Motherhood, CultureMotherhood, Culture

“Breast-Feed or Else,” is the front-page headline of the New York Times science section on June 13, 2006. “Warning,” health policy writer Roni Rabin begins the article, “public health officials have determined that not breast-feeding may be hazardous to your baby's health.” Rabin describes a current controversial government public health campaign advising mothers to breastfeed for six months. The campaign includes television advertisements depicting a pregnant woman thrown off a mechanical bull, suggesting such behavior was the equivalent of choosing not to breastfeed. “You wouldn't take risks before your baby's born,” the ad continues. “Why start after?” In the center of the page, a giant baby bottle with a pink line through it draws attention to the stark nature of the controversy. To the right, graphs and charts illustrate the small percentage of mothers, by race, education, income, and marital status, who currently breastfeed up to six months. Overall, fewer than 20% breastfeed exclusively by six months, a statistic that has become a cause of concern for public health leaders.¹

As Rebecca Kukla reveals in Mass Hysteria: Medicine, Culture, and Mothers' Bodies, this type of controversy is nothing new. Kukla offers a fascinating analysis of how and when American culture became fixated on the social meaning of pregnancy and nursing. She locates the origins of current conceptions of the maternal body in the Enlightenment ideas of late 18th-century France. Here, philosophers and medical doctors, beginning with Rousseau, facilitated a shift in the meaning of motherhood. They imbued motherhood with new social and political significance grounded in Enlightenment thought. As a result, pregnancy and nursing, formerly conceived of as the private duties of women, became part of public and civic culture.

One clear example of this shift is in the use of wet-nursing, which had formerly been a common practice of the upper classes. After the French Revolution, Kukla explains, “Republican ideology promoted mother's milk as being capable of transmitting moral as well as patriotic virtues to children, the future of the Republic” (p 51). Both literally and figuratively, breastfeeding became important to modern motherhood: nursing or bare-breasted women appeared symbolically on Republican fountains and monuments; their images were celebrated in art, architecture, and festivals in order to “mold Republican passions” (p 51); and women were implored to nurse as a way of transmitting Republican values to their children. Proponents of breastfeeding as a civic duty drew on all three of these promotional methods, using them interchangeably. The fact that the president of the French National Convention made some forms of state support available only to mothers who nursed their own children (in 1793) certainly encouraged women to reconsider their options. Before the revolution, less than 5% of all babies in Paris were nursed by their mothers, but the ratio began to dramatically shift shortly thereafter (pp 51-52).

But in the process of attributing greater social significance to the maternal body, Enlightenment thinkers also heightened anxiety about its destructive potential. If mothers had the power to shape the moral development of the Republic's children, then it was all the more crucial to ensure proper transmission of these values. Thus the social significance of the maternal body was double-edged, eliciting “anxieties over its power to deform, as well as romantic admiration for its power to restore, perfect, and harmonize nature” (p 81). Kukla argues that, beginning in the late 18th century, this double-edged belief led to the emergence of two “distinct imaginary mother figures”: the “Fetish Mother” and the “Unruly Mother” (p 81). These were not just symbols, she argues, but idealized bodies that shaped the way in which actual bodies were understood and judged. One celebrated the sentimental, while the other suggested the potential for monstrosity.

In the second half of her book, Kukla jumps to contemporary North American society, where she locates the extension of these idealized bodies. Indeed, her argument is that these Enlightenment-born figures “continue to exert a powerful and formative influence over the institutions surrounding motherhood and the practices and care of individual women” (p 81). Much of the current concern over pregnancy and nursing, including the recent breastfeeding campaign, can be traced back to late 18th-century philosophical and medical debates over maternal bodies, when childbirth and prenatal care first became medicalized. Today, it is not wet-nursing that is demonized, but bottle feeding. Questions over what is “natural” vs “unnatural” now focus on medical technology, such as ultrasounds and epidurals, rather than who is nursing an infant. Concerns about an unruly pregnant body—specifically, cravings or arousals—are no longer linked to a marking on the fetus (labeled “maternal imagination”) but are still present today, underscoring the permeability of the pregnant body. “The proper pregnant woman is still expected to cultivate rigorous self-discipline and to police her boundaries and appetites,” remarks Kukla, referring to this phenomenon as a “mass hysteria over the permeability of the mother's boundaries” (pp 106-107). From remarks of strangers to restaurant warnings to pregnancy guides, pregnant American women are urged to believe that anything they consume has a direct effect on the fetus. As with the breastfeeding controversy, Kukla is careful here not to suggest women should ignore medical advice. Instead, she proposes a more critical approach to our understanding of the social meanings behind pregnancy and breastfeeding. “We need to demystify the maternal body and the milk it produces and to undermine the mythologies of the maternal body's magical powers, both good and evil” (p 212).

For anyone who has gone through a pregnancy in Europe or North America, reading Kukla's analysis of the “What to Expect Pregnancy Universe” is fascinating. It is hard to escape the lure of the pregnancy Web site or manual that describes “what your baby looks like now” at every week, creating a sense of participation in a perceived shared norm. Similarly, the monthly drawings of “what you may look like” in What to Expect When You're Expecting led Kukla, and probably countless others (myself included) to examine herself in the mirror, comparing herself with the picture in order to determine whether she had the “proper look” for that particular month (p 125). The problem with this, as well as celebratory accounts of breastfeeding, is that it allows for little variation, instead affirming the concept of the “fetish mother.” The woman who does not look like the diagram, or who cannot breastfeed, or who simply does not enjoy breastfeeding, does not have a model from which to draw. Kukla suggests that contemporary reliance on this centuries-old dichotomy of fetish vs unruly mother continues to distort experiences today.

The title of this book is misleading (“hysteria” as a medical condition receives minor treatment here and its use as a metaphor can be confusing), and some historians might be uncomfortable with the jump from the 18th to the 21st century. Nevertheless, the story is a fascinating one, and Kukla's analysis is beautifully crafted.