Breasts, Wombs, and the Body Politic

Although studies indicate no significant medical benefits from routine ultrasounds during pregnancy, ultrasound screening has become a standard component of obstetrical care and is regularly covered by health insurance plans. Why is that? And what has it got to do with "natural" childbirth and the government's "Babies were born to be breastfed" advertising campaign? In Mass Hysteria: Medicine, Culture, and Mothers' Bodies, Rebecca Kukla argues that about two and a half centuries ago, Enlightenment ideology, modern science, and the rise of the nation-state produced a profound change that persists to this day in the cultural meanings assigned to maternal bodies: they were transformed "from private, almost furtive matters into vivid centers of public management, surveillance, celebration, approbation, and regulation" (p. 53). As a result, fetal images are everywhere, childbirth is supposed to be forceps-free, and breastfeeding is touted as the only safe way to nourish one's infant.

Kukla begins her tale in the seventeenth century, when tracts and medical texts explicitly addressed to women offered advice on pregnancy and birth in almost total ignorance of female anatomy. In this era, direct physical examinations of women by male physicians constituted an assault on modesty and privacy, so the interior of the gestating body was poorly understood. The expectant mother's frights, cravings, and sexual arousals were thought to mark her fetus; but while a monstrous birth was a testimony to the mother's bad character, the maternal vice or weakness that a defective baby might reveal was treated fundamentally as a private matter, of no particular social or civic significance.

In the late eighteenth century a dramatic reversal took place as maternal bodies became public, both culturally and medically. Kukla attributes the cultural shift directly to the popularity of Jean-Jacques Rousseau's political thought. Rousseau, contemptuous of those who attempted to trace the authority of human laws back to some sort of given natural law, argued that human beings must be liberated from the tyranny of mere found nature by fostering their second natures. Doing so would help them freely choose sociable principles that would unite them into a public body. Mothers were to bring about this radical piece of social engineering in practice. On Rousseau's view, not only were mothers' bodies responsible for the material production of their children's first natures, but also, once the children were born, mothers' caregiving shaped the habits, sentiments, and bodily constitution that made up their second natures.

Breastfeeding was an integral part of this agenda for molding the citizens of a free republic. Rousseau wrote: "The newly born infant, upon first opening his eyes, must gaze upon the fatherland, and until his dying day should behold nothing else. Your true republican is a man who imbibed the love of the fatherland, which is to say love of the laws and of liberty, with his mother's milk" (quoted on p. 43). France took this injunction literally. Just before the Revolution, fewer than 5 percent of Parisian babies were nursed by their mothers, but by 1801, a full 51 percent of Parisian mothers breastfed their children. Images of lactating, bare-breasted women could be seen everywhere—on monuments, fountains, and state-sponsored art—and by 1850 the bare-breasted Marianne was a well-entrenched symbol of la Patrie.

As their gestational and nurturing activities came to play a crucial role in the well-being of the state, however, mothers were subjected to increasing levels of public scrutiny. Marianne, after all, was only an ideal of motherhood, while an actual mother was likely to be "a volatile, fragile, contingent, appetitive being, with little resistance against temptation, craving, and the extremities of passion" (p. 83); she therefore stood in need of continual supervision.

The management of what Kukla calls the Unruly Mother was largely given over to doctors. By the late eighteenth century, dissections of gravid bodies at different stages of pregnancy had laid the uterus and its contents open to view, and the direct examination of pregnant women became accepted medical practice. Once the inside of the maternal body became external and visible, mothers could be policed, disciplined, and monitored...