Source: French to English Tester Published on: 2026-04-21
Source: The Conversation – in French– By Thomas Delawarde-Saïas, Professor of Psychology, Université du Québec à Montréal (UQAM)
Reproductive medicine is very familiar with the quality of breast milk, neonatal indicators, and risk curves. However, when 20% of Quebec women report coercive pressures, non-consensual actions, or ignored pain during breastfeeding or childbirth, this knowledge—about their experiences, their anxiety, their decisional autonomy—counts almost not at all in the medical decision. Perhaps it is time for medicine to fully integrate their experience as a legitimate scientific criterion.
Professor at UQAM and researcher in community psychology, my work focuses on reducing social health inequalities, public policies in perinatal care, and the transformation of institutions to serve the well-being of families and professionals. Together with my academic colleagues and those working in obstetrics, we recently conducted two empirical studies examining women’s experiences. Our results show that medical practices in perinatal care, although aimed at the safety of mothers and children, can sometimes come at the expense of their decisional autonomy and mental health.
Two forms of knowledge
In reproductive health, medical decisions are based on various scientific knowledge, which do not all have the same value. This knowledge notably describes what the female body should allow, preserve, or optimize: the development of the child, the continuity and quality of reproduction, the management of obstetric risk. This knowledge, extensively studied, measured, and funded, forms the core of clinical recommendations.
Other sources of knowledge, however, focus on the women themselves: their mental health, their decision-making capacity, and their emotional experiences. These studies do exist – but they are fewer in number, less frequently utilized in decision-making frameworks, and more rarely established as a public health priority. Thus, there is considerable information on milk quality, neonatal indicators, or risk curves, but data on what women experience when they have to cope with these recommendations is much more fragmented.
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The problem arises when these two forms of knowledge come into conflict. In such situations, those who consider women’s bodies as a means serving other purposes tend to prevail, relegating to the background those focused on their lived experience and decisional autonomy.
What place do mothers have in breastfeeding?
In astudy conducted in 2024In Quebec, with 944 women, we wanted 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% of people reported having received judgmental, coercive, intrusive, or mismatched messages with their needs.
Some express a total lack of consideration for their mental health: “The message never takes into account the mother’s needs, physical or psychological.” Others describe non-consensual acts, repeated pressures to continue despite the pain, or the absence of information about alternatives: “They hurt me and I was not in a state to refuse.”
The study also shows that the difficulties experienced – pain, stress, anxiety, feelings of failure – are often minimized or attributed to “a lack of effort.” And when women choose not to exclusively breastfeed, a significant number report having received no support, or even having faced negative judgments from medical professionals.
In the field of breastfeeding, institutionally structured by the “Baby-Friendly Hospital Initiative”babies” (I emphasize), the considerations on the benefits for the child – immunity, infection prevention, long-term effects – occupy a central place and largely guide theinternational recommendations.
In comparison, research on the psychological and social consequences of policies encouraging breastfeeding for women is much less visible in decision-making frameworks. However, thesework existsand document links between normative pressure, guilt, lack of consent, and emotional distress, including anxiety, loss of confidence, and feelings of maternal failure.
The two corpora come from the same scientific fields. But in clinical practice, knowledge focused on the child’s needs prevails, while those concerning mental health, the limits and the capacity of mothers to act (choosing to breastfeed or not) remain peripheral.
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On the sidelines of her own childbirth
The work on obstetric violence offers another particularly revealing ground for observing these tensions between knowledges. In arecent researchConducted in Quebec with 271 people who gave birth in the last two years, we documented the forms that these violences can take as well as their emotional consequences.
Three main types of experiences stand out: unsupportive interactions with professionals, lack of consent for certain medical procedures, and organizational failures in the services. More broadly, 78% of participants report having experienced at least one unpleasant event during their childbirth, often related to the way the care was performed or imposed.
These practices are rarely called violence. They are rather part of a logic of protocolization and safety: speeding up work, preventing complications, optimizing perinatal outcomes. In other words, they rely on abiomedical knowledge corpusfocused on the management of obstetric risk and the protection of the fetus.
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Here is how to recognize and prevent obstetric and gynecological violence
But when their effects are examined from the women’s point of view, another knowledge emerges. The participants describe feelings of powerlessness, humiliation, and dispossession of their childbirth, with some even saying they felt “like a laboratory experiment.” The minimized pain, actions performed without consent, or ignored birth plans illustrate a recurring disqualification of their own bodily expertise.
Here again, two knowledge frameworks coexist: one centered on obstetric safety, the other on the psychological integrity and decision-making autonomy of women. And when these frameworks come into conflict, it is most often the biomedical imperatives that shape the decision, relegating the emotional and subjective consequences of the practices to the background.
Reconciling biomedical issues and the lived experience
These two studies show that people whose bodies are objectified are not lacking in information or reflective capacity. What is missing is the value given to their knowledge. When knowledge derived from their lived experience, mental health, or life trajectory conflicts with biomedical knowledge focused on body function (carrying, giving birth, nourishing, preserving the ability to procreate), it is almost always the latter that prevail.
It is essential in this regard to recognize that scientific evidence is always produced, selected, and interpreted within a normative framework. When the body is primarily considered through its reproductive functions, the corresponding knowledge tends to structure decisions.
Questioning this hierarchy means broadening the framework in which it is mobilized. This involves considering the effects of medical practices not only in terms of biomedical outcomes, but also in terms of lived experience, mental health, and decision-making capacity.
The author here reports results produced within the framework of collaborative research programming with Cécile Delawarde-Saïas, Coralie Mercerat, Julie Poissant, and Eloïse St-Denis.
The author thanks Eloïse Lara Desrochers and Julie Zaky for their proofreading of this article and their critical comments which improved its quality.
Thomas Delawarde-Saïas does not work for, advise, own shares in, or receive funds from any organization that could benefit from this article, and has declared no other affiliation than his research organization.
–ref. Women, the forgotten in science on childbirth and breastfeeding –https://theconversation.com/women-the-forgotten-in-science-on-childbirth-and-breastfeeding-270337