Black Women Giving Birth in Prison Face Surveillance Disguised as Medical Care

It is no hidden fact that the history and etymology of the term hysteria is rooted in the gendered body. Hysteria stems from the Latin word for womb, “matrix.” In this context, the word “mother” was directly (and simply) interchangeable with the term “womb.” Husteria in Greek also derives its meaning from husteriko, “of the womb,” and from husteria, “uterus.” Hysteria, as “the suffocation of the womb” or “the wandering womb,” was considered a “female” malady that was associated with demonic possession and maternal fits (of course, erroneously conflating the category of “woman” with certain biological and anatomical traits).

When the construction and perception of “illness” runs along gendered lines, what becomes unequivocally lost is how the same social construction enables other identities of difference. It is in this vein that the dissemblance of institutional mechanisms of repression and control are all the more exacting in targeting those whose identity as women (and also those who are perceived or labeled as women) involves the extraordinary policing and surveillance of their desires — and in turn, the meaning of policing to include the desire to contain ways of being through a particular state.

There has been more public attention to the forced sterilization and reinforcement of shackling laws in recent months, which predominantly target Black women in prison. What is a shackle? A shackle is any type of constraint that limits the freedom of movement. In birthing processes, they are most commonly used around the wrists, ankles, arms and midsection. Shackles disallow freedom of movement and necessitate increased supervision. The increased “supervision” increases the risk of danger to the fetus or birthing person. The risk to the fetus is not only due to how shackling restrains movement; rather, the demand for the birthing person to be shackled presumes the coinciding supposition for surveillance, which keeps in place the laws of restraint, the psychic and symbolic enforcement that condemns the future child to a type of captivity even before they move into the passage of the physical “world.”

In this sense, we can scale shackling inside and outside the prison-industrial complex to cut across the ways that surveillance techniques are used to monitor the (imagined) racialized violent and uninhibited body. The restraining device paradoxically increases the need for surveillance as it simultaneously reinforces its own demand, its own wish to presume that there is the so-called violent female body to hold captive and restrain, a facsimile of the demonic and hysterical womb. In today’s birthing room, there is an identifiable technology that disallows free movement and that hinges on the replacement of caregiving with surveillance: the use of the midsection shackle. The midsection shackle, or restraint, materially restricts birthing bodies, and its use can be understood as a response to the racial anxieties of Black birthing bodies. The midsection shackle limits the movement of the woman giving birth, but also as a consequence forces the body into a position in which their movement as a whole and their body including the uterus must be monitored. The surveillance, which is guised as choice, operates under the auspices of providing safety at the behest of providing hands-on birth care. It also keeps the body in the bed and on the back, which has proven to prolong labor. In short, the midsection restraint is one of the many technologies of the contemporary birth scene that appears to give birthing people “choice” (while, in fact, they are left with no options but to have a guard standing over them during the birthing process), but is also intertwined with questions of access, racial capitalism and disciplining the body for surveillance.

These stories speak to the ways that the history of racial medical violence perpetuates the punishment of Black mothers and the separation of Black families as an objective of the state — a paradigm of anti-Black violence, socio-corporeal control, and repression all targeting and taking place at the level of the Black female body. Scholars across the fields of African American and Black Studies (such as Joy James and Judith Weisenfeld, to name a few) have already taken up this argument in their respective works, and have illustrated how carceral structures of the prison and the clinic — and their intersections without an analysis of race and gender together — fail to broach, let alone address, questions of political freedom and liberation.

Extending these critiques, we raise the question: What if the history of the sex-selective disorder of hysteria was read through (and not alongside) the history of slavery and colonialism? What if the separation of Black families and forced reproduction for Black mothers via sexual violence undercut the possibilities of carceral structures and institutional meaning-making? Jared Sexton’s provocations on the unbearability of blackness, in and against the relation of reproductive possibility, might provide a way to think about how “the analogy of the fetus and the slave recasts the womb as a slave estate and the state of fetal development as a condition of servitude or, better, a state of captivity.”

The present-day policing and punishment of Black mothers might then be the example par excellence in which the desire for capture, captivity and containment undercut by anti-Blackness throws new light onto that matrix of the Mother, the womb, as it interfaces with notions of psychological disorder and demonic possession. Since 1980, hysteria has not been considered an official illness according to the Diagnostic and Statistical Manual of Mental Disorders, but despite its reconsideration as a classifiable disorder, these characterizations continue to imbue racialized gendered subjects.

One such resonance is in the medicalized system of labor and childbirth. Hysteria is a precursor to the manufactured medical “crisis” known as childbirth, which must be medicalized and intervened upon, and in relation to which Black women must be protected from their “unpredictable” bodies. During the mid-20th century, multiple medical, professional and cultural factors contributed to the medicalization of birth within the hospital and with the aid of a (white, male) obstetrician. Traditionally, the pain and risks of childbirth were related to the biblical story of Adam and Eve. Eve’s “curse” justified the pain caused as a rite of passage from womanhood to motherhood. A woman’s ability to withstand the pain, thus, became the mark of her entry into becoming a mother.

In the modernization of institutionalized medical “care,” Eve’s curse could soon be mediated by the sophistication of anesthesia. The concurrent unregulated use of anesthesia provided an easy pain and surveillance technique for many hospitals that were looking to cure women of their biblical labor pains. It also allowed them to monitor birth without actually supporting laboring women. Such births have been referred to as “twilight sleep,” named for the unconscious state achieved when a combination of morphine and scopolamine (which is now a primary ingredient in “date-r*pe” drugs) was administered. Twilight sleep resulted in the birthing of the child while the mother lay unconscious. Mothers then awoke to no memory of the process. Many twilight sleep births resulted in psychotic episodes that included violence, thrashing and prolonged disorientation. Shackling women to their hospital beds was common practice during twilight sleep, although many of those who gave birth would not remember being shackled. Today, the historical use of anesthesia and restraint against perceived violence leaves women prone to surveillance with little attentive care from their health care providers.

A historiography of the privatization and medicalization of birth can be found in the robust work of many medical historians and sociologists including Alicia Bonaparte and Dorothy Roberts. However, there is a surviving culture that typecasts hysteria among women, and especially Black women. One impact of this typecasting is the unnecessary medical surveillance of Black women giving birth, which betrays a coinciding racialized anxiety. This anxiety is the result of a distrust of Black women’s bodies and of the myth that Black women are prone to enacting violence, particularly during birth.

Although research is plentiful in disrupting tropes and narratives about birth as a medical crisis that causes violence, contemporary surveillance and monitoring techniques are often justified because of the abysmal rates of Black infant and maternal death in the United States. Paradoxically, Black women did not experience such rates of infant and maternal death until the demonization and, at times, outlawing of home midwifery care in the mid-20th century. In this sense, the hospital is the scene of carcerality and surveillance both inside and outside the prison. Put otherwise, the gendered racial anxieties that abound in relation to Black women giving birth signal that the clinic is not separate from the prison. While the scene of carcerality might appear multiple, we see instead how the indistinction between the two is simultaneously conditioned by and facilitates the gendered sexual anti-Blackness that underscores the overlap of medical and carceral institutions, in which policing and punishment are justified as medical practices and vice versa. This indistinction enables the convergence of carceral technologies, such as the shackle and midsection fetal monitor used during labor and birth to “closely monitor” Black women and their fetuses. This is a carceral cycle that punishes Black mothers: one is shackled before and beyond chains — physically, techno-virtually, medically and psychically. Moreover, these monitoring techniques replicate the use of restraint and control for the benefit of surveillance, not care.

Although it has been reported that nearly 12,000 pregnant women are incarcerated on a yearly basis, there is no government agency that keeps track of these statistics. To analyze any dimension of mass incarceration is inherently to analyze Blackness and anti-Blackness. Given the disproportionate number of Black women in jail and in prison at present, the distrust of bodies to carry children to full term and labor and birth safely arises at the intersection of the historically gratuitous hyper-violence enacted upon Black women’s bodies and then the fear of the gendered racial stereotype of the “enraged” birthing Black woman. Shackling practices exist in a similar apex in which Black birthing bodies are racialized as an endangerment to others while simultaneously “vulnerable” to birth-related death and ailments and prone to medical mistreatment. While the use of restraint or shackles is a problem for any birthing person, the shackling of Black birthing people has a specific cultural history related to forced gynecological experimentation and the lasting material vestiges of chattel slavery. We may then see the use of restraint both as a manifestation of anxiety about the entire parturient period, the birthing body, and the postpartum period and as a demonstration of a particular desire to control Black women’s reproductive choices and the reproductive futures of their children within the purview of physical carcerality.

Black women’s bodies face a specific violence rooted in institutional manifestations of mental and physical pathologization. The re-staging of the clinic, which occurs in an attempt to control the “hysterical” body, is reiterated through the deeply racialized, ongoing crisis of the over-incarceration of Black people. The merciless technologies of control acted upon Black people’s lives while pregnant and incarcerated warn us of the continued stakes of interpreting mental, emotional and physical responses to carcerality as further necessitated by the theft of body sovereignty. Such thefts must be resisted in policy and practice. As writer and culture worker Toni Cade Bambara teaches us, “If your house ain’t in order, you ain’t in order. It is so much easier to be out there than right here. The revolution ain’t out there. Yet. But it is here.”

Whether it be the clinic, the hospital birth room, the prison hospital birth room, or the cell, the pathologization of Black pregnant bodies may appear to be “out there.” Unfortunately, the dehumanizing practices of surveillance we believe to also be “out there” are already “at home” for many Black people who are pregnant.