Kinh nghiệm của phụ nữ bị bỏ quên trong nghiên cứu về sinh nở và cho con bú

In the field of reproductive medicine, there is high awareness of the quality of breast milk, neonatal indicators and risk profiles. But 20 per cent of women in the province of Québec describe coercive pressure, non-consensual acts or pain ignored while breastfeeding or childbirth.

Doctors rarely take into account patients’ own understanding of their experiences, their anxiety or their ability to make decisions about their care. It’s time for medicine to treat these lived experiences as valuable evidence alongside other scientific considerations.

As a professor at the Université du Québec à Montréal and a researcher in community psychology, my work focuses on reducing social inequalities in health, on public policy in the perinatal field and on institutional reform to promote the well-being of families and professionals.

In collaboration with colleagues both at the university and in obstetrics, we recently conducted two empirical studies examining women’s experiences. Our findings show that medical practices in perinatal care, which aim to ensure the safety of mothers and children, are sometimes detrimental to their decision-making autonomy and mental health.

Two forms of knowledge

In reproductive health, medical decisions rely on different forms of scientific knowledge, although some are given more importance than others. Much of this research focuses on what the female body is expected to support, protect or optimize: fetal development, reproductive capacity and the management of risks during pregnancy and childbirth. Because these areas have received extensive research funding and clinical attention, they form the basis of most medical recommendations.

But other forms of knowledge focus on women themselves: their mental health, their ability to make decisions and their emotional experiences. Research in these areas does exist, but it is less extensive, less often used in medical decision-making and less frequently treated as a public health priority.

As a result, while there is abundant data on milk quality, newborn health indicators and medical risk, there is far less understanding of how women experience and navigate these recommendations.

The problem arises when these two forms of knowledge come into conflict. In such situations, knowledge that views women’s bodies as a means to other ends tends to prevail. Knowledge that focuses on women’s lived experiences and their decision-making autonomy is relegated to the background.

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Women’s freedom of choice

In a 2024 Québec study of 944 women, we sought to understand how breastfeeding incentive policies interacted with women’s choices. The results showed that, regardless of the choice to breastfeed and women’s attitudes towards breastfeeding, 20 per cent of respondents reported receiving messages that were judgmental, coercive, intrusive or out of step with their needs.

Some survey respondents described a complete lack of consideration for their mental health: “The message never takes the mother’s needs into account, whether physical or psychological.” Others described non-consensual actions, repeated pressure to continue breastfeeding despite of pain or a lack of information about alternatives: “They were hurting me and I wasn’t in any state to refuse.”

The study also shows that the difficulties women experience — pain, stress, anxiety, feelings of failure — are often downplayed or attributed to “a lack of effort.” And when women choose not to breastfeed exclusively, a significant number report receiving no support or facing negative judgments from medical staff.

In terms of breastfeeding — shaped institutionally by “baby-friendly initiative” hospitals (my emphasis) — the focus is largely placed on benefits for the child, such as immunity, infection prevention and long-term health outcomes. These priorities strongly influence international recommendations..

By comparison, research into the psychological and social consequences of policies that promote breastfeeding is far less visible in policy-making circles. Yet this research does exist and documents links between pressure, guilt, lack of consent and emotional distress, including anxiety, loss of confidence and feelings of maternal failure.

Both bodies of research originate from the same scientific fields. Yet in clinical practice, knowledge centred on the child’s needs takes precedence, while anything related to mothers’ mental health, limitations and capacity to act (choosing whether to breastfeed) remains marginal.

On the sidelines of their own childbirth

Research on obstetric violence — abuse or mistreatment during labour and birth — offers another particularly illuminating avenue for observing these tensions between different forms of knowledge. In a recent study conducted in Québec of 271 women who had given birth in the previous two years, we documented the forms this violence can take, as well as its emotional consequences.

Three main types of experience stand out: unsupportive interactions with health-care professionals, a lack of consent for certain medical procedures and organizational failings in the delivery of services. More broadly, 78 per cent of participants reported having experienced at least one unpleasant incident during their childbirth, often linked to the way in which care was provided or imposed.

These practices are rarely described as violence. Rather, they are part of a culture of standardized protocols and safety: speeding up labour, preventing complications and optimizing perinatal outcomes. In other words, they are based on a body of biomedical knowledge centred on the management of obstetric risk and protection of the fetus.

À lire aussi: Obstetric violence: abuse during childbirth is widespread, but the first step to fighting it is naming it

But when we examine their effects from the women’s perspective, a different understanding emerges. Participants describe a sense of powerlessness, humiliation and being stripped of ownership of their birth experience, with some going so far as to say they felt “like a laboratory experiment.” Pain was downplayed, procedures were carried out without consent, or birth plans were ignored, illustrating a recurring disregard for women’s own bodily autonomy.

Here again, two bodies of knowledge coexist: one that’s centred on obstetric safety, the other on women’s psychological well-being and decision-making autonomy. And when these frameworks come into conflict, it’s most often biomedical imperatives that shape the decision. The emotional and subjective consequences of these practices are relegated to the background.

Lived experiences

These two studies show that people whose bodies are treated as objects do not lack information or the ability to think critically about their experiences. What is missing is recognition of the value of their knowledge.

When insights drawn from lived experience, mental health or personal circumstances conflict with biomedical priorities focused on bodily functions — such as carrying a child, giving birth, breastfeeding or preserving fertility — biomedical knowledge almost always takes precedence.

That’s why it is important to recognize that scientific evidence is never neutral: it is produced, selected and interpreted within a particular set of values and assumptions. When the body is viewed mainly through its reproductive functions, the knowledge tied to those functions tends to dominate medical decision-making.

Questioning this hierarchy means expanding the framework used to make those decisions. It requires considering medical practices not only for their biomedical outcomes, but also for their effects on patients’ lived experiences, mental health and ability to make informed choices.

This article is based on findings from a collaborative research program with Cécile Delawarde-Saïas, Coralie Mercerat, Julie Poissant and Eloïse St-Denis. Eloïse Lara Desrochers and Julie Zaky contributed to this analysis.

Thomas Saïas ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d’une organisation qui pourrait tirer profit de cet article, et n’a déclaré aucune autre affiliation que son organisme de recherche.