Feminist Epistemology and American Pragmatism: Dewey and Quine (review)

Alexandra Shuford's book is primarily designed to address the following question: "What can Deweyan pragmatism contribute to a feminist empiricist epistemology?" (viii). Her answer is Dewey's conception of habit, and in her final chapter, she illustrates the utility of this conception by comparing what she labels the "medicalized" model of labor and birth to that employed by practitioners of midwifery. Before looking at Shuford's reading of this contrast more closely, however, it needs to be noted at the outset that she also regards her constructive project to be one of "augmenting" or "extending" the efforts of Lynn Hankinson Nelson to formulate a feminist empiricism derived from Quine's naturalized epistemology. I point this out both because Shuford makes explicit use of Nelson's analysis in her account of the differences between the two approaches to birthing and because much of her book is a sustained examination and criticism of not only Nelson's but also Louise Antony's attempts to appropriate Quine's insights for feminist ends.

To my mind, there are tensions between Shuford's critical examination and her constructive project, not the least of which is that too much of her book is engaged in the former. (This imbalance is typified in her chapter on Antony. While provocative, especially in its charge that Antony's appeal to "truth-conductivity" is inimical to central commitments of Quinean empiricism, its inclusion detracts from Shuford's main argument.) I will return briefly to other reservations about her critical examination at the end of this review. Since I regard her last chapter to be the strongest of her book, however, I propose to spend the bulk of my review in an exploration of it.

Shuford focuses upon childbirth because it shows how "differences in respective cultural values and worldviews about what constitutes normal birth shape the embodied habits of each community member" (141). In this way, she aims to "combine" (81) Nelson's insight that the values operative in a scientific community are epistemically relevant with Dewey's definition of habit as the "link [between] the biological organism and the cultural environment" (108). Her chapter is thus replete with (often disturbing) illustrations of how mainstream obstetrics, with its focus upon "the pathological potential of pregnancy and birth" (120), engages in practices that promote "the active management of labor" (123). This can be seen, for example, in the now (almost) universal use of electronic fetal monitoring (EFM) during labor. As Shuford argues, current widespread use of EFM is troubling. This is not simply because false alarms of fetal distress can result in unnecessary Cesarean surgeries. It is also because its use both directly informs the behavior of birth attendants (who now spend more time staring at a central computerized monitor than in direct examination of the laboring woman) and can harm the mother and fetus: "Physically tethered to a machine, a woman cannot get up and move around. This inability to change position, to squat, to walk, to kneel, to use a birthing stool, a bathing tub, or ball may actually prolong labor and reduce oxygenation levels in the mother's blood resulting in fetal hypoxia" (128). The difference in the employment of "diagnostic touch, physically supportive touch, and comfort touch" (129) definitive of midwifery is dramatic and, more important, gives concrete evidence of its contrasting commitments to an understanding of pregnancy and birth as "normal life events" with the correlative insistence that "a woman [should be able to] deliver her baby with noninvasive supportive assistance tailored as closely and specifically to her needs as possible" (129).

Shuford's demonstration that a conception of labor as a "problem" to be "managed" transforms labor into an experience that requires obstetrical intervention and supervision makes compelling her claim that a feminist pragmatist epistemology must "include the ways in which our experiences of being embodied creatures are reciprocally informed by theories and values, and how these experiences contribute to epistemology and...