Responsibilization in Pregnancy and Birth

Back in March, I released a blog post about responsibilization for fertility. For many, this may have been the first time you’ve heard about responsibilization (a sociological term I’m borrowing). Today, I want to talk about how responsibilization affects folks who are currently pregnant or will become pregnant and who are planning for their birth experiences. For those of you just joining now, I’ll give you the refresher:

Responsibilization is a social process whereby individual people are made responsible for things that aren’t entirely under their control and without attention to their social context. In the case of pregnancy and birth, this means that individual people feel responsible for maintaining a perfectly healthy pregnancy, preventing pregnancy or birth complications, and performing the idealized ‘happy pregnant person’ socially, despite the very real obstacles on their path that simply are not under their control. Yes, we can do our best to eat right, move our bodies, and attend regular appointments with our health care providers, but there will always be elements of pregnancy and birth that are outside of our control. If we could control everything, nobody would experience loss, have a baby that is unwell, or become unwell themselves. Responsibilization often puts pressure on people to do everything ‘right’ and to have everything figured out even though there are barriers that get in the way. The standards to which people are held are often unrealistic (ex: never being exposed to environmental toxins). Even when we acknowledge that these standards are unrealistic, this often isn’t enough to eliminate the expectation that people at least strive to meet them. Responsibilization exists on the spectrum of social control, in which people are taught to govern their own behaviour in socially acceptable ways. When you feel responsible for something – like feeling unwell in pregnancy is somehow your fault – you put all the expectation to fix things on yourself. And when the people who are struggling are responsibilized, their struggles are seen with less empathy and compassion by people around them who have not encountered these difficulties.

So, what does this look like for people who are currently pregnant or going through their birth experiences? Most of us are at least somewhat familiar with the intense focus and scrutiny that society places on pregnant people and how they govern their own body. You, yourself, may have noticed how you take a long, hard look if you see a pregnant person smoking cigarettes or drinking an alcoholic drink. We’re socialized to be monitoring each others’ (and our own) behaviours. However, when you’re pregnant, it can feel like everything is under the microscope – how you eat, how you exercise, what you do for fun, your sex life, how you behave socially… suddenly now that you’re inhabiting an obvious parenting role, all eyes are on you and expecting you to meet certain social norms around being a ‘good’ pregnant person. And chances are, you feel that way about yourself too! As a Calgary birth doula, I see this all the time – pregnant folks who are so concerned with doing everything ‘right’ during pregnancy because they feel a lot of pressure to make sure everything goes okay for them and their baby. People also experience a lot of pressure on the choices they make for their birth experience, even though no two people’s birth experiences are the same. To get the epidural or no epidural? Should your in-laws be present in the birth room or is it acceptable to set that boundary? What should partner involvement look like? Are you going to have your baby at a hospital or at home? And if something doesn’t go exactly the way we hoped it would, people might ask themselves: what did I do wrong? People around them might also start questioning their choices as if one or the other was responsible for the outcome.

When it comes to birth outcomes, it’s perfectly fair to acknowledge that two things can be true at the same time: 1) not everything is under our control; and 2) the things we do can make a difference in our experiences. We often overemphasize the things we can do to get the outcomes we want while also forgetting that not everyone has the same opportunities to affect change in their own lives. Not everyone has access to appropriate information about prenatal health and the ability to discern quality information from misinformation. Some people have ample financial resources to afford a nutrient dense, organic diet, but many people struggle financially and must make the best choices they can with the resources they have. People’s jobs may not accommodate changing physical needs in pregnancy or may not permit people the work-life balance required to maintain other healthful habits during pregnancy. Not everyone has equal access to the medical providers they would like to work with for prenatal screening and support. Depending on where people live, they may have fewer options about where and with whom to birth. For people who are in positions of privilege, it’s easy to forget that not everyone has the same options. And if you are someone who is currently struggling with the pressure you feel, it’s not your fault. At the end of the day, we do the best we can with the things that are inside of our control and have to have some grace for ourselves with everything else.

As a doula, I always do my best to try to help people find the balance between what we can control – finding empowering ways to support ourselves – and acknowledging our feelings about the things we cannot control. It’s not an easy thing to do and the stakes can feel so high when we are so in love and invested in our babies and want everything to be good for them and for ourselves. No one was meant to walk this path alone. If you’re looking for someone to help you find the balance for yourself during pregnancy, please check out my birth doula package.