Faculty of Philosophy, Complutense University of Madrid, Madrid, Spain.
J Eval Clin Pract. 2022 Oct;28(5):875-882. doi: 10.1111/jep.13747. Epub 2022 Aug 1.
Nowadays, a considerable number of women have a negative or outright traumatic birth experience. Literature shows that being involved in decision-making and exercising autonomy are important factors in having a positive birth experience. In this article, I explore the hypothesis that some views characteristic of the biomedical model of childbirth may hinder women's involvement in decision-making, leading them to what I have dubbed as a 'stigmatizing dilemma'; that is, to be perceived and treated as either irrational or selfish when trying to exercise their autonomy in the labour room. I suggest that such a stigmatizing dilemma arises when the following views are uncritically and unqualifiedly endorsed: (1) childbirth is a process fraught with risk, particularly to babies; (2) labouring women's reports are unreliable and their subjective perspective does not constitute a valuable source of information; (3) medical knowledge and procedures are the safest means to give birth. In a scenario where (1)-(3) are strongly endorsed, if birthing women act according to instrumental rationality and want the best for their babies, they will be expected to just leave decisions to medical experts. Thus, not following expert directions might lead women to fall under the stigma of either irrationality or selfishness: they could be perceived and treated as either irrational, since they may not seem to seek the best means to accomplish their goal; or selfish, since they may seem to pursue goals other than the baby's health. I examine these stigmas in relation to two ideals: that of disembodied rationality and that of selfless motherhood. I also explore different ways in which the views and prejudices underlying this stigmatizing dilemma could be challenged.
如今，相当一部分女性对分娩有着消极或创伤性的体验。文献表明，参与决策和行使自主权是获得积极分娩体验的重要因素。在本文中，我探讨了这样一种假设，即分娩的生物医学模式的某些观点可能会阻碍女性参与决策，使她们陷入我所谓的“污名化困境”；也就是说，当她们试图在产房行使自主权时，会被视为不理智或自私。我认为，当以下观点被不加批判和无条件地认可时，就会出现这种污名化困境：（1）分娩是一个充满风险的过程，尤其是对婴儿而言；（2）产妇的报告不可靠，她们的主观观点不能构成有价值的信息来源；（3）医学知识和程序是最安全的分娩方式。在（1）-（3）被强烈认可的情况下，如果分娩的女性按照工具理性行事，并为她们的孩子着想，那么人们就会期望她们将决策权交给医学专家。因此，如果女性不遵循专家的指导，她们可能会被贴上不理智或自私的标签：她们可能会被视为不理智，因为她们似乎没有寻求实现目标的最佳手段；或者被视为自私，因为她们似乎追求的是除了孩子健康之外的目标。我将这些污名与两种理想联系起来：非人格化理性和无私母性。我还探讨了挑战这种污名化困境背后的观点和偏见的不同方法。
