‘Labour Does You’: Might thinking through pregnancy as work help us radicalise the politics of care?

How might re-conceptualising pregnancy as work—that is, alienated labour—help us radicalise the politics of care in trans-inclusive ways?

I’ve never known anyone to disagree with the old saying ‘it takes a village to raise a child.’ Yet this general approval of the distributed, collaborative character of the work of parenting does not frequently carry over—for some reason—to the question of making a baby. In my forthcoming book Full Surrogacy Now, I look at the gestational surrogacy industry politically and think speculatively about how to abolish actually-existing pregnancy (both waged and unwaged) as a form of capitalist work. I defend the utopian position that infants don’t belong to anybody but, rather, belong to everybody: they will belong only to themselves, in the phrase of the Sisterhood of Black Single Mothers. Nothing new, then: feminists and queers have mounted uncompromising assaults on the institution of the family for well over a century. However, wherever I’ve presented it, I’ve noticed that this call for family abolition, which I root in the Black-lesbian Marxist-feminist critique of kinship and the gender binary, appears rather contentious. It seems my proposition that the complicatedness of pregnancy itself might be a useful heuristic for complicating the politics of ‘care’ (and replacing kinship with comradeliness is, for some, a tough one to swallow. Why is this? Why, in other words, is a blog-post entitled ‘Gestators of all Genders, Unite!’ or the statement ‘The gender of gestating is ambiguous’ still guaranteed to scandalise not only Angela Nagle, but most cisgender feminists? These are some of the questions I want to persuade you it is important for anti-capitalists to pose.

Pregnancy is cyborg

First things first: some basic things about the biology of gestating remain widely unheard-of. Notably, many scientists nowadays emphasize the two-way character of human gestation. In particular, advances in understanding of the phenomenon called ‘microchimerism’ over the past decade have allowed social scientists to think philosophically about the ways in which foetuses ‘co-produce’ gestators at the genetic and epigenetic level. Essentially, during pregnancy, maternal anatomy becomes a “chimera” (hybrid), permanently infiltrated by foetal DNA. There is thus more of a biological basis than ever in which to ground feminists’ theorisations of gestation as a model of—variously—‘bodily generosity’, parasitism, identity plasticity or permeability, and welcome or unwelcome fusion. (For my part, I’ve called the relation ‘amniotechnics’.) Whatever the take, it seems indisputable that it is not simply a baby that is birthed during a birth, but rather, two asymmetric beings who are both survivors of their mutual manufacture.

In determining how best to capture this chimeric character of anthrogenesis (manufacture of human beings) in non-scientific language, many have intuitively opted for the impure, partial agent—what Donna Haraway has called the ‘cyborg’—over and against the powerful and pure mother-goddess archetype of ecofeminism. After all, “I would rather be a cyborg than a goddess”-the immortal closing lines of the ‘Cyborg Manifesto’ (1984)—had not only articulated but neatly resolved this choice. With its line of demarcation and clear anti-capitalist stance, the cyborg made clear that, while limitless co-imbrication may sound polymorphously sexy and exciting, we should never forget that—as in gestation—multispecies entanglements are often unpretty, unpleasant, and non-consensual. For, as decolonial indigenous critics of the more euphoric moments in “new materialism” have repeatedly and patiently reminded us: those who are already disempowered, dispossessed, colonised and marginalised are likely to view simply being ‘imbricated’ (without the mitigating help of boundaries, barricades and methods of maintaining sovereign space) as a state of unsupported, vulnerable exposure.

As I argued in ‘Cthulhu Plays No Role for Me’, the cyborg was and remains an account of a historically specific proletarian labourer, a subjectivity that is hybrid: colonised yet complicit, more-than-human yet corporeal, network-situated yet latently antagonistic (anti-racist, anti-colonial, abolitionist)—as are all gravediggers of capitalism. Neither pro- nor anti-natalist, neither pro- nor anti-maternal, the cyborg, alienated, works. She (not necessarily a ‘she’) makes and unmakes babies, identities, cities. Avowedly not innocent—that is, not even necessarily non-fascist—she is here, she is real, she is us, and she deserves a maximal liberation from capitalist work. Because of this foundational ambivalence, cyborgicity is, to my mind, far more conducive to spatial-historic thinking than any vitalist, pro-maternal figuration of the human as tragically divorced from (yet innately returnable to to) the web of life. Moreover, it is far more conducive to thinking uterine labour-power and uterine labour geographies in a unsentimental as well as anticapitalist way.

So, what I’ve elsewhere called cyborg uterine geography is just one way (one queer geographer’s way) of naming an approach to the work of gestating that would accept no grounds for siloing off such presently disparate-seeming issues as indigenous midwifery, surrogacy, underground abortion providers, co-parenting, gamete donation, DIY hysterectomies, mitochondrial transfers (a new technique yielding ‘three-parent babies’), shelters for queer homeless people, womb transplants, polymaternalism and ‘full-spectrum doulas’; instead gathering them together. Its starting-point would be, for me, the contention that ‘uterine’ relations are labour relations, historically contingent, scalar, and spatial. This includes not only abortion, miscarriage, menstruation and pregnancy, but also other life-enabling forms of holding and letting go that do not involve anatomical uteri, such as transgender mothering, end-of-life care, adoption, fostercare, and other practices that provide for births, better deaths, or survival.

A large part of what I am trying to convey here (and in Full Surrogacy Now) is the sense that we should be having more conversations about gestating, not gestating, refusing to gestate, ceasing to gestate, and gestating ‘otherwise’ (sharing, delegating, carefully distributing or automating gestation) all together in one breath. Desegregating these matters highlights sensitive but quite urgent political imperatives rarely addressed on the left, such as the imperative not to provision and care for certain relations, classes, and groups (to refuse to reproduce fascism, for example!). My point is that, if ‘care’ and ‘social reproduction’ are going to persist as the (newly re-popularised) terms available to us to describe this business of making/remaking/unmaking humankind, then they require a thoroughgoing deromanticisation. Social reproduction isn’t just good and nice. ‘Care’ isn’t just good and nice. Pregnancy, it turns out, is quite useful for driving this point home.

The problems of pregnancy-work

Maggie Nelson has described the endpoint of a successful pregnancy as an event that ‘runs you over like a truck’. If all goes well, she writes, ‘the baby will make it out alive, and so will you. Nonetheless, you will have touched death along the way. You will have realized that death will do you too, without fail and without mercy.’ Consequently, in The Argonauts, there are two survivors of pregnancy: Maggie and the baby. There is nevertheless but one, chimerical, internally agonistic, subject in pregnancy. The desire of the gestatee is of course to grow and be grown. But is this always the desire of the gestator? Of course not: about 50% of pregnancies are unintended. The job of the cervix, as such, is to override any disagreement: firstly, to stay the fuck shut, and thereafter, as Nelson reflects (since her delivery was vaginal) to “go to pieces”. Nelson recalls receiving sobering advice during her pregnancy that sums all of this up quite neatly: ‘You don’t do labor. Labor does you.’ It’s no joke. The moment of parturition ‘demands surrender’ and brings the pregnant person psychically to their knees.

Extrapolating from this traumatic moment—full-blown PTSD from childbirth is astoundingly widespread—Nelson hypothesises that there is a social necessity for humans to forget gestation. She notes compellingly, by way of evidence, that hegemonic narratives about pregnancy tend to subsume any and all suffering (the individual’s heroic means) under ends (the baby). As the wracked anonymity of a BBC article of December 2016 confirms—collecting testimonies from ‘Parents who regret having children’—most morally prescribed scripts gloss over postpartum trauma, and not only presume but (as Sara Ahmed puts it) demand happiness. Meanwhile, in commercial gestational surrogacy, as many people are now aware, clinics put in place an alternative script to ‘demand happiness’ of pregnant workers, postpartum. In these contexts, surrogates are enjoined to be happy (often in ghoulishly upbeat managerial tones) precisely because they will not be ‘having’ the children they have produced. You have helped give an infertile couple the gift of life! employees are often told, while they are handed the final installment of their wage. The baby was never yours, to begin with—you were just babysitting it for its real parents. You didn’t want another mouth to feed, did you?

A plethora of shop-floor disputes in surrogacy clinics over the past 5 years have made extremely clear that, even if you don’t miss the tiny body that used to be inside you, there is still plenty to not be happy about if you’re a commercial surrogate. Surrogates have been clear: payment-related abuses—deception, wage stealing, and money skimming—are rife in many Surrogacy™ locales. Adequate medical care for postpartum surrogates (certainly in India, Romania, Mexico, and Guatemala) is horrifyingly absent. Lack of informed consent appears depressingly endemic outside of the United States: workplace ethnographies from Bucharest to Bangalore have found that ‘most surrogates do not understand what surrogacy really entails.’ Often, multiple attempts are required to achieve implantation, while the long-term effects of the hefty hormone cocktails administered each time (in order to ‘synchronise’ the surrogate’s and egg-donor’s bodies) are unknown. At the end of the process, birth itself is typically taken entirely out of the worker’s hands. It is typically premature (eight months is standard), non-consultative, heavily sedated, rushed, invasive, long to recover from, and retroactively traumatic. C-sections, as such, conform to the inhumane temporal logic of logistics: shaving five weeks or so off production time, delivering the baby just-in-time for collection. The repercussions of this ‘choice’ in the workers’ lives are significant: they risk years of infection, pain, and scarring. What’s more, they become ‘locked’ into the method as employees. Vaginal births after a C-section are widely deemed medically risky. Conveniently, then, if one re-enrols successfully, a C-section it will have to be, once more.

Defending which pregnancy?

There is, in short, plenty to kick up a fight about. And the self-organisation of gestational surrogates ought by rights to garner widespread support since, on the left, there is a growing awareness that bioethically policed feminised work—such as babysitting and sex work—is work, and can be subject to strategic withdrawal (think of the motherhood, midwives’, or sex-workers’ strikes). It should not be surprising, especially given how many recruits to surrogacy are already-existing parents (almost all of them), that the concerns and demands raised in the industry have lots of resonance with those of proletarian parents and Reproductive Justice militants everywhere: better healthcare, better visitation, better pay, better childcare. Unfortunately, however, in the section of the British media dedicated to shrilly excoriating the existence of commercial gestational surrogacy (“Stop Surrogacy Now”!), these are not the forms of problem that tend to be highlighted. In fact, the regrets and interests of ‘normal’ survivors of gestation are thought of as having nothing to do, nothing in common, with the regrets and interests of these poor, abstractly violated surrogates.

In the new wave of antisurrogacy ‘RadFem’ activism spearheaded by figures like Kajsa Ekman, there is surprisingly little consideration of the fact that, when they campaign or mobilise around the world, surrogates themselves have repeatedly articulated demands as workers that are various, practical, and material. So extensive, in fact, are the overlaps between the ‘feminist’ anti-surrogacy lobbying formation and the anti-transgender and antiprostitution (or ‘antitrafficking’) camps—right down to their key players, funding sources and core arguments—that I’ve found it useful to coin the term “Surrogate-Exclusionary Radical Feminist” (SERF), to complement SWERF and TERF. The SERF message, in a nutshell, is an abstract moral story about surrogacy clinicians and commissioning parents jointly inflicting on women a form of spiritual devastation—womb trafficking’, ‘a twisted form of slavery’—that is, they are confident, qualitatively worse than that incurred in other widely available form of capitalist work. In the antisurrogacy imaginary, you see, the one thing the surrogates must want—more than anything, and despite what they themselves say—is the baby they gestated. The problem with the industry is purely symbolic and abstract: it is the idea that ‘natural bonds’ of parentage are being purposively broken, ‘women’ used as ‘vessels’, and ‘wombs farmed’.

Frankly, it’s weird when feminists speak like this in criticism of surrogacy, given the longstanding feminist tradition of criticism of the ‘biological’ nuclear family for exactly the things that are now, here, suddenly supposed to represent a unique evil in surrogacy: alienation; abuse; invisibilisation and exploitation of feminised labour. It is all the weirder when they do so in the ‘naturalising’ language that most forms of feminism have always excoriated as a way of extracting work from certain bodies and calling it ‘love’ (or maternal instinct). As I’ve suggested, though, the fact that media pundits are so prone to getting exercised about the putative unhappiness of paid surrogates reflects, more than anything, our collective unwillingness to confront our unhappiness in our own untenable and unjust (unpaid) gestational relations.

On the other hand, if things are already so miserable, how can I seriously be suggesting bashing social reproducers even more? Isn’t mothering—together with the desire to abstain from it —already structurally subject to a barrage of punitive coercion and policing? Yes, it is; yes, exactly. Critics of white-supremacist capitalist patriarchy absolutely need to trumpet that knowledge. Mothers (particularly mothers of colour) are very much not primarily culprits of systemic evils but rather, primarily, victims. Matrophobia (of various, racist, sometimes even queer-posturing, ilks) remains rife, including on the white left. Yet it is as mothers—following Black polymaternalists like Alexis Pauline Gumbs—that we must be ruthless in our critique of our mothering. Of course, as Kate Doyle-Griffiths and Jules Joanne Gleeson also succinctly put it: ‘A purely negative effort to destroy the family would simply result in starving infants.’ Yet we can’t keep excoriating ‘the family’ in theory while at the same time keeping it immune from criticism simply because it as a site of ‘care’.

I am convinced that there are unexplored or unwoven possible links between the idea that labour ‘does you without fail and without mercy’, and the Wages for Housework account of social reproduction under capitalism. Recall that in the eyes of the 1970s Italian militants, ‘every miscarriage is a workplace accident’. As a partisan (of sorts) of the Wages for Housework tradition, I’m trying, here, to suggest an experiment: what happens to this latter contention if we also take seriously the idea that, to an extent, ‘labour does you’? What can the gestational ‘workplace’ (the home, the surrogacy clinic) tell us about other workplaces? How could grappling with this non-individual, non-autonomous, not simply withdrawable, character of work, radicalise our politics around care?

Reducing the harms of uterine care

While the monopolising of womb-related matters by biological determinists and various either pro- or anti-natal mythologies provides some explanation for the relative dearth within contemporary left-feminism of theorising with the uterus as a site of doing, it does not really provide an excuse. Unlike almost all other animals, humans die because of their pregnancies every year in their hundreds of thousands, making a mockery of UN millennium goals to stop the carnage. It has long since been extensively established that many survivors of pregnancy suffer a range of health problems, including hyperemesis gravidarum, gestational diabetes and cholestasis. But why aren’t we talking about it? Normal human gestation is a site of considerable, species-exceptional violence.

Contrary to the fantasy of human maternal biology as idealised “generosity”, evolutionary biologist Suzanne Sadedin avers that pregnancy in our species (unlike most other species) essentially involves battling the foetus. Can refusal–can self-defence–be care? Unless aggressively contained, human placental cells “rampage” through every tissue they touch. Rather than simply interfacing through a filter or contenting itself with freely proffered secretions as other placentas do, the hemochorial placenta (with which humans, for now, are saddled) ‘digests’ its way into its host’s arteries, securing full access to all tissues. ‘Mammals whose placentae don’t breach the walls of the womb [in this way] can simply abort or reabsorb unwanted foetuses at any stage of pregnancy,’ Sadedin notes. For them, ‘life goes on almost as normal during pregnancy’. Conversely, a human cannot rip away a placenta (because they’ve changed their mind or, say, found themselves in a drought or warzone) without risk of fatal haemorrhage. The embryo has hugely enlarged and paralysed the arterial system while at the same time elevating (hormonally) blood pressure and sugar supply.

Sadedin’s interpretation unfortunately resonates with a misogynist narrative pinpointed by Emily Martin in The Woman in the Body, whereby, in medical textbooks, the foetus is ‘at risk’ in the hostile womb because it represents the binary ‘otherness’ of the father’s genetic difference from the mother. This narrative long underpinned notions of the foetus-as-subject which have, to date, been deployed exclusively to gestators’ detriment. (Fascinatingly, Sadedin’s account has also been taken up wrong-headedly by trans-hostile feminists with a wounded attachment to pregnancy, gloating that trans women who receive womb transplants will be devoured from the inside by ‘1,000 cancers’—whereas Sadedin’s point is that this is what happens to cis-female gestators.)

However, in my view, acknowledgement of the agonism of gestation does not have to lead to subjectification (or vilification) of the foetus. Rather, it tells us that the relationship between uterine activity and a ‘feminist care ethic’—indeed, the relationship between the uterus and feminism generally—is not best parsed through ‘generosity’. Rather, we should be thinking about comradeliness, and attenuating the harms of this work. What would happen to care politics if we supplanted our tendency to celebrate maternal generosity with a comradely harm-reduction framework? What politics of gestating-ness, gestated-ness, aborting and miscarrying might become imaginable if a wider range of ongoing social labours were felt to be ‘uterine’, and the uterine, conversely, were made seriously comparable to other labours?
A way of articulating gestational labour still needs to be found that both acknowledges its violence and does something feminist with that acknowledgment. Sadedin leaves to others the task of contemplating a possible affirmative politics informed by her claims. ‘How did we humans get so unlucky?’ is the scientific question for Sadedin. ‘What do we do about this?’ is a political question that could be taken up on the left.

There is a lot of boundary violation and reciprocal non-consensual use happening, and we are currently under-equipped to guess how much of it is inevitable, or decide how much of it is ‘acceptable’. We know that humans come into the world with astonishingly resource-intensive, brain-heavy bodies, expensive to manufacture and to maintain, so much so that giving us life is fatal to many other beings—even before one considers the disposabilities of race, class, and coloniality. We too seldom ‘stay’ with that trouble, instead organising babies as private property. Admittedly, holding one another is hard, and letting go is even harder. More widely under capitalism, there is a tendency among people—and the many entities that compose them—towards extractivism. But there is also, latently, a commune. The cyborg matter of uterine labour geography is all about drawing out this bloodstained and productive comradeliness; this other ‘care’ that involves a mutual holding and letting go, whether or not an actual uterus is involved.

All reproduction is assisted

I take The Argonauts to be part of a queer canon that takes for granted that all reproduction is assisted reproduction. The book’s title recalls the mythical Argo, a ship whose parts were all replaced, one by one. The ship is analogous (on Nelson’s terms) to any human being, the better word for which would in fact be ‘human becoming’: becoming and remaining yourself are substantially the same (collaborative) endeavour. Humans, in this view, are regenerative fictions; Nelson produces a sense of the self as a social relation, an encounter that can only be collective and emergent. In this case, a universalisable wisdom springs painfully and contingently from the experience of transsexual, gender-transitioning, and artificially fertilised pregnant bodies. Like other contemporary calls for reproductive freedom, voiced by trans or cis people alike, it frames itself as an anti-fascist insistence on the right to live well, and, thus, part of a fight that can also be channelled via direct actions seizing healthcare, user-directed research methods, and universal free access to (i.e. common ownership of) the ‘means of reproduction’.

I suspect ‘uterine’ politics may be one way of finding conceptual purchase on the contours of this reproductive freedom struggle. A ‘uterine’ conceptualisation of care and social reproduction—in which we become-human through each other, asymmetrically holding and letting go—should attend to the plethora of reasons why given bodies do not literally gestate, from contraceptives to lifestyle to not having a uterus, appreciating that the bearers of uteri all too often literally transmit life and/or help mediate death. These geographies must include such things as migrations of wet-nurses, surrogates, and au pairs, as well as the removal, recrafting, redistribution, and making-temporary of uteri through transplant technology.

Have radicals, in hesitating on the whole to map or theorise plain old uterine work despite (or as part of) their enthusiasm for mapping ‘new’ reproscapes, assumed that pregnancy itself is somehow repro-normative, trans-exclusionary? If so, as I’ve suggested, they have simultaneously tended to forget their criticisms of the normative nuclear family when parsing ‘reprotech’, implying that a special evil inheres in Surrogacy™’s unsettling (because marketised) departure from ‘normal’ reproduction. Meanwhile, childless, non-reproductive, or ‘found’ families (oddkin) are too often excluded from the topic of reproduction.

For Nelson, in contrast, pregnancy is a quintessentially cyborg phenomenon: ‘How can an experience so profoundly strange and wild and transformative also symbolise or enact the ultimate conformity? Or is this just another disqualification of anything tied too closely to the female animal from the privileged term (in this case, nonconformity, or radicality)?’ she wonders. To read Nelson’s question against the grain: the sheer hyperdetermination of the terrain can make it seem fatally difficult to venture any normative account of uterine activity without making constant reference to ‘women’ or speaking from that subject-position. Nonetheless, as today’s pioneers of trans reproductive justice amply demonstrate, it is possible. I would even venture to say that a non-gynocentric gestational politics has always existed in the cracks and underpassages of the prisonhouse of binary sex/gender.

A shared consequence of these various relocations of uterine matters beyond the borders of ‘womanhood’ is that ‘assisted reproduction’, as it is characterised today, ceases to be categorically separate from any other kinds of reproduction. All reproduction reveals itself as, in a sense, ‘surrogate’—for good and for bad. In other words: there are many things, relations, and ways to reproduce—including temporary and utopian insufficiencies, experiments, and absences. A normal, prosthesis-free family doesn’t exist.

Another ‘care’ (and social reproduction studies) is possible

We do not really want to see the violent side of care, the violent side of gestation. We are deeply attached to these processes: they’ve all we’ve got. They are the strangely undervalued and at the same time morally sacralised “contribution” of a disproportionately feminised and racialised humanity to the history of the world. But this in itself does not prove that they are good by default. Instead of endlessly demonstrating everything that (in the complete absence of proper recognition) keeps the world ticking over, the question we must get better at asking about social reproduction is: social reproduction of what? To what end? Alienated low-status carers and multigendered mothers are, unfortunately more often than not, complicit with and even instrumental in systemic violence. Too often, ‘care studies’ and ‘social reproduction’ scholarship merely draws attention to the unpaid love that glues everything together. A critical, anti-violent politicisation of these processes would need to radically transform (and not just revalue, ‘as is’) these domains.

Accordingly, we also need to strengthen our defence of non-nihilistic carers who are, biologically speaking, non-reproducers. In many circumstances, the act of the most oppressed —for instance, the enslaved—has been to refuse participation in uterine creativity altogether, through subversive and secret use of abortifacients, or by committing infanticide in response to circumstances they have judged unliveable. It is not (always) nihilistic to abort, to kill, to sabotage the production of life. ‘Only a collective, non-nihilistic non-reproduction of certain aspects of the status quo can ensure that we are thinking and acting according to the right scale,’ says Nina Power; ‘the trick is to work out what we can and cannot say no to, together.’

The horizon of procreative possibility has been greatly expanded in the last two decades: successful human uterus transplants have been undertaken since 2014; commercial surrogacy clinics routinely curate pregnancies involving no genetic link between gestator and gestated; neonatal machine-incubators are able to take over from the human body at 20 weeks’ gestation if necessary; and ectogenetic experiments (for fully disembodied gestation) continue, albeit without much progress. By showing us just how little these innovations actually innovate on ‘normal’ gestating, they apply strain to the naturalness of ‘unassisted’ reproduction. Ongoingly, then, one of the best places to grasp the weirdest more-than-human fundamentals of social reproduction is… just everyday pregnancy.

Maggie Nelson’s poetic account of labour ‘doing you’ proposed that, in crafting human life, we touch something we seemingly have to forget—the limits of our agency— along the way. But I want us to ask: what kind of care might emerge from gestators’ commitment not to forget that encounter with death? How might we generate conditions in which such not-forgetting is possible, and less scary, for instance, because the violence of gestating has been reduced to a minimum through a universalisation of healthcare and a communal redistribution of its burdens?

‘Care’ may or may not be an adequate name for what happens inside uteri; frankly, for my part, I’d say that—like a lot of care that takes place inside the family—it’s care all right, but it’s very bad. Like families, gestating wombs are often very harmful zones; harmful, in part because they are currently, for everyone involved, capitalist workplaces. So, what I’d like to know is: might uteri help expose the limits— and thus, better define the value— of the ‘care’ framework? Because, even if care is all we’ve got, that’s no reason to spare it from critique, or to believe it somehow doesn’t need thoroughgoing remediation, transformation, and automation. More than just ‘care’— any old care— we need to become fluent at good care, comradely care: a mode of social reproduction that, in itself, un-reproduces and destroys the present state of things.


Sophie Lewis (@reproutopia)

Sophie Lewis is a theorist living in Philadelphia whose book, Full Surrogacy Now, is coming out with Verso on May 7th 2019. She tweets as @lasophus and @reproutopia, edits at Blind Field journal and participates in the Out of the Woods anticapitalist ecological writing collective. She studied English at Oxford, and did a PhD in geography at Manchester University.