about further social change.
As the text displays greater confidence in a woman-centered culture, it seems increasingly able to take in facts of the existing world: new sections appear in the latest edition on environmental and occupational health (1985:77); the latest edition includes a photo of a woman dead from an illegal abortion (1985:310), a photo meant to highlight the feared consequences of the turn toward the right in this country and elsewhere with respect to women’s having access to abortion. There are many more pictures of women of color, and greater sensitivity in the text to differences of class and race among women.9 Owing to letters and comments from older women, the text now extends its discussion of the life course beyond menopause, with a chapter on women growing older (1985:435). If over various editions the text has moved toward finding the right social context for our bodies and ourselves, as OBOS matures some chapters seek to ground us in a spiritual reality of what Christ calls “powers or forces of being larger than the self” (p. 10); that is, a recognition emerges in the text of the grounding of social reform in deeper “powers of being and life” (p. 11). How this spiritual quest has evolved and what its limits might be will be discussed next.
In some respects, finding the right place for the woman’s body is nowhere better seen than in the childbirth chapters. By contrast, the foremost obstetrical text in the US (also revised several times during the same years as OBOS) has increasingly taken the woman’s body out of context and placed it—all fragmented— solely in the medical domain. Conceptually, the obstetrical text has placed the woman’s body within the “elegant” or “attractive” theories of the physicians; her actual physical presence removed from the home to the hospital.10 The early OBOS text can be thought of as an attempt to steal the woman’s body away from the medical context and, by the latest edition, it has found a contextual or conceptual place for it. That is, through successive editions of OBOS we watch the stolen-away body find its right place.
Although the first edition of OBOS devoted more than a third of the book to discussing pregnancy and birth, these are the most problematic topics the book addressed. In fact, the development of the childbirth chapter toward the right context for the body took much longer than many other issues of women’s health. This uneven development principally was due to two factors. First, childbirth was, and still is, more “medicalized” than almost any other health care matter the text discussed, since by the 1950s almost all women in the U.S. gave birth in hospitals. Second, because the knot between childbearing and childrearing has been tied so tight, feminists have been afraid to embrace childbearing out of a fear of getting stuck with all that follows from it—long years (with little help) caring for children. Thus the voice that spoke out in the first edition, published by New England Free Press, unwittingly came from deep within the institution of childbirth and motherhood as Adrienne Rich has called it (in other words, inside patriarchy);11 when the authors tried to celebrate the experience of childbirth and motherhood the attempt largely was unsuccessful, tending toward the rhetorical (as in the slogan “Childbirth preparation for all! Power to women!” [1970:154]). The result was a very unintegrated sense of the woman’s body, and a fear of the transformation of pregnancy:
It is important to know that these fears and doubts can occur during a good pregnancy too, for in a very real sense, your body has been taken over by a thing and a process which is not within your control, and you must come to terms with that, not passively, but actively, by knowing what the fetus looks like as it grows, what is happening to your body, and what your specific fears are. Talk to friends and try to sort out the inevitable old wives’ tales from the realities. (1970:113-114; emphasis added)
In the next edition (first Simon and Schuster edition) there is a happier description:
During your pregnancy there are two kinds of development: (1) the physical and emotional changes you are going through, and (2) the growth of the fetus within you—two stories going on at once. (1973:164)
The text goes on to say:
It’s important to know that these doubts and fears occur during a “good” pregnancy too. for in a very real sense your body has been taken over by a process out of your control. (1973:165)
The phrase “out of your control” remains throughout the various editions, but these words are a long step from calling the baby “a thing” and is accompanied by the following remarks urging the woman not so much to regain control but to be an active participant in her pregnancy:
You can come to terms with that takeover actively and consciously by knowing what’s happening to your body, by identifying your specific feelings (especially the negative ones, because they are the most difficult to deal with), and also by learning what the fetus looks like as it grows. Its growth is dramatic and exciting. (1973:165)
Until the latest edition this comment was followed by a quantitative statement about the length of pregnancy and its division into trimesters. The latest edition, 1985, opens to a larger, even spiritual reality:
Our society tends to treat pregnancy as a solitary, clinical experience. Many nonindustrialized societies have invested it with religious significance, respect it as an altered physical and psychic state and celebrate it as significant not only for the couple but for the entire community. Making and deepening bonds with people who make you feel special can be an important source of strength. (1985:342)
This reflection not only is not quantitative: it is qualitatively different from statements about birth which occur in all previous editions. It challenges the narrow view that we must speak flatly about life experience, an inhibition which neglects to take into account that most of the world has a more spiritual relationship to nature, the body, and community than we do in the West. An example of earlier discomfort with the spiritual can be seen in the following quotation from the second Simon and Schuster edition (1976):
When we become a mother our response to our child borders on the sentimental, or cliche, since it involves us in the universal experience of childbearing and child-rearing, and there is obviously little new to be said. Still, when it is our experience and our body, it’s a new miracle, and familiar words take on new meanings. (1976:246)
This cautious comment works against spiritual understanding as well as against enjoying the unparalleled pride of motherhood. Born, perhaps, from the persistence of a scientific sensibility, from a reaction against the emotive sixties, from a secular cast of mind, from a fear of the institution of motherhood and an inclination toward androgynous parenting—all characteristics of middle-class culture and feminism in the U.S.—this reserve lessens by 1985. Why the change? Clearly, as the text opens out to the world—to other ethnic and racial groups, to women of different social classes, to women living in other cultures—the authors became aware of how motherhood is valued, and aware, too, of the continuing vitality of spiritual life.12 These influences help women reach for a spiritual grounding for the birth experience.
If the earlier text speaks with reserve about motherhood, it also recommends medical care by physicians relatively unquestioningly: “It’s a good idea to see a doctor when you either think or know you are pregnant (1970:116).” The later editions challenge whether doctors should be the primary caregivers for pregnant women; by the latest edition the term “practitioner” (1985:335) is used instead of doctor when discussing persons who deliver care to women, thereby relativizing the physician’s role. However, the questioning of caesareans came belatedly. The 1973 edition says:
If the doctor recommends a Caesarean section, you must trust that judgment if you haven’t enough medical knowledge to argue. Almost always the operation is done to save your life or your baby’s (1973:189).
It is not until 1979 that the text took a critical stance toward caesareans:
Caesarean sections used to be undertaken only in emergencies—i.e., when mother or baby suddenly had an adverse change of condition, or when the baby’s head was too big to pass through the mother’s pelvis. . . . These days, “elective” Caesareans are the rule; one in every four women will be delivered this way (these figures are the highest in the world and rising) (1979:287).
Home birth was viewed skeptically even in the 1976 edition: “An alluring picture, but how safe is home birth?” (1976:269). It was not until 1979 that the text came out in favor of it (1979:269).
Early descriptions of birth in the text were overladen not only by hospital routines (hospital birth is assumed) but also by the logic of childbirth preparation. Both hospital protocols and childbirth regimens attempt to control the process of birth; in the following quotation it can be seen how the two work hand in hand:
A contraction is about to begin and the doctor signals you to push. You’ll use the following technique: to fill your lungs as completely as you can with air and hold it. As you are taking the breath get into position to push by putting your head on your chest. (The exercises for the various muscles of your abdomen prepared you for this.) And now you push hard with all the muscles of the abdomen against your vagina. . . . Probably after a few pushes the doctor will give you a local anesthesia (if you haven’t had anesthesia already). . . . Next comes the episiotomy, or cut into the perineum (1970:148).
Or in discussing the meaning of birth, the 1973 edition states:
Your baby is born, and you have done all that was in your power to give that baby the safest and healthiest birth possible. As women we know that the experience of childbirth is an extremely important experience in our lives. If we are prepared and unanesthetized during childbirth we are in touch with our entire self, mind and body, and we are working intelligently along with inevitable biological process. We are in control (1973:206; emphasis added)
Words such as “control,” “prepared,” “intelligently” make of birth a logical process governed by what could be called the “above” forces of the mind or “birth from above.” Similarly, the phrase consistently given in the text for the management of labor and delivery until the latest edition is “dissociation techniques and controlled breathing” (1979:275)—words which instruct you to be apart from, to control your labor from above. The latest edition, on the other hand, takes a highly critical look at childbirth techniques and how they work together with hospital routines:
Critics of the method point out that it fits all too well with the American way of birth, coexisting with all forms of intervention. We are led to believe that we are having “natural” births when in fact we are lying in bed, horizontal, motionless; our labors are accelerated by Pitocin; we are shaved, hooked to monitors, cut (episiotomy) and sometimes partially drugged. Mentally active—concentrating on breathing, panting away like machines—but physically inactive, we are not “in control” but doubly controlled by the interventions and by the breathing method itself. In the words of a labor attendant and childbirth preparation teacher: “I’ve seen women told to ‘do your breathing’ as they were objecting to painful exams and procedures.” From a conversation with a midwife: ‘Teach women how to breath? Why, we know how to breathe honey—we’ve been doing it all our lives!” (1985:334)
The shift recorded from the 1973 to the 1985 editions is from birth from above, perfectly compatible with the ultimate birth from above—caesarean section (as it happens physicians refer to the operation by this phrase, contrasting it with “birth from below,” through the vagina)—from control exerted by the reason and logic of doctor and woman working together, to birth from below where the woman gives birth by her own powers, joining with these powers rather than ruling over them. One mother’s experience pushing is recorded in the 1985 edition:
When I was ready to give birth the nurse said, “Push with your mouth shut.” But I thought to myself (it wasn’t exactly thinking), “That’s not the best way for the baby to get oxygen.” I wanted to groan, so I groaned deep, loud primal groans and pushed my daughter out. My doctor was amazed. He’d never heard such sounds before. They worked so well he said he would suggest them to other women. (1985:335; emphasis added)
How deep the changes in the 1985 edition go can be seen by the increasing clarification of the context of birth. The most recent chapter introduces two new sections called “climate of confidence” and “climate of doubt” which give a clear sociology of knowledge of the birth experience. Practicing what it preaches, the section titled “climate of confidence” begins with a quotation which reaches for the spiritual dimension of birth:
To birthing … we bring our histories, our relationships, our rituals … needs and values that relate to intimacy, sexuality, the quality and style of family life and community, and our deepest beliefs about life, birth and death. . . . When you believe in your basic health and strength, in your ability to give birth in your own way, trusting yourself and the people around you to provide guidance and support; when your practitioners believe in you, bringing to the birth of your baby their cumulative experience of seeing many normal births and healthy babies, then you and they together create a climate of confidence… (1985:361)
Overturning the Climate of Doubt
The 1985 edition presents a brief history of how a climate of doubt has come about, explaining how and when obstetricians took over from midwives. No such history appears in the comparable obstetrical text, Williams Obstetrics; indeed, by the latest edition of Williams the term “midwife” even has been removed from the index. Once so deferential toward the medical profession, in its 1985 edition OBOS describes the hospital as a place where the climate of doubt is strongest:
Hospitals reduce labor and birth to a medical, debilitating event. As healthy, strong women with good energy, we enter these places for sick people and our strength is systematically depleted; often we are put into wheelchairs. Our personal effects are taken away. We are cut off from friends and the people closest to us, isolated among strangers and made dependent and anonymous. When medical personnel give us enemas and shave (prep) us, they desex and infantilize us…. As one nurse-midwife said, regretfully, “The most natural aspects of birth—sexuality, blood, sweat, shit, movement and sounds—have no place here.” This terrible care distracts us, causes insecurity and confusion at a time when we should be relaxing, comfortable, concentrating on ourselves and our babies (1985:364; emphasis added).
The text vividly states the effect upon confidence of a climate of doubt:
It is as if our confidence is a large, bright piece of fabric. When little pinprick holes of fear and doubt appear, the medical mentality makes them larger and larger until the once beautiful cloth is nothing but gaping holes (1985:365).
Finally, the text is not shy to connect women to other mammals, an association avoided in earlier editions. Traditionally women have been considered close to nature, and therefore lower than men, a ranking at least as ancient as the Genesis account. The text strongly advises a female-centered birth linking us to other mammals. Gone is the childbirth classes’ focus on having the father in the delivery room, the conservative program with which the childbirth movement began:
Like any other animal, we need a calm environment for labor to proceed at its own pace, and we tense up when we are afraid, causing labor to slow down. Like elephants and dolphins, we labor best with females like ourselves nearby (1985:379).
Uncorseting birth from hospital care and childbirth regimes, under the influence of knowledge gained from other cultures (discussed earlier), became possible as a culture of homebirth and midwifery practice emerged in the U.S. The Collective drew upon members of this community in revising the text. As one lay midwife put it, they “soaked up” the experiences of midwives and homebirth parents. When preparing a new edition the Collective regularly held public meetings (which they taped) with pregnant and postpartum women, which provided fresh knowledge about birth. The 1985 edition clearly profited from these open meetings.
The chapters on childbirth in OBOS became more convincing as they became more novelistic; that is, they don’t just call for a different way of giving birth, they render it, in signifying representations, both images and words. Before 1985 the text only tended to invoke what could be called “unimpeded birth” (birth free from the constraints of medical and childbirth class protocols) rhetorically; sometimes unimpeded birth glimmered out of the subjective accounts, an important part of the structure of the book. But by 1985 the central text renders unimpeded birth, both legitimating it and making it narratively real. For example:
Women who attend childbirth preparation classes are often taught to practice pushing by taking huge, deep breaths, holding them and bearing down as hard as they can. Yet strenuous active pushing doesn’t necessarily get the baby out faster. In fact, it can lead to the baby’s being deprived of oxygen.
Your uterus contracts involuntarily and will push the baby out itself most of the time if not interfered with. Feel it pushing and bear down only when you feel the urge. Don’t close your throat unless your body wants to. (Breathe deeply or sigh between contractions.) You may want to grunt, moan, howl or simply “breathe” the baby out. (1985:372)
Another reason for the verisimilitude of unimpeded birth undoubtedly is that several women in the Collective had given birth at home by 1985. However, this text, so self-reflexive in other respects, does not identify these homebirth experiences as a reason for the dramatic change in the childbirth chapter in 1985. I believe that this oversight goes to the heart of what still remains problematic in OBOS about the maternal body, by which I mean the social body of birth grounded in the larger forces of being and of life.
The Unretrieved Maternal Body
OBOS is more successful restoring the social and spiritual aspects of the maternal body in childbirth than in the postpartum period. This uneven development in the text undoubtedly is due to the difference between childbearing and childrearing. The first is of fairly short duration, the second stretches out in time. To retrieve maternal functions with a limited time period is much less threatening to the feminist aspiration of widening the circle of life for women than is the work of raising children. Even the authors of OBOS unconsciously may have focused upon other aspects of embodied life than the maternal, since they neglect to comment self-reflexively upon their own birth experiences in relation to the development of the childbirth material.
With respect to the most problematic aspect of the maternal body—the tie to the child—the childbearing chapter in the 1985 edition does support bonding with the infant at birth (374-375); it doesn’t question the importance of touch so that you get to know your child and s/he to know you. But this bonding refers only to the immediate period following birth. By contrast, the postpartum chapter takes a critical stance on attachment theories (1985: 412-413) which make it seem that constant contact with the mother is indispensable to the child’s development. I agree with this critique but I feel that in advancing it the text does not go beyond envisioning androgyny. Surely full recovery of the maternal body could not mean metamorphizing into an androgyne. While the text does state that many women in the group breastfed (no mention, though, of long nursing relationships), until the 1985 edition breastfeeding remained in the appendix of the postpartum chapter.13 Even in the 1985 edition (and unlike the rest of the book) there are no personal anecdotes given in the section on breastfeeding which would accentuate the experience (1985: 399-402). Instead, there is a picture of a mother nursing an infant with her other child next to her sucking its thumb, a child who actually could still be of nursing age (399).
The postpartum chapter stresses both the recovery of the mother’s body for herself (410) and shared “parenting,” a word which blurs difference between men and women (409-410): the final image (416) shows a father playing a saxophone to his enraptured infant (although the infant appears to be sucking its fist or thumb and might have been just as happy nursing). The text offers commendable and well-expressed advice about urging mothers to take care of their own bodies: “We have to stand back from the ideals of self-sacrifice and monitor our own health just as we do our children’s: tooth for tooth, vitamin for vitamin” (411), But this chapter provides an unwitting (unwitting because the chapters typically are written by different women) complement to an earlier chapter on relationship (1985: 123-140) which advises that parity of income in households helps equalize relations of power between male and female (127-128); both sexes should be in the workforce with equal vigor. These directions in the book—stressing the return of the mother’s body from a body-in-relation to a body-for-itself; calling for androgynous parenting; and recommending equal incomes between men and women—are understandable. Women have neglected themselves while worrying over their children’s health and wellbeing; men do need to be drawn into the care of children; women have had and still have unequal status in the workforce. For example, women only are able to earn approximately twenty-five percent of the man’s income due both to time away from work caring for children and the dual labor market, which segregates women into low-paying occupations.14
The postpartum chapter is sensitive to the need for women to re-vision their lives by moving out into the world, as is the text as a whole, but these desired actions tend to require suppressing the maternal body, which ties women to what has been called gendered time and space—the cyclical time of the needs of children and the private space of the home.15 To free the maternal body would require vast changes both within society and within persons—for example/ to make the public world more receptive to those who live within cyclical time, and who must respond with their bodies to the needs of children. In a forum on breast cancer held about ten years ago at Harvard Medical School, it was explained that long breastfeeding might provide a protection against breast cancer: by long the speaker meant thirty-six months or beyond. One medical student sitting ahead of me turned to another and whispered, “do you realize how many children you’d have to have to breastfeed that long?” She could not conceptualize that such a duration of time could be expended nursing one child, which is the custom in many parts of the world. It is cultural blindspots like these which would have to be removed before women could entertain the possibility of allowing greater freedom for the maternal body.16
To render the lactating body-in-relation in OBOS more fully undoubtedly would mean that the social conditions for this kind of mothering would need to be enriched, as we saw with the childbirth chapter, OBOS had to wait for hospitable social circumstances—a subculture of midwives and homebirth—to render birth vividly. Uncorseted nursing is not widely accepted, not the least reason for which is many women’s discomfort over the sexuality of nursing, since our culture splits maternity and sexuality so severely.17 In its present form, the postpartum chapter of OBOS mostly renders the physiological advantages of breastfeeding to mother and baby. The possibility of nursing as a pleasure for the mother, both physically and emotionally, takes up only a short part of the section on breastfeeding; and there is no exploration of the significance of the recovery of the maternal body from a feminist perspective.
Perhaps the next revision of OBOS will begin to move toward freeing the maternal body more fully. At the moment, caught between two major directions of feminism—androgyny vs. a women-centered vision—the text shows the pull of both and is in tension with itself on account of it. The childbirth chapter leans toward a woman-centered world, the postpartum and relationships chapters toward the blurring of sex differences.
OBOS and Educational Change
To say that OBOS does not take us altogether out of the constraints of patriarchy with respect to the maternal body does not minimize the degree to which OBOS has brought us an almost immeasurable distance in most areas of women’s health, including childbirth, from where we were in the late nineteen-sixties. Even if the text retained a conservative attitude toward birth until 1985, compared to other texts which came out in the seventies and early eighties, OBOS brought its message to such a wide audience, including many women who are not feminists, that the developmental lag is not that important.”18 The conservative bent came about in part from not wanting to rush too far ahead of social change, since such impetuosity often results in convincing only the already convinced.
On the level of self-education alone—as a self-help book— OBOS educates every woman who reads it. Women turn to the text for advice on matters ranging from nutrition, or basic self-care, to advice which serves as a “second opinion” to information given by a physician in the medical encounter. OBOS offers information to women who wish to become active politically in the women’s health movement; the text also provides a powerful analysis of the medical care system in the United States.
The Women’s Health Information Center, the living offshoot of the text, provides a voluminous library which women may research in deciding how to handle a health problem, or in deciding on a method of birth control. Women and men also conduct scholarly research at the Center. The Health Information Center cannot be overestimated as an educational source for women worldwide; the staff mails material nationally and internationally to women who cannot conduct research in person.
Besides educating at the level of self-help, the very process by which OBOS came into being and by which it is revised also offers a pattern for educational change. Beginning with the self and moving out into the world, even into the prestigious domain of the written word, with information which has come to challenge traditional knowledge, in particular “scientific” discourse, the text is a model of a way of knowing, producing, and reproducing knowledge.19 In writing, the group democratized educational experience by having chapters co-authored and by including public testimony and outside readers. As the text explains, sometimes a chapter is recast entirely in response to the comments of one person (1985:xi). When giving public talks the Collective always encourages women in the audience to begin their own women’s health groups. In other words, the Collective’s knowledge process is not exclusive but inclusive, and contradicts professional models of knowledge acquisition where competence is coveted and denied to the majority. The Collective also has contributed significantly to strengthening the international feminist movement. Many feminists feel that the most vital part of the international feminist movement, which struggles to overcome many national and cultural incompatibilities and differences, is in women’s health. For although differences among women of different cultures must not be underestimated, the common experience of living in a woman’s body—a body subject to similar manipulations and controls under different social and political organizations—brings women together to fight against such indignities as forced sterilization, the marketing of dangerous contraceptives, and the promotion of bottle feeding in third world countries. Finally, the group offers a model for combining political action with the necessarily reflective process of writing—action and reflection often are fatal antipodes. For example, the Collective was instrumental in beginning the National Women’s Health Network, an advocacy group based in Washington, D.C. which monitors government activity on women’s health issues, and presses for legislative and regulatory reforms.
As the Collective approaches its twentieth anniversary it is fair to say that women across the world have been brought from the dark ages to enlightenment on matters of women’s health by the imagination and efforts of a group of women who met initially around the symbol of women’s domain, a kitchen table. From that humble spot, the Collective moved out into the world with the publication of their book, the founding of the Women’s Health Information Center, and their political activism nationally and internationally. They substantially helped to create an infrastructure of women’s information and political organization where none existed before and upon which women of many nationalities now depend. We all have reason to be grateful to this group for their vision and generosity as the second decade of their existence draws to a close and the third commences.
1. The title, “Taking Our Maternal Bodies Back,” is adapted from the title of an early feminist film on women’s health called Taking Our Bodies Back, by Margaret Lazarus and Renner Wunderlich (Cambridge Documentary Films, Inc., 1974).
2. Boston Women’s Health Collective, Women and Their Bodies: A Course (Somerville: New England Free Press, 1970).
3. Boston Women’s Health Book Collective, Our Bodies, 0urselves; A Book By And For Women (New York: Simon and Schuster, 1973, revised 1976, 1979 and 1985).
4. For reference on Williams Obstetrics, see n. 10.
5. Boston Women’s Health Book Collective, Ourselves and Our Children: A Book By And For Parents (New York: Random House, 1978); Ruth Bell and members of the Teen-Book Project, Changing Bodies, Changing Lives: A Book for Teens on Sex and Relationships (New York: Random House, 1980, 1987) and a companion manual by Ruth Bell and Leni Zeiger Wildflower, Talking With Your Teenager (New York: Random House, 1983); Paula Brown Doress, Diana Laskin Siegel and the Midlife and Older Women’s Book Project, Ourselves, Growing Older: Women Aging With Knowledge and Power (New York: Simon and Schuster, 1987); Massachusetts Coalition for Occupational Safety and Health and the Boston Women’s Health Book Collective, Our Jobs, Our Health: A Woman’s Guide to Occupational Health and Safety (Watertown: Boston Women’s Health Book Collective and MASSCOSH, 1983); ISIS (Women’s International Information and Communication Service) and Boston Women’s Health Book Collective, International Women and Health Resource Guide (Watertown: ISIS and Boston Women’s Health Book Collective, 1980).
6. Women’s Health Information Center, 204 A Elm St., Somerville, Mass. 02144; 617-625-0271.
7. Boston Women’s Health Book Collective, The New Our Bodies, Ourselves: A Book By And For Women (New York: Simon and Schuster, 1985).
8. Carol P. Christ, Diving Deep and Surfacing: Women Writers on Spiritual Quest (Boston: Beacon Press, 1980).
9. Note, e.g., the following passage from the preface/ introduction:
We are increasingly proud of our dependence upon one another in a culture which so prizes independence. Yet our efforts (along with so many others’) to form a community of women are still evolving and, despite their strengths, are quite fragile. A competitive society like ours makes it difficult to work collectively, to be open, to trust one another. It is more difficult to be a feminist these days than it was in the optimistic climate of the early seventies. And when the many women with backgrounds and experiences different from our own speak up and tell the truth about their lives, they make it clear just how diverse this huge community is. Sometimes the great differences between us–race, class, ethnicity, sexual preference, values and strategies–turn us against one another. Keeping in mind our common ground as women must be one of our main tasks. Acknowledging the past and present hurts, the inner fears of difference and the external realities which separate us can enable us to learn to hear each and every woman’s voice clearly, to nurture each and every woman’s life. (OBOS, 1985, p. 14).
10. Jack A. Pritchard and Paul C. MacDonald, Williams Obstetrics, (Norwalk, Conn.: Appleton-Century-Crofts, 17th ed. 1985). A more extended discussion of Williams Obstetrics can be found in my dissertation, “The Language of Birth: Female Generativity in Western Tradition” (Brandeis University, 1988), chaps. 3-5.
11. Adrienne Rich, Of Woman Born: Motherhood as Experience and Institution (New York: W. W. Norton, 1976). Rich distinguishes between “two meanings of motherhood, one superimposed on the other: the potential relationship of any woman to her powers of reproduction and to children; and the institution, which aims at ensuring that potential–and all women–shall remain under male control” (p. xv). For Rich the “experience of mothering” means the “potential relationship” free from patriarchy.
12. See the new chapter in the 1985 edition of OBOS called “Developing An International Awareness,” pp. 611-620.
13. An inattention to lactation is not just peculiar to the postpartum chapter, but has been part of OBOS from the beginning. In the second edition (1973), the anatomy section contains a lovely line drawing of a woman; her body becomes transparent in the pelvic region in order to show her reproductive organs. She looks proud and smiles slightly in a pleasurable awareness of herself. While the image offers an obvious contrast to the obstetrical text which does not show the woman’s body parts in context, it is of considerable interest that the OBOS picture does not make visible the mammary glands in the breasts. This also is true of a series of drawings in the pregnancy section which show the development of the fetus inside the mother, and while the breasts are shown to become larger as pregnancy progresses, the breasts remain opaque so that the mammary glands cannot be seen. Even more striking is how long it takes to include a diagram of the lactating breast in the anatomy section. Where the male reproductive system is shown together with the female from the first edition on–by the second edition there is a rendering of the quiescent as well as the erect penis–there is no anatomical rendering of the female breasts in the first or second edition. Only with the third edition do we find a section on breasts in the anatomy chapter which shows the mammary glands at different stages of the reproductive cycle.
14. See Mary Jo Bane and George Masnick, The Nation’s Families, Cambridge: Joint Center for Urban Studies of MIT and Harvard (1980) and Ruth Sidel, Women and Children Last: The Plight of Poor Women in Affluent America (Harmondsworth: Penguin Books, 1986) pp. 60-6l.
15. See Robbie Pfeufer Kahn, “Women and Time in Childbirth and During Lactation,” in Taking Our Time: Feminist Perspectives on Temporality, ed. Frieda Forman (New York: Pergamen Press, 1989).
16. For excellent information about breastfeeding patterns in comparison to those of the West see Niles Newton, “Psychologic Differences Between Breast and Bottle Feeding,” The American Journal of Clinical Nutrition, 24 (August 1971), 993-1004. See also Susan B. Reamer and Muriel Sugarman, “Breastfeeding Beyond 6 months: Mothers’ Perceptions of the Positive and Negative Consequences,” Journal of Tropical Pediatrics, 33 (Apr. 1987), 93-97; and Dara Raphael, The Tender Gift: Breastfeeding (Englewood Cliffs: Prentice-Hall, 1973), especially chap. 11, “Mothering Around the World,” pp. 131-140.
17. For the connection between maternity and sexuality see Niles Newton, Maternal Emotions (New York; Paul Roeber, 1955); Sheila Kitzinger, The Experience of Childbirth, (New York: Taplinger, 1972) and Women’s Experience of Sex: The Facts and Feelings of Female Sexuality at Every Stage of Life (New York and London: Penguin, 1985).
18. See for example, Raven Lang, Birth Book (Palo Alto: Genesis P, 1972); Suzanne Arms, Immaculate Deception: A New Look At Childbirth in America (Boston: Houghton Mifflin, 1975); Ina May Gaskin. Spiritual Midwifery, rev. ed. (Summertown: The Book Publishing Co., 1978); Nancy Wainer Cohen, Silent Knife: Cesarean Prevention and Vaginal Birth After Cesarean (So. Hadley: J.F. Bergin, 1983).
19. See Mary F. Belenky et al., Women’s Ways of Knowing: The Development of Self, Voice, and Mind (New York: Basic Books, 1986).