References
A post-structuralist feminist analysis of electronic fetal monitoring in labour
Abstract
Constant electronic fetal monitoring has become a ubiquitous part of birth management in most high-income countries, both reflecting and creating the social context. This article uses a post-structuralist feminist critique to show that the use of the cardiotocograph in birth reinforces and reflects the logic of the separate sovereign self. This creates a rupture in the intrinsic relationality of the mother–fetus and the mother–midwife on a philosophical and physiological level. The cardiotocograph in labour privileges the medical model, constrains women through wires and the imperative to ‘keep the trace’, takes everyone’s attention and gives midwives tasks other than caring for the woman. It externalises the fetus and gives it selfhood separate from the mother, to the extent that it can seem like the machine is keeping the baby alive. This undermines women’s and midwives’ subjective knowledge, relegating women to organic containers. A reimagining of birth that centres relationality would start by acknowledging the nature of the self as semi-permeable and the being/doing, both/and nature of the mother–placenta–fetus in pregnancy and birth. Intermittent auscultation of the fetal heart in labour is better able to centre the mother–placenta–fetus relation and the midwife–mother relation.
Constant electronic fetal monitoring in the form of the cardiotocograph has become a ubiquitous part of birth management in most high-income countries, profoundly affecting birth and often leading to interventions (Miller et al, 2016). Like any intervention in birth, it both reflects and creates its social context. This article uses a poststructuralist feminist critique to interrogate the role and meaning of the cardiotocograph. It argues that use of the cardiotocograph in birth reinforces and reflects the logic of the separate sovereign self (Irigaray and Whitford, 1991; Jones, 2016) and reveals an enactment of the symbolic ‘matricide’ (Irigaray, 1993a; Green, 2012) and the creation of fetal selfhood (Barad, 2007). The mother–fetus and the mother–midwife are fundamentally relational dynamics on a philosophical and physiological level. The cardiotocograph creates a false rupture in these relations. The author suggests that intermittent auscultation of the fetal heart in labour is better able to centre the mother–placenta–fetus relation and the midwife–mother relation.
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