In January 2009 the media midwifed a new hybrid species and dubbed it Octomom.
Octomom was 33-year-old Nadya Suleman, a California woman who had an unknown number of eggs implanted using IVF and gave birth to octuplets on January 26, 2009, bringing her total brood to 14. Since then Octomom has never quite left us. Just last week she appeared on Oprah to talk financial difficulties.
Once it became known that Suleman's octuplets, only the second set to be born alive in the United Sates, were no miracle but the result of an assisted reproductive technology [ART], that all her other children had also been born through IVF, and that Suleman herself was single and unemployed, a media storm blitzed its way through the nation. The public spiritedly lambasted Suleman as a selfish woman who had irresponsibly used ARTs to bring 14 children into a world in which she and 11.6 million other Americans were unemployed.
Yet just a decade earlier in December 1998 Nkem Chukwu became the first American woman to successfully give birth to octuplets. Chukwu also used IVF to achieve this feat, but the American public did not gnash its teeth at the announcement. Chukwu was portrayed as a tired woman in a wheelchair next to her husband, a woman who discussed how her faith in God had brought her through a hard pregnancy, and who explained that she had refused a selective reduction operation during her pregnancy because she "could not find such words in [her] Bible." No one pointed out that neither could she have found "IVF" there. Chukwu sacralized the births: "I wanted to have as many babies as God would give me," and in turn the media portrayed the pregnancy as miracle rather than monstrosity.
In contrast no mention was initially made of Suleman's refusal to undergo the same selective reduction procedure. A bioethicist at the University of Pennsylvania called the scandal an "ethical failure" and there were invocations only of Suleman's obsessions, not God's gifts. Of course Suleman embodied one of the media's favorite objects of fascination and reproach: young, female, desirous, and with a body that performed feats unknown to natural woman. Like other media favorites, Suleman even got her own hybridized nickname, Octomom, but unlike Brangelina, the hybridity was maternal rather than romantic, interspecies rather than intra-; Octomom was part-mom, part-(marine)-beast, and implicitly part-machine.
Though at first the nickname Octomom seems to reduce Suleman to the sum of her eight kids, the focus on Suleman's desire or "obsession" instead reduced her eight newborns to herself. The scorn heaped on Suleman's actions carried the implication that the children should never have been born in the first place, a curious stance for a society obsessed with abortion, celebrity children, and big families like the conservative Christian Duggars and John & Kate Plus 8. But Suleman made no attempt to explain her extraordinary pregnancy outside her own personal desires, and she lacked the trappings-husband, comfortable income, religious belief-that might have normalized it socially.
As a result, Octomom became a symbol of selfish enhancement, artificial excess, and irresponsible motherhood, and a reproductive technology that has been used to conceive over 250,000 pregnancies in the United States since the early 1980s suddenly became the focus of intense public discussion, giving bioethicists a platform to point out that while IVF is widely regulated throughout Europe, the US federal government only demands that ART clinics track their success rates.
Was the reaction to Octomom merely symptomatic of society's anxiety about the impact of new technologies on society, or was something deeper at work concerning our contemporary understanding of maternal agency? I think Carl Elliott's Better than Well: American Medicine Meets the American Dream  is an interesting place to start thinking about the relationship between society, agency, treatment, and enhancement. Elliott theorizes that Americans' obsession with identity and authenticity helps explain why Americans appear uneasy with enhancement technologies yet seek them in droves:
We need to understand the complex relationship between self-fulfillment and authenticity, and the paradoxical way in which a person can see an enhancement technology as a way to achieve a more authentic self, even as the technology dramatically alters his or her identity.
This authenticity often depends on the assertion of deficiency. By turning a characteristic into a deficit, such as the lack of social ease in those prescribed Paxil, an enhancement becomes a treatment.
Of course this construction of deficient or disabling conditions is an ever-evolving social process with consequences for a person's understanding of his or her authentic self. Today social phobia is the third most common mental disorder in the US, but 15 years ago it was a rare problem. Diseases are not just culturally symptomatic, they are causal and therein lies the risk. Ian Hacking's looping effect suggests that the identification of a disease creates the conditions for the manifestation of that disease in others. For instance the emergence of the idea of gender identity disorder gave people a means to conceptualize and reinterpret their experiences around a single idea, in this case a disorder with a surgical solution.
Elliott calls this semantic contagion, and while it is a more complex idea than the gloss I give it here, its relation to the idea of copycatting may help explain the suspicion and fear with which certain diseases or disabilities are approached.
In general, Elliott is sympathetic to those who make use of the possibilities of biomedicine like pharmaceuticals or sex-reassignment surgery to achieve self-fulfillment because he sees bodies, technology, and identity as co-constructive entities. He is even sympathetic to voluntary amputees, who want to cut off their limbs as surgical treatment for what they claim is a psychological condition, asking which is worse: to amputate your leg or to live with an obsession that controls your life. Elliott provocatively suggests that voluntary amputation is fair game in a world where you can "pay a surgeon to suck fat from your thighs, lengthen your penis, augment your breasts, redesign your labia, implant silicone horns in your forehead or split your tongue like a lizard's." Thirty years after the first test-tube baby, is Octomom just what society should come to expect?
In an America that takes its individual responsibility seriously and its babies very seriously, how a gestating mother behaves and what she ingests has become increasingly socially and medically monitored. Authors who have explored the construction of fetal alcohol syndrome or tracked the impact of obstetric tools like ultrasound have argued that this has resulted in the objectification and erasure of the mother, and her individual needs, as she comes to embody the potential life within her.
In The Making of the Unborn Patient: A Social Anatomy of Fetal Surgery  Monica Casper traces the implications of what in the 1990s was the relatively new medical field of fetal surgery. In fetal surgery a woman's fetus is partially taken out of the uterus, operated on, and, if it survives, placed back into her womb for further gestation. In 1998, fewer than 100 fetuses, all of which would otherwise have died in the womb, had been operated on. Only 35% of the fetuses survived the surgery.
Though the numbers suggest that most women will miscarry or choose to abort a fetus that is likely to die in the womb, Casper sees fetal surgery as contributing to the materialization of the fetal patient at the expense of the mother. The mother and fetus are first separated as subjects, and then one is given preference over the other. Pathologization in this case doesn't result in the reorientation of an identity but instead in the creation of one subject and the erasure of another.
Casper obviously sees her book as a warning signal to women; they should be aware that in being made invisible, their agency risks obliteration. In becoming patients, fetuses problematically become persons. Casper surely uncovers a discursive realm, with very material consequences, that represents a serious threat to maternal agency. But does she overstate the extent to which the creation of a fetal patient necessarily erases the pregnant woman, or the extent to which such erasure necessarily threatens the woman's agency?
If we take Carl Elliott's biomedical world as our own, then bodies are frequently objectified and technologized for one's own interests. Does the materialization of another subject through this technologization necessarily threaten those interests? I am not doing Casper, who recognizes that both fetal and maternal interests could be valued in fetal surgery and argues that the field is a ripe area for a women's health intervention, full justice. But I do want to challenge the idea that invisibility, in the face of social and bioethical surveillance, is necessarily a handicap to a pregnant woman's agency. In a world where increased biomedical capabilities has engendered a field of bioethicists, of which a substrata warn the public to value mystery in the face of mastery, do efforts to regulate maternal behavior in fact intensify when a pregnant woman's own subjective desires and agency become visible? In other words, are pregnant women in fact more free because the gestating woman is absent from the sonogram?
The case of Octomom would seem to confirm the idea that unmediated maternal agency provokes surveillance and can even reverse a typically pro-life discourse (though not necessarily its anti-choice iteration). Obviously the media's issue with Octomom was partly the abnormality of giving birth to eight children at once, combined with the perceived social disadvantage of the children as members of a 14-child family led by an unemployed, unmarried mother. I want to argue, however, that the intense media circus surrounding Octomom suggests that we, benefactors of the biomedical era, owners of our own bodies, who need merely pop a pill each day to prevent pregnancy and who can pull out a fetus and put it back in, whose obsession with identity grants us leave to do most of what we want with our bodies, have centered many of our anxieties surrounding the blurry divide between perfection and freakishness, human mastery and mystery, on the bugaboo of maternal hubris.
Yet how to explain the fact that most women who undergo IVF are not seen as hubristic cyborgs? In Making Parents: The Ontological Choreography of Reproductive Technologies  Charis Thompson details the small everyday negotiations that are made to normalize ARTs in fertility clinics. She argues that not just babies but parenthood is constructed in the reproductive clinic, and that we exist in a new biomedical era which requires us to reconceptualize objectification, agency, and naturalness. Rather than seeing a sharp division between personhood and non-personhood, for either the fetus or mother, Thompson sees many forms of fetal personhood that operate in direct relation to the mother's own expressions of agency:
The clinics deal on a daily basis with human gametes and embryos, which function in this clinical setting as questionable persons, potential persons, or elements in the creation of persons. Embryos, for example, can go from being a potential person (when they are part of the treatment process), to being in suspended animation (when they are frozen), to not being a potential person (when it has been decided that they will be discarded or donated to research), and even back again to being a potential person (when a couple has a change of heart and frozen embryos are defrosted for their own use or for embryo donation.
As in Casper's narrative, the pregnant woman still comes to embody the potential life attributed to the embryos, but Thompson asserts that this ontological change contains not just objectification but agency and subject-formation-a dense choreography on whose merits Thompson makes no explicit judgments, though she herself used IVF to give birth to her daughter. Just as Elliott's voluntary amputees objectify their own bodies to achieve a more authentic conception of themselves, women using ARTs allow the medical objectification of their bodies in order to assume the identity of motherhood.
Thompson traces how the work done in reproductive clinics naturalizes kinship and procreative intent, smokescreening patients' exceptional agency in selecting gametes with certain characteristics or constructing non-normative, and previously impossible, bio-social family structures. Significantly, of course, IVF actually has a high failure rate, and many women often require three or four rounds before an embryo implants, though this fact doesn't necessarily obscure the appearance of extraordinary control, as the ambivalent reactions to the NY Times story of the Twiblings recently demonstrated.
Because of the costs involved, many of those who use ARTs embody a certain socially desirable profile: white, heterosexual, partnered, middle to upper class. Toward the end of the 1990s, however, there was a shift in focus from childrens' to parents' reproductive rights, corresponding to a legal trend protecting privacy in the bedroom. Infertility has become pathologized so that some states now mandate that insurance companies cover a certain number of treatment cycles. What were once called artificial reproductive technologies, denoting enhancement, are now called assisted reproductive technologies, denoting aid and treatment. Finally, the language of genes has helped reconstruct kinship ties whose traditional linearity can sometimes be disrupted by ARTs. A mother who uses a daughter's egg to give birth to her daughter's sister can focus on genetic kinship rather than processual kinship. An Italian-American woman can invoke the idea that genes code for race and ethnicity to seek gametes that appear to represent a specific group identity.
All these factors contribute to the strategic naturalization of ARTs. When the biological facts of parenthood are underdetermined-for instance when a woman gestates a different woman's egg-legal, medical, and familial conventions step in to naturalize kinship. In turn, biological entities, like genetics, are used to substantiate the social. In this biomedical process neither the natural nor the social is essentialized-elements of each work together and contribute to a recognizable process of "family building."
The irony then is that a woman can achieve a great deal of agency by putting herself at the mercy of medicine so long as the desire and control that technology grants her to achieve an exceptional, nontraditional pregnancy in form or substance, is mediated, normalized, and made invisible. And when other forces fail to naturalize an IVF procedure, abortion politics and its close companion, contemporary American religion, have a significant role to play in shaping public perception, as demonstrated by the Nkem Chukwu narrative.
Octomom incurred scathing public scorn and initiated a debate on the regulation of a reproductive technology that has been around for nearly three decades because Suleman made visible-literally embodied-the potential abnormality of ARTs and did nothing to mediate this abnormality through socio-naturalization or by deploying a supernatural discourse of God and miracles. Instead, Suleman's story was told through the language of human "obsession," "desire," and "fixation." As a result tabloids painted her as selfish and irresponsible, a drain on society's resources, and the pregnancy as regrettable, the work of human hubris and misappropriated technology.
Ten years ago when Nkem Chukwu had her eight children there was no media storm; in fact the Chukwu octuplets were largely forgotten until Octomom. Nearly two years later, Octomom is still with us. An image of her very pregnant stomach photographed eight days before giving birth saturates the internet-in this photo both Suleman's stomach and her face, which looks directly into the camera with a half-smile, are distinct and memorable. In October 2010 news sources began to report on the California trial of Suleman's doctor for negligence. Paparazzi follow Suleman around and blogs speculate about post-pregnancy plastic surgery, the great symbol of American artificiality.
Childbearing in the US is tightly bound to narratives of self-sacrifice-whether it's the mother who gives up drinking during pregnancy, her career to stay home, or her body to fetal surgery. And while we have reached a point where we endorse a normalized agency and right to parent that supports such sacrifices and naturalizes ARTs as treatments rather than enhancements, maternal self-interest must be mediated and muted, better off obscured than exposed.
Suleman was unusual in her use of reproductive technology to achieve an extraordinary birth, but she was also unusual because she made no effort to portray her pregnancy as natural, therapeutic, miraculous, or self-sacrificial. As a result she became an object of fascination, a much-photographed freakish symbol of hubristic enhancement. Yet the sudden public attention on the question of legal regulation of IVF thirty years after its American birth suggests that Suleman and her pathologized self-interest were also seen as potentially contagious. The border between extraordinary reproductive enhancement and typical treatment was a little too blurry. A fence had to be built, and the media have always been excellent fence-builders. They drew up plans and the easiest way to build it was to turn a woman into a cyborg.
This post originally appeared on PhD Octopus. Republished with permission.
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