Failure of Progress

I have real issues with the notion of “progress.” I first started thinking critically about the term while studying history during my undergrad degree.  Thinking about history—the process of change over time—you start to realize just how few things in life go steadily upward or get steadily, unproblematically better.  Rather, things happen in contradictory, often unpredictable, and always contingent ways.  We don’t get smarter with the passage of time or more clever, or stop repeating the same mistakes or necessarily do anything better; in the present and the future we are just as flawed as we were in the past, only in an ever-changing context.

I’m not going to write more here about the source of our collective faith in the notion of progress—that’s another essay for another time.  But I am going to say something about what our faith in progress does to our bodies in the context of both fitness and birth, two situations where the word “progress” gets used all the time, uncritically, and with damaging results.

In both fitness and birth, “progress” is an effort to impose objective values on the most subjective thing of all, individual bodies.  It maligns our bodily integrity by suggesting that we should gauge the work our bodies do from an outside perspective:  somehow, we won’t know that our bodies are working well unless we take the extra step of measuring, stacking ourselves up against an external set of values that most of us really don’t understand.  In fitness circles you’ll often hear things like, “Track your progress!  Get measureable results!” as if fitness should be measured in inches or six packs, and as if there are some magical measurements that guarantee we’ve done something right. 

In birth, tracking “progress” during labour—the rate of dilation and effacement, combined with a baby’s descent through the pelvis—holds a woman’s body to the rules of statistical averages at a time that we know is quite unpredictable.  And that makes me angry because it doesn’t really make a lot of sense.  We persist in making assumptions about labour progress, insisting that “normal” dilation is 1.2 cm per hour and holding women to that standard even though we know that birthing bodies frequently don’t follow those rules

Well, taken by the thousands, parsed into all sorts of ideal numerical values, added together and divided appropriately, they do.  But yours doesn’t.  Neither does mine.  Statistics are numerical abstractions reflecting large-scale trends; but they aren’t illustrations of any one human being.  You and me:  we are individuals who are likely to follow a typical curve, but who may not, and may still be perfectly fine.  In fact, interfering with a body during birth to try and compel it to get in line with numerical averages can cause problems where none would otherwise have existed.  How many times does a perfectly healthy woman with a perfectly healthy baby end up in the OR because of “failure to progress,” when that “failure” was in fact no failure at all, but rather a body that simply needed longer than the charts said it should to give birth, and as a result longer than people—birth attendants, family members, the woman herself—were willing to wait?  

The critique I offer here is not new.  Emily Martin, a cultural anthropologist, wrote years ago about the damage done to women by superimposing the schedule of industrial capitalism on to our bodies.  Anything irregular—anything challenging the pace of the mechanical clock and the expectations of the schedule-setters—has been termed a failure or a problem, when it could have been recognized positively, as an adaptive response to a particular set of physiological cues.  This has set women up to be at war with ourselves because while we may wish to follow the schedule—who doesn’t want to have her baby on that magical due date, her period on the very day it’s expected, her labour to end after a predicted number of hours?—these are things that, without herculean effort, we simply can’t control.  Instead of accepting that unpredictability, we fight against it in what is, overall, a losing battle.  Because no matter how much we try, our bodies are not machines.  Our bodies don’t respect the clock (or the measuring tape or the scale) and they probably never will.

We can’t make our bodies meet the metrics of progress without doing things that put us at risk.  Inducing or augmenting labour without medical necessity, for example—something I admit I’ve done myself—is risky behaviour that multiple studies have shown invites complication.  Following exercise plans that focus solely on measureable “results”—again, something I have definitely done in the past—is risky, too.  It interferes with our internal sense of our own fitness and health, and instead makes our visual cues, mediated by cultural ideals of beauty and strength, paramount, often leading to injury, illness or frustration.

The good news is that there is a way out.  It is possible to improve your fitness level, challenge yourself physically, and to move through a major life event such as birth without the judgment that “progress” implies.  Your body need not always be in competition with itself.  Imagine what it might feel like to let your body be as it is on its own schedule (or lack thereof), aware of and embracing a kind of movement through time that is completely different from the time on the clock, and existing in shapes and forms that have no relationship to the number on the label of your pants.  Imagine what fitness might mean if it was mainly about how you felt, instead of how you looked.  Imagine what labour might mean if there were no “right” due date or number of hours or centimetres.   

How would acknowledging the failures of progress change your fitness goals?  How would it change the way you treat your body not only in signal moments like labour and birth, but in everyday life?


A Crisis in the Crib

As a pre and postnatal fitness specialist and a student childbirth educator, I am building my resume as a birth professional, and I am building it on top of my background as a PhD-level historian who specializes in the social, political, economic and cultural legacies of slavery and segregation in the 20th– and 21st-century United States.  Most people think my two professional personas are entirely unrelated.  I know otherwise, and I rarely see the links illustrated so clearly as in Tonya Lewis Lee’s documentary, A Crisis in the Crib.

Lee focuses on health disparities in Shelby County, Tennessee, the county that is home to the great city of Memphis. She outlines the health challenges that African American parents in the county face, and the ways in which they and their children suffer from widespread, systemic inequality. Poverty and stress contribute in major ways to African American women across the nation—of varying levels of education, including those with college degrees—giving birth at far higher rates to pre-term and low birth weight babies, a proportion of whom die within their first year as a result.  

The documentary follows a group of students who work together as preconception peer educators to try and instigate a grassroots effort to improve outcomes for black mothers and children.  It highlights commentary by a range of prominent health researchers and clinicians who identify the problems they see and suggest solutions, all of which centre on the point that black babies do not have to be born small or die young.  Although it has become normal over 400 years for African Americans to be less healthy than white Americans, it does not have to continue to be that way.

In a recent talk I gave on reproductive justice for people of colour in the United States, I quoted the following statistics:  In the United States today, the maternal mortality rate for black women is 3.4 times higher than for white women.  Black babies are 2.3 times more likely than white to die during birth, and 1.8 times more likely to die from SIDS.  Black women are 2.5 times more likely to receive late prenatal care or no prenatal care at all.

These statistics are sobering on many levels, but not least of all when we think about the deep injustice of allowing the children of women who quite literally gave birth to the nation to die untimely deaths.  If not for black women’s reproductive labour, the United States as we know it today would not exist. 

Black women’s reproduction has been a political issue since the 17th century, when the early American colonists defined slavery as a hereditary condition passed through the mother.  In other words, no matter what the father’s identity—a slave of African descent, a white European indentured servant or worker, or a white planter or master—enslaved mothers gave birth to enslaved children, thus building the enslaved population one baby at a time.  Black women as mothers were therefore the keystone in the system of slavery, the system that enabled American economic, political and cultural growth and development.  To say that the United States was built in the wombs of black women is no exaggeration. 

Nearly 300 years of slavery, and the formal and informal systems of segregation that followed in the century and a half since, have left a specific mark on the lives of black women, leaving them vulnerable to all measure of abuse.  This is especially clear when we look at the issue of reproduction. As slaves, African American women were compelled to create property for their masters, to understand the painful truth that on a legal level, the children they birthed were not their own.  As free people in the twentieth century, they have been roundly condemned for having babies at all, caricatured in the later decades as “welfare queens” and irresponsible single mothers, and/or victimized by campaigns that forced sterilization without consent and tied government economic support to compulsory contraception. Talk about being damned if you do and damned if you don’t.

African American women have resisted this abuse and victimization since the moment it began, but they have fought against a government and a society with little empathy and a seemingly inexhaustible willingness to continue sacrificing their health and wellbeing for economic gain.  The reasons why are complex, but to put it very simply, American society has evolved into a place where there is an often unspoken acceptance of the notion that black women and children just don’t matter very much. 

In so-called “post-racial” 2010, African American babies are paying the price for a society in which racism is so deeply entrenched that we often don’t see it at all.  Ironically, despite their original national significance and their basic humanity, which should be but is not enough to guarantee them at least minimal protection and care, black children are more likely to be born less healthy and die early.  No matter how responsible an individual mother may be, or how privileged, mothers who are black bear children whose lives are at risk for reasons that are entirely preventable but which racism precludes most of us from seeing or taking seriously.

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