By Dr. Leila El-Alti

What is the first image or scenario that comes to mind when childbirth is mentioned?

Suppose we were to survey random people and ask them this question. It is likely that those who haven’t had direct experience with birth, professionally or through giving birth themselves, will have similar answers involving some or all aspects of the following scenario: A woman lying in a bed, perhaps in a hospital room, legs spread, screaming in pain, one or more people emphatically tell her to PUSH, a baby cries, the woman looks happy.

One can say that this scenario is perhaps recognizable to many of us simply because in our minds this is how birth actually takes place. After all, labor and birth are notoriously painful, and people tend to scream when experiencing high levels of pain. Birthing a human baby also requires a lot of physical effort and women often have to actively push the babies out of their bodies. It is understandable that others will want to encourage the woman to push. Human babies cry when they’re born because they need to breathe, so this is also to be expected. And over the last decades, it has become the norm for women to give birth in a hospital, making it more likely that we imagine hospitals to be a typical birth setting, etc.

This might seem to sufficiently explain the scenario’s familiarity to us, especially considering that at least some births indeed look like what the scenario describes. However, this fails to explain why these specific details are so commonly associated with birth. The images and narrative within the above scenario aren’t really familiar because they are accurate depictions of birth events, experiences, or outcomes. Rather, they are consistent with prevalent images or clips of birth we’ve been exposed to through pop culture, books, media, art, literature, or social media. Simply put, it is a stereotypical portrayal of childbirth: simplistic, based on a predefined outsider perspective, excluding the woman’s own experience and narrative, and built on expectations of certain events and outcomes.

Yet, birth is one of the most complex of human experiences and life events, as it carries significance for most, if not all, aspects of a person’s life. Due to both its complexity and significance, there are countless factors which determine how birth eventually ends up taking place for each woman, how it is experienced in the first person, and how it is later integrated into her life narrative; making it extremely unlikely that any two births are ever the same, even for the same woman.

Broad factors include the woman herself, her pregnancy, her pregnancy history, individuality of her current baby, medical history, genetics, epigenetics, mental state, mental health history, ethnicity, values, preferences, feelings, her perspective(s) on birth, birth events and her response to them, past and current support structures, her partner, individual anatomy, family dynamics, education, previous trauma, work or career, cultural background, spiritual or religious beliefs, socioeconomic background, sexuality, spoken language(s), birth setting, timings of her pregnancy and birth, interventions needed or desired, current or past subjective experience(s) of birth, birth complications, possible or actual (mis)match between her expectations and reality, different outcomes for herself and her baby, the birth attendants, healthcare system, and multiple other contextual factors.

One can note that within each of the aforementioned factors, there also exists a myriad of variability as well as very complex interactions between these variables. This implies that it’s simply unreasonable to expect that one birth scenario or story can ever be representative of the labyrinthine possibilities of human birth. One might be inclined to question whether it is even possible to have accurate representation of birth at all. And perhaps it is not possible. But would that also imply that stereotypes about birth are inevitable?

Why is this important? Are stereotypes problematic?

The short answer is yes. The long answer is also yes, but with a pinch of philosophy.

Representations are descriptive of things, actions, events, people, or phenomena. This description is accurate when it is able to capture a certain reality well, and is incorrect when it is erroneous, imprecise, simplistic, exclusionary, misleading, or any combination of those. What is important to highlight here is that representations are a powerful tool. When they are truthful and accurate, they help shape our understanding of the world, our compassion towards others, and how we address problems. When they are unintentionally biased or intentionally weaponized, they distort the reality of certain contexts and contribute to censorship, divisive discourse, and even oppression.

This is not to say that all possible variations of a certain reality have to be comprehensively listed to ensure accuracy. An accurate representation simply provides a fair and truthful description free from bias, distortion, exaggeration, or oversimplification. Therefore, a representation is inaccurate if it omits or falsifies particular aspects of the reality it describes, whether intentionally or otherwise. The tone of the representation also matters. For instance, if a particular scenario is repeatedly represented in association with negative sentiments or outcomes, it tends to skew how we perceive something or what we believe about it. An example many of us are familiar with is the selective or exclusive representation of a particular group of people in the media or pop culture in relation to crime, or vice versa, i.e., presenting certain negative acts in relation to selected characteristics of particular groups. I’ll leave it up to the reader to connect the dots here. 

When a representation is consistently presented to us incorrectly, stereotypes start to take shape in our minds. In other words, a representation becomes stereotypical when it fails to correctly portray whatever it’s aiming to represent and when this lack of correctness happens to be routinely recurring. Stereotypes aren’t only limited in terms of representation accuracy, but they are also limiting to our understanding of a certain reality. Because they reduce complexity and variability of a subject to a simplistic and fixed depiction, stereotypes are less likely to be scrutinized as they blur the boundary between the descriptive (is statements) and the normative (should statements). Allow me to explain.

Descriptive statements are factual claims that describe what is. Examples include: “My car is blue”, “Earth has one moon”, and “In 2024, the average life expectancy in the European Union was 81.7 years[1]”. Normative statements, on the other hand, involve the oughts and shoulds of actions. They are necessary to navigate the world of morality because they set the rules regarding what’s right and wrong, or what’s good and bad. This provides guidance on what we may or may not do in different situations. Examples include: “It is wrong to lie”, “Being kind is good”, and “Employers should treat their employees fairly”. In a nutshell, descriptive describes while normative prescribes.

But there’s a catch.

While normative claims are accepted or challenged based on different reasons, they cannot be verified in the same way as descriptive statements. This means that even when we present a strong justification for a normative claim, we still can’t present evidence to demonstrate its truth. So, if I claim that my car is blue and someone questions my statement, for example, I could simply show them my car to verify its color. But when someone questions my claim that lying is wrong, I can only present an argument to convince them how lying is harmful to others and why it should be avoided, for example. This reveals the presence of a gap between descriptive and normative claims. We cannot assume how something should be based on how it is in the world. This is because normative claims can only be derived from other normative claims, but not from descriptive ones. So, just because the car is blue does not mean that it should be blue. If we do end up making the jump from is to should, we commit a logical error known as the is–ought problem or the is-ought fallacy[2].

Now let’s keep this in mind as we circle back to stereotypes.

When a skewed image of a subject consistently passes as an acceptable representation for it, without being questioned for accuracy, said image is bound to become familiar to us through repetition, and this familiarity reinforces an expectation for further consistency. In other words, the more consistently we are exposed to an inaccurate portrayal of something, the more familiar this particular portrayal becomes to us, and the more likely we are to anticipate future portrayals to be similar to what we’ve become familiar with. This makes it easy to fall into the is-ought trap because the line between “what we expect to happen” and “what we assume should happen” is quite blurry.

In social psychology, this can be explained by stereotypes inducing our heuristic processing[3], which is a simplified way of processing information to judge something or someone quickly, often through if-then associations or rules of thumb. This is in contrast to systematic processing, which requires more thorough thinking and assessment of information accuracy before arriving at an opinion[4]. But I digress.

I only intend to point out how stereotypes are sort of a cognitive shortcut which hinders our scrutiny of how accurate a representation is and muddles the descriptive-normative boundary. In plain English, stereotypes make it harder for us to question things but make it easier to confuse is and should.

In more practical terms, how does this affect women or birth?

When stereotypical narratives, language, images, or videos of birth become familiar and expected, we can lose sight of the multitude of ways birth can happen and the scores of experiences, stories, and outcomes it can result in. From there, it is but one short step to claiming that a given stereotype is how birth should look like. This is a dangerous normative assumption which inevitably leads to the suffering of certain groups of women, because the path between stereotyping and normativity is a two-way street. Stereotypes can lead to dangerous normative expectations, which in turn can lead to reinforcing stereotypes. In the latter case, women can be harmed in an attempt to make them fit a normative expectation, either by actively restricting their choices or by erasing their narratives from wider birth representations. And both of these lead to disempowerment, loss of control, alienation, and trauma.

Let’s start with choice restrictions. How we believe birth should take place may be used to justify actions, policies, or practices which will likely result in – what we consider to be – an ideal birth. A certain platform promoting the idea that labor is intrinsically painless, for example, can focus on birth representations where pain was minimal or absent, then use this stereotype to campaign for restricting the use of epidurals in labor. Since every individual woman will experience labor pain differently as well as respond to pain differently, implementing a blanket policy based on the pain-free birth stereotype will likely result in denying pain relief to women who want it and need it. Alternatively, a different platform might repeatedly and exclusively focus on portrayals of vaginal birth complications requiring immediate life-saving medical care, then use this stereotype to push for defunding homebirth services. Since women have different needs in terms of psychological safety, limiting choices of birth settings forces some women into experiences they actively want to avoid.

And now let’s see how stereotypes and normativity feed into erasure of certain narratives. How we believe birth should look like may also be used to justify omitting the representation of women whose birth events, experiences, or outcomes differ from our normative assumptions about birth. For example, widespread stereotyping of birth as a natural event for which women’s bodies were perfectly designed can lead some healthcare providers to hide information about how common vaginal birth injuries are, or to shrug off women’s negative experiences of natural birth as rare. As a result, some women will plan for vaginal birth without being given the opportunity to understand the potential risks they face or to make meaningful decisions about their care to avoid negative experiences. Those who do experience complications or trauma will often feel like their bodies have failed in comparison to how normal female bodies are supposed to function. Alternatively, stereotypes about cesarean births being extremely traumatic may lead to associating terms like empowerment exclusively with vaginal births and omitting women’s positive cesarean birth stories from dominant birth representations in a certain context. Targeted exclusion of certain stories others some groups of women and nurtures blame and stigma for their birth choices and experiences.  

Of course, neither are birth stereotypes limited to the hypotheticals provided above nor is the predicted harm limited to the given examples. Stereotyping and its consequent damage vary depending on context and the assigned authorities for birth in that context. Yet, one constant remains. Birth representations are tied to the worldview of whoever is authoring them. Because of the significance birth carries, there will always be parties attempting to exert control over how it is represented in the collective mind. Most, if not all, of these parties will also claim that they hold a truth about birth no one else understands and that their representations are in the interest of women and mothers.

But consider this:

Is stereotyping birth as a happy occasion helpful to women? Or does it lead to disbelief, minimization, or indifference to a woman’s story of a violent birth? Does it promote the understanding and acceptance of birth fundamentally as a human experience? Or does it invalidate the humanity of a woman’s grief for her stillborn baby by prioritizing the collective peace of mind? Does it help women celebrate birth for its significance to them? Or does it conceal that birth also follows from rape and other violations of a woman’s bodily autonomy?

Does stereotyping birth as intrinsically risky protect women from poor outcomes? Or does it justify biomedical dominance and authority over a woman’s reproductive capacity? Does it promote knowledge exchange between women and their providers, and recognize women as experts on their own bodies? Or does it assume that a woman’s ignorance of biomedical knowledge justifies the medical entitlement to interfere, manipulate, and modify? Does it provide pathways for nuanced decision-making based on a wide range of risks that are meaningful to women? Or does it predetermine which risks are important to control, on behalf of a woman?   

Does stereotyping medically-assisted birth as unnatural, undesired, or dangerous protect women from harm? Or does it alienate a woman who desires relief from labor pain to help her sleep, avoid distress, or cope with the long process? Does it practically address obstetric violence and misogyny in medical practice? Or does it stigmatize a sexual assault survivor’s choice of a cesarean birth as entitled, weak, or ignorant? Does it lend more decision-making power to women in maternity care? Or does it punish a woman whose definition of control differs from the stereotype? Is it genuinely concerned about improving outcomes for women and their babies? Or is it more willing to accept a woman’s life-altering injuries from a natural birth, on her behalf?

Does stereotyping birth as a normal process that all women can naturally complete without medical assistance, empower women? Or does it normalize a woman’s pain? Does it bestow the pride of accomplishment, power, and agency on all women or selectively on those whose bodies perform as expected? Does it liberate women from inflexible medical standards and control? Or does it replace the standards but stealthily hang on to the inflexibility and control? Does it by default unfetter women from subjugation through helping them embrace their biological purpose? Or is it conflating a woman’s empowerment with a bodily function to allow framing her value instrumentally?

Does stereotyping birth in terms of serenity, nature, bodily wisdom, calm, and surrender liberate women from fear? Or does it leave a vulnerable woman unprepared for potential traumatic events and experiences? Does it help women go through the birth process by mentally disconnecting negativity from the projected birth experience? Or does it devalue and reject the reality and the humanity of a woman’s struggle and suffering during birth? Does removing the anxiety of trauma render women more level-headed when making birth-related decisions? Or does it assign the responsibility for trauma prevention to a woman who has limited control over how birth unfolds? Does it invite power and freedom from fear through surrender and relinquishing control? Or does it replace a woman’s experienced passivity and compliance under biomedical dominance with a more palatable form of obedience and submission?

Where to go from here?

If any good is to come from this long-winded text, let it be this: an appeal for urgent scrutiny of stereotypical birth ideas, descriptions, stories, images, narratives, videos, accounts, premises, assumptions, and perspectives.

This is an open invitation to the reader to reflect on the familiarity of new or old birth representations, to assess their implications, to consider their description accuracy relative to the complexity of women and variability of birth, and question whether their repetition is ever in the interest of humanizing any woman who fails to fit a given stereotype.

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[1] https://ec.europa.eu/eurostat/web/products-eurostat-news/w/ddn-20250911-1

[2] The is-ought problem appears in David Hume’s Treatise of Human Nature published in 1739.

[3] For those interested, there’s a well-cited experiment which demonstrates how familiarity increases stereotyping:  https://www.sciencedirect.com/science/article/abs/pii/S0022103105000922

[4] https://sk.sagepub.com/ency/edvol/socialpsychology/chpt/heuristicsystematic-model-persuasion

Note: The featured image in this post is AI-generated.