It is postulated by Lupton (1997a) that power, as it operates in the medical encounter, is a disciplinary power that provides guidelines about how patients should understand, regulate and experience their bodies. It may be considered that ‘the central strategies of disciplinary power are observation, examination, measurement and the comparison of individuals against an established norm, bringing them into a field of visibility’ (Lupton, 1997a, p.99). Power is also viewed as relational, and a strategy that is transmitted through all social groups (Lupton, 1997a). Lupton (1997a) argues that there is always a certain level of power that exists between a doctor and a patient, but that it is continually negotiated and dependent upon the interaction.
The notion of biopower, as developed by Foucault (1976, 1991, 2000), is important to the understanding of power. The medicalisation of the body (as defined later in Section 2.6) in a new power configuration was termed biopower by (Foucault, 1979). Biopower highlights an understanding of how bodies need to be regulated and maintained, in order to ensure that bodies are normal and conforming in society. Using Foucault’s notion of power, Ettorre (2008) describes how biopower aims for control over humans, as the social force producing and normalising bodies to serve relations of dominance and subordination in society. Bio-power is therefore a process that ensures embodied normativity, meaning that bodies therefore conform to normality, and is maintained in society.
This notion of biopower is important to our understanding of the consumption of alcohol during pregnancy. In her work looking at the use of drugs by women, Ettorre (2008) shows, biopower produces and normalises female bodies to serve prevailing gender relations. Female bodies are defined and shaped by their reproductive capacity, being seen as unstable, irrational and unpredictable. The concept of bio
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power represents a type of domination that makes the body politically docile and accepting of power and advice. Jones and Chandler (2007) argue that this notion informs our understanding of women’s bodies as contested centres locus of power. Foucault used the concept of ‘surveillance’ to characterise the process by which discourses define people’s understanding of the world and encourage them to conform to certain norms of behaviour (Davies and Allen, 2007). Surveillance denotes the process of exercising disciplinary power. Through their access to technical knowledge and the development of expertise, health professionals are able to shape the experience and behaviour of patients through this disciplinary power; however there is the potential to provoke resistance. Indeed, Davies and Allen (2007) consider this to be likely as non-professionals express their values and views of the world.
The intense focus on the pregnant woman’s body has produced an impetus towards self-regulatory behaviour; as a self-regulated citizen a pregnant woman is therefore expected to minimise the risks to which she is exposed (Lupton, 1999b). This is not surprising as pregnancy is becoming what Handwerker (1994, p.666) defines as ‘one of the most extensively documented medical conditions’. Women are therefore subject to a high level of expert surveillance and are expected to exert a continuing self-surveillance with ‘subtle pressure on women to conform to expectations’ (Lupton, 1999b, p.69). They are therefore expected to adhere to this self-surveillance voluntarily, and become autonomous, self-regulating citizens in order to maximise the chances of their foetus being in good health. Women are therefore expected to police their own behaviour, drawing on the arguments of Foucault, Lupton (1995) argues that the emphasis on self-regulation is evident in discourses on health and risk as there is increasing reliance on the individual for the self-responsibility for health. As Lupton (1999b, p.61) defines ‘risk discourse in relation to pregnancy can be linked to the apparatus of ‘biopolitics’ in neo-liberal societies, efforts on the part of the state and other agencies to discipline and normalize citizens, to render then docile and productive bodies’.
At the end of the twenty-first century the pregnant woman is surrounded by a complete network of discourses and practices directed at the surveillance and regulation of her body. No longer a single body, but one
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harbouring the potentiality of another human, the more obviously pregnant a woman becomes, the more she is rendered the subject of other’s appraisal and advice
(Lupton, 1999b, p.60) The work of Michael Foucault is highly relevant to the surveillance of women, through the concept of the medical gaze, a ‘way of seeing’ that provides a regulatory role over women by doctors. The ‘medical gaze’, ‘at once a perception but also an active mode of seeing’ represents ‘the process through which specific social objects, namely disease categories, come into existence and how more recent shifts can be seen as changes in the gaze’ (Armstrong, 1997, p.21). The ‘gaze’ is entwined with different notions and forms of power and is one of the functions which the medical profession use to enable social control (Davies and Allen, 2007). As Turner (1987, p.11) identified ‘the clinical gaze enabled men to assume considerable social power in defining reality and hence in identifying deviance and social order’. The deployment of the gaze is argued to be an integral part of power, viewing ‘the patient in this sense is no more than a container for the lesion’ (Armstrong, 1997, p.22). Lupton (1997b) argues that the human body is understood through the ‘clinical gaze’ exerted by medical practitioners but that the gaze is not about one group seeking domination over another group. This, however, is contested through the idea that the patient caught in the clinical gaze is a ‘docile body’. The concept of the ‘docile body’ infers that the patient caught in the clinical gaze is powerless and submissive, therefore giving the clinician immense power over the patient. The work of Braidotti (1994) uses the idea of Foucault in the discussion of the ‘scopic drive’ which is linked to both knowledge and control used to make the invisible, visible ‘the biomedical quest to make the unseen visible in the biotechnological world’ (Ettorre, 2002, p.5). The ‘scopic drive’ therefore is the process by which all is surveyed and pressed into normality or disciplined or ostracised.
As previously examined in Section 2.2.1, motherhood is a time when women experience heightened surveillance. The transition to motherhood is highly regulated and monitored but is also experienced as a very private and personal transition, which requires self-surveillance and personal policing of a self (Miller, 2005). Public health promotion valorises some groups whilst marginalizing others (Lupton, 1995)
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and highlights the appropriate ways of becoming a mother through shared assumptions and stereotypes. When examining power it is noted that there is often resistance to it. There is thus opposition to the ‘god-like powers’ (Phoenix et al., 1991, p.74) that the medical profession has. In this sense, control over bodies is therefore never complete, for example the choice of a woman to have a natural birth at home, without medical supervision would class as resistance to the power that expert’s hold and the expectation that labour should be conducted within a medical setting under medical observation and power. Consequently, as Foote and Frank (1999) expounded not only is power directed first and foremost towards the body but also resistance to it begins in the body. The ‘good’ mother ideology has led women to conduct self-surveillance, in order to ensure that they conduct motherhood in the correct manner but this is not to say that some women resist the surveillance and biopower placed on them.
Despite the power relations between the doctor and the patient Lupton and Fenwick (2001) recognise that power is not always repressive, it can also be productive creating forms of knowledge and self-empowerment. When women seek guidance and assurance there is therefore an increased engagement with the expert bodies of knowledge (Miller, 2005). Davies and Allen (2007) argue that the positive use of power through the surveillance of health professionals over bodies exists. This is often neglected as there is a tendency to:
Neglect examination of the ways that hegemonic medical discourses and practices are variously taken up, negotiated or transformed by members of the lay population in their quest to maximise their health status and avoid physical distress and pain
(Lupton, 1997b, p.97) The consequence is therefore that there is engagement with the expert knowledge of the professionals. Not all people challenge the power of the medical profession. Miller (2005) contends that women chose to engage with the medicalisation of motherhood by choosing to have their birth in the regulated environment of the hospital, under the care of doctors. Other health recommendations are also engaged with, for example as women choose to follow the guidelines for taking folic acid.
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Some women actively seek high degrees of professionalism and expertise to validate their mothering practices, or seek discourses from other sources such as books.